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THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA (EIN 23-0794160)
Tax period
2013-07-01 to 2014-06-30
Filed
2015-05-15
IRS object ID
201511369349300801
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-05-15T23:37:57-05:00ReturnTs
Tax Period End2014-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GRANT THORNTON LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12001 MARKET STREET SUITE 700AddressLine1
CityPHILADELPHIACity
StatePAState
ZIP Code19103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN230794160EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan HospitalBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of% ROBERT J RICHARDSInCareOfNm
Business Name ControlGOODBusinessNameControlTxt
Phone7172707500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1281 4th Walnut StreetsAddressLine1
Address Line2SuiteAddressLine2
CityLebanonCity
StatePAState
ZIP Code170421281ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonROBERT RICHARDSPersonNm
Person TitleCFOPersonTitleTxt
Phone7172707864PhoneNum
Signature2015-05-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonFrank GiardiniPreparerPersonNm
PTINP00532355PTIN
Phone7172707864PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRobert J LongoPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line14th walnut StreetsAddressLine1
CityLebanonCity
StatePAState
ZIP Code170421281ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$178,263,952GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.gshleb.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1989FormationYr
Legal Domicile StatePALegalDomicileStateCd
Activity Or MissionTO PROVIDE HIGH-QUALITY, COMPASSIONATE HEALTHCARE THAT IMPROVES THE OVERALL HEALTH OF OUR COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body18VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee1508TotalEmployeeCnt
Total Volunteers385TotalVolunteersCnt
Total Gross UBI$4,131,559TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$394,600NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$3,433,131PYContributionsGrantsAmt
CY Contributions Grants$3,957,723CYContributionsGrantsAmt
PY Program Service Revenue$173,975,259PYProgramServiceRevenueAmt
CY Program Service Revenue$165,702,225CYProgramServiceRevenueAmt
PY Investment Income$1,821,436PYInvestmentIncomeAmt
CY Investment Income$1,767,172CYInvestmentIncomeAmt
PY Other Revenue$6,872,248PYOtherRevenueAmt
CY Other Revenue$6,816,127CYOtherRevenueAmt
PY Total Revenue$186,102,074PYTotalRevenueAmt
CY Total Revenue$178,243,247CYTotalRevenueAmt
PY Grants And Similar Paid$9,573,550PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$7,058,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$77,743,685PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$76,866,688CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$108,582,766PYOtherExpensesAmt
CY Other Expenses$100,632,852CYOtherExpensesAmt
PY Total Expenses$195,900,001PYTotalExpensesAmt
CY Total Expenses$184,557,540CYTotalExpensesAmt
PY Revenues Less Expenses-$9,797,927PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$6,314,293CYRevenuesLessExpensesAmt
Total Assets BOY$141,426,575TotalAssetsBOYAmt
Total Assets EOY$146,479,246TotalAssetsEOYAmt
Total Liabilities BOY$135,544,512TotalLiabilitiesBOYAmt
Total Liabilities EOY$143,739,768TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$5,882,063NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,739,478NetAssetsOrFundBalancesEOYAmt
MissionTHE MISSION OF GOOD SAMARITAN HEALTH SYSTEM IS TO PROVIDE HIGH-QUALITY, COMPASSIONATE HEALTHCARE THAT IMPROVES THE OVERALL HEALTH OF OUR COMMUNITY. TO FULFILL THIS MISSION, GOOD SAMARITAN HAS FOCUSED ITS EFFORTS ON MAKING YOUR COMMUNITY HOSPITAL ONE OF THE TOP PERFORMING HOSPITALS IN THE NATION WITH ADVANCED, HIGH-QUALITY CARE THAT ALSO CARES ABOUT THE RESIDENTS OF LEBANON COUNTY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$163,255,003ExpenseAmt
Grant$7,058,000GrantAmt
DescInpatient/Outpatient Services Rehabilitation Unit - The GSH operates a 14 bed rehabilitation unit providing a full range of basic services required by an acute care rehab program including physical therapy, speech therapy, occupational therapy, social services and audiology.Desc
Total Program Service Expenses$163,255,003TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgYes (true)TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document101IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee1508EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members18GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonROBERT J RICHARDSPersonNm
Phone7172707500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1241 SOUTH FOURTH STREETAddressLine1
CityLebanonCity
StatePAState
ZIP Code170421281ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
John P Welch MD
Chairman/ Trustee1.01.0Yes (X)Yes (X)$0$0$0
Dennis L Shalters
Past Chairman/ Trustee1.01.0Yes (X)Yes (X)$0$0$0
Donald H Dreibelbis
First Vice Chairman/ Trustee1.01.0Yes (X)Yes (X)$0$0$0
Robert J Funk
Second Vice Chairman/ Trustee1.01.0Yes (X)Yes (X)$0$0$0
Jane W Juppenlatz
Secretary/ Trustee1.01.0Yes (X)Yes (X)$0$0$0
Frederick S Wolfson
Treasurer/ Trustee1.01.0Yes (X)Yes (X)$0$0$0
Carol Blecker
Trustee1.01.0Yes (X)$0$0$0
Evelyn C Colon
Trustee1.01.0Yes (X)$0$0$0
Paul R DiGiacomo MD
Trustee1.01.0Yes (X)$0$0$0
Robert P Hoffman
Trustee1.01.0Yes (X)$0$0$0
Frederick C Laurenzo
Trustee1.01.0Yes (X)$0$0$0
Robert J Phillips
Trustee1.01.0Yes (X)$0$0$0
William E Schaeffer Jr MD
Trustee1.01.0Yes (X)$0$0$0
Galen G Weaber
Trustee1.01.0Yes (X)$0$0$0
Deborah T Weaver
Trustee1.01.0Yes (X)$0$0$0
Gregory S Wickey MD
Trustee1.01.0Yes (X)$0$0$0
Julie Zinsser
Trustee1.01.0Yes (X)$0$0$0
Robert J Longo
President & CEO49.01.0Yes (X)Yes (X)$422,046$0$27,010
Kimberly Feeman
Senior VP & COO35.015.0Yes (X)$314,945$0$19,382
Robert J Richards
VP Finance & CFO35.015.0Yes (X)$313,729$0$28,809
Jacquelyn M Gould
VP of Nursing35.015.0$223,953$0$13,831Yes (X)
Robert Shaver
VP Medical Affairs50.0$347,698$0$3,308Yes (X)
William Mulligan
VP Strategic Planning & MKTG50.0$135,340$0$19,116Yes (X)
Marc Bonin
medical director- ed50.0$449,366$0$28,080Yes (X)
Daria Kovarikova
Residency Physician50.0$217,376$0$3,146Yes (X)
Elizabeth Muhiire-Ntaki
Residency Physician50.0$214,231$0$988Yes (X)
aaron lane
Residency Physician50.0$207,259$0$1,620Yes (X)
byard yoder
residency physician50.0$203,765$0$14,754Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$3,049,708TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$160,044TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K38IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
MCKESSON TECHNOLOGIES
PO Box 98347CHICAGOIL606938347IT Support$4,286,041
