2015-05-14T07:02:00-05:00 2014-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2013-07-01 930425580 Good Shepherd Health Care System GOOD 5416673400 610 NW 11th Street Hermiston OR 97838 Dennis Burke President/CEO 5416673400 2015-05-05 1 Kim Hunwardsen CPA P00484560 6122536500 2015-05-05 2013 2016-02-25 16:41:14Z Good Shepherd Medical Center Dennis Burke 610 NW 11th Street Hermiston OR 97838 139526107 0 X www.gshealth.org X 1953 OR Hospital and health care services. 12 11 639 136 0 0 308309 125663 78776801 83761041 4138296 4321534 128348 119592 83351754 88327830 326745 313800 0 0 38275999 41975186 0 0 0 32409194 32244427 71011938 74533413 12339816 13794417 122960248 147108147 7169831 14262394 115790417 132845753 X To provide compassionate, high quality, and accessible health care and to promote a healthy community. 0 0 69989644 313800 82953327 Good Shepherd Health Care System (GSHCS) served 1,795 inpatients over 4,661 patient-days and 47,933 outpatients in fiscal year 2013-14, as well as 17,576 patients in our Emergency Center. Although reimbursement for services rendered is critical to the operations and stability of GSHCS, not all individuals have the ability to purchase essential medical services. In recognition of this, during FY 2013-14 GSHCS wrote off to collection $4,956,543 valued at charges foregone as bad debt. Direct charity care to our community amounted to an additional $7,411,436, valued at charges foregone. GSHCS provides care to persons covered by governmental programs at deeply discounted rates. Recognizing its mission to the community, services were provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients during fiscal year 2013-14 was $42,530,576, valued at charges foregone.Our Emergency Center is open around-the-clock to all community members, visitors, and travelers, without regard to one's ability to pay. 69989644 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 154 0 1 639 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 OR X Jan Peter 5416673416 610 NW 11th Street Hermiston OR 97838 Steve Eldrige Chair 2.00 0.00 X X 0 0 0 Nancy Mabry Vice Chair 2.00 0.00 X X 0 0 0 Dr Derek Earl Secretary 2.00 0.00 X X 0 0 0 Tom Wamsley Treasurer 2.00 2.00 X X 0 0 0 Bob Carlson Director 2.00 0.00 X 0 0 0 Richard Lindner Director 2.00 2.00 X 0 0 0 Tricia Fenley Director 2.00 1.00 X 0 0 0 Bill Elfering Director 2.00 0.00 X 0 0 0 Sue Daggett Director 2.00 0.00 X 0 0 0 Rachel Archer Director 2.00 0.00 X 0 0 0 Janet Cooley Director 2.00 0.00 X 0 0 0 Gabino Gispert Director 2.00 0.00 X 0 0 0 Dennis E Burke President/CEO 40.00 0.00 X 355718 0 52216 Jan D Peter VP/CFO 40.00 0.00 X 202754 0 38276 David T Hughes VP/COO 40.00 0.00 X 197896 0 36444 Dr Olga Stobart Hospitalist 40.00 0.00 X 349551 0 5907 Dr Thomas L Farney Physician - Surgeon 40.00 0.00 X 291831 0 46199 Dr Thomas J Holt Physician - Urologist 40.00 0.00 X 323655 0 26007 Dr Kim A Peterson Physician - ER Doctor 40.00 0.00 X 293317 0 5688 Dr Diana Edenfield Physician - OB/GYN 40.00 0.00 X 289056 0 10513 2303778 0 221250 63 0 1 0 McCormack Construction Corp 422 SW 6th Pendleton OR 97801 Construction 6110512 Rehab Associates 600 NW 11th St Ste E31 Hermiston OR 97838 Physical Therapy 1281020 Tualatin Imaging 6464 SW Boreland Rd Suite A-4 Tualitin OR 97062 Diagnostic Imaging 1147824 Peterson Kolberg & Associates 6969 SW Hampton Portland OR 97223 Architecture 931249 Medical Doctor Assoc Inc PO Box 277185 Atlanta GA 30384 Locum Doctors 472304 17 125663 125663 Net Patient Services 622110 82158204 82158204 Other Supporting Revenue 900099 708759 708759 Cafeteria 900099 554747 554747 Daycare 900099 252967 252967 EHR Funding 900099 75331 75331 11033 11033 83761041 1968743 1968743 119592 0 119592 119592 119592 53479838 71230 51188450 9827 2291388 61403 2352791 2352791 88327830 82953327 0 5248840 X 313800 313800 889705 889705 32180312 30556446 1623866 1336409 1268972 67437 5627148 5343194 283954 1941612 1800403 141209 52917 52917 60210 60210 40812 40812 9271475 8142243 1129232 104207 97263 6944 9122848 8914086 208762 709033 709033 301014 262293 38721 202018 202018 8398 8398 4877753 4877753 591166 591166 Medical Supplies 3415967 3415967 Bad Debts 3268032 3268032 Taxes & Licenses 136991 136991 81586 81586 74533413 69989644 4543769 0 2985714 6122733 12364329 12019309 13058734 13056234 1976111 2233847 1121830 1388640 98867750 48120503 44117207 50747247 48268655 63147316 630000 630000 -6573810 -6567963 5011478 4330784 122960248 147108147 7169831 8493670 570357 0 5198367 7169831 14262394 X 115290964 132312481 499453 533272 115790417 132845753 122960248 147108147 13794417 3266105 -5186 0 X 0 1 X 1 0 X 2860961 951448 3812409 44415757 18821827 25593930 39535121 28046396 11488725 11104463 1252280 9852183 50747247 Estimated 3rd party payor settlements 280000 Capital Lease Obligations 4918367 5198367 X 87979510 3266105 -3573613 -307508 88287018 40812 40812 88327830 