SAMARITAN HEALTH SERVICES INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SAMARITAN HEALTH SERVICES INC (EIN 93-0951989)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-12
- IRS object ID
- 201343169349305684
- Schema version
- 2012v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-12T18:45:24-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930623286 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AKT LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5665 SW MEADOWS RD SUITE 200 | AddressLine1 |
| City | LAKE OSWEGO | City |
| State | OR | State |
| ZIP Code | 97035 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930951989 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SAMA | NameControl |
| Phone | 5417684773 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O SHS ACCOUNTING PO BOX 3000 | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 973393000 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANIEL B SMITH | Name |
| Title | VP FINANCE/CFO | Title |
| Phone | 5417684773 | Phone |
| Date Signed | 2013-11-05 | DateSigned |
| Authorize Third Party | 0 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOYLYN ANKENEY | Name |
| PTIN | P00366587 | PTIN |
| Phone | 5036204489 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LARRY A MULLINS DHA | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3600 NW SAMARITAN DR | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 97330 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 146028691 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SAMHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | TO ENHANCE COMMUNITY HEALTH THROUGH QUALITY SERVICES ACROSS A CONTINUUM OF CARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 863 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 981689 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -119977 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 452871 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 439254 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 143512534 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 134083575 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 22498481 | InvestmentIncomePriorYear |
| Investment Income Current Year | 843936 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3343411 | OtherRevenuePriorYear |
| Other Revenue Current Year | 4043644 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 169807297 | TotalRevenuePriorYear |
| Total Revenue Current Year | 139410409 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 67034 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 71443 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 58440786 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 50855578 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 104000 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 114703 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 756875 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 86493113 | OtherExpensePriorYear |
| Other Expenses Current Year | 88410973 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 145104933 | TotalExpensesPriorYear |
| Total Expenses Current Year | 139452697 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 24702364 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -42288 | RevenuesLessExpensesCY |
| Total Assets BOY | 207378313 | TotalAssetsBOY |
| Total Assets EOY | 235412269 | TotalAssetsEOY |
| Total Liabilities BOY | 172642593 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 200568578 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 34735720 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 34843691 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SAMARITAN HEALTH SERVICES (SHS) IS THE PARENT COMPANY OF A REGIONAL NETWORK OF HOSPITALS, PHYSICIANS AND SENIOR CARE FACILITIES. THE NETWORK, FORMED IN THE LATE 1990'S, SERVES APPROXIMATELY 290,000 RESIDENTS IN LINN, BENTON, LINCOLN AND PORTIONS OF POLK AND MARION COUNTIES IN OREGON. IT IS LOCALLY OWNED, AND ITS BOARDS OF DIRECTORS INCLUDE HOSPITAL LEADERS, PHYSICIANS AND COMMUNITY REPRESENTATIVES. SHS PROVIDES HEALTHCARE SERVICES REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, DISABILITY OR AGE. THE MISSION OF SHS IS TO ENHANCE COMMUNITY HEALTH AND ACHIEVE HIGH VALUE THROUGH QUALITY SERVICES ACROSS A CONTINUUM OF CARE. THE COLLECTIVE VISION OF THE SHS SYSTEM IS TO BE A VALUES-DRIVEN ORGANIZATION GOVERNED BY COMMUNITY MEMBERS, PHYSICIANS AND OTHER HEALTH CARE PROVIDERS. SHS SEEKS TO BE THE FIRST CHOICE OF CONSUMERS IN THE REGION AND TO LEAD COLLABORATIVE EFFORTS AMONG THOSE WHO SHARE SIMILAR GOALS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 128821097 | Expense |
| Revenue | 137391435 | Revenue |
| Description | SEE SCHEDULE OAS THE PARENT ORGANIZATION, SHS PROVIDES ADMINISTRATIVE AND OTHER SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS, SUCH AS PATIENT BILLING, INFORMATION SERVICES, ACCOUNTING, AND EMPLOYEE RECRUITMENT. SHS SPONSORS A HEALTH PLAN THAT PROVIDES MEDICAL, DENTAL, AND PHARMACY BENEFITS TO EMPLOYEES OF SHS AND ITS AFFILIATES. AS A SYSTEM, SHS LOOKS CAREFULLY AT LOCAL HEALTH CARE NEEDS AND GIVES THOUGHTFUL CONSIDERATION TO THE MOST EFFECTIVE WAYS TO MEET THOSE NEEDS. THE RESULT IS A RICH MIX OF LOCAL AND CENTRALIZED REGIONAL SERVICES, WHICH PROVIDE HIGH VALUE AND EXCELLENT HEALTH CARE FOR PEOPLE AT ALL STAGES OF THEIR LIVES. SAMARITAN HEALTH SERVICES, INC. (SHS) HAS POLICIES THAT PROVIDE FOR SERVING THOSE WITHOUT THE ABILITY TO PAY FOR TREATMENT. THE POLICIES ESTABLISH CRITERIA BASED ON THE INCOME OF THE PERSON RESPONSIBLE FOR THE BILL AND COLLECTIONS ARE AT AMOUNTS LESS THAN ITS ESTABLISHED RATES ON A SLIDING SCALE DOWN TO NO PAYMENT AT ALL. IN 2012, SHS PROVIDED SERVICES THAT BENEFITED THE POOR AND OTHERS IN THE COMMUNITIES IT SERVED. COMMUNITY BENEFIT SERVICES($1,740,000) ARE PAYMENTS/COSTS CONTRIBUTED BY SHS FOR COMMUNITY PROGRAMS ADMINISTERED BY OTHER NON-PROFIT ORGANIZATIONS AND SCHOOLS PLUS ACTIVITIES PROVIDED BY SHS EMPLOYEES FOR THE BENEFIT OF VARIOUS GROUPS IN THE COMMUNITY SERVED. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 71443 | Expense |
| Grants | 71443 | Grants |
| Description | GRANTS AND ASSISTANCE PROVIDED BY SAMARITAN HEALTH SERVICES TO VARIOUS ORGANIZATIONS AND INDIVIDUALS TO BENEFIT THE COMMUNITY. SEE PART IX, LINES 1 AND 2 AND RELATED SCHEDULE I FOR MORE DETAILS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 128892540 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 1 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 1 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 1214 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 863 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 1 | ForeignFinancialAccount |
| Name Of Foreign Country | CJ | NameOfForeignCountry |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | OR | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5417684773 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3000 | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 973393000 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (28 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| GILBERT BECK | |||||||||
| BOARD MEMBER | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| CHARLES MOURADIAN | |||||||||
| BOARD SECRETARY | 1.00 | 1.00 | X | 0 | 0 | 0 | X | ||
| RANDY SPRINGER | |||||||||
| BOARD CHAIR | 1.00 | 2.00 | X | 0 | 0 | 0 | X | ||
| JUDY LIST | |||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| REV WILLIAM MCCARTHY | |||||||||
| BOARD MEMBER | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| SHIRLEY PETERSON | |||||||||
| BOARD TREASURER/BOARD CHAIR ELECT | 1.00 | 1.00 | X | 0 | 0 | 0 | X | ||
| JAMES DENHAM | |||||||||
| BOARD MEMBER | 1.00 | 4.00 | X | 0 | 0 | 0 | |||
| SENATOR FRANK MORSE | |||||||||
| BOARD MEMBER | 1.00 | 3.00 | X | 0 | 0 | 0 | |||
| ROBERT ADAMS | |||||||||
| BOARD MEMBER | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| LOREN ROTH | |||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| PATRICK HAGERTY DMD | |||||||||
| BOARD MEMBER | 1.00 | 3.00 | X | 0 | 0 | 0 | |||
| LESLIE PLISKIN MD | |||||||||
| BOARD MEMBER/PHYSICIAN | 1.00 | 39.00 | X | 0 | 258625 | 42996 | |||
| TROY GARRETT MD | |||||||||
| BOARD MEMBER/PHYSICIAN | 1.00 | 39.00 | X | 0 | 204154 | 19630 | |||
| TIM HINDMARSH MD | |||||||||
| BOARD MEMBER/PHYSICIAN | 1.00 | 39.00 | X | 0 | 246632 | 51573 | |||
| LOUIS WEINSTEIN MD | |||||||||
| BOARD MEMBER/PHYSICIAN | 1.00 | 39.00 | X | 0 | 314837 | 39979 | |||
| LARRY A MULLINS DHA | |||||||||
| PRESIDENT & CEO | 33.00 | 7.00 | 1521885 | 0 | 47761 | X | |||
| DANIEL B SMITH | |||||||||
| VP FINANCE/CFO | 24.00 | 16.00 | 307217 | 0 | 50011 | X | |||
| JULIE MANNING | |||||||||
| VP DEVELOPMENT & COMMUNITY RELATIONS | 40.00 | 179528 | 0 | 39236 | X | ||||
| KIRK R GERNER | |||||||||
| VP PHYSICIAN RECRUITING | 40.00 | 289620 | 0 | 50333 | X | ||||
| ROBERT J POWER | |||||||||
| VP INFORMATION SYSTEMS/CIO | 40.00 | 240415 | 0 | 33422 | X | ||||
| SHERYL HELMS | |||||||||
| VP HUMAN RESOURCES | 3.00 | 284758 | 0 | 18112 | X | ||||
| DOUGLAS BOYSEN | |||||||||
| VP GENERAL COUNSEL | 38.00 | 2.00 | 233167 | 0 | 48739 | X | |||
| DAWNELL BUELL | |||||||||
| VP REVENUE CYCLE | 40.00 | 243019 | 0 | 31111 | X | ||||
| KELLEY C KAISER | |||||||||
| VP/CEO HEALTH PLANS | 20.00 | 20.00 | 246427 | 0 | 51535 | X | |||
| RICHARD WOPAT MD | |||||||||
| PHYSICIAN | 40.00 | 253244 | 0 | 52006 | X | ||||
| DAVID G TRIEBES | |||||||||
| VP/CEO SAGH | 1.00 | 39.00 | 321706 | 0 | 48378 | X | |||
| STEVEN W JASPERSON | |||||||||
| VP/CEO GSRMC | 1.00 | 39.00 | 420320 | 0 | 47317 | X | |||
| KEVIN EWANCHYNA MD | |||||||||
| MEDICAL DIRECTOR-HEALTH PLANS | 39.00 | 1.00 | 334142 | 0 | 52319 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 4875448 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1024248 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 724458 | TotalOtherCompensation |
| Number Individuals GT100 K | 72 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| GREENBERRY CONSTRUCTION LLC | |||||
| 2211 NW PROFESSIONAL DR 201 | CORVALLIS | OR | 97330 | CONSTRUCTION | 2958161 |
| THE CORVALLIS CLINIC PC | |||||
| 3680 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | MEDICAL SERVICES | 2768978 |
| T GERDING CONSTRUCTION CO | |||||
| PO BOX 1082 | CORVALLIS | OR | 97339 | CONSTRUCTION | 2428221 |
| LEGACY LABORATORY SERVICES LLC | |||||
| PO BOX 5337 | PORTLAND | OR | 97228 | LAB SERVICES | 2066614 |
| GERDING BUILDERS LLC | |||||
| PO BOX 1082 | CORVALLIS | OR | 97339 | CONSTRUCTION | 2065717 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 63 | NumberOfContractorsGT100K |
| Related Organizations | 50000 | RelatedOrganizations |
| Government Grants | 70327 | GovernmentGrants |
| All Other Contributions | 318927 | AllOtherContributions |
| Total Contributions | 439254 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| SUPPORT SERVICE FEES | 561000 | 73966488 | 73966488 |
| EMPL HEALTH PLAN PREM | 525100 | 60094550 | 60094550 |
| NET PATIENT REVENUES | 900099 | 22537 | 22537 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 134083575 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 675185 | TotalRevenueColumn |
| Unrelated Business Revenue | 75000 | UnrelatedBusinessRevenue |
| Exclusion | $600,185 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1268293 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1439198 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -170905 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -170905 | TotalRevenueColumn |
| Exclusion | -$170,905 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4800000 | Securities |
| Other | 547835 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4800664 | Securities |
| Other | 378420 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -664 | Securities |
| Other | 169415 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 168751 | TotalRevenueColumn |
| Exclusion | $168,751 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| EHR INCENTIVE REV | 900099 | 2766970 | 2766970 | |
| MISCELLANEOUS REVENUE | 900099 | 723554 | 104853 | 618701 |
| GROUP PURCHASING | 561499 | 282787 | 282787 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 441238 | TotalRevenueColumn |
| Related Or Exempt Function Income | 436037 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 5201 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 4214549 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 139410409 | TotalRevenueColumn |
| Related Or Exempt Function Income | 137391435 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 981689 | UnrelatedBusinessRevenue |
| Exclusion | $598,031 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63550 | Total |
| Program Services | 63550 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7893 | Total |
| Program Services | 7893 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3618336 | Total |
| Management And General | 3618336 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31977404 | Total |
| Program Services | 28362804 | ProgramServices |
| Management And General | 3257172 | ManagementAndGeneral |
| Fundraising | 357428 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3164199 | Total |
| Program Services | 2843656 | ProgramServices |
| Management And General | 288846 | ManagementAndGeneral |
| Fundraising | 31697 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8448958 | Total |
| Program Services | 7593054 | ProgramServices |
| Management And General | 771268 | ManagementAndGeneral |
| Fundraising | 84636 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3646681 | Total |
| Program Services | 3277262 | ProgramServices |
| Management And General | 332889 | ManagementAndGeneral |
| Fundraising | 36530 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81513 | Total |
| Management And General | 81513 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 537702 | Total |
| Program Services | 69581 | ProgramServices |
| Management And General | 468121 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 391518 | Total |
| Program Services | 375365 | ProgramServices |
| Management And General | 16153 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114703 | Total |
| Fundraising | 114703 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63750 | Total |
| Program Services | 31875 | ProgramServices |
| Management And General | 31875 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 488450 | Total |
| Program Services | 333174 | ProgramServices |
| Management And General | 125114 | ManagementAndGeneral |
| Fundraising | 30162 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1234091 | Total |
| Program Services | 1219936 | ProgramServices |
| Management And General | 7409 | ManagementAndGeneral |
| Fundraising | 6746 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3769679 | Total |
| Program Services | 3576413 | ProgramServices |
| Management And General | 140570 | ManagementAndGeneral |
| Fundraising | 52696 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6811160 | Total |
| Program Services | 6811160 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1238089 | Total |
| Program Services | 1046408 | ProgramServices |
| Management And General | 177737 | ManagementAndGeneral |
| Fundraising | 13944 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 476388 | Total |
| Program Services | 407773 | ProgramServices |
| Management And General | 65126 | ManagementAndGeneral |
| Fundraising | 3489 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 308273 | Total |
| Program Services | 249548 | ProgramServices |
| Management And General | 56983 | ManagementAndGeneral |
| Fundraising | 1742 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 308491 | Total |
| Program Services | 194607 | ProgramServices |
| Management And General | 113884 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5260014 | Total |
| Program Services | 5258937 | ProgramServices |
| Management And General | 940 | ManagementAndGeneral |
| Fundraising | 137 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1271917 | Total |
| Program Services | 1243731 | ProgramServices |
| Management And General | 28186 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| CLAIM FEES | 54886856 | 54882528 | 4328 | |
| PURCHASED SERVICES | 10730960 | 10711935 | 19025 | |
| DUES, TAXES, & LICENSES | 509176 | 288404 | 216832 | 3940 |
| MEDICAL SUPPLIES | 42946 | 42946 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139452697 | Total |
| Program Services | 128892540 | ProgramServices |
| Management And General | 9803282 | ManagementAndGeneral |
| Fundraising | 756875 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 800 | BOY |
| EOY | 900 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 111953993 | BOY |
| EOY | 124458433 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1105534 | BOY |
| EOY | 983417 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2440770 | BOY |
| EOY | 1891910 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 127229509 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 41641280 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60174204 | BOY |
| EOY | 85588229 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2301096 | BOY |
| EOY | 2510075 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24659351 | BOY |
| EOY | 14339033 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4742565 | BOY |
| EOY | 5640272 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 207378313 | BOY |
| EOY | 235412269 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17758714 | BOY |
| EOY | 22005592 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18482 | BOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 136332681 | BOY |
| EOY | 135437154 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5995337 | BOY |
| EOY | 29096317 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12537379 | BOY |
| EOY | 14029515 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 172642593 | BOY |
| EOY | 200568578 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34735720 | BOY |
| EOY | 34843691 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34735720 | BOY |
| EOY | 34843691 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 207378313 | BOY |
| EOY | 235412269 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -42288 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -4070 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 154329 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (4 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| ALBANY GEN HOSP | |||||
| 930110095 | 3 | 1 | 1 | 1 | $13,554,792 |
| GOOD SAM HOSP | |||||
| 930391573 | 3 | 1 | 1 | 1 | $39,024,809 |
| MID-VALLEY HC | |||||
| 930396847 | 3 | 1 | 1 | 1 | $9,228,721 |
| FIRSTCARE MED FND | |||||
| 930932697 | 9 | 1 | 1 | 1 | $1,284,130 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 4 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 63092452 | SumOfAmounts |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: PART I, LINE H, COLUMN VII: AS THE PARENT ORGANIZATION, SHS PROVIDES ADMINISTRATIVE AND OTHER SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS, SUCH AS PATIENT BILLING, INFORMATION SERVICES, ACCOUNTING, AND EMPLOYEE RECRUITMENT. | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 1 | GrantsOtherOrganizations |
| Grants Other Organizations | $49,230 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 49230 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE FILING ORGANIZATION MAINTAINS MEMBERSHIPS IN THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND OREGON ASSOCIATION OF HOSPITALS AND HEALTHCARE SYSTEMS (OAHHS). DURING TAX YEAR 2012, THE FILING ORGANIZATION PAID MEMBERSHIP DUES TO THE OAHHS AND THE AHA OF $193,819 AND $90,526 RESPECTIVELY. 14.20% OF OAHHS DUES AND 23.98% OF AHA DUES WENT FOR LOBBYING PURPOSES. THUS, THE FILING ORGANIZATION MADE INDIRECT LOBBYING EXPENDITURES OF $49,230 THROUGH ITS MEMBERSHIP DUES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10397880 | OtherCostOrOtherBasis |
| Book Value | 10397880 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 42774624 | OtherCostOrOtherBasis |
| Depreciation | 6527221 | Depreciation |
| Book Value | 36247403 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3665815 | OtherCostOrOtherBasis |
| Depreciation | 61154 | Depreciation |
| Book Value | 3604661 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 49162949 | OtherCostOrOtherBasis |
| Depreciation | 34846830 | Depreciation |
| Book Value | 14316119 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 21228241 | OtherCostOrOtherBasis |
| Depreciation | 206075 | Depreciation |
| Book Value | 21022166 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 85588229 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INVESTMENTS HELD BY TRUSTEE | Description |
| Book Value | 14339033 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 14339033 | TotalOfBookValueProgramRelated |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| LIABILITY FOR UNPAID MEDICAL CLAIMS | $7,430,672 |
| TENANT DEPOSITS | $150,000 |
| ACCRUED INTEREST | $137,489 |
| OTHER RESERVES | $3,909,346 |
| PAYABLE DUE TO AFFILIATE | $2,402,008 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 14029515 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 139640129 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 1439198 | OtherRevenues |
| Revenue Not Rptd F990 | 1439198 | RevenueNotRptdF990 |
| Revenue Subtotal | 138200931 | RevenueSubtotal |
| Other Revenues Not Included | 1209478 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1209478 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 139410409 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 139682417 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 1708725 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 1708725 | ExpensesNotRptdF990 |
| Expenses Subtotal | 137973692 | ExpensesSubtotal |
| Other Expenses Not Included | 1479005 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1479005 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 139452697 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENT EXPENSES NETTED WITH REV PER T/R 1,439,198. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENT EXPENSES NETTED WITH REV PER AFS 1,479,005. UBI LOSSES INCLUDED WITH EXPENSES PER AFS -269,527. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENT EXPENSES NETTED WITH REV PER T/R 1,439,198. UBI LOSSES INCLUDED WITH EXPENSES PER AFS 269,527. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | RENT EXPENSES NETTED WITH REV PER AFS 1,479,005. |
| PART VIII, LINE 1 PROGRAM RELATED INVESTMENTS: INVESTMENTS HELD BY TRUSTEE - BOND RESERVE AND PROJECT FUNDS: 14,264,033 INVESTMENTS - RESTRICTED FOR PROFESSIONAL LIABILITY CLAIMS: 75,000 TOTAL FOR PART VIII, LINE 1: 14,339,033 |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | ActivityActivity | Fundraiser Control Of FundsFundraiserControlOfFunds | Gross ReceiptsGrossReceipts | Amount Retained By ContractorAmountRetainedByContractor | Net To OrganizationNetToOrganization |
|---|---|---|---|---|---|---|---|---|
| THOMPSON & ASSOC | ||||||||
| 1135 LA HOMA DRIVE | NAPA | CA | 94558 | ADVISORY SERVICES | 0 | 0 | 99000 | 0 |
| EDWORKS INC | ||||||||
| 1410 PENNY LANE NW | ALBANY | OR | 97321 | ADVISORY SERVICES | 0 | 0 | 11925 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | 110925 | TotalRetainedByContractors |
| Licensed States | OR | LicensedStates |
Form990 Schedule G Part IV Form990ScheduleGPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | FORM 990,SCHEDULE G, PART I: | ReturnReference |
| Explanation | THE PROFESSIONAL FUNDRAISING ACTIVITIES REPORTED ON SCHEDULE G ARE FOR ADVISORY SERVICES RELATED TO PLANNED GIVING. THESE ADVISORY SERVICES INCLUDE EDUCATING MEMBERS OF THE COMMUNITY ABOUT PLANNED GIVING OPPORTUNITIES AND ASSISTING POTENTIAL DONORS WITH SETTING UP FUTURE CHARITABLE GIFTS AS PART OF THEIR WILLS OR OTHER ESTATE PLANNING DOCUMENTS. BECAUSE THESE GIFTS ARE NONBINDING PLEDGES AND MAY NOT BE RECEIVED FOR MANY YEARS, REVENUES CANNOT BE MATCHED WITH CURRENT PERIOD FUNDRAISING EXPENSES. THEREFORE, NO ASSOCIATED REVENUE IS REPORTED ON SCHEDULE G. | Explanation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| COMMUNITY OUTREACH INC | |||||||
| 865 NW REIMAN AVE | CORVALLIS | OR | 97330 | 930602094 | 501(C)(3) | 10000 | MEDICAL, DENTAL, MENTAL HEALTH CLINICS |
| OREGON CASCADES WEST COUNCIL OF GOVERNMENTS | |||||||
| 1400 QUEEN AVE SE STE 201 | ALBANY | OR | 97322 | 930584306 | GOV'T | 10800 | SUPPORT FOR THE "HOSPITAL TO HOME PROJECT" |
| LEBANON BASIC SERVICES CENTER | |||||||
| PO BOX 2225 | LEBANON | OR | 97355 | 931047123 | 501(C)(3) | 25000 | SUPPORT FOR ADULT DENTAL CARE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | PATIENT ASSISTANCE | TypeOfGrant |
| Number Of Recipients | 80 | NumberOfRecipients |
| Amount Of Cash Grant | 7893 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: AGENCIES IN THE COMMUNITY ARE INVITED TO SUBMIT GRANT PROPOSALS THROUGH AN APPLICATION PROCESS. A COMMITTEE REVIEWS THE APPLICATIONS TO DETERMINE IF THE FUNDS REQUESTED WILL BE USED TO ADDRESS THE ORGANIZATION'S ESTABLISHED COMMUNITY HEALTH PRIORITIES, IDENTIFIED NEEDS, AND SUPPORTS THE ORGANIZATION'S MISSION. ONCE APPROVED AND FUNDED, AGENCIES MUST SUBMIT A COMPLETE ANNUAL REPORT DESCRIBING HOW THE FUNDS WERE USED, THE NUMBER OF CLIENTS SERVED, AND HOW OUTCOMES WERE ACHIEVED. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 1 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LESLIE PLISKIN MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | 0 | 126487 | 0 | 108797 | 0 | 23341 | 0 | 20596 | 0 | 22400 | 0 | 301621 | 0 | 0 |
| TROY GARRETT MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | 0 | 197255 | 0 | 5083 | 0 | 1816 | 0 | 15970 | 0 | 3660 | 0 | 223784 | 0 | 0 |
| TIM HINDMARSH MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | 0 | 238069 | 0 | 8317 | 0 | 246 | 0 | 20596 | 0 | 30977 | 0 | 298205 | 0 | 0 |
| LOUIS WEINSTEIN MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | 0 | 289840 | 0 | 5146 | 0 | 19851 | 0 | 20596 | 0 | 19383 | 0 | 354816 | 0 | 0 |
| LARRY A MULLINS DHA | ||||||||||||||
| PRESIDENT & CEO | 587213 | 0 | 0 | 0 | 934672 | 0 | 20596 | 0 | 27165 | 0 | 1569646 | 0 | 712232 | 0 |
| DANIEL B SMITH | ||||||||||||||
| VP FINANCE/CFO | 299636 | 0 | 0 | 0 | 7581 | 0 | 20596 | 0 | 29415 | 0 | 357228 | 0 | 0 | 0 |
| JULIE MANNING | ||||||||||||||
| VP DEVELOPMENT & COMMUNITY RELATIONS | 174362 | 0 | 0 | 0 | 5166 | 0 | 13739 | 0 | 25497 | 0 | 218764 | 0 | 0 | 0 |
| KIRK R GERNER | ||||||||||||||
| VP PHYSICIAN RECRUITING | 249377 | 0 | 0 | 0 | 40243 | 0 | 20596 | 0 | 29737 | 0 | 339953 | 0 | 0 | 0 |
| ROBERT J POWER | ||||||||||||||
| VP INFORMATION SYSTEMS/CIO | 232599 | 0 | 0 | 0 | 7816 | 0 | 18956 | 0 | 14466 | 0 | 273837 | 0 | 0 | 0 |
| SHERYL HELMS | ||||||||||||||
| VP HUMAN RESOURCES | 125611 | 0 | 0 | 0 | 159147 | 0 | 10749 | 0 | 7363 | 0 | 302870 | 0 | 0 | 0 |
| DOUGLAS BOYSEN | ||||||||||||||
| VP GENERAL COUNSEL | 232611 | 0 | 0 | 0 | 556 | 0 | 19566 | 0 | 29173 | 0 | 281906 | 0 | 0 | 0 |
| DAWNELL BUELL | ||||||||||||||
| VP REVENUE CYCLE | 225129 | 0 | 0 | 0 | 17890 | 0 | 19846 | 0 | 11265 | 0 | 274130 | 0 | 0 | 0 |
| KELLEY C KAISER | ||||||||||||||
| VP/CEO HEALTH PLANS | 227790 | 0 | 0 | 0 | 18637 | 0 | 20596 | 0 | 30939 | 0 | 297962 | 0 | 0 | 0 |
| RICHARD WOPAT MD | ||||||||||||||
| PHYSICIAN | 230888 | 0 | 7192 | 0 | 15164 | 0 | 20596 | 0 | 31410 | 0 | 305250 | 0 | 0 | 0 |
| DAVID G TRIEBES | ||||||||||||||
| VP/CEO SAGH | 296311 | 0 | 0 | 0 | 25395 | 0 | 20596 | 0 | 27782 | 0 | 370084 | 0 | 0 | 0 |
| STEVEN W JASPERSON | ||||||||||||||
| VP/CEO GSRMC | 387815 | 0 | 0 | 0 | 32505 | 0 | 20596 | 0 | 26721 | 0 | 467637 | 0 | 0 | 0 |
| KEVIN EWANCHYNA MD | ||||||||||||||
| MEDICAL DIRECTOR-HEALTH PLANS | 302038 | 0 | 490 | 0 | 31614 | 0 | 20596 | 0 | 31723 | 0 | 386461 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | IN CONNECTION WITH ITS EMPLOYEE WELLNESS PROGRAM, THE ORGANIZATION HAS A GYM/FITNESS FACILITY BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. UNDER THIS PROGRAM, EMPLOYEES MUST MEET MINIMUM USAGE REQUIREMENTS IN ORDER TO QUALIFY FOR ONGOING BENEFITS. IF AN EMPLOYEE PARTICIPATES AT A NON-SAMARITAN GYM, REIMBURSEMENT IS MADE FOR UP-FRONT FEES, AND THEN PERIODICALLY UPON COMPLETION OF AT LEAST 60 VISITS. REIMBURSEMENT DOES NOT EXCEED $300 PER YEAR AND IS INCLUDED IN THE EMPLOYE'S TAXABLE WAGES AND IS SUBJECT TO FEDERAL/STATE WITHHOLDING TAX. ONE OFFICER, ONE BOARD MEMBER, ONE KEY EMPLOYEE, AND TWO HIGHEST PAID EMPLOYEES RECEIVED THIS TAXABLE GYM BENEFIT IN 2012. IF AN EMPLOYEE PARTICIPATES AT A SAMARITAN FITNESS CENTER (SAMFIT), MEMBERSHIP IS FREE OF CHARGE (PROVIDED AS A NONTAXABLE FRINGE BENEFIT), BUT THE EMPLOYEE IS REQUIRED TO ATTEND THE GYM 50 TIMES DURING EACH PERIOD OF 6 CONSECUTIVE MONTHS TO MAINTAIN THIS BENEFIT. ONE OFFICER, ONE KEY EMPLOYEE, AND THREE HIGHEST PAID EMPLOYEES UTILIZED THE SAMFIT BENEFIT IN 2012. |
| PART I, LINES 4A-B | PART I, LINES 4A-B: 4.A. SHERYL HELMS' POSITION, VP OF HUMAN RESOURCES, WAS ELIMINATED PER A REDUCTION OF FORCE PLAN. SHE RECEIVED A SEVERANCE PACKAGE THAT INCLUDED $157,600 OF TAXABLE PAYMENTS, AND $5,807 OF NON-TAXABLE BENEFITS. 4.B. THE ORGANIZATION MAINTAINS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. UNDER THIS PLAN, LARRY A. MULLINS, DHA, ACCRUED DEFERRED COMPENSATION BENEFITS DURING 2012. HE ALSO RECEIVED A PAYMENT IN 2012 FROM THIS PLAN OF $712,232, WHICH IS INCLUDED IN HIS 2012 COMPENSATION ON SCHEDULE J AND FORM 990. THIS AMOUNT WAS ACCRUED IN PRIOR YEARS AND WAS ALSO INCLUDED IN COMPENSATION DISCLOSED IN PRIOR YEARS AS REQUIRED ON SCHEDULE J AND FORM 990. |
| PART I, LINE 5 | VARIOUS PHYSICIAN COMPENSATION METHODOLOGIES ARE UTILIZED AND, DEPENDING ON SPECIALTY, RELATIVE VALUE UNITS (RVU'S) MAY BE USED IN DETERMINING A PORTION OF OR ALL OF THEIR COMPENSATION. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| STATE OF OREGON - FACIL AUTHORITY | ||||||||
| A | 936001787 | NONEAVAIL | 2009-09-30 | 15800000 | CONST. OF MEDICAL SCHOOL | 0 | 0 | 0 |
| STATE OF OREGON - FACIL AUTHORITY | ||||||||
| B | 936001787 | 68608JLL3 | 2010-03-17 | 122055000 | HOSPITAL EXPANSION & REMODEL | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Amount In Reserve FundAmountInReserveFund | Refunding EscrowRefundingEscrow | Amount UnspentAmountUnspent |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 2437174 | 15865543 | 283537 | 15582006 | 2011 | 0 | 0 | 1 | 1 | |||
| B | 122654514 | 2086481 | 40784912 | 2013 | 1 | 0 | 0 | 1 | 10512634 | 66501180 | 2769307 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs | Engage Bond Counsel ContractsEngageBondCounselContracts | Prcntge Bond Financed PropPrcntgeBondFinancedProp | Remedial Action TakenRemedialActionTaken |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 1 | |||
| B | 0 | 1 | 1 | 0 | 0.00480 | 0.00000 | 0.00480 | 0 | 1 | 1 | 1 | 0.00090 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 1 |
| B | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | 1 |
| B | 1 |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART II, LINE 3: | Identifier |
| Explanation | DIFFERENCES ON THIS LINE AS COMPARED TO PART I(E) IS DUE TO INVESTMENT EARNINGS AND UNREALIZED GAINS/LOSSES. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| ROBERT MULLINS | |||
| FAM MBR, L. MULLINS | 79854 | EMP BY ORG | 0 |
| VERONICA MULLINS | |||
| FAM MBR, L. MULLINS | 67991 | EMP BY ORG | 0 |
| CITIZEN'S BANK | |||
| L. ROTH, OFFICER | 508104 | LOAN PMTS | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES), AS ULTIMATELY FILED WITH THE IRS, WAS PROVIDED TO EACH VOTING MEMBER OF THE SAMARITAN HEALTH SERVICES (SHS) AUDIT AND COMPLIANCE COMMITTEE PRIOR TO ITS FILING WITH THE IRS. SHS'S CHIEF FINANCIAL OFFICER CONDUCTED THE FORM 990 REVIEW WITH THE COMMITTEE AND PROVIDED TIME FOR QUESTIONS FROM THE GROUP. A FORMAL REPORT OF THIS COMMITTEE HAS BEEN MADE TO THE FULL BOARD OF DIRECTORS OF SHS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBER CONFLICTS OF INTEREST: THE MEMBERS OF THE BOARD MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE, WHICH REQUIRES DISCLOSURE OF ANY CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CORPORATE COMPLIANCE OFFICER. IF A CONFLICT IS DISCLOSED THAT COULD PROHIBIT A MEMBER FROM SERVING ON THE BOARD, THIS IS EVALUATED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES (SHS) BOARD OF DIRECTORS TO DETERMINE WHETHER THE MEMBER SHOULD CONTINUE TO SERVE ON THE BOARD. IF A CONFLICT IS DISCLOSED THAT DOES NOT PROHIBIT A MEMBER FROM SERVING ON THE BOARD, THE CONFLICT IS MANAGED THROUGH A PROCESS SET FORTH IN THE ORGANIZATION'S BYLAWS. THE BYLAWS PROHIBIT ANY BOARD MEMBER FROM VOTING ON AN ACTION WHERE AN INDIVIDUAL MEMBER HAS A CONFLICT OF INTEREST. EMPLOYEE CONFLICTS OF INTEREST: THE SHS CODE OF ETHICS AND CONDUCT POLICY REQUIRES THAT ALL SHS EMPLOYEES COMPLETE AN ANNUAL DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST. THROUGH THE HUMAN RESOURCES SOFTWARE, PERFORMANCE MANAGER, THE DISCLOSURE REQUIREMENT NOTICE IS ASSIGNED TO ALL EMPLOYEES AND BY YEAR END ALL TASKS ARE TO BE COMPLETED. IF THERE IS A PERCEIVED CONFLICT OF INTEREST IT IS REVIEWED BY THE CORPORATE COMPLIANCE OFFICER, LEGAL COUNSEL AND/OR SENIOR MANAGEMENT. ACTUAL CONFLICTS OF INTEREST ARE REVIEWED AND DISCUSSED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE OF SAMARITAN HEALTH SERVICES, INC. ANNUALLY ENGAGES AN INDEPENDENT CONSULTANT TO ASSIST IT IN PROVIDING COMPARABLE MARKET DATA FOR THE CEO, WHO IS THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL. THIS ANALYSIS INCLUDES REGIONAL AND NATIONAL DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THIS INFORMATION IS USED BY THE COMPENSATION COMMITTEE IN ITS DELIBERATIONS REGARDING THE CEO'S COMPENSATION WHICH IS DOCUMENTED IN THE COMMITTEE'S MINUTES. THE CEO OF THE ORGANIZATION RELIES ON PUBLICLY AVAILABLE INFORMATION TO DETERMINE THE COMPENSATION FOR OTHER TOP MANAGEMENT OFFICIALS WITHIN THE ORGANIZATION. HE CONSULTS WITH THE INDEPENDENT CONSULTANT AS TO THE REASONABLENESS OF THIS DATA TO ENSURE THAT EACH TOP MANAGEMENT OFFICIAL'S COMPENSATION IS REASONABLE AS COMPARED TO SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. PHYSICIAN EMPLOYEE COMPENSATION, INCLUDING PHYSICIANS WHO ARE BOARD MEMBERS, IS REVIEWED AT LEAST ANNUALLY BY SENIOR MANAGEMENT. THIS REVIEW INCLUDES COMPARISON WITH PUBLISHED PHYSICIAN COMPENSATION STUDIES. FOR ALL OTHER EMPLOYEES, THE ORGANIZATION PERFORMS AN ANALYSIS EACH YEAR TO COMPARE COMPENSATION OF ALL PAID POSITIONS TO MARKET SURVEYS OF COMPENSATION FOR SIMILAR POSITIONS IN OTHER ORGANIZATIONS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. SYSTEM-WIDE SUMMARIZED DATA IS ALSO PROVIDED IN THE ANNUAL REPORT TO THE COMMUNITY. THIS REPORT IS MADE AVAILABLE IN ALL KIOSKS AND HIGH-TRAFFIC AREAS OF ALL HOSPITALS AND PHYSICIAN CLINICS, AS WELL AS COMMUNITY PLACES SUCH AS THE PUBLIC LIBRARY. IT IS ALSO DISTRIBUTED TO THE BOARDS OF DIRECTORS AND DIRECTLY MAILED TO DONORS AND NEW RESIDENTS IN THE COMMUNITY. ADDITIONALLY, THE REPORT IS MADE AVAILABLE AT ALL EVENTS, COMMUNITY OUTREACH PROJECTS, AND SCREENINGS ATTENDED THROUGHOUT THE YEAR. GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART XI, LINE 9: | INTERCOMPANY TRANSFERS -89,432. OTHER CHANGES 235,432. DISTRIBUTIONS TO MINORITY INTEREST IN CONSOLIDATED JVS 8,329. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN DIALYSIS SERVICES LLC | |||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 931246368 | PROVIDE DIALYSIS SERVICES TO THE COMMUNITY | OR | 122922 | 4086 | SAMARITAN HEALTH SERVICES |
| SAMARITAN RESOURCES | |||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 931262271 | ENVIRONMENTAL SERVICES | OR | 103375 | SAMARITAN HEALTH SERVICES | |
Form990 Schedule R Part II Form990ScheduleRPartII (18 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ALBANY GENERAL HOSPITAL | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930110095 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 1 | |
| ALBANY GENERAL HOSPITAL FOUNDATION | |||||||||||
| 1046 SIXTH AVENUE SW | ALBANY | OR | 97321 | 930712890 | TO SUPPORT ALBANY GENERAL HOSPITAL | OR | 501(C)(3) | 7 | ALBANY GENERAL HOSPITAL | 0 | |
| FIRSTCARE HEALTH FOUNDATION | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930900124 | TO SUPPORT AFFILIATED EXEMPT ENTITIES | OR | 501(C)(3) | 11B, II | SAMARITAN HEALTH SERVICES | 1 | |
| FIRSTCARE MEDICAL FOUNDATION | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930932697 | PROVIDER OF MEDICAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 9 | SAMARITAN HEALTH SERVICES | 1 | |
| GOOD SAMARITAN HOSPITAL AUXILIARY | |||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 973393000 | 936024034 | TO SUPPORT GOOD SAMARITAN HOSPITAL | OR | 501(C)(3) | 11D, III-O | 0 | N/A | |
| GOOD SAMARITAN HOSPITAL FOUNDATION | |||||||||||
| PO BOX 1068 | CORVALLIS | OR | 97339 | 237252406 | TO SUPPORT GOOD SAMARITAN HOSPITAL | OR | 501(C)(3) | 7 | GOOD SAMARITAN HOSPITAL | 0 | |
| INTERCOMMUNITY HEALTH PLANS INC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 931124326 | SERVE OREGON HEALTH PLAN FOR MEDICAID | OR | 501(C)(4) | N/A | SAMARITAN HEALTH SERVICES | 1 | |
| LEBANON COMMUNITY HOSPITAL FOUNDATION | |||||||||||
| PO BOX 739 | LEBANON | OR | 97355 | 931260080 | TO SUPPORT LEBANON COMMUNITY HOSPITAL | OR | 501(C)(3) | 7 | MID-VALLEY HEALTHCARE INC | 0 | |
| MID-VALLEY HEALTHCARE INC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930396847 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 1 | |
| PARADIGM INDEMNITY CORPORATION | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 731668317 | PURE NON-PROFIT CAPTIVE INSURANCE COMPANY | HI | 501(C)(3) | 11A, I | SAMARITAN HEALTH SERVICES | 1 | |
| GOOD SAMARITAN HOSPITAL CORVALLIS | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930391573 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 1 | |
| SAMARITAN NORTH LINCOLN HOSPITAL | |||||||||||
| 3043 NE 28TH STREET | LINCOLN CITY | OR | 97367 | 931305493 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 1 | |
| SAMARITAN PACIFIC HEALTH SERVICES | |||||||||||
| 930 SW ABBEY STREET | NEWPORT | OR | 97365 | 931329784 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 1 | |
| SAMARITAN SENIOR CARE INC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 931245534 | PROVIDE HEALTHCARE FOR SENIORS | OR | 501(C)(3) | 9 | SAMARITAN HEALTH SERVICES | 1 | |
| PACIFIC COMMUNITIES HEALTH DISTRICT | |||||||||||
| PO BOX 873 | NEWPORT | OR | 97365 | 930603489 | HEALTHCARE DISTRICT | OR | GOV'T | 6 | 0 | N/A | |
| PACIFIC COMMUNITIES HEALTH DISTRICT FND | |||||||||||
| PO BOX 945 | NEWPORT | OR | 97365 | 930858825 | TO SUPPORT PAC COMM HLTH DIST & SAMARITAN PAC HLTH SVCS | OR | 501(C)(3) | 11B, II | 0 | N/A | |
| NORTH LINCOLN HEALTH DISTRICT | |||||||||||
| 3043 NE 28TH STREET | LINCOLN CITY | OR | 97367 | 930555769 | HEALTHCARE DISTRICT | OR | GOV'T | 6 | 0 | N/A | |
| NORTH LINCOLN HOSPITAL FOUNDATION | |||||||||||
| PO BOX 767 | LINCOLN CITY | OR | 97367 | 930867677 | TO SUPPORT N. LINCOLN HLTH DIST & SAMARITAN NORTH LINCOLN HOSPITAL | OR | 501(C)(3) | 11A, I | 0 | N/A | |
Form990 Schedule R Part III Form990ScheduleRPartIII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership | Code VCodeVAmount |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN ENDOSCOPY CENTER LLC | ||||||||||||||
| 3600 NW SAMARITAN DR | CORVALLIS | OR | 97330 | 202860067 | MEDICAL SERVICES | OR | N/A | |||||||
| CORVALLIS MEDICAL BUILDINGS LLC | ||||||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 931257913 | REAL ESTATE RENTAL | OR | N/A | |||||||
| EAST LINN MRI LLC | ||||||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 320229399 | IMAGING | OR | N/A | |||||||
| HULL IMAGING LLC | ||||||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 203255479 | IMAGING | OR | N/A | |||||||
| CBA-SAM LLC | ||||||||||||||
| PO BOX 433 | LINCOLN CITY | OR | 97367 | 931314523 | REAL ESTATE RENTAL | OR | N/A | |||||||
| CORVALLIS MRI A JOINT VENTURE | ||||||||||||||
| 3615 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 930949704 | IMAGING | OR | N/A | |||||||
| MID-VALLEY MEDICAL PROPERTIES ASSOC LLC | ||||||||||||||
| 1046 SIXTH AVE SW | ALBANY | OR | 97321 | 300508747 | REAL ESTATE RENTAL | OR | N/A | |||||||
| MID-VALLEY MEDICAL BUILDINGS LLC | ||||||||||||||
| PO BOX 557 | LEBANON | OR | 97355 | 931126353 | REAL ESTATE RENTAL | OR | N/A | |||||||
| NORTHWEST MEDICAL ISOTOPES LLC | ||||||||||||||
| 815 NW 9TH ST STE 256 | CORVALLIS | OR | 97330 | 273007752 | RESEARCH | OR | N/A | UNRELATED | -269527 | 197449 | 0 | 1 | 0.42600 | |
| 2750 HARRISON BLVD LLC | ||||||||||||||
| 413 SW 13TH AVE STE 300 | PORTLAND | OR | 97205 | 274665571 | REAL ESTATE RENTAL | OR | N/A | UNRELATED | -2500 | 2294340 | 0 | 1 | 0.24430 | -$2,500 |
| CASCADE VIEW MEDICAL OFFICE BUILDING LLC | ||||||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 300658805 | REAL ESTATE RENTAL | OR | N/A | |||||||
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH PLANS INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3600 NW SAMARITAN DRIVE | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 97330 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930860860 | EIN |
| Primary Activity | HEALTH INSURANCE CARRIER FOR THE COMMUNITY | PrimaryActivity |
| Legal Domicile State | OR | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 2065686 | ShareOfTotalIncome |
| Share Of EOY Assets | 15740991 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (20 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| INTERCOMMUNITY HEALTH PLANS INC | ||
| A | 118274 | COST |
| INTERCOMMUNITY HEALTH PLANS INC | ||
| L | 128550 | COST |
| INTERCOMMUNITY HEALTH PLANS INC | ||
| P | 4501763 | COST |
| SAMARITAN ENDOSCOPY CENTER LLC | ||
| L | 178298 | COST |
| SAMARITAN HEALTH PLANS INC | ||
| A | 140707 | COST |
| SAMARITAN HEALTH PLANS INC | ||
| L | 78000 | COST |
| SAMARITAN HEALTH PLANS INC | ||
| O | 2194778 | COST |
| SAMARITAN HEALTH PLANS INC | ||
| Q | 332538 | COST |
| GOOD SAMARITAN HOSPITAL CORVALLIS | ||
| L | 39024809 | COST |
| MID-VALLEY HEALTHCARE INC | ||
| L | 9228721 | COST |
| FIRSTCARE MEDICAL FOUNDATION | ||
| L | 1284130 | COST |
| ALBANY GENERAL HOSPITAL | ||
| L | 13554792 | COST |
| SAMARITAN NORTH LINCOLN HOSPITAL | ||
| L | 3830293 | COST |
| SAMARITAN PACIFIC HEALTH SERVICES | ||
| L | 5250017 | COST |
| ALBANY GENERAL HOSPITAL | ||
| Q | 7920201 | COST |
| FIRSTCARE MEDICAL FOUNDATION | ||
| Q | 1308545 | COST |
| GOOD SAMARITAN HOSPITAL CORVALLIS | ||
| Q | 18615122 | COST |
| MID-VALLEY HEALTHCARE INC | ||
| Q | 5973913 | COST |
| SAMARITAN NORTH LINCOLN HOSPITAL | ||
| Q | 3153461 | COST |
| SAMARITAN PACIFIC HEALTH SERVICES | ||
| Q | 4576205 | COST |