LEBANON ANESTHESIA ASSOC LTD
PO Box 1281LEBANONPA17042Anesthesiologists$3,579,688
LEBANON CARDIOLOGY ASSOCIATES
775 Norman DriveLEBANONPA17042Cardiologists$2,130,021
REHAB CARE GROUP INC
PO Box 502096ST LOUISMO631502096Rehab Mgmt Services$1,610,795
Sodexo Operations LLC
PO Box 360170PITTSBURGHPA152516170Dietary mgmt Service$1,442,867
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K110CntrctRcvdGreaterThan100KCnt
Fundraising$92,900FundraisingAmt
Related Organizations$35,000RelatedOrganizationsAmt
Government Grants$70,321GovernmentGrantsAmt
All Other Contributions$3,759,502AllOtherContributionsAmt
Total Contributions$3,957,723TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT SERVICE REVENUE/LABORATORY900099$165,546,721$161,415,162$4,131,559
HEALTH PROGRAMS900099$125,335$125,335
PHARMACY SALES900099$30,169$30,169
FieldValueIRS element (for citing)
Total Program Service Revenue$165,702,225TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,730,522TotalRevenueColumnAmt
Exclusion$1,730,522ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$40,917TotalRevenueColumnAmt
Exclusion$40,917ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$507,313RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$507,313RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$507,313TotalRevenueColumnAmt
Exclusion$507,313ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other-$4,267OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$4,267OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$4,267TotalRevenueColumnAmt
Exclusion-$4,267ExclusionAmt
FieldValueIRS element (for citing)
Contri Rpt Fundraising Event$92,900ContriRptFundraisingEventAmt
Fundraising Direct Expenses$20,705FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$20,705TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
MALPRACTICE INSURANCE524298$1,612,045$1,612,045
SNACK BAR/CAFE722511$559,395$559,395
MANAGEMENT SERVICES900099$551,520$551,520

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,606,559TotalRevenueColumnAmt
Exclusion$3,606,559ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$6,329,519OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$178,243,247TotalRevenueColumnAmt
Related Or Exempt Func Income$161,570,666RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$4,131,559UnrelatedBusinessRevenueAmt
Exclusion$8,604,004ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$7,035,000TotalAmt
Program Services$7,035,000ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$23,000TotalAmt
Program Services$23,000ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,869,167TotalAmt
Program Services$588,790ProgramServicesAmt
Management And General$1,280,377ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$55,672,156TotalAmt
Program Services$48,321,334ProgramServicesAmt
Management And General$7,350,822ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$6,912,251TotalAmt
Program Services$5,875,413ProgramServicesAmt
Management And General$1,036,838ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$8,307,621TotalAmt
Program Services$7,061,478ProgramServicesAmt
Management And General$1,246,143ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$4,105,493TotalAmt
Program Services$3,489,669ProgramServicesAmt
Management And General$615,824ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$540,269TotalAmt
Management And General$540,269ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$1,160TotalAmt
Management And General$1,160ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$13,569TotalAmt
Management And General$13,569ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$640,971TotalAmt
Management And General$640,971ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$8,028,673TotalAmt
Program Services$6,824,372ProgramServicesAmt
Management And General$1,204,301ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,060,731TotalAmt
Program Services$901,621ProgramServicesAmt
Management And General$159,110ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,296,128TotalAmt
Program Services$1,101,709ProgramServicesAmt
Management And General$194,419ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,431,023TotalAmt
Program Services$2,066,370ProgramServicesAmt
Management And General$364,653ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$55,876TotalAmt
Program Services$47,495ProgramServicesAmt
Management And General$8,381ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$3,936,320TotalAmt
Program Services$3,345,872ProgramServicesAmt
Management And General$590,448ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$11,691,709TotalAmt
Program Services$9,937,953ProgramServicesAmt
Management And General$1,753,756ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$2,246,721TotalAmt
Program Services$1,909,713ProgramServicesAmt
Management And General$337,008ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$30,869,508$30,869,508
BAD DEBT$11,390,274$11,390,274
PURCHASED SERVICES$23,637,112$20,091,545$3,545,567
UNRELATED BUSINESS INC TAXES$345,000$345,000

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,447,808TotalAmt
Program Services$2,373,887ProgramServicesAmt
Management And General$73,921ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$184,557,540TotalAmt
Program Services$163,255,003ProgramServicesAmt
Management And General$21,302,537ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$5,601BOYAmt
EOY$5,870EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,025,060BOYAmt
EOY$4,425,803EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,378,611BOYAmt
EOY$4,971,913EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$19,078,552BOYAmt
EOY$19,527,175EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$770,817BOYAmt
EOY$630,974EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,458,540BOYAmt
EOY$1,378,552EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$2,448,490BOYAmt
EOY$3,178,058EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$190,785,667LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$132,933,671LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$63,689,949BOYAmt
EOY$57,851,996EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$38,777,746BOYAmt
EOY$44,266,754EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$2,269,669BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$9,523,540BOYAmt
EOY$10,242,151EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$141,426,575BOYAmt
EOY$146,479,246EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$20,216,970BOYAmt
EOY$22,457,026EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$62,583,286BOYAmt
EOY$61,155,896EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$4,042,313BOYAmt
EOY$5,138,118EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$48,701,943BOYAmt
EOY$54,988,728EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$135,544,512BOYAmt
EOY$143,739,768EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,808,407BOYAmt
EOY-$4,674,000EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,385,178BOYAmt
EOY$6,725,000EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$688,478BOYAmt
EOY$688,478EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,882,063BOYAmt
EOY$2,739,478EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$141,426,575BOYAmt
EOY$146,479,246EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$6,314,293ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$3,126,253NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$45,455OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$13,569OtherActivitiesAmt
Total Lobbying Expenditures$13,569TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceLobbying ActivitiesFormAndLineReferenceDesc
ExplanationSchedule C, Part II-B, Line 1G The Hospital holds membership in the American Hospital Association (AHA) and the Hospital & Health system Association of Pennsylvania (HHAP) both of which engage in lobbying as a part of their mission to represent the interests of the hospitals at both the federal and state levels. For the year end 6/30/14 the amount of dues paid to the HHAP for General membership dues totaled $37,871 of which 17.77 percent was used for lobbying purposes and HHAP AHA dues totaled $29,999 of which 22.80 percent was used for lobbying purposes. The total used for lobbying purposes is $13,569. On occasion, HHAP requests the help of member providers to communicate concerns to legislators regarding pending legislation which could impact hospitals. This can involve direct contact with legislators or letter writing. This occurs infrequently and the cost to the hospital is negligible.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,073,656BeginningYearBalanceAmt
Contributions$3,551,208ContributionsAmt
Investment Earnings Or Losses$40,947InvestmentEarningsOrLossesAmt
Other Expenditures$253,584OtherExpendituresAmt
End Year Balance$7,412,227EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,719,409BeginningYearBalanceAmt
Contributions$2,252,267ContributionsAmt
Investment Earnings Or Losses$54,351InvestmentEarningsOrLossesAmt
Other Expenditures$952,371OtherExpendituresAmt
End Year Balance$4,073,656EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,945,233BeginningYearBalanceAmt
Contributions$424,618ContributionsAmt
Investment Earnings Or Losses$53,135InvestmentEarningsOrLossesAmt
Other Expenditures$703,577OtherExpendituresAmt
End Year Balance$2,719,409EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,005,818BeginningYearBalanceAmt
Contributions$834,833ContributionsAmt
Investment Earnings Or Losses$26,652InvestmentEarningsOrLossesAmt
Other Expenditures$922,070OtherExpendituresAmt
End Year Balance$2,945,233EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,236,426BeginningYearBalanceAmt
Contributions$458,155ContributionsAmt
Investment Earnings Or Losses$36,900InvestmentEarningsOrLossesAmt
Other Expenditures$725,663OtherExpendituresAmt
End Year Balance$3,005,818EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY0.24720PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.75280TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,468,847OtherCostOrOtherBasisAmt
Book Value$1,468,847BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$90,150,052OtherCostOrOtherBasisAmt
Depreciation$45,680,401DepreciationAmt
Book Value$44,469,651BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,525,278OtherCostOrOtherBasisAmt
Depreciation$5,030,634DepreciationAmt
Book Value$494,644BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$92,241,140OtherCostOrOtherBasisAmt
Depreciation$82,222,636DepreciationAmt
Book Value$10,018,504BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,400,350OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$1,400,350BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$57,851,996TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (7 entries)

DescDescBook ValueBookValueAmt
DEBT SERVICES FUND NON-CURRENT$5,776,564
MALPRACTICE INS RECEIVABLE$2,354,298
DEFERRED BOND INSURANCE COST$525,116
INTERCOMPANY RECEIVABLES$190,211
OTHER RECEIVABLES$1,300,236
DUE FROM FOUNDATION$32,158
DUE FROM EMP/STAFF/PHY$63,568
FieldValueIRS element (for citing)
Total Book Value Other Assets$10,242,151TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (10 entries)

DescDescAmtAmt
PENSION LIABILITY$36,559,050
POST RETIREMENT BENEFITS$2,143,128
3RD PARTY PAYABLES$1,538,738
INSURANCE RESERVES$4,616,380
ANNUITY PAYABLE$848,298
EMPLOYEE W/H PAYABLE$487,550
INTEREST PAYABLE$473,390
DUE TO OTHER$1,063,199
OTHER PAYABLES$2,200
REHAB LIABILITY$7,256,795
FieldValueIRS element (for citing)
Total Liability$54,988,728TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$162,367,941TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$3,126,253NetUnrealizedGainsInvstAmt
Other Revenue-$18,381,293OtherRevenueAmt
Revenue Not Reported-$15,255,040RevenueNotReportedAmt
Revenue Subtotal$177,622,981RevenueSubtotalAmt
Investment Expenses Not Incld$640,971InvestmentExpensesNotIncldAmt
Other Revenues Not Included-$20,705OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$620,266RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$178,243,247TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$165,512,000TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$20,705OtherExpensesIncludedAmt
Expenses Not Reported$20,705ExpensesNotReportedAmt
Expenses Subtotal$165,491,295ExpensesSubtotalAmt
Investment Expenses Not Incld2$640,971InvestmentExpensesNotIncld2Amt
Other Expenses Not Included$18,425,274OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$19,066,245ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$184,557,540TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Endowment FundsSchedule D, Part V, Line 4 The Good Samaritan Hospital maintains temporarily restricted and permanently restricted assets to purchase specific pieces of equipment and provide qualified applicants a scholarship
Fin 48 (ASC 740) FootnoteSchedule D, Part X, Line 2 GOOD SAMARITAN Hospital is included in the consolidated audited financial statements of Good Samaritan Health services Foundation. GOOD SAMARITAN Hospital FOLLOWS THE ACCOUNTING GUIDANCE FOR UNCERTAINTIES IN INCOME TAX POSITIONS WHICH REQUIRES THAT A TAX POSITION BE RECOGNIZED OR DERECOGNIZED BASED ON A "MORE LIKELY THAN NOT" THRESHOLD. THIS APPLIES TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. GSH DOES NOT BELIEVE ITS CONSOLIDATED FINANCIAL STATEMENTS INCLUDE ANY MATERIAL UNCERTAIN TAX POSITIONS. AT JUNE 30, 2014, GSH'S TAX YEARS ENDED JUNE 30, 2011 THROUGH 2014 FOR THE FEDERAL TAX JURISDICTION REMAIN OPEN.