70910769 0 70910769 40812 3581832 3622644 74533413 Part X, Line 2: GSHCS is organized as an Oregon non-profit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). GSHCS is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, GSHCS is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. GSHCS has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Hospital's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2011. Part XI, Line 2d - Other Adjustments: Grants to Other Organizations recorded in Revenue on the F/S -313,800. Net Assets released from Restrictions recorded in Revenue on the F/S 8,219. Provisions for Bad Debt recorded in Revenue on the F/S -3,268,032. Part XII, Line 4b - Other Adjustments: Grants to Other Organizations recorded in Revenue on the F/S 313,800. Provisions for Bad Debt recorded in Revenue on the F/S 3,268,032. 1 1 X 1 X 138.000000000000 1 X 275.000000000000 1 1 1 0 1 1 3651000 3651000 0.05120 3651000 3651000 0.05120 292442 110422 182020 0.00260 10511 10511 0.00010 271800 271800 0.00380 574753 110422 464331 0.00650 4225753 110422 4115331 0.05770 42000 42000 0.00060 42000 42000 0.00060 0 3268032 436271 17724213 18424787 -700574 X 1 1 1 1 Good Shepherd Health Care System 610 NW 11th Street Hermiston OR 97838 www.gshealth.org 055598-6 X X X X Good Shepherd Health Care System 1 1 X X X X X X X X 12 1 1 1 X http://gshcs.net/pub/gschf-chna.pdf X X X X X X X X 0 0 1 1 138.000000000000 1 275.000000000000 1 X X X 1 1 X X X 1 0 X X X X 1 X 0 0 Good Shepherd Health Care System Part V, Section B, Line 3: The needs assessment was envisioned, designed, and executed by dozens of community leaders and members representing healthcare, public health, law enforcement, education, and social services. The assessment was conducted in partnership with St. Anthony Hospital in Pendleton, OR. The assessment process included regular consultation with the local Healthy Communities Coalition, a grass-roots advisory committee comprised of 35 community members of diverse background and professions. Good Shepherd Health Care System Part V, Section B, Line 4: The CHNA was conducted with St. Anthony Hospital, Pendleton, OR. Good Shepherd Health Care System Part V, Section B, Line 5d: The CHNA was made widely available through a newspaper article providing a synopsis of the assessment's findings, as well as public forums discussing the assessment's findings. Good Shepherd Health Care System Part V, Section B, Line 6i: Implementation Strategy was also made available at the following website url: http://www.co.umatilla.or.us/health/main/Health_Improvement_Plan.pdf Good Shepherd Health Care System Part V, Section B, Line 7: The following prioritized health needs were determined by CHNAs for Umatilla and Morrow counties, along with their current mitigation strategies:1. Obesity: Healthy Communities Coalition provided nutritional guideline presentations in schools and workplaces, along with ad hoc community nutrition classes.2. Mental Health: Good Shepherd will provide corporate support (friendship lease of land) for Lifeways acute inpatient mental health center in Hermiston (groundbreaking started in summer of 2014).3. Alcohol/drug addiction: Supported recruitment of additional mental health practitioners with addiction mitigation expertise. Established pain clinic with pain control specialist at Good Shepherd.4. Diabetes: Continued active diabetes education program, open to the public without restrictions on ability to pay.5. Tobacco use: Not currently addressed by Good Shepherd in deference to public health programs in place. Good Shepherd regularly offers tobacco cessation classes and support. Good Shepherd Health Care System Part V, Section B, Line 14g: A summary of the FAP is distributed in unemployment offices and other areas in the community that target the eligible population. A summary is also available at local physician offices, admissions offices, and sent with billings invoices. Also, upon discharge, a patient financial representative meets with patients to discuss their ability to pay for services. Included as part of this discussion is a summary of the FAP. 3 Good Shepherd Medical Group 610 NW 11th Street Hermiston OR 97838 Clinic Vange John Memorial Hospice 610 NW 11th Street Hermiston OR 97838 Hospice TLC Home Health 610 NW 11th Street Hermiston OR 97838 Home Health Part I, Line 6a: The state posts the community benefit report online. Part I, Line 7: The charity care included in Part I, Line 7a is calculated by multiplying the ratio of cost to gross charges for the hospital by the gross uncompensated charges associated with providing charity care to its patients. The community health services, education and contributions in Part I, Lines 7e, 7f and 7i are based on actual expenses. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation on Part 1, Line 7, column f was $3,268,032. Part II, Community Building Activities: The organization gave money to the City of Hermiston for the purpose of extending the Oxbow Trail, a walking trail. An extension of the Oxbow Trail will promote physical activity within the community. Part III, Line 2: Bad debt on line 2 is reported at charges. Part III, Line 3: Management considers historical write off and recovery information in determining the estimated bad debt provision. The organization estimates the amount of bad debt attributable to charity patients to be $436,271. This estimate is based on an overall charity care percentage of gross revenue. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 9 of the attached audit report. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules & regulations set forth by Centers for Medicare and Medicaid Services.Good Shepherd Health Care System provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit. Part III, Line 9b: The organization's collection procedures requires a financial advisor to work with any patient who is identified as potentially being eligible for financial assistance prior to sending the account to collection. If during the course of the collection process the collection agency determines an account may be eligible for financial assistance, it is referred back to the hospital for further discussion with the patient or for write off. All further collection action is ceased. Part VI, Line 2: Our community healthcare needs assessment process has five components that are conducted every third year:1. The ongoing collection and evaluation of community feedback from patient surveys and comment forms.2. Patient and community-member healthcare needs focus groups.3. A healthcare needs survey completed by employers and other community leaders.4. A formal telephone survey.5. A demographic study conducted by the Oregon Office of Rural Health. Part VI, Line 3: Our financial counselors inform and educate the people we serve with respect to charity care and governmental assistance programs. All patients and responsible parties, where possible, are apprised of the availability of financial counseling services at the time and point of service. We have arranged our patient flow to maximize the convenience of visiting our financial counselors as part of the Good Shepherd treatment regime.In addition, the financial assistance policy is provided in writing to the patients upon request, and when the Hospital is able to identify a potential FAP-eligible individual upon admissions. Part VI, Line 4: Good Shepherd Health Care System (GSHCS) is the corporate name for an organization made up of several entities, including Good Shepherd Medical Center, Vange John Memorial Hospice, TLC Home Health, Good Shepherd Medical Group, Good Shepherd Clinic Pharmacy, Good Shepherd Medical Foundation, and Good Shepherd Community Health Foundation. Good Shepherd serves a core population of almost 50,000 people in the city of Hermiston, Oregon and in 14 outlying smaller towns within a rough 50-mile radius. This population is largely rural, with agriculture dominating industrial enterprises.The average household income in Hermiston is $35,865.17.1% of residents have incomes below federal poverty guidelines.31.3% of residents identify as non-white Hispanic ethnicity, with a sizable number of Spanish-primary speakers. Part VI, Line 5: Good Shepherd maintains open active, affiliate, and courtesy medical staffs, with privileges available to all qualified and interested physicians in the communities we serve. GSHCS is governed by a twelve-member board of trustees. The board is comprised of independent representatives of the community, with an emphasis on maintaining a true cross-section of core population communities within its membership.Our surplus funds are used to fund community health education classes, as well as funding building and equipment upgrades to maintain the highest quality healthcare for our community. Surplus funds are also applied to ongoing professional education among our clinical staff to remain current in the best practices of modern healthcare. We operate a fully-staffed 24-hour emergency room, available to the public regardless of ability to pay. Good Shepherd operates two foundations that provide funds to appropriate community groups and activities, as well as providing scholarship funds to local residents establishing or furthering healthcare-related education. We live our mission to promote a healthy community. Good Shepherd is the host and driving force behind the Good Shepherd Wellness Coalition, a grass-roots group of community leaders that identify, analyze, and address pressing healthcare issues in the community.We maintain a dialogue with the people we serve through a biweekly radio show, with an emphasis on wellness and preventative care.Good Shepherd hosts an annual Family Health and Fitness Day, with free access to healthcare professionals, free