SAMARITAN PACIFIC HEALTH SERVICES INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- SAMARITAN PACIFIC HEALTH SERVICES INC (EIN 93-1329784)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-13
- IRS object ID
- 201223189349304682
- Schema version
- 2011v1.2
- 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 D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-13T16:54:48-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | 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 | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 931329784 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN PACIFIC HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SAMA | NameControl |
| Phone | 5415744824 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 930 SW ABBEY STREET | AddressLine1 |
| City | NEWPORT | City |
| State | OR | State |
| ZIP Code | 97365 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANIEL B SMITH | Name |
| Title | VP FINANCE/CFO | Title |
| Phone | 5415744824 | Phone |
| Date Signed | 2012-11-08 | 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 | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN PACIFIC COMMUNITIES HOSP | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID C BIGELOW | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 930 SW ABBEY STREET | AddressLine1 |
| City | NEWPORT | City |
| State | OR | State |
| ZIP Code | 97365 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 69920805 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SAMHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2001 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | SAMARITAN PACIFIC HEALTH SERVICES (SPHS) ACHIEVES ITS MISSION OF IMPROVING THE HEALTH AND WELL BEING OF THE COMMUNITY THROUGH ITS CRITICAL-ACCESS HOSPITAL AND HEALTHCARE CLINICS PROVIDING OUTPATIENT CARE SERVICES AT SEVERAL AREA LOCATIONS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 582 | TotalNbrEmployees |
| Total Nbr Volunteers | 99 | TotalNbrVolunteers |
| Total Gross UBI | 733446 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -185410 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1331186 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1151890 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 66461008 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 62065554 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 13654 | InvestmentIncomePriorYear |
| Investment Income Current Year | 5669863 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 395883 | OtherRevenuePriorYear |
| Other Revenue Current Year | 482673 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 68201731 | TotalRevenuePriorYear |
| Total Revenue Current Year | 69369980 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 612445 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 607512 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 37125468 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 37898497 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 228461 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 28222105 | OtherExpensePriorYear |
| Other Expenses Current Year | 25711038 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 65960018 | TotalExpensesPriorYear |
| Total Expenses Current Year | 64217047 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2241713 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 5152933 | RevenuesLessExpensesCY |
| Total Assets BOY | 21111877 | TotalAssetsBOY |
| Total Assets EOY | 26500056 | TotalAssetsEOY |
| Total Liabilities BOY | 12466681 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 12701927 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8645196 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 13798129 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SAMARITAN PACIFIC HEALTH SERVICES (SPHS) IS A MEMBER OF SAMARITAN HEALTH SERVICES (SHS), 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. SPHS PROVIDES HEALTHCARE SERVICES REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, DISABILITY OR AGE. THE MISSION OF SPHS 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 | 54301919 | Expense |
| Revenue | 61039663 | Revenue |
| Description | PROGRAM SERVICES:SAMARITAN PACIFIC HEALTH SERVICES (SPHS) INCLUDES A CRITICAL-ACCESS HOSPITAL AND SEVERAL MEDICAL CLINICS PROVIDING HEALTH CARE FOR RESIDENTS AND TOURISTS THROUGHOUT A 270-SQUARE-MILE AREA IN LINCOLN COUNTY. SPHS HAS OVER 500 EMPLOYEES AND 90 VOLUNTEERS. DURING 2011, SPHS SERVED 1,438 INPATIENTS, HAD 12,606 EMERGENCY DEPARTMENT VISITS, PERFORMED 2,064 SURGERIES, AND DELIVERED 190 BABIES. IN ADDITION, SPHS PERFORMED 25,878 IMAGING PROCEDURES, HAD 4,856 HOME HEALTH AND 4,622 HOSPICE VISITS, AND HAD 51,538 PHYSICIAN CLINIC VISITS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 526546 | Expense |
| Grants | 526546 | Grants |
| Revenue | 350276 | Revenue |
| Description | SEE SCHEDULE OTHE SENIOR COMPANION PROGRAM IS A PROGRAM SPONSORED, IN PART, BY SAMARITAN PACIFIC HEALTH SERVICES. THE PURPOSE OF THE PROGRAM IS TO IMPROVE THE LIVES OF FRAIL ELDERLY AND YOUNGER DISABLED NEIGHBORS ALLOWING THEM TO STAY IN THEIR OWN FAMILIAR SURROUNDINGS FOR AS LONG AS SAFELY POSSIBLE. A SENIOR COMPANION PROVIDES COMPANIONSHIP AND TRANSPORTATION TO APPOINTMENTS, SOCIAL EVENTS, OR PERSONAL ERRANDS. THE SENIOR COMPANION PROGRAM SERVED 215 PEOPLE IN 2011.THE FOSTER GRANDPARENT PROGRAM USES SENIOR VOLUNTEERS AGE 55 AND OLDER TO HELP CHILDREN IN SCHOOLS, CHILD CARE CENTERS AND HEAD START CLASSROOMS. FOSTER GRANDPARENT VOLUNTEERS ENCOURAGE CHILDREN WITH ONE-ON-ONE SUPPORT BY LISTENING TO A CHILD READ, HAVING LUNCH WITH A CHILD OR LISTENING TO A CHILD TALK ABOUT A NEW CONCEPT OR IDEA. THE PROGRAM SERVED 1000 CHILDREN IN 2011. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 77285 | Expense |
| Grants | 77285 | Grants |
| Description | GRANTS:GRANTS MADE BY SAMARITAN PACIFIC HEALTH SERVICES TO VARIOUS ORGANIZATIONS TO BENEFIT THE COMMUNITY. SEE PART IX, LINE 1, AND RELATED SCHEDULE I FOR GRANTS GREATER THAN $5,000. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 54905750 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | 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 | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 1 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 87 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 582 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| 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 | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | 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 | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | 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 | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| 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 PACIFIC HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5415744824 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 930 SW ABBEY STREET | AddressLine1 |
| City | NEWPORT | City |
| State | OR | State |
| ZIP Code | 97365 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| LARRY A MULLINS DHA | |||||||
| BOARD CHAIR/CEO SHS | 6.00 | X | X | 0 | 685646 | 697289 | |
| DAVID TRIEBES | |||||||
| BOARD VICE-CHAIR/CEO AGH | 1.00 | X | X | 0 | 337203 | 61343 | |
| SUSAN WOODRUFF | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| STEPHEN BURNS MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BONNIE SAXTON | |||||||
| BOARD SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| KEITH HARCOURT MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAVID C BIGELOW | |||||||
| CEO | 40.00 | X | 0 | 216520 | 45822 | ||
| DANIEL B SMITH | |||||||
| VP FINANCE/CFO SHS | 6.00 | X | 0 | 320608 | 51431 | ||
| FRED V SCHNEIDER MD | |||||||
| PHYSICIAN | 40.00 | 251379 | 0 | 40367 | X | ||
| GERALD BUTLER MD | |||||||
| PHYSICIAN | 40.00 | 466745 | 0 | 31751 | X | ||
| RICHARD NORTH MD | |||||||
| PHYSICIAN | 40.00 | 330007 | 0 | 40831 | X | ||
| DAVID A LARSEN MD | |||||||
| PHYSICIAN | 40.00 | 323172 | 0 | 45950 | X | ||
| JERRY FLAMING DO | |||||||
| PHYSICIAN | 40.00 | 232974 | 0 | 24365 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1604277 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1559977 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1039149 | TotalOtherCompensation |
| Number Individuals GT100 K | 43 | 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 |
|---|---|---|---|---|---|
| WAMPLER LARRY DO | |||||
| 611 SE 3RD STREET | NEWPORT | OR | 97365 | MEDICAL SERVICES | 1216985 |
| CENTRAL COAST INTERNAL MEDICINE | |||||
| 775 SW 9TH ST STE B | NEWPORT | OR | 97365 | HOSPITALIST SERVICES | 837287 |
| PETERSON MICHAEL MD | |||||
| PO BOX 1985 | NEWPORT | OR | 97365 | MEDICAL SERVICES | 322945 |
| COMPHEALTH | |||||
| PO BOX 972651 | DALLAS | TX | 753972651 | EMPLOYMENT SERVICES | 310069 |
| LEGACY LABORATORY SERVICES LLC | |||||
| PO BOX 5337 | PORTLAND | OR | 97228 | LAB SERVICES | 184277 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 12 | NumberOfContractorsGT100K |
| Government Grants | 1106992 | GovernmentGrants |
| All Other Contributions | 44898 | AllOtherContributions |
| Total Contributions | 1151890 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT SVC REV | 900099 | 57448450 | 57444143 | 4307 |
| DURABLE MEDICAL EQP | 446199 | 4617104 | 3887965 | 729139 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 62065554 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 23670 | TotalRevenueColumn |
| Exclusion | $23,670 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 165377 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 45254 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 120123 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 120123 | TotalRevenueColumn |
| Exclusion | $120,123 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 5802835 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 156642 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 5646193 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5646193 | TotalRevenueColumn |
| Exclusion | $5,646,193 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 487553 | GrossSalesOfInventory |
| Cost Of Goods Sold | 348929 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 138624 | TotalRevenueColumn |
| Exclusion | $138,624 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA | 722210 | 166095 | $166,095 | |
| DISTRICT ADMIN SVCS | 900099 | 31500 | 31500 | |
| RELEASE OF INFORMATION | 561000 | 26331 | 26331 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 223926 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 69369980 | TotalRevenueColumn |
| Related Or Exempt Function Income | 61389939 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 733446 | UnrelatedBusinessRevenue |
| Exclusion | $6,094,705 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 77285 | Total |
| Program Services | 77285 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 530227 | Total |
| Program Services | 530227 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28520078 | Total |
| Program Services | 26573725 | ProgramServices |
| Management And General | 1819219 | ManagementAndGeneral |
| Fundraising | 127134 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1445235 | Total |
| Program Services | 1346605 | ProgramServices |
| Management And General | 92188 | ManagementAndGeneral |
| Fundraising | 6442 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5286068 | Total |
| Program Services | 4925320 | ProgramServices |
| Management And General | 337184 | ManagementAndGeneral |
| Fundraising | 23564 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2647116 | Total |
| Program Services | 2466464 | ProgramServices |
| Management And General | 168852 | ManagementAndGeneral |
| Fundraising | 11800 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 137291 | Total |
| Management And General | 137291 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6500 | Total |
| Fundraising | 6500 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5189623 | Total |
| Program Services | 5185274 | ProgramServices |
| Management And General | 4349 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13148 | Total |
| Program Services | 688 | ProgramServices |
| Management And General | 12460 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2073422 | Total |
| Program Services | 1913610 | ProgramServices |
| Management And General | 138354 | ManagementAndGeneral |
| Fundraising | 21458 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1265696 | Total |
| Management And General | 1265696 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1229848 | Total |
| Program Services | 1108179 | ProgramServices |
| Management And General | 111662 | ManagementAndGeneral |
| Fundraising | 10007 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 131167 | Total |
| Program Services | 121809 | ProgramServices |
| Management And General | 6454 | ManagementAndGeneral |
| Fundraising | 2904 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108717 | Total |
| Program Services | 90099 | ProgramServices |
| Management And General | 18618 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31466 | Total |
| Management And General | 31466 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1170646 | Total |
| Program Services | 1143688 | ProgramServices |
| Management And General | 25928 | ManagementAndGeneral |
| Fundraising | 1030 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 915212 | Total |
| Program Services | 825520 | ProgramServices |
| Management And General | 89692 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES | 7934434 | 7934434 | ||
| PURCHASED SERVICES | 5405360 | 608826 | 4780080 | 16454 |
| DUES, TAXES, & LICENSES | 98508 | 53997 | 43343 | 1168 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64217047 | Total |
| Program Services | 54905750 | ProgramServices |
| Management And General | 9082836 | ManagementAndGeneral |
| Fundraising | 228461 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 161284 | BOY |
| EOY | 297295 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3186080 | BOY |
| EOY | 899792 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8441909 | BOY |
| EOY | 7121729 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 92949 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62047 | BOY |
| EOY | 68400 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2514403 | BOY |
| EOY | 2216255 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 183841 | BOY |
| EOY | 155825 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 10089610 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5965411 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5069684 | BOY |
| EOY | 4124199 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 388889 | BOY |
| EOY | 370370 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1103740 | BOY |
| EOY | 11153242 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21111877 | BOY |
| EOY | 26500056 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4954251 | BOY |
| EOY | 5263588 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12975 | BOY |
| EOY | 26125 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 942531 | BOY |
| EOY | 622834 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6556924 | BOY |
| EOY | 6789380 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12466681 | BOY |
| EOY | 12701927 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8645196 | BOY |
| EOY | 13798129 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8645196 | BOY |
| EOY | 13798129 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21111877 | BOY |
| EOY | 26500056 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 5152933 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1347002 | OtherCostOrOtherBasis |
| Depreciation | 375541 | Depreciation |
| Book Value | 971461 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8657436 | OtherCostOrOtherBasis |
| Depreciation | 5589870 | Depreciation |
| Book Value | 3067566 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 85172 | OtherCostOrOtherBasis |
| Book Value | 85172 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4124199 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES/ASSETS | 732038 |
| ACCOUNTS RECEIVABLE - AFFILIATES | 10421204 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 11153242 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CONTRACTUAL REIMB OBLIGATIONS | $1,164,731 |
| PROFESSIONAL LIABILITY RESERVES | $288,000 |
| WORKING CAPITAL RESERVES | $4,879,683 |
| OTHER RESERVES | $456,966 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 6789380 | TotalOfAmounts |
| Total Revenue | 69369980 | TotalRevenue |
| Total Expenses | 64217047 | TotalExpenses |
| Excess Or Deficit For Year | 5152933 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 5152933 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 69761517 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 391537 | OtherRevenues |
| Revenue Not Rptd F990 | 391537 | RevenueNotRptdF990 |
| Revenue Subtotal | 69369980 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 69369980 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 64608584 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 391537 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 391537 | ExpensesNotRptdF990 |
| Expenses Subtotal | 64217047 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 64217047 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | EXPENSES NETTED WITH REV PER T/R 391,537. |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | EXPENSES NETTED WITH REV PER T/R 391,537. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 3810 | PersonsServed |
| Total Community Benefit Expense | 2053387 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2053387 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03200 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 6 | NumberOfActivitiesOrPrograms |
| Persons Served | 27880 | PersonsServed |
| Total Community Benefit Expense | 8965975 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9086824 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -120849 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 20 | NumberOfActivitiesOrPrograms |
| Persons Served | 31690 | PersonsServed |
| Total Community Benefit Expense | 11019362 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9086824 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1932538 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03200 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 3321 | PersonsServed |
| Total Community Benefit Expense | 375729 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 216334 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 159395 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 98 | PersonsServed |
| Total Community Benefit Expense | 252891 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 252891 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00390 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 17 | NumberOfActivitiesOrPrograms |
| Persons Served | 64664 | PersonsServed |
| Total Community Benefit Expense | 16463826 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11273659 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5190167 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08080 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 899 | PersonsServed |
| Total Community Benefit Expense | 108143 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 108143 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 44 | NumberOfActivitiesOrPrograms |
| Persons Served | 68982 | PersonsServed |
| Total Community Benefit Expense | 17200589 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11489993 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5710596 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08890 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 64 | NumberOfActivitiesOrPrograms |
| Persons Served | 100672 | PersonsServed |
| Total Community Benefit Expense | 28219951 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 20576817 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7643134 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12090 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 1450 | PersonsServed |
| Total Community Building Expense | 251957 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 133942 | DirectOffsettingRevenue |
| Net Community Building Expense | 118015 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 52 | PersonsServed |
| Total Community Building Expense | 22583 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 22583 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 1502 | PersonsServed |
| Total Community Building Expense | 274540 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 133942 | DirectOffsettingRevenue |
| Net Community Building Expense | 140598 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $2,441,961 | BadDebtExpenseAmount |
| Amount Attributable To | 48636 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 16905775 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16741410 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 164365 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN PACIFIC HEALTH SERVICES | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 930 SW ABBEY STREET | AddressLine1 |
| City | NEWPORT | City |
| State | OR | State |
| ZIP Code | 97365 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN PACIFIC HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 10 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (10 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SAMARITAN WALDPORT CLINIC | ||||
| 150 SW ARROW ST | WALDPORT | OR | 97394 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN PACIFIC WOMENS HEALTH GROUP | ||||
| 775 SW 9TH ST STE H | NEWPORT | OR | 97365 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN DEPOE BAY CLINIC | ||||
| 531 NW HWY 101 STE A | DEPOE BAY | OR | 97341 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN PACIFIC SURGICAL ASSOCIATES | ||||
| 929 SW BAY ST | NEWPORT | OR | 97365 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN TOLEDO CLINIC | ||||
| 199 NW BUSINESS HWY 20 | TOLEDO | OR | 97391 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN PACIFIC INTERNAL MEDICINE | ||||
| 1010 SW COAST HWY STE 201 | NEWPORT | OR | 97365 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN ORTHOPEDIC SURGEONS | ||||
| 1010 SW COAST HWY STE 101 | NEWPORT | OR | 97365 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN PACIFIC ENT & ALLERGY | ||||
| 904 SW BAY ST | NEWPORT | OR | 97365 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN OCCUPATIONAL MED - NEWPORT | ||||
| 775 SW 9TH ST STE E | NEWPORT | OR | 97365 | MEDICAL CLINIC - OUTPATIENT |
| SAMARITAN PACIFIC WALK-IN CLINIC | ||||
| 775 SW 9TH ST STE F | NEWPORT | OR | 97365 | MEDICAL CLINIC - OUTPATIENT |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 6A: THE FILING ORGANIZATION SUBMITS AN ANNUAL COMMUNITY BENEFIT REPORT TO THE STATE OF OREGON. IN ADDITION, THE PARENT ORGANIZATION, SAMARITAN HEALTH SERVICES (SHS) PROVIDES AN ANNUAL REPORT TO THE COMMUNITY THAT INCLUDES COMMUNITY BENEFIT REPORTING FOR THE SYSTEM AS A WHOLE. | ||
| PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN SCHEDULE H, PART I, LINE 7A AND 7B IS A COST-TO-CHARGE RATIO DERIVED USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES FROM THE SCHEDULE H INSTRUCTIONS. FOR LINE 7G, A COMBINATION OF THE COST-TO-CHARGE RATIO AND COST ACCOUNTING SYSTEM CALCULATIONS IS USED SINCE NOT ALL SERVICES ARE TRACKED IN THE COST ACCOUNTING SYSTEM. | ||
| PART I, LINE 7G: PHYSICIAN CLINICS MEETING THE DEFINITION OF SUBSIDIZED HEALTH SERVICES WERE INCLUDED IN THE REPORTING FOR LINE 7G. THE PORTION OF NET COMMUNITY BENEFIT EXPENSE RELATED TO THESE CLINICS IS $2,068,579. | ||
| PART II: SPHS PROVIDES SERVICES AND ACTIVITIES THAT ARE CLASSIFIED AS COMMUNITY BUILDING. SPHS LEADS DISASTER PREPAREDNESS DRILLS WITH LOCAL AGENCIES AND STAFF PARTICIPATION IN SUPPORT SERVICES FOR HOMELESS FAMILIES IN THE COMMUNITY. SPHS STAFF SERVE ON MANY LOCAL COALITIONS AND BOARDS THAT PROMOTE THE HEALTH OF THE COMMUNITY. THE NURSING STAFF SPENDS MANY HOURS SPEAKING TO LOCAL FAITH GROUPS AND RECRUITING PARISH NURSES. | ||
| PART III, LINE 4: THE COSTING METHODOLOGY USED TO CALCULATE BAD DEBT EXPENSE (AT COST) ON LINE 2 OF PART III IS BASED ON THE FACILITY COST-TO-CHARGE RATIO, IN CONJUNCTION WITH WORKSHEET A FROM THE SCHEDULE H, PART III INSTRUCTIONS.LINE 3 REPRESENTS AN ESTIMATE OF THE AMOUNT OF COST INCLUDED IN LINE 2 (BAD DEBT EXPENSE AT COST) THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, BUT FOR WHOM THE ORGANIZATION WAS NOT ABLE TO OBTAIN SUFFICIENT INFORMATION TO MAKE A DETERMINATION. THE METHODOLOGY USED TO ESTIMATE THIS POTENTIAL CHARITY CARE COST IS BASED ON FINANCIAL ASSISTANCE APPLICATIONS DENIED DUE TO INCOMPLETE DOCUMENTATION, MULTIPLIED BY THE AVERAGE CHARITY CARE WRITE-OFF FOR APPROVED APPLICATIONS.SAMARITAN PACIFIC HEALTH SERVICES (SPHS) IS ONE OF FIVE HOSPITALS OF SAMARITAN HEALTH SERVICES (SHS). AS A NETWORK, SHS PREPARES ITS FINANCIAL STATEMENTS ON A CONSOLIDATED BASIS. FOOTNOTE 1(O) FROM THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS ENTITLED "PROVISION FOR BAD DEBTS AND ALLOWANCE FOR DOUBTFUL ACCOUNTS" DESCRIBES BAD DEBT EXPENSE AS FOLLOWS: "ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, SHS ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE PATIENTS WITHOUT INSURANCE), SHS RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. FOR THIRD-PARTY RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, SHS ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, WHICH PRIMARILY RELATES TO SELF-PAY PATIENT BALANCES THAT WILL REMAIN AFTER PAYMENTS FROM THE THIRD-PARTY PAYOR HAVE BEEN COLLECTED. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS." | ||
| PART III, LINE 8: TOTAL MEDICARE ALLOWABLE COSTS REPORTED ON PART III, SECTION B, LINE 6 IS CALCULATED BY UTILIZING WORKSHEET B IN THE SCHEDULE H INSTRUCTIONS IN CONJUNCTION WITH AMOUNTS TAKEN DIRECTLY FROM THE FILING ORGANIZATION'S MEDICARE COST REPORT. THE COST REPORT INCLUDES ACTIVITY FOR MEDICARE FEE-FOR-SERVICE PATIENTS BUT NOT MEDICARE MANAGED CARE PATIENTS. | ||
| PART III, LINE 9B: PER HOSPITAL GUIDELINES, IF A PATIENT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS, THE CHARITY WRITE-OFF IS PROCESSED AND NO COLLECTION ATTEMPT IS MADE. IF AN ACCOUNT IS ALREADY IN COLLECTIONS AND MEDICAID ELIGIBILITY IS DEEMED ACTIVE DURING THE ACCOUNT DATE OF SERVICE, NO FURTHER COLLECTION ATTEMPT WILL BE MADE. | ||
| PART V, SECTION B, LINE 19D: THE MAXIMUM AMOUNT CHARGED BY THE HOSPITAL FACILITY TO FAP-ELIGIBLE INDIVIDUALS IS SET TO BE LESS THAN THE AVERAGE OF ALL NEGOTIATED COMMERCIAL INSURANCE RATES. | SAMARITAN PACIFIC HEALTH SERVICES | |
| PART VI, LINE 2: SAMARITAN PACIFIC HEALTH SERVICES (SPHS) ACTIVELY PARTICIPATES IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY. IN CONJUNCTION WITH THE LINCOLN COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT, LINCOLN COUNTY FEDERALLY QUALIFIED HEALTH CENTER, LINCOLN COUNTY UNIFIED SCHOOL DISTRICT, OREGON COAST COMMUNITY COLLEGE, UNITED WAY OF LINCOLN COUNTY, THE LINCOLN COUNTY COMMISSION ON CHILDREN AND FAMILIES AND OTHER COMMUNITY PARTNERS, THE SAMARITAN NORTH LINCOLN HOSPITAL COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP (CHIP) COORDINATOR AND OTHER SPHS EMPLOYEES ACTIVELY PARTICIPATED IN A COMMUNITY HEALTH ASSESSMENT DURING 2010. THIS PROCESS INCLUDED EXAMINING PRIMARY DATA COLLECTED THROUGH TELEPHONE SURVEYS, FOCUS GROUPS, COMMUNITY FORUMS AND PERSONAL INTERVIEWS WITH SEVERAL COMMUNITY MEMBERS FROM THROUGHOUT LINCOLN COUNTY. SECONDARY DATA WAS GATHERED FROM STATE AND LOCAL AGENCIES THAT ADDRESS HEALTH NEEDS OF CHILDREN, YOUTH AND FAMILIES. AS A RESULT OF THE COMMUNITY HEALTH ASSESSMENT, SPHS IS ABLE TO UPDATE THE ANNUAL COMMUNITY BENEFIT PLAN THAT OUTLINES GOALS AND OBJECTIVES AND SERVICES THAT EXPAND ACROSS THE SAMARITAN HEALTH SERVICES SYSTEM AND RESPOND TO COMMUNITY NEEDS. | ||
| PART VI, LINE 3: SPHS IS COMMITTED TO PROVIDING THE HIGHEST QUALITY HEALTH CARE SERVICES TO ALL, REGARDLESS OF THEIR ABILITY TO PAY. IF QUALIFICATIONS ARE MET, PATIENTS' CARE MAY BE PROVIDED FREE OR AT A REDUCED COST. THE DETERMINATION IS BASED IN PART ON POVERTY INCOME GUIDELINES ISSUED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. ONCE A COMPLETED FINANCIAL QUESTIONNAIRE HAS BEEN SUBMITTED, INDIVIDUALS/FAMILIES AT OR BELOW 200 PERCENT OF THE ESTABLISHED FEDERAL POVERTY LEVEL (FPL) COULD BE ELIGIBLE TO RECEIVE FREE OR DISCOUNTED CARE (CHARITY CARE).THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND COMMUNITY MEMBERS BY PUBLISHING INFORMATION REGARDING ALL FINANCIAL ASSISTANCE OPTIONS ON ITS WEBSITE, IN ADDITION TO IN PERSON AT THE REGISTRATION AREA, AND THROUGH CLEARLY IDENTIFIED MATERIALS LOCATED IN THE REGISTRATION AREA. | ||
| PART VI, LINE 4: SAMARITAN PACIFIC HEALTH SERVICES (SPHS) OPERATES SAMARITAN PACIFIC COMMUNITIES HOSPITAL (SPCH), A CRITICAL-ACCESS HOSPITAL LOCATED IN NEWPORT THAT PRIMARILY SERVES THE RESIDENTS IN SOUTHERN LINCOLN COUNTY. LOCATED ON A PRIMARILY RURAL PORTION OF OREGON'S CENTRAL COAST, LINCOLN COUNTY IS HOME TO 46,034 (U.S. CENSUS) RESIDENTS. WITHIN LINCOLN COUNTY, THE LARGE TRIBAL POPULATION IS DISPROPORTIONATELY BURDENED BY HEALTH INEQUITIES. THERE ARE 4,769 ENROLLED TRIBAL MEMBERS OF THE CONFEDERATED TRIBES OF SILETZ INDIANS, OF WHICH 22% LIVE IN LINCOLN COUNTY. LINCOLN COUNTY LACKS A MAJOR METROPOLITAN AREA AND CONSISTS OF MANY SMALL COMMUNITIES SCATTERED THROUGHOUT THE REGION. NEWPORT IS THE COUNTY SEAT AND HAS A POPULATION OF 9,989. LINCOLN CITY IS THE SECOND LARGEST TOWN AND HAS A POPULATION OF 7,930. THE MEDIAN INCOME FOR LINCOLN COUNTY IS $50,600, WITH 16% LIVING BELOW THE FEDERAL POVERTY LEVEL. AS OF DECEMBER 2011, THE OREGON EMPLOYMENT DEPARTMENT REPORTED A 9.4% UNEMPLOYMENT RATE FOR LINCOLN COUNTY. THIRTY-EIGHT PERCENT OF THE POPULATION LIVES IN RURAL UNINCORPORATED AREAS AND 25% OF RESIDENTS ARE UNINSURED. SAMARITAN NORTH LINCOLN HOSPITAL, LOCATED IN LINCOLN CITY, IS THE SISTER HOSPITAL IN NORTHERN LINCOLN COUNTY SERVING LOCAL RESIDENTS. LINCOLN COUNTY IS DESIGNATED AS MEDICALLY UNDERSERVED POPULATION AND THE MIGRANT SEASONAL FARMWORKER POPULATION HAS BEEN DESIGNATED A PRIMARY MEDICAL CARE HEALTH PROVIDER SHORTAGE AREA BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION. THE SILETZ COMMUNITY HEALTH CLINIC, WHICH SERVES THE 3,666-ACRE RESERVATION OF THE CONFEDERATED TRIBES OF SILETZ INDIANS, IS A DESIGNATED HEALTH PROVIDER SHORTAGE AREA. | ||
| PART VI, LINE 5: SPHS'S GOVERNING BOARD IS COMPRISED OF LOCAL-AREA RESIDENTS AND OFFICERS OF AFFILIATED ORGANIZATIONS. THE MAJORITY OF THE BOARD MEMBERS ARE INDEPENDENT, MEANING THEY AND THEIR FAMILY MEMBERS ARE NOT EMPLOYEES OF SPHS NOR DO THEY HAVE SIGNIFICANT BUSINESS RELATIONSHIPS WITH SPHS. SPHS EXTENDS ITS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. SPHS APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. SPHS INVESTS IN UPDATING EQUIPMENT, TECHNOLOGY AND FACILITIES TO IMPROVE PATIENT CARE. SPHS IS ACCREDITED FOR CONTINUING MEDICAL EDUCATION AND OFFERS FREQUENT PROGRAMS FOR AREA PHYSICIANS AND OTHER HEALTH PROFESSIONALS. THE CENTER FOR HEALTH RESEARCH AND QUALITY, A DEPARTMENT OF SPHS'S PARENT COMPANY, SAMARITAN HEALTH SERVICES (SHS), PROVIDES ADMINISTRATIVE OVERSIGHT FOR HEALTH AND CLINICAL RESEARCH, QUALITY IMPROVEMENT PROJECTS AND STUDIES AND OTHER SPONSORED ACTIVITIES FOR SPHS AND ITS AFFILIATED HOSPITALS. SPHS ALSO PROVIDES SCHOLARSHIPS FOR STUDENTS AND EMPLOYEES IN HEALTH OCCUPATIONS AND CONTRIBUTES FINANCIALLY TO THE OREGON COAST COMMUNITY COLLEGE. | ||
| PART VI, LINE 6: "BUILDING HEALTHIER COMMUNITIES TOGETHER" IS THE COMMITMENT OF, AND THE MOTIVATION FOR, SAMARITAN HEALTH SERVICES (SHS), A NETWORK OF OREGON HOSPITALS, PHYSICIANS, AND SENIOR CARE FACILITIES THAT SERVES THE HEALTH CARE NEEDS OF PEOPLE IN THE MID-WILLAMETTE VALLEY AND THE CENTRAL OREGON COAST.AS THE INDIVIDUAL ENTITIES OF SHS CAME TOGETHER TO BUILD HEALTHIER COMMUNITIES, THEY WERE DRAWN BY A SHARED MISSION "TO ENHANCE COMMUNITY HEALTH AND ACHIEVE HIGH VALUE THROUGH QUALITY SERVICES ACROSS THE CONTINUUM OF CARE." THAT MEANS SHS LOOKS CAREFULLY AT LOCAL HEALTH CARE NEEDS, AND IT 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 HEALTHCARE FOR PEOPLE AT ALL STAGES OF THEIR LIVES. SERVICES ARE PROVIDED TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY. THE COLLECTIVE VISION OF SHS IS TO SUCCESSFULLY OPERATE AS A VALUES-DRIVEN, CHURCH-RELATED ORGANIZATION GOVERNED BY A PARTNERSHIP OF COMMUNITY MEMBERS, PHYSICIANS AND OTHER HEALTH CARE PROVIDERS. SHS SEEKS TO LEAD COLLABORATIVE EFFORTS AMONG PROVIDERS, EMPLOYERS, HEALTH PLANS AND CONSUMERS WHO SHARE SIMILAR GOALS AND VALUES TO MEET THE CHALLENGES OF THE FUTURE.SAMARITAN PACIFIC COMMUNITIES HOSPITAL IS ONE OF TWO LINCOLN COUNTY CRITICAL ACCESS HOSPITALS OF SHS PRIMARILY SERVING RESIDENTS OF SOUTH LINCOLN COUNTY. OTHER AFFILIATED HOSPITALS ARE GOOD SAMARITAN HOSPITAL SERVING RESIDENTS OF BENTON COUNTY, SAMARITAN ALBANY GENERAL HOSPITAL AND SAMARITAN LEBANON COMMUNITY HOSPITAL, SERVING RESIDENTS OF LINN COUNTY, AND SAMARITAN NORTH LINCOLN HOSPITAL, SERVING RESIDENTS OF NORTH LINCOLN COUNTY. | ||
| OR | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| OCCC - FOUNDATION | |||||||
| 400 SE COLLEGE WAY | NEWPORT | OR | 97366 | 931290953 | 501(C)(3) | 25000 | NURING PROGRAM SUPPORT |
| PACIFIC COMMUNITIES HEALTH DISTRICT | |||||||
| PO BOX 873 | NEWPORT | OR | 97365 | 930603489 | GOV'T | 21035 | CAPITAL PURCH FOR USE IN HOSPITAL FACILITIES |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII (4 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|---|---|---|
| SENIOR COMPANION PROGRAM | 215 | 275606 | BOOK | WAGES, BUILDING, UTILITES, AND SUPPLIES | |
| FOSTER GRANDPARENT PROGRAM | 1000 | 250940 | BOOK | WAGES, BUILDING, UTILITES, AND SUPPLIES | |
| TRANSPORTATION ASSISTANCE | 28 | 2181 | |||
| SCHOLARSHIPS | 2 | 1500 |
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 |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 0 | 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 | 0 | 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 (9 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LARRY A MULLINS DHA | |||||||||||||
| 0 | 578681 | 0 | 6000 | 0 | 100965 | 0 | 672392 | 0 | 24897 | 0 | 1382935 | 0 | 0 |
| DAVID TRIEBES | |||||||||||||
| 0 | 285814 | 0 | 22950 | 0 | 28439 | 0 | 34264 | 0 | 27079 | 0 | 398546 | 0 | 0 |
| DAVID C BIGELOW | |||||||||||||
| 0 | 173536 | 0 | 21813 | 0 | 21171 | 0 | 17548 | 0 | 28274 | 0 | 262342 | 0 | 0 |
| DANIEL B SMITH | |||||||||||||
| 0 | 285276 | 0 | 28000 | 0 | 7332 | 0 | 20228 | 0 | 31203 | 0 | 372039 | 0 | 0 |
| FRED V SCHNEIDER MD | |||||||||||||
| 247295 | 0 | 2500 | 0 | 1584 | 0 | 20228 | 0 | 20139 | 0 | 291746 | 0 | 0 | 0 |
| GERALD BUTLER MD | |||||||||||||
| 455998 | 0 | 4560 | 0 | 6187 | 0 | 20228 | 0 | 11523 | 0 | 498496 | 0 | 0 | 0 |
| RICHARD NORTH MD | |||||||||||||
| 324586 | 0 | 3154 | 0 | 2267 | 0 | 20228 | 0 | 20603 | 0 | 370838 | 0 | 0 | 0 |
| DAVID A LARSEN MD | |||||||||||||
| 319170 | 0 | 3600 | 0 | 402 | 0 | 20228 | 0 | 25722 | 0 | 369122 | 0 | 0 | 0 |
| JERRY FLAMING DO | |||||||||||||
| 229446 | 0 | 2292 | 0 | 1236 | 0 | 14267 | 0 | 10098 | 0 | 257339 | 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 REIMBURSEMENT BENEFIT THAT IS AVAILABLE TO ALL EMPLOYEES WHO WORK AT LEAST 32 HOURS PER MONTH. THE EMPLOYEE MUST ATTEND THE GYM FOR 6 CONSECUTIVE MONTHS, AT LEAST 50 TIMES, IN ORDER TO QUALIFY FOR REIMBURSEMENT. THIS GYM REIMBURSEMENT BENEFIT IS INCLUDED IN THE EMPLOYEE'S TAXABLE WAGES AND IS SUBJECT TO STATE/FEDERAL WITHHOLDING TAX. ONE BOARD MEMBER, WHO IS ALSO AN EMPLOYEE OF A RELATED ORGANIZATION, AND TWO HIGHEST PAID EMPLOYEES RECEIVED THIS BENEFIT IN 2011. |
| PART I, LINE 4B | 4.B. THE ORGANIZATION MAINTAINS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. UNDER THESE PLANS, LARRY A. MULLINS, DHA, ACCRUED DEFERRED COMPENSATION BENEFITS DURING 2011. NO PAYMENTS WERE MADE TO HIM FROM THESE PLANS IN 2011. |
| 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 L IRS990ScheduleL
Loan Table LoanTable (2 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|
| JERRY FLAMING DO | ||||||
| RECRUITMENT PACKAGE | X | $30,000 | 19374 | 0 | 1 | 1 |
| DAVID LARSEN MD | ||||||
| RECRUITMENT PACKAGE | X | $80,000 | 73575 | 0 | 1 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 92949 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | SAMARITAN PACIFIC HEALTH SERVICES HAS A SOLE CORPORATE MEMBER, SAMARITAN HEALTH SERVICES, INC., WHICH IS A SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | SAMARITAN PACIFIC HEALTH SERVICES ELECTS MEMBERS OF ITS BOARD OF DIRECTORS. THOSE ELECTED MEMBERS ARE THEN SUBMITTED TO THE SOLE CORPORATE MEMBER FOR APPROVAL. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE CORPORATE MEMBER HAS SEVERAL RESERVED POWERS OVER THE ORGANIZATION. THESE RESERVED POWERS INCLUDE, BUT ARE NOT LIMITED TO, APPROVAL AT CERTAIN THRESHOLD LEVELS: THE BORROWING OF FUNDS, MERGERS AND ACQUISITIONS, AND SALES OR TRANSFERS OF ASSETS. IN ADDITION, THE SOLE CORPORATE MEMBER MUST APPROVE ANY CHANGE IN THE MISSION OF THE ORGANIZATION, THE ANNUAL BUDGET, AND ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS. | |
| 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 IS A 501(C)(3) CORPORATION AND IS THE SOLE MEMBER OF THE FILING ORGANIZATION. 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 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. | |
| PART VII - COMPENSATION EXPLANATION | DR. MULLINS WORKED 40 HOURS PER WEEK FOR SEVERAL RELATED ORGANIZATIONS. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THE FILING ORGANIZATION AND SEVERAL RELATED ORGANIZATIONS. | LARRY A. MULLINS, DHA |
| PART VII - COMPENSATION EXPLANATION | MR. TRIEBES WORKED 40 HOURS PER WEEK FOR SEVERAL RELATED ORGANIZATIONS. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THE FILING ORGANIZATION AND SEVERAL RELATED ORGANIZATIONS. | DAVID TRIEBES |
| PART VII - COMPENSATION EXPLANATION | MR. BIGELOW'S COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THE FILING ORGANIZATION. | DAVID C. BIGELOW |
| PART VII - COMPENSATION EXPLANATION | MR. SMITH WORKED 40 HOURS PER WEEK FOR SEVERAL RELATED ORGANIZATIONS. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THE FILING ORGANIZATION AND SEVERAL RELATED ORGANIZATIONS. | DANIEL B. SMITH |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (15 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 | 0 | |
| 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 | 0 | |
| 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 | 0 | |
| 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 | 0 | |
| 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 | 0 | |
| 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 | 0 | |
| SAMARITAN HEALTH SERVICES INC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930951989 | PROVIDE HEALTHCARE SUPPORT SERVICES | OR | 501(C)(3) | 11C, III-FI | 0 | N/A | |
| 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 | 0 | |
| GOOD SAMARITAN HOSPITAL CORVALLIS | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930391573 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 0 | |
| SAMARITAN SENIOR CARE INC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 931245534 | PROVIDE HEALTHCARE FOR SENIORS | OR | 501(C)(3) | 9 | SAMARITAN HEALTH SERVICES | 0 | |
| 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 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN ENDOSCOPY CENTER LLC | |||||||||||
| 3600 NW SAMARITAN DR | CORVALLIS | OR | 97330 | 202860067 | MEDICAL SERVICES | OR | GOOD SAMARITAN HOSPITAL | N/A | 0 | 0 | |
| CORVALLIS MEDICAL BUILDINGS LLC | |||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 931257913 | REAL ESTATE RENTAL | OR | GOOD SAMARITAN HOSPITAL | N/A | 0 | 0 | |
| EAST LINN MRI LLC | |||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 320229399 | IMAGING | OR | MID-VALLEY HEALTHCARE INC | N/A | 0 | 0 | |
| HULL IMAGING LLC | |||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 203255479 | IMAGING | OR | GOOD SAMARITAN HOSPITAL | N/A | 0 | 0 | |
| CBA-SAM LLC | |||||||||||
| PO BOX 433 | LINCOLN CITY | OR | 97367 | 931314523 | REAL ESTATE RENTAL | OR | N/A | 0 | 0 | N/A | |
| CORVALLIS MRI A JOINT VENTURE | |||||||||||
| 3615 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 930949704 | IMAGING | OR | GOOD SAMARITAN HOSPITAL | N/A | 0 | 0 | |
| MID-VALLEY MEDICAL PROPERTIES ASSOC LLC | |||||||||||
| 1046 SIXTH AVE SW | ALBANY | OR | 97321 | 300508747 | REAL ESTATE RENTAL | OR | ALBANY GENERAL HOSPITAL | N/A | 0 | 0 | |
| MID-VALLEY MEDICAL BUILDINGS LLC | |||||||||||
| PO BOX 557 | LEBANON | OR | 97355 | 931126353 | REAL ESTATE RENTAL | OR | N/A | 0 | 0 | N/A | |
| NORTHWEST MEDICAL ISOTOPES LLC | |||||||||||
| 815 NW 9TH ST STE 256 | CORVALLIS | OR | 97330 | 273007752 | RESEARCH | OR | SAMARITAN HEALTH SERVICES | N/A | 0 | 0 | |
| CASCADE VIEW MEDICAL OFFICE BUILDING LLC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 300658805 | REAL ESTATE RENTAL | OR | GOOD SAMARITAN HOSPITAL | N/A | 0 | 0 | |
| 2750 HARRISON BLVD LLC | |||||||||||
| 413 SW 13TH AVE STE 300 | PORTLAND | OR | 97205 | 274665571 | REAL ESTATE RENTAL | OR | N/A | 0 | 0 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 0 | 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 | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERCOMMUNITY HEALTH PLANS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | K | TransactionType |
| Amount Involved | 5009742 | AmountInvolved |
| Method Of Amt Determination | COST | MethodOfAmtDetermination |