Part XI, Line 2dPension Income Adjustment 971,941 Change in Post Retirement Obligation 3,303,038 Change in Pension Obligation (1,961,000) Good Impairment (2,270,000) Rounding Adjustment 1,476 Reclass: Bad Debt (11,390,274) Reclass: Grant to Affiliate (7,035,000) ------------ Total (18,381,293) Part XI, Line 4b Reclass: Special Events Expenses (20,705)
Part XII, Line 2dReclass: Special Event Expenses 20,705 Part XII, Line 4b Reclass: Bad Debt (11,390,274) Reclass: Grant to Affiliate (7,035,000) ------------ Total (18,425,274)

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Name Of Event1Golf TournamentNameOfEvent1Amt
Charitable Contri Event1$92,900CharitableContriEvent1Amt
Gross Revenue Event1-$92,900GrossRevenueEvent1Amt
Other Direct Expenses Event1$20,705OtherDirectExpensesEvent1Amt
Other Events Total0OtherEventsTotalCnt
Charitable Contributions Tot$92,900CharitableContributionsTotAmt
Gross Revenue Total Events-$92,900GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$20,705OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$20,705DirectExpenseSummaryEventsAmt
Net Income Summary-$113,605NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,674,078TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,674,078NetCommunityBenefitExpnsAmt
Total Expense0.01590TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,316,669TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,574,416DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,742,253NetCommunityBenefitExpnsAmt
Total Expense0.01040TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$15,312,637TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,838,681DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,473,956NetCommunityBenefitExpnsAmt
Total Expense0.04460TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$21,303,384TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$9,413,097DirectOffsettingRevenueAmt
Net Community Benefit Expns$11,890,287NetCommunityBenefitExpnsAmt
Total Expense0.07090TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$33,150TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$33,150NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,930,039TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$764,156DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,165,883NetCommunityBenefitExpnsAmt
Total Expense0.01290TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,963,189TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$764,156DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,199,033NetCommunityBenefitExpnsAmt
Total Expense0.01310TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$24,266,573TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,177,253DirectOffsettingRevenueAmt
Net Community Benefit Expns$14,089,320NetCommunityBenefitExpnsAmt
Total Expense0.08400TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$46,664TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$46,664NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$33,613TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$33,613NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$80,277TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$80,277NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$11,390,274BadDebtExpenseAmt
Bad Debt Expense Attributable$9,639,000BadDebtExpenseAttributableAmt
Reimbursed By Medicare$35,582,177ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$68,783,408CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$33,201,231MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1The Good Samaritan HospitalBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1fourth and walnut streetAddressLine1
CitylebanonCity
StatePAState
ZIP Code17042ZIPCode
FieldValueIRS element (for citing)
Website Addresswww.gshleb.orgWebsiteAddressTxt
State License230794160StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Teaching HospitalYes (X)TeachingHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1The Good Samaritan HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLwww.gshleb.orgOwnWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Adopt BudgetYes (X)AdoptBudgetInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
All Needs AddressedfalseAllNeedsAddressedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (true)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (true)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care300.FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (true)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Uninsured DiscountYes (X)UninsuredDiscountInd
Other FactorsYes (X)OtherFactorsInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Provided On AdmissionYes (X)ProvidedOnAdmissionInd
Available On RequestYes (X)AvailableOnRequestInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Collection ActivitiesfalseCollectionActivitiesInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesYes (true)GrossChargesInd
FieldValueIRS element (for citing)
Facility11FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (11 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeFacilityFacilityTxt
The Good Samaritan Hospital
fourth Willow StreetsLebanonPA17042Rehab & Tuc Units
The Good Samaritan Hospital
830 Tuck StreetLebanonPA17042Outpatient surgical center
The Good Samaritan Hospital
840 Tuck StreetLebanonPA17042Wound Care & Hyperbaric Cntr
The Good Samaritan Hospital
206 Hathaway ParkLebanonPA17042Sleep Disorders Center
The Good Samaritan Hospital
805 Helen DriveLebanonPA17042Outpatient Radiology Center
The Good Samaritan Hospital
750 Norman DriveLebanonPA17042Blood Donor Cntr & Lab
The Good Samaritan Hospital
297 West Lincoln AveLebanonPA17042Outpatient Diagnostics Center
The Good Samaritan Hospital
1400 South Forge RoadLebanonPA17042Ambulatory Services Center
The Good Samaritan Hospital
100 Queen StreetLebanonPA17042Satellite Services Center
The Good Samaritan Hospital
950 Isabel DriveLebanonPA17042Outpatient Physical Therapy
The Good Samaritan Hospital
781 Norman DriveLebanonPA17042Cardiovascular Diagnostic

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Community Benefit ReportPart I, Line 6a Our annual community benefit report is prepared by our marketing department. The report can be found at our website, www.gshleb.org. We also mail the report out to the members of our community.
Part I, Line 7, Column (f)Our total expenses from form 990, part ix, line 25, column (a) was $184,557,540. the bad debt exchange included in this amount was $11,390,274. This left us with a total expense of $173,167,266 for purposes of calculating Line 7, column (f).
Part I, Line 7The Good Samaritan Hospital used the cost to charge ratio cost methodology to calculate the charity unreimbursed Medicaid and other government programs. The hospital used direct costs for the other community benefits on Line 7.
Community Building ActivitiesPart II The Good Samaritan Health System is involved in some community building programs which are designed to - improve the overall health of our community - (mission statement). The GSH participates in a disaster preparedness program which provides a plan in the case of a disaster that affects the community. The GSH also provides space for support groups to meet and education classes for the people within the community, like expectant parents. The activities are not included elsewhere on the Schedule H.
Bad Debt, Medicare, & Collection PracticesPart III, Line 4 AFS Footnote: The Hospital establishes an allowance for doubtful accounts to report the net realizable amounts to be received from patients. Increases to this allowance are reflected as a provision for doubtful accounts in the statements of operations and changes in net assets (deficiency). The Hospital regularly performs a detailed analysis of the collectability of patient accounts receivable and considers such factors as prior collection experience and the age of the receivables to determine the appropriate allowance level. Bad Debt Methodology: The Good Samaritan Hospital is a tax-exempt non-for-profit hospital that provides quality medical services to patients regardless of their ability to pay. By providing medical services to all community members regardless of their ability to pay, the hospital's bad debt expense qualifies as a community benefit. The bad debt expense calculated on line 2 was calculated using the patient care cost to charges methodology. The Good Samaritan Hospital uses an automated system called presumptive to charity care tool to calculate the amount on line 3. All self-pay accounts and all the self-pay after insurance accounts are imported into the tool, then the tool scores each account based on the government guidelines for poverty levels. For FYE 6/30/14, the tool estimated $9,639,000 of the organization's bad debt expense should be considered charity care.
Medicare ShortfallPart III, Line 8 Medicare allowance costs were calculated using a cost to charge ratio. The Good Samaritan Hospital provides quality medical services to all patients regardless of what insurance they have. Approximately 58% of The Good Samaritan Hospital's revenue is attributable to Medicare patients. The Good Samaritan Hospital is relieving the government's burden, because the hospital is providing services to Medicare patients which cost more than the Medicare reimbursement. Therefore, the $33,201,231 Medicare shortfall should be considered a community benefit.
Collection PoliciesPart III, Line 9b Collection policies are the same for all patients. if a patient notifies the hospital about their inability to pay, the hospital will send them the charity care and financial assistance forms to fill out. Once the forms are completed and returned to the hospital and the patient qualifies for financial assistance, then the patient's account will be removed from collections and the account will be written off.
Needs AssessmentPart VI, Line 2 The Good Samaritan Hospital (the Hospital) has participated in a variety of community health needs assessments over the past 17 years. The hospital was instrumental in helping to launch the Community Health Council of Lebanon County. In partnership with the council, a community health needs assessment was created 17 years ago and an updated assessment completed 12 years ago. Another assessment was created in 2005, led by efforts of The United Way of Lebanon County. The Hospital's most recent community health needs assessment was completed in conjunction with the Community Health Council of Lebanon County, the United Way and Lebanon Family Health Services. The assessment report was developed by Civic Research Alliance LLC, published in June 2012 and subsequently approved by the Board of Directors of the Hospital on July 24, 2012. Data were collected and analyzed by the Hospital from sources that included the Pennsylvania Department of Health, the Centers for Disease Control and Prevention, the U.S. Census, the American Community Surveys, and interviews of community leaders and healthcare professionals in Lebanon County. over time. Additional data were gathered when a trend identified a high priority need. Priorities were then categorized as a need to be addressed by the community or by the Hospital. The following were identified as the priority health care needs of the communities the Hospital serves and the action plan adopted by the Board of Directors of the Hospital. - Chronic Disease Management Provide programs that educate and assist patients with chronic diseases to self-manage their condition. Continue to offer Medical Home services at Good Samaritan primary care practices to deliver preventive care that reduces need for acute care services. Increase awareness and use of Diabetic Education services in community. Promote tobacco cessation programs. Offer cardiac education at hospital and in community. Participate in healthy lifestyle events, such as Give Thanks for Lebanon 5k/10k event. - Overweight and Obesity Raise community awareness about obesity issues. Provide education about healthy lifestyles to patients and to community groups. - Smoking Promote smoking cessation among hospital employees. Support community smoking cessation programs. Encourage doctors to tell patients to quit and share information about hospital and community-based cessation programs. - Accidents and Injuries Emergency department readiness. Continue to enforce hospital rules for use of child care seats. Raise awareness about accidents for young drivers. Raise awareness and provide education for patients and families about the risks of falling for the population 75 years and older. - Oral Health Services These services are not part of the acute health care mission of the Hospital. - Mental Health Services These services are not part of the acute health care mission of the Hospital. - Maternal and Child Health Prepare for younger maternity patients as demographics shift. Maintain high-quality maternity facilities. Raise awareness for pre- natal health checks. Promote smoking cessation to those in child- bearing years. - Access to Healthcare This issue falls outside the scope of The Hospital because most primary care is provided by independent community physicians. Encourage providers to accept Medicaid and Medicare. Keep access to public insurance at The Good Samaritan Family Practice Center, ELCO Family Practice, and Good Samaritan Pediatrics. - Culturally and linguistically appropriate healthcare Continue to provide diversity education to employees. Conduct additional outreach efforts to non- English speaking populations in community. Additional supplemental information: The hospital also maintains an independent, countywide physician needs assessment to evaluate gaps in healthcare access. A new physician needs assessment was also completed in 2011. In addition to these countywide efforts, the hospital has performed a variety of studies on specific health concerns and community needs. Key studies have included services for cardiovascular, oncology, gastroenterology, wound care, and more. The hospital has also acted to fulfill the needs identified in these studies. The hospital created one of the nation's leading cardiac and vascular centers, which has earned several national awards for quality of care. The hospital introduced a new wound care service to deal with patients suffering from complications of diabetes - a particular problem to Lebanon County - and has already expanded operations to add a third hyperbaric oxygen treatment chamber to the two originally installed in the center. In addition, the hospital has protected the community by recruiting new physicians for key services - general surgery, oncology, and gastroenterology - allowing patients to get access to care in Lebanon County instead of traveling throughout the region.
Patient Education of eligibilty for assistancePart VI, Line 3 The Good Samaritan Hospital Charity Care policy outlines the process of financial, medical and catastrophic categories where a patient could qualify for charity care. the hospital has a self-pay brochure available that provides information and available hours. Financial counselors are on site to meet with patients to discuss their financial obligations, assist them in completing the application for the charity care, and answer their questions. Patients are encouraged to apply for charity care if they are unable to come in for an appointment. There is a note on the statements that is mailed to patients, letting them know that financial assistance is available. The Good Samaritan hospital's website also provides the contact information for those community members who need medical services and financial assistance.
Community InformationPart VI, Line 4 Lebanon County includes a mix of urban, suburban, and rural areas. The city of Lebanon is centrally located, serving as the county seat. The city is home to more than 24,000 residents and is classified by the commonwealth of Pennsylvania as a third class city. The county includes 25 other municipalities. the rest of the county is made up of suburban and rural areas, with rural farmland providing a dominant character of county life. while most of the population tends to be of white ancestry (91%), the county has a fast-growing Hispanic population (7.8%) that centers in the city of Lebanon (source: U.S. Census Bureau). The U.S. census bureau also reports that 8% of the population speaks a language other than English at home. Employment rates in the county are currently at 6.8% - one of the lowest rates in the state - and average household income is at $50,334 according to the USDA economic research service. The federal government is the county's largest employer, with large work forces at the Lebanon veteran's administration hospital and fort Indiantown gap. The Good Samaritan hospital is the largest non-governmental employer with 1,500 employees. according to the U.S. census bureau American community survey, 8% of the population lives in poverty. The Good Samaritan Hospital is the only hospital in Lebanon county. The hospital has performed thousands of outpatient procedures - from surgeries to imaging to laboratory to physical therapy - every year. The hospital also provides a continuity of care through a skilled nursing unit, rehabilitation services, home healthcare, and hospice care. the hospital is the largest provider of care to Medicaid and Medicare populations. while most Lebanon county residents choose to stay in the county for their care, with more than 60% choosing the Good Samaritan hospital for services. according to the Robert Wood Johnson Foundation community health rankings, Lebanon county is the 13th most healthy of Pennsylvania's 67 counties. the health rankings indicate key areas of improvement, including diabetes, tobacco use, and other health behaviors that are problematic. the hospital has taken steps to address these areas by expanding services and educational opportunities.
Promotion of Community HealthPart VI, Line 5 Good Samaritan strives to deliver powerful medicine with comforting care every day. As part of our non-profit mission, The Good Samaritan Hospital and its affiliated organizations deliver healthcare services that improve the quality of life throughout the region. As Lebanon County's only hospital, Good Samaritan is the community's primary - and sometimes only - resource for: -Inpatient hospital care -Emergency care -Surgical services -Digestive health services -Maternity services -Cardiac & vascular services -Radiology and medical imaging services -Laboratory diagnostic services and blood bank -Physical and occupational therapies -Transitional care and rehabilitation services -Home health and hospice services -Wound care and hyperbaric medicine -Diabetic education and nutrition counseling -Audiology and speech therapy -Sleep disorders -Physician services for needed specialties including cardiac, gastroenterology, general surgery, hematology, hospitalists, oncology, pediatrics, primary care (particularly for Medicaid population), thoracic, vascular, and wound care. -Medical residency program to train new physicians -And many more Community Benefit Total $2,371,205 Good Samaritan and its employees donate many hours of time to improve the health of the community. In 2014, key projects included: -Health Fairs - the countywide 50+ Festival and Women's Health Expo as well as individual events hosted by various nursing and retirement facilities, employers and other community groups -Education programs - offered at the hospital or presented to community groups on topics such as smoking cessation, cardiac health, cancer prevention, sleep disorders, diabetic health, breast health and more -Medical clinic - Good Samaritan donated employee time to support a new independent medical clinics for poor and low-income patients -Health screenings - screenings for cholesterol, blood glucose, BMI, skin cancer, blood pressure, varicose veins and other health conditions were provided throughout the year Charitable and Uncompensated Care In reflection of our non-profit mission, Good Samaritan delivered over $21 million dollars in charitable and uncompensated care to the community. Economic Impact In addition to our core healthcare mission, Good Samaritan is Lebanon County's largest non-government employer - and positively impacts the economy by generating more than 1,000 jobs outside of the health system. The Good Samaritan Hospital had a Net Hospital Revenue of $160 million in 2014. Service Statistics The Good Samaritan Hospital treated 7,582 patients in 2014. In addition, the health system offers a wide variety of diagnostic and non-acute health services that are needed by the community. Many of these services would not be available to the community if they were not offered by Good Samaritan. Behind the Statistics Many of the 109,852 radiology services we provided in 2014 include those services provided by our Women's Imaging Center, mainly screening mammograms. Breast cancer remains an important women's health issue with thirty-two percent of women in Pennsylvania diagnosed daily with the disease. One in eight women will be diagnosed with invasive breast cancer in their lifetime, including those with no family history of the disease. To help women fight this disease, Good Samaritan provides the latest, comprehensive breast imaging services and follow-up care to improve detection and shorten the time from diagnosis until treatment can begin. Dense breast tissue can make cancer harder to find on a mammogram, which increases the risk of a late-stage cancer diagnosis in many women. Because of this, Pennsylvania now requires all patients with dense breast tissue be notified in their result letter after a mammogram. Good Samaritan goes beyond the required notification for our patients, introducing new software that utilizes several different risk assessment tools to assist in calculating if a woman is high-risk for developing breast cancer in her lifetime. This risk assessment may recommend that breast ultrasound or magnetic resonance imaging (MRI) be utilized in conjunction with screening mammography to assist in detecting breast cancer. In addition to the use of this risk assessment tool in screening, Good Samaritan has focused our efforts on reducing the "door-to-diagnosis" time for women having diagnostic imaging. All diagnostic mammograms and ultrasounds are promptly read by a board-certified radiologist who specializes in breast imaging so the patient receives the results before leaving the Women's Imaging Center. If an abnormality is detected, a certified breast patient navigator in imaging and cancer care works with the patient to help her understand the process and schedule a biopsy. Good Samaritan is now able to perform all minimally-invasive biopsies in the Women's Imaging Center under stereotactic or ultrasound guidance and MRI-guided breast biopsies also available. Reducing the time from imaging to treatment is important both psychologically and physically. In the past women may have had to wait weeks after an abnormality was found for a biopsy and the following surgical consultation if the biopsy was positive. Now many women are having diagnostic imaging, a biopsy and their surgical consult in days rather than weeks. By shortening this process, women are able to either eliminate unnecessary worry more quickly or receive the earliest possible treatment for a cure. Breast cancer remains a focus of Good Samaritan's efforts to provide quality care that changes lives. Supporting Our Community The employees of the Good Samaritan Health System have a spirit of generosity. Each year employees donate their time, goods and money to support worthy causes. -United Way - Good Samaritan employees donate more than $30,000 annually to the United Way of Lebanon County. -Reach Out and Read - a national program to give free books to children of low income families. -Cribs for Kids - brand new cribs provided to low-income families -Bridge of Love - personal care items provided to families in need -Car Seats - new car seats are made available to low-income families -American Heart Association - more than 100 employees participate in the annual Heart Walk, raising thousands of dollars each year -Operation Good Sam - During the Thanksgiving Food Drive, food is collected and delivered to more than 100 families in need. -Good Samaritan Christmas Toy Drive - employees donate toys that are delivered to more than 250 children each year to spread holiday cheer Community Health Council The Good Samaritan Hospital helped to create the independent Community Health Council of Lebanon County. From its humble inception, the Council has grown into a premier county organization. More than 400 volunteers collaborate on programs to increase healthy lifestyles and to eliminate alcohol and drug abuse in the county. The Council sponsors programs that address the special needs of youth, parents and seniors. A Home for Community Groups The Good Samaritan Hospital opens its doors to support a variety of community groups. The hospital provides rent-free classroom space for a variety of support groups such as: -Alcoholics Anonymous -Alanon -Better Breather's Club -I Can Cope (cancer support) -Journey Through Grief Bereavement Support (adult focused Hospice support) -Support and Help in Airing and Resolving Experiences (for grieving parents) -Rainbow Connection (teen focused Hospice support) -Narcotics Anonymous Sharing Our Knowledge At Good Samaritan Health System, caring for our community extends beyond providing medical services. Through our educational services department, we offer classes and support groups that address multiple health related topics, which in turn offer the members of our community an opportunity to improve their health, both physically and emotionally. The educational services department oversees community education classes such as babysitter training and a variety of Heartsaver CPR programs, which range from basic first aid to advanced cardiac life support. These classes provide individuals a chance to obtain skills which can benefit their lives both personally and professionally. Diabetes is prominent in the Lebanon County. To address this growing health concern, Good Samaritan offers Diabetic Education Classes. This program is a series of four classes which addresses topics such as: the importance of managing diabetes; meal planning; use of medication; glucose monitoring; and coping with diabetes. Community members dealing with substance addiction or those who are grieving can receive much needed support through community groups whose meetings are scheduled through the educational services department. These include: Al-Anon; Journey through Grief; and Narcotics Anonymous. Most of these programs are offered on a weekly or bi-weekly basis and all are free of charge. In addition to offering classes to the general public, the educational services dep
Affiliated Health Care SystemPart VI, Line 6 The Good Samaritan Hospital is a part of the Good Samaritan Health System. The system includes a foundation, real estate companies, family practices, specialty health services, and a DME company. In addition to the community benefits provided by the hospital, the health system evaluates the needs the community and the system will participate in community benefit programs, like supporting the volunteers in medicine free clinic which serves the underprivileged members of the community.
State Filing of the community benefit reportPart VI, Line 7 Pennsylvania

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan Health Services FoundationBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1259 Fourth StreetAddressLine1
CityLebanonCity
StatePAState
ZIP Code17042ZIPCode
FieldValueIRS element (for citing)
Recipient EIN232356151RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$7,035,000CashGrantAmt
Purpose Of GrantProgram SupportPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (4 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
David Broderic Scholarship15$7,500
Margaret Connel Scholarship8$5,000
GSH Auxiliary Scholarship2$4,000
Caplan Nursing Scholarship5$6,500

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceProcedures to monitor use of grantsFormAndLineReferenceDesc
ExplanationParts I, Line 2 The david broderic employee scholarship program and the margaret l. connelY scholarship fund are for the sons and daughters of employees. the GSH auxiliary and caplan nursing scholarships are awarded to lebanon county residents enrolled in a nursing program. The Good Samaritan hospital distributes a portion of the money allotted to every person who applies for the scholarship. The Good Samaritan Hospital has internal controls with regards to issuing grants to individuals.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmt
Robert J Longo
President & CEO$417,922$0$0$0$4,124$0$21,202$0$5,808$0$449,056$0
Kimberly Feeman
Senior VP & COO$264,579$0$50,000$0$366$0$16,073$0$3,309$0$334,327$0
Jacquelyn M Gould
VP of Nursing$172,063$0$50,000$0$1,890$0$10,522$0$3,309$0$237,784$0
Robert J Richards
VP Finance & CFO$255,552$0$50,000$0$8,177$0$23,000$0$5,809$0$342,538$0
Robert Shaver
VP Medical Affairs$297,584$0$50,000$0$114$0$0$0$3,308$0$351,006$0
William Mulligan
VP Strategic Planning & MKTG$135,214$0$0$0$126$0$15,166$0$3,950$0$154,456$0
Marc Bonin
medical director- ed$349,178$0$99,449$0$739$0$22,719$0$5,361$0$477,446$0
Daria Kovarikova
Residency Physician$183,814$0$32,856$0$706$0$0$0$3,146$0$220,522$0
Elizabeth Muhiire-Ntaki
Residency Physician$148,421$0$65,672$0$138$0$0$0$988$0$215,219$0
aaron lane
Residency Physician$142,047$0$65,171$0$41$0$0$0$1,620$0$208,879$0
byard yoder
residency physician$176,523$0$26,200$0$1,042$0$9,108$0$5,646$0$218,519$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 3The compensation committee hires an independent compensation consultant to establish the CEO's compensation amount and compose the contract. the compensation committee presents the information to the board and the board member can ask to review the contract privately.
Part I, Line 4bRobert Longo is a participant in a 457f retirement plan. he recieved no payment from the plan this year.
Part I, Line 7The executive bonus program is a non-fixed payment program. discretion is exercised as to the amount and when/if payment will be made.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Lebanon County Health Facilities AuthorityBusinessNameLine1
FieldValueIRS element (for citing)
Bond Issuer EIN232546819BondIssuerEIN
Bond Issued2004-03-11BondIssuedDt
Issue Price$17,255,816IssuePriceAmt
PurposeSee Part VIPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$0RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$17,255,816TotalProceedsAmt
In Reserve Fund$0InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$0IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$0CapitalExpendituresAmt
Other Spent Proceeds$0OtherSpentProceedsAmt
Unspent$0UnspentAmt
Substantial Completion2004SubstantialCompletionYr
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0PrivateBusUseByOthersPct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Remedial Action TakenfalseRemedialActionTakenInd
Procs Nonqualified Bond RemdtdfalseProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Exception To RebateYes (true)ExceptionToRebateInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsfalseWrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionfalseProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
John P Welch MD
See Part V$310,157Property Rentalfalse
Frederick C Laurenzo
See Part V$15,129Car Salesfalse
Frederick S Wolfson
See Part V$154,767Attorney Feesfalse

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part IV, line 2John Welch, a trustee of the good samaritan hospital, is a partner in Welch wagner partnership.
Part IV, Line 3Frederick Laurenzo, a trustee of the good samaritan hospital, is a partner in federick chevrolet, cadillac, and toyota.
Part IV, Line 4Frederick Wolfson, a trustee of the good samaritan hospital, is a partner in reilly, wolfson, sheffey, schrum & lundberg.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Committees With Board AuthorityPart VI, Section A, Line 1a There are no material differences in voting rights among the members of the governing body. The executive committee shall consist of the officers of the corporation other than the vice president, the president of the medical staff, the solicitor, the chairman of all standing committees and the most recent past chairman of the board. It shall be the duty of the executive committee to review matters brought to its attention and to make recommendations to the board for board action. It shall have the power to transact emergency business of the corporation during the interval between board meetings, provided such action does not conflict with policies and expressed wishes of the board. It shall report any actions taken to the board at the board's next regular meeting.
Members or StockholdersPart VI, Section A, Line 6 The Good Samaritan Health Services Foundation, another 501(c)(3) organization, is the sole member of the good samaritian hospital.
Members who may elect trustees of the governing bodyPart VI, Section A, Line 7a The Good Samaritan Health Services Foundation, as the sole member of the Good Samaritan Hospital, may elect one or more trustees of the hospital's governing body.
decision of governing body subject to approval by membersPart VI, Section A, Line 7b Certain decisions of the hospital's governing body are subject to approval by the Hospital's sole member, The Good Samaritan Health Services Foundation.
Form 990 Review ProcessPart VI, Section B, Line 11 An external accounting firm prepares the Form 990 for the Good Samaritan Hospital. The Hospital accounting and finance personnel and the chief financial officer then review the completed Form 990. The completed Form 990 will be provided to the full board.
Conflict of Interest PolicyPart VI, Section B, Line 12a The Good Samaritan Hospital has a Compliance Officer that is responsible for the monitoring and enforcing the compliance of policies. The board members sign a conflict of interest statement every year which states what organizations or businesses he or she is the owner, officer, member or employee. If an issue is brought to the board members, the board member would remove himself from the discussion and abstain from voting on the issue.
Compensation ReviewPart VI, Section B, Line 15a The compensation committee hires an independent compensation consultant to establish the CFO's compensation and compose the contract. The compensation committee presents the information to the board for discussion. The deliberation and compensation decision are documented in the committee and/or Board meetings.
Disclosure of Documents to the PublicPart VI, Section C, Line 19 The governing documents, conflict of interest policy and audited financial statements are available upon request.
Form 990, Part XI, Line 9Pension Income Adjustment 971,941 Change in Post Retirement Benefits 3,303,038 Change in Pension Obligation (1,961,000) Goodwill Impairment (2,270,000) Rounding Adjustment 1,476 ----------- Total 45,455

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationInd
Good Samaritan Health Service Foundation
259 South 4th StreetLebanonPA17042232356151ParentPA501(c)(3)11 Type INAfalse
Good Samaritan Physician Services
259 South 4th StreetLebanonPA17042251832359Family MedPA501(c)(3)9GSHS FDNfalse
GSH Dialysis Inc
440 Oak StreetLebanonPA17042232500940DialysisPA501(c)(3)3GSHS FDNfalse
Good Samaritan Real Estate Inc
241 South 4th StreetLebanonPA17042232447262TitleholdingPA501(c)(2)GSHS FDNfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Lebanon MRI AssocBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line14th and Walnut StAddressLine1
CityLebanonCity
StatePAState
ZIP Code17042ZIPCode
FieldValueIRS element (for citing)
EIN363730905EIN
Primary ActivitiesImagingPrimaryActivitiesTxt
Legal Domicile StatePALegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1GSH ServicesBusinessNameLine1

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Entity TypeEntityTypeTxt
GSH Services Inc
241 South 4th StreetLebanonPA17042232353047Mgmt/AcctPAGSH FndC Corp
GSH Home Med Center Inc
301 Schneider DriveLebanonPA17042232028099Med EquipPAGSH FDNC Corp
GSH Realty Inc
241 South 4th StreetLebanonPA17042232446622Title HoldingPAGSH FDNC Corp
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd