2016-11-11T12:16:16-06:00 2015-12-31 930623286 AKT LLP 5665 SW MEADOWS RD SUITE 200 LAKE OSWEGO OR 97035 990 2015-01-01 930951989 SAMARITAN HEALTH SERVICES SAMA 5417684773 C/O SHS ACCOUNTING PO BOX 3000 CORVALLIS OR 973393000 DANIEL B SMITH VP FINANCE/CFO 5417684773 2016-11-09 0 JOYLYN ANKENEY P00366587 5036204489 2015 2017-02-10 21:41:12Z LARRY A MULLINS DHA 3600 NW SAMARITAN DR CORVALLIS OR 97330 188654945 0 X WWW.SAMHEALTH.ORG X 1986 OR TO ENHANCE COMMUNITY HEALTH THROUGH QUALITY SERVICES ACROSS A CONTINUUM OF CARE. 14 10 1188 11 2283664 0 1082795 1246315 144620219 155555940 606981 3928300 12883572 20764210 159193567 181494765 94278 44320 0 0 57232052 69538192 109942 102716 717508 102578515 111309777 160014787 180995005 -821220 499760 288970033 304648681 251445067 266674561 37524966 37974120 X SAMARITAN HEALTH SERVICES (SHS) IS THE PARENT COMPANY OF A REGIONAL NETWORK OF HOSPITALS, PHYSICIANS AND SENIOR CARE FACILITIES. 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 TO ENHANCE COMMUNITY HEALTH AND ACHIEVE HIGH VALUE THROUGH QUALITY SERVICES ACROSS A CONTINUUM OF CARE. THE COLLECTIVE VISION OF THE SHS SYSTEM IS TO BE A VALUES-DRIVEN ORGANIZATION GOVERNED BY COMMUNITY MEMBERS, PHYSICIANS AND OTHER HEALTH CARE PROVIDERS. 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 165994751 173895290 SEE SCHEDULE OAS 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, INC. (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 2015 SHS PROVIDED SERVICES THAT BENEFITED THE POOR AND OTHERS IN THE COMMUNITIES IT SERVED. COMMUNITY BENEFIT SERVICES ($1,956,000) ARE PAYMENTS/COSTS CONTRIBUTED BY SHS FOR COMMUNITY PROGRAMS ADMINISTERED BY OTHER NON-PROFIT ORGANIZATIONS AND SCHOOLS PLUS ACTIVITIES PROVIDED BY SHS EMPLOYEES FOR THE BENEFIT OF VARIOUS GROUPS IN THE COMMUNITY SERVED. 44320 44320 GRANTS AND ASSISTANCE PROVIDED BY SAMARITAN HEALTH SERVICES TO VARIOUS ORGANIZATIONS TO BENEFIT THE COMMUNITY. SEE PART IX, LINE 1 AND RELATED SCHEDULE I FOR MORE DETAILS. 166039071 1 1 0 1 0 0 0 0 0 0 1 1 1 0 1 1 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 1 0 1 1221 0 1 1188 1 1 1 0 0 0 0 0 0 0 0 1 0 X 14 10 0 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 5417684773 PO BOX 3000 CORVALLIS OR 973393000 CHARLES MOURADIAN BOARD CHAIR 1.00 1.00 X X 0 0 0 BOB ADAMS BOARD SECRETARY 1.00 2.00 X X 0 0 0 JUDY LIST BOARD TREASURER 1.00 1.00 X X 0 0 0 LOREN ROTH BOARD CHAIR ELECT 1.00 1.00 X X 0 0 0 SHIRLEY PETERSON BOARD MEMBER 1.00 1.00 X 0 0 0 RANDY SPRINGER BOARD MEMBER 1.00 2.00 X 0 0 0 JIM DENHAM BOARD MEMBER 1.00 3.00 X 0 0 0 BRUCE MADSEN MD BOARD MEMBER 1.00 3.00 X 2663 0 0 MILTON MORAN BOARD MEMBER 1.00 1.00 X 0 0 0 TROY GARRETT MD BOARD MEMBER / PHYSICIAN 1.00 39.00 X 0 194170 17110 REVEREND WILLIAM MCCARTHY BOARD MEMBER 1.00 2.00 X 0 0 0 SENATOR FRANK MORSE BOARD MEMBER 1.00 2.00 X 0 0 0 LESLIE PLISKIN MD BOARD MEMBER / PHYSICIAN 1.00 39.00 X 0 211326 41055 LOUIS WEINSTEIN MD BOARD MEMBER / PHYSICIAN 1.00 39.00 X 0 199553 24667 LARRY MULLINS DHA PRESIDENT & CEO 23.00 17.00 X 1465392 0 47400 DANIEL SMITH VP FINANCE / CFO 24.00 16.00 X 436557 0 88384 ROBERT POWER VP INFORMATION SYSTEMS / CIO 40.00 X 275433 0 44201 KIRK GERNER VP PHYSICIAN RECRUITING 40.00 X 271084 0 53747 ELIZABETH LINCOLN MD VP CHIEF MEDICAL INFO OFFICER 40.00 X 257019 0 32381 KIMBERLY CLIFT VP REVENUE CYCLE 40.00 X 248651 0 11157 JULIE MANNING VP DEVELOPMENT & COMMUNITY RELATIONS 40.00 X 211739 0 38241 GAIL WORDEN-ACREE VP HUMAN RESOURCES 40.00 X 203666 0 44468 DOUGLAS BOYSEN EVP CHIEF ADMIN OFFICER (JUN-DEC) 38.00 2.00 X 200678 0 64495 TYLER JACOBSEN VP GENERAL COUNSEL 40.00 X 153504 0 40994 STEVEN JASPERSON VP SOUTHERN CALIFORNIA OPS 40.00 X 476259 0 46642 DAVID TRIEBES VP CEO SAGH 1.00 39.00 X 419911 0 52868 KELLEY KAISER VP CEO HEALTH PLANS 20.00 20.00 X 359770 0 75710 KEVIN EWANCHYNA MD VP CHIEF MEDICAL OFFICER SHPO 24.00 16.00 X 354523 0 51655 BECKY PAPE VP CEO GSRMC 1.00 39.00 X 340865 0 53257 5677714 605049 828432 99 0 1 0 GREENBERRY CONSTRUCTION LLC 2273 NW PROFESSIONAL DR STE 200 CORVALLIS OR 97330 CONSTRUCTION 14811876 GERDING BUILDERS LLC PO BOX 1082 CORVALLIS OR 97339 CONSTRUCTION 8638201 SODEXO MARRIOTT SERVICE 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 FOOD SERVICES 5507421 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 SOFTWARE SUPPORT SERVICES 4291001 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 LOCUM PHYSICIANS 4075836 125 641102 238580 366633 3000 1246315 SUPPORT SERVICE FEES 561000 82669238 82669238 EMPL HEALTH PLAN PREM 525100 72614306 72614306 DURABLE MEDICAL EQUIP 446119 272396 261681 10715 155555940 866393 153000 713393 5076868 3345593 1731275 1731275 -119807 1851082 1347676 5528818 1360979 2453608 -13303 3075210 3061907 1556886 1505021 QUALITY INCENTIVES 900099 9788669 9788669 EHR INCENTIVE REV 900099 5189817 5189817 FITNESS CENTER REVENUE 713940 2522003 830397 1691606 1532446 2541182 -1008736 19032935 181494765 173895290 2283664 4069496 44320 44320 4191854 4191854 47681650 42566407 4749494 365749 3604330 3248908 330009 25413 9425730 8496259 863012 66459 4634628 4177607 424343 32678 432560 51926 380634 622202 622202 102716 102716 86626 43313 43313 582933 540965 16315 25653 1838751 1784979 37412 16360 2372151 2167072 165639 39440 9289829 9271740 18089 1974420 1909243 55920 9257 919209 763506 153459 2244 412350 394109 14972 3269 2631707 1259210 1372497 11721589 11250787 470802 1261884 1043086 218798 CLAIM FEES 67421147 67421147 PURCHASED SERVICES 7758651 7463697 271914 23040 DUES, TAXES, & LICENSES 1482918 1117738 359950 5230 MISCELLANEOUS 384858 284858 100000 115992 115992 180995005 166039071 14238426 717508 900 600 125391918 118633612 82484 444365 868903 1932835 68436 2271447 3818332 200969890 70790957 109423670 130178933 458979 22028760 30059259 19153364 20412473 8389444 288970033 304648681 38660578 41464843 151866619 149533370 46263503 44331949 14654367 31344399 251445067 266674561 X 37524966 37974120 37524966 37974120 288970033 304648681 499760 -50606 0 X 0 1 X 1 1 1 X X 5 ALBANY GEN HOSP 930110095 3 1 0 18669988 GOOD SAM HOSP 930391573 3 1 0 39982660 MID-VALLEY HC 930396847 3 1 0 11233978 N LINCOLN HOSP 931305493 3 0 0 5371479 SAM PAC HLTH SVCS 931329784 3 0 0 8451792 5 0 83709897 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 X 1 1 PART I, LINE 11G 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 1 THE FILING ORGANIZATION, SHS, IS THE SOLE CORPORATE MEMBER OF ALL SUPPORTED ORGANIZATIONS SHOWN IN PART I OF SCHEDULE A. THREE OF THE FIVE SUPPORTED HOSPITALS ARE NAMED AS SUPPORTED ORGANIZATIONS WITHIN SHS' ARTICLES OF INCORPORATION. THE OTHER TWO HOSPITALS, SAMARITAN NORTH LINCOLN HOSPITAL (SNLH) AND SAMARITAN PACIFIC HEALTH SERVICES (SPCH), ARE NOT MENTIONED BY NAME; HOWEVER, SNLH AND SPCH ARE SUPPORTED IN THE SAME MANNER AS THE OTHER THREE HOSPITALS NAMED IN THE GOVERNING DOCUMENTS, WHICH INCLUDES THE FOLLOWING SUPPORT SERVICES: PATIENT BILLING, ACCOUNTING, INFORMATION TECHNOLOGY, HUMAN RESOURCES, RECRUITING, CREDENTIALING, ADMINISTRATION, LEGAL, AND PROFESSIONAL DEVELOPMENT. 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 FORM 990 AND GOVERNING DOCUMENTS OF SHS ARE CONTINUALLY MADE AVAILABLE TO EXECUTIVE LEADERSHIP OF ALL SUPPORTED ORGANIZATIONS. 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. AMONG THESE ARE THAT 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 54135 0 0 1 6816 60951 0 PART II-B, LINE 1: THE FILING ORGANIZATION MAINTAINS MEMBERSHIPS IN THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND OREGON ASSOCIATION OF HOSPITALS AND HEALTHCARE SYSTEMS (OAHHS). DURING TAX YEAR 2015, THE FILING ORGANIZATION PAID MEMBERSHIP DUES TO OAHHS AND AHA OF $185,120 AND $97,266 RESPECTIVELY. 14.92% OF OAHHS DUES AND 22.12% OF AHA DUES WENT FOR LOBBYING PURPOSES. THUS, THE FILING ORGANIZATION MADE INDIRECT LOBBYING EXPENDITURES OF $49,135 THROUGH ITS MEMBERSHIP DUES. IN MARCH 2015, THE FILING ORGANIZATION MADE A CONTRIBUTION OF $5,000 TO "NEIGHBORS FOR A NEW HOSPITAL", A PAC ESTABLISHED TO PROMOTE A LINCOLN COUNTY BOND MEASURE FOR A NEW HOSPITAL TO BE BUILT BY THE PACIFIC COMMUNITIES HEALTH DISTRICT (PCHD) IN NEWPORT. THIS BOND MEASURE WAS PASSED BY VOTERS IN MAY 2015, AND UP TO $57 MILLION IN BONDS CAN BE ISSUED BY PCHD TO FINANCE CONSTRUCTION OF A NEW HOSPITAL. THE AMOUNT ON LINE 1I REPRESENTS THE LABOR COSTS DURING 2015 FOR A FEW EMPLOYEES OF THE FILING ORGANIZATION THAT WORKED WITH THE "NEIGHBORS FOR A NEW HOSPITAL" PAC TO PROMOTE THE BOND MEASURE. 17904274 17904274 79324661 14151460 65173201 3976647 822259 3154388 93935213 55204805 38730408 5829095 612433 5216662 130178933 22028760 C 22028760 INVESTMENTS HELD BY TRUSTEE 19153364 F 19153364 LIABILITY FOR UNPAID MEDICAL CLAIMS 9436152 TENANT DEPOSITS 150000 ACCRUED INTEREST 108231 OTHER RESERVES 6637587 PAYABLE DUE TO AFFILIATE 15012429 31344399 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, 2015, 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 2012. X X 1 THOMPSON & ASSOC 1135 LA HOMA DRIVE NAPA CA 94558 ADVISORY SERVICES 0 0 99000 0 99000 OR FORM 990,SCHEDULE G, PART I: THOMPSON & ASSOC.: THE PROFESSIONAL FUNDRAISING ACTIVITIES REPORTED ON SCHEDULE G ARE FOR ADVISORY SERVICES RELATED TO PLANNED GIVING. THESE ADVISORY SERVICES INCLUDE EDUCATING MEMBERS OF THE COMMUNITY ABOUT PLANNED GIVING OPPORTUNITIES AND ASSISTING POTENTIAL DONORS WITH SETTING UP FUTURE CHARITABLE GIFTS AS PART OF THEIR WILLS OR OTHER ESTATE PLANNING DOCUMENTS. BECAUSE THESE GIFTS ARE NONBINDING PLEDGES AND MAY NOT BE RECEIVED FOR MANY YEARS, REVENUES CANNOT BE MATCHED WITH CURRENT PERIOD FUNDRAISING EXPENSES. THEREFORE, NO ASSOCIATED REVENUE IS REPORTED ON SCHEDULE G. 1 UNITED WAY OF LINN COUNTY PO BOX 905 ALBANY OR 97321 930470252 501(C)(3) 15250 SUPPORT COMMUNITY NEEDS IN LINN COUNTY UNITED WAY OF BENTON COUNTY PO BOX 2499 CORVALLIS OR 97339 936013898 501(C)(3) 10625 SUPPORT COMMUNITY NEEDS IN BENTON AND LINCOLN COUNTIES ABC HOUSE PO BOX 68 ALBANY OR 97321 931163555 501(C)(3) 10000 SUPPORT SERVICES FOR CHILD ABUSE VICTIMS 3 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 X 1 1 X X X X X X 0 1 0 0 1 0 0 0 0 TROY GARRETT MD BOARD MEMBER / PHYSICIAN 0 81959 0 110447 0 1764 0 14579 0 2531 0 211280 0 0 LESLIE PLISKIN MD BOARD MEMBER / PHYSICIAN 0 115481 0 72266 0 23579 0 16799 0 24256 0 252381 0 0 LOUIS WEINSTEIN MD BOARD MEMBER / PHYSICIAN 0 149263 0 35129 0 15161 0 15208 0 9459 0 224220 0 0 LARRY MULLINS DHA PRESIDENT & CEO 679857 0 242000 0 543535 0 21760 0 25640 0 1512792 0 225675 0 DANIEL SMITH VP FINANCE / CFO 350633 0 77000 0 8924 0 56843 0 31541 0 524941 0 0 0 ROBERT POWER VP INFORMATION SYSTEMS / CIO 258384 0 9500 0 7549 0 21760 0 22441 0 319634 0 0 0 KIRK GERNER VP PHYSICIAN RECRUITING 234960 0 14000 0 22124 0 21760 0 31987 0 324831 0 0 0 ELIZABETH LINCOLN MD VP CHIEF MEDICAL INFO OFFICER 249210 0 7000 0 809 0 20925 0 11456 0 289400 0 0 0 KIMBERLY CLIFT VP REVENUE CYCLE 234603 0 7000 0 7048 0 7279 0 3878 0 259808 0 0 0 JULIE MANNING VP DEVELOPMENT & COMMUNITY RELATIONS 188027 0 22000 0 1712 0 16559 0 21682 0 249980 0 0 0 GAIL WORDEN-ACREE VP HUMAN RESOURCES 167268 0 22701 0 13697 0 16127 0 28341 0 248134 0 0 0 DOUGLAS BOYSEN EVP CHIEF ADMIN OFFICER (JUN-DEC) 180051 0 20250 0 377 0 50559 0 13936 0 265173 0 0 0 TYLER JACOBSEN VP GENERAL COUNSEL 126443 0 16500 0 10561 0 9096 0 31898 0 194498 0 0 0 STEVEN JASPERSON VP SOUTHERN CALIFORNIA OPS 386534 0 0 0 89725 0 21760 0 24882 0 522901 0 0 0 DAVID TRIEBES VP CEO SAGH 351183 0 39000 0 29728 0 21760 0 31108 0 472779 0 0 0 KELLEY KAISER VP CEO HEALTH PLANS 302111 0 33500 0 24159 0 46798 0 28912 0 435480 0 0 0 KEVIN EWANCHYNA MD VP CHIEF MEDICAL OFFICER SHPO 325894 0 5170 0 23459 0 21760 0 29895 0 406178 0 0 0 BECKY PAPE VP CEO GSRMC 300950 0 37000 0 2915 0 21760 0 31497 0 394122 0 0 0 PART I, LINE 1A ONE PERSON LISTED ON PART VII OF FORM 990 UTILIZED FIRST-CLASS TRAVEL DUE TO A MEDICAL EVENT. 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 BOARD MEMBER, WHO IS AN EMPLOYEE OF A RELATED ORGANIZATION, AND ONE KEY EMPLOYEE RECEIVED THIS TAXABLE GYM BENEFIT IN 2015. IF AN EMPLOYEE PARTICIPATES AT A SAMARITAN FITNESS CENTER (SAMFIT), MEMBERSHIP IS FREE OF CHARGE (PROVIDED AS A NONTAXABLE FRINGE BENEFIT). ONE BOARD MEMBER, ONE OFFICER, THREE KEY EMPLOYEES, AND ONE HIGHEST PAID EMPLOYEE UTILIZED THE SAMFIT BENEFIT DURING 2015. PART I, LINE 4B 4.B. THE ORGANIZATION MAINTAINS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. UNDER THIS PLAN, LARRY MULLINS, DHA, KELLEY KAISER, DOUGLAS BOYSEN, AND DANIEL SMITH ACCRUED DEFERRED COMPENSATION BENEFITS DURING 2015. LARRY MULLINS, DHA RECEIVED A PAYMENT IN 2015 FROM THIS PLAN, WHICH IS INCLUDED IN HIS 2015 COMPENSATION ON SCHEDULE J AND FORM 990. $225,675 OF THIS PAYMENT WAS ACCRUED IN PRIOR YEARS AND WAS ALSO INCLUDED IN COMPENSATION DISCLOSED IN PRIOR YEARS AS REQUIRED ON SCHEDULE J AND FORM 990. KELLEY KAISER, DOUGLAS BOYSEN, AND DANIEL SMITH RECEIVED NO PAYMENTS FROM THEIR PLANS IN 2015. 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 A 4539911 15865543 283537 15582006 2011 0 0 1 1 B 2250000 122401666 10259123 66501180 2086481 43554882 2013 1 0 1 1 C 531719 18959353 169620 12236530 6553203 0 0 0 1 A 0 0 0 0 0 0 1 B 0 1 1 1 0 0.00400 0.00400 0 1 0.00100 1 1 C 0 0 0 0 0.00400 0.00400 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 0 1 A 1 B 1 C 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) IS DUE TO INVESTMENT EARNINGS AND UNREALIZED GAINS/LOSSES. VERONICA MULLINS FAM MBR, L. MULLINS 68143 EMP BY ORG 0 MICHELE SMITH FAM MBR, D. SMITH 20974 EMP BY ORG 0 FORM 990, PART VI, SECTION A, LINE 1 ONE NON-EMPLOYEE BOARD MEMBER OF THE FILING ORGANIZATION LACKS INDEPENDENCE DUE TO BUSINESS TRANSACTIONS WITH A RELATED ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 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. 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 ETHICS AND CONDUCT POLICY 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, INC. ANNUALLY 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 ALL KIOSKS AND HIGH-TRAFFIC AREAS OF ALL 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 ALL EVENTS, COMMUNITY OUTREACH PROJECTS, AND SCREENINGS ATTENDED THROUGHOUT THE YEAR. GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. 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