screenings, and a wealth of health and wellness information available to the public.We are active in community health-related activities, including the American Cancer Society's Relay for Life, the March of Dimes' March for Babies, and the Umatilla County Fair, where we provide health information and healthcare-related giveaways. Part VI, Line 7, Reports Filed With States OR 1 Good Shepherd Community Health Foundation 610 NW 11th Street Hermiston OR 97838 931170546 501(c)(3) 250000 Annual Tithe Blue Mountain Community College 2411 NW Carden Ave PO Box 100 Pendleton OR 97801 936033846 Government 20000 Nursing Program Funding City of Hermiston 180 NE 2nd Hermiston OR 97838 936002182 Government 42000 Oxbow Trail Extension (walking trail) 3 0 Part I, Line 2: Grants are awarded to Good Shepherd Community Health Foundation, a related organization which is tax exempt under Section 501(c)(3). Any organization receiving an award must sign an agreement before the funds are dispursed stating the funds will be used for the stated purpose as listed in their grant application. They are also asked to submit regular reports until all funds have been spent. These reports are reviewed at the Foundation meetings of which board members who serve on both the Hospital and the Foundation Boards attend. There are no reporting requirements required to be sent to the Hospital from the other organizations listed on Schedule I. X X X X 0 0 0 0 0 0 0 1 0 Dennis E Burke President/CEO 274038 0 23000 0 58680 0 26699 0 26117 0 408534 0 0 0 Jan D Peter VP/CFO 176758 0 17217 0 8779 0 14519 0 24406 0 241679 0 0 0 David T Hughes VP/COO 172395 0 16901 0 8600 0 11907 0 25187 0 234990 0 0 0 Dr Olga Stobart Hospitalist 348551 0 1000 0 0 0 5907 0 0 0 355458 0 0 0 Dr Thomas L Farney Physician - Surgeon 284955 0 6876 0 0 0 20030 0 26769 0 338630 0 0 0 Dr Thomas J Holt Physician - Urologist 318861 0 4794 0 0 0 14981 0 11025 0 349661 0 0 0 Dr Kim A Peterson Physician - ER Doctor 292317 0 1000 0 0 0 0 0 5688 0 299005 0 0 0 Dr Diana Edenfield Physician - OB/GYN 283949 0 5107 0 0 0 0 0 11113 0 300169 0 0 0 Part I, Line 7 At the end of the fiscal year the Board determines the amount of funds that will be disbursed for bonuses based on the acheivement of specified goals. Management then determines the percentage of bonuses allocated to each level and each individual. In regards to the CEO the Hospital may pay the CEO a discretionary annual bonus in an amount to be determined by the Board or Committee based upon CEO's annual review. Credits Inc Company is owned 100% by board member Nancy Mabry 515161 Charges for collection services 0 Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 The return is reviewed by the CFO and Controller and presented on a high level to the Board of Directors. A final copy is provided to the Board before filing. Form 990, Part VI, Section B, line 12c All officers, directors, and key employees with conflicts are expected to disclose conflicts of interest on a voluntary basis and refrain from discussion and/or voting on related matters as necessary. These disclosures are reviewed and determined to exist or not to exist by the Board of Directors. Form 990, Part VI, Section B, line 15a The CEO's compensation is approved by the compensation committee of the Board of Directors based on survey information. This process is completed annually in the month of October. The compensation of other officers or key employees is determined by the CEO based on survey information. This process is completed annually on the anniversary date of the individual's hire date. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 4,104,337. Management and general expenses 810,861. Fundraising expenses 0. Total expenses 4,915,198. Professional Fees: Program service expenses 3,371,791. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,371,791. Contract Labor/Temp Staff: Program service expenses 150,954. Management and general expenses 0. Fundraising expenses 0. Total expenses 150,954. Collection Expenses: Program service expenses 515,161. Management and general expenses 0. Fundraising expenses 0. Total expenses 515,161. Recruiting Fees: Program service expenses 0. Management and general expenses 318,371. Fundraising expenses 0. Total expenses 318,371. Good Shepherd Community Health Foundation 610 NW 11th Street Hermiston OR 97838 931170546 Fundraising OR 501(c)(3) Line 11a, I Good Shepherd Health Care System 1 Good Shepherd Medical Foundation 610 NW 11th Street Hermiston OR 97838 930844485 Fundraising OR 501(c)(3) Line 7 Good Shepherd Health Care System 1 Good Shepherd Medical Service Corp 610 NW 11th Street Hermiston OR 97838 930688940 Rental & Retail Pharmacy OR N/A C 5846 9587878 1.00000 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 Good Shepherd Medical Service Corp A 425725 book value Good Shepherd Community Health Foundation B 250000 book value