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GOOD SHEPHERD HEALTH CARE SYSTEM: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
GOOD SHEPHERD HEALTH CARE SYSTEM (EIN 93-0425580)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-14
IRS object ID
201231359349302778
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-14T11:33:43-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1800 NICOLLET MALL STE 1300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code554027033ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN930425580EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1GOOD SHEPHERD HEALTH CARE SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGOODNameControl
Phone5416673400Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1610 NW 11TH STREETAddressLine1
CityHERMISTONCity
StateORState
ZIP Code97838ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDENNIS BURKEName
TitlePRESIDENT/CEOTitle
Phone5416673400Phone
Date Signed2012-05-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKIM HUNWARDSEN CPAName
Phone6122536500Phone
Date Prepared2012-05-09DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1GOOD SHEPHERD MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonDENNIS BURKENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1610 NW 11TH STREETAddressLine1
CityHERMISTONCity
StateORState
ZIP Code97838ZIPCode
FieldValueIRS element (for citing)
Gross Receipts81245716GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.GSHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1953YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionHOSPITAL AND HEALTH CARE SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees594TotalNbrEmployees
Total Nbr Volunteers150TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year61052ContributionsGrantsPriorYear
Contributions Grants Current Year142973ContributionsGrantsCurrentYear
Program Service Revenue Prior Year75922610ProgramServiceRevenuePriorYear
Program Service Revenue CY77991866ProgramServiceRevenueCY
Investment Income Prior Year2167163InvestmentIncomePriorYear
Investment Income Current Year3036209InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year78150825TotalRevenuePriorYear
Total Revenue Current Year81171048TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year457373GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY306894GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year33556015SalariesEtcPriorYear
Salaries Etc Current Year34097339SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year31440262OtherExpensePriorYear
Other Expenses Current Year33218762OtherExpensesCurrentYear
Total Expenses Prior Year65453650TotalExpensesPriorYear
Total Expenses Current Year67622995TotalExpensesCurrentYear
Revenues Less Expenses Prior Year12697175RevenuesLessExpensesPriorYear
Revenues Less Expenses CY13548053RevenuesLessExpensesCY
Total Assets BOY95300648TotalAssetsBOY
Total Assets EOY116270116TotalAssetsEOY
Total Liabilities BOY20784253TotalLiabilitiesBOY
Total Liabilities EOY21352430TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY74516395NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY94917686NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO PROVIDE COMPASSIONATE, HIGH QUALITY, AND ACCESSIBLE HEALTH CARE AND TO PROMOTE A HEALTHY COMMUNITYMissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change0SignificantChange
Expense63483548Expense
Grants306894Grants
Revenue77289346Revenue
DescriptionGOOD SHEPHERD HEALTH CARE SYSTEM (GSHCS) SERVED 2,236 INPATIENTS OVER 5,983 PATIENT-DAYS AND 44,921 OUTPATIENTS IN FISCAL YEAR 2010-11, AS WELL AS 17,528 PATIENTS IN OUR EMERGENCY CENTER. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF GSHCS, NOT ALL INDIVIDUALS HAVE THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. IN RECOGNITION OF THIS, DURING FY 2010-11 GSHCS WROTE OFF TO COLLECTION $4,978,778 VALUED AT CHARGES FOREGONE AS BAD DEBT. DIRECT CHARITY CARE TO OUR COMMUNITY AMOUNTED TO AN ADDITIONAL $7,725,064, VALUED AT CHARGES FOREGONE. GSHCS PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT DEEPLY DISCOUNTED RATES. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES WERE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS DURING FISCAL YEAR 2010-11 WAS $7,725,064 VALUED AT CHARGES FOREGONE.OUR EMERGENCY CENTER IS OPEN AROUND-THE-CLOCK TO ALL COMMUNITY MEMBERS, VISITORS, AND TRAVELERS, WITHOUT REGARD TO ONE'S ABILITY TO PAY.Description
Total Program Service Expense63483548TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096132NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees594NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JAN PETERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5416673416TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1610 NW 11TH STREETAddressLine1
CityHERMISTONCity
StateORState
ZIP Code97838ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
STEVE ELDRIGE
CHAIR2.00XX000
NANCY MABRY
VICE CHAIR2.00XX000
BARBARA PLACE
SECRETARY2.00XX000
BILL ELFERING
TREASURER2.00XX000
BOB CARLSON
DIRECTOR2.00X000
RICHARD LINDNER
DIRECTOR2.00X000
TRICIA FENLEY
DIRECTOR2.00X000
DR DEREK EARL
DIRECTOR2.00X000
SUE DAGGETT
DIRECTOR2.00X000
TOM WAMSLEY
DIRECTOR2.00X000
DR WINN GREGORY
DIRECTOR2.00X000
GLENN CHOWNING
DIRECTOR2.00X000
DENNIS E BURKE
PRESIDENT/CEO40.00X322193052801
JAN D PETER
VP/CFO40.00X130507033478
WILLIAM ALSDURF
VP/CFO (THRU 9-28-10)40.00X20387805277
DAVID T HUGHES
VP/COO40.00174947028927X
DR GARY V TRUPP
PHYSICIAN40.00250229014431X
DR FREDERICK G TINIO
PHYSICIAN40.00327334012596X
DR THOMAS L FARNEY
PHYSICIAN40.00224317023151X
DR THOMAS J HOLT
PHYSICIAN40.0021285307777X
DR JACK M BERTMAN
ER PHYSICIAN40.00244637027722X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2090895TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation206160TotalOtherCompensation
Number Individuals GT100 K39NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MCCORMACK CONSTRUCTION CO
422 SW 6THPENDLETONOR97801CONSTRUCTION1378292
RICK BURRILL
610 NW 11TH STREETHERMISTONOR97838PHYSICAL THERAPY1145433
TUALITIN IMAGING
6464 SW BORELAND RDTUALITINOR97062IMAGING SERVICES1061085
MEDICAL DOCTOR ASSOC INC
PO BOX 277185ATLANTAGA30384PHYSICIAN SERVICES839961
CREDITS INC
461 E MAINHERMISTONOR97838COLLECTION SERVICES432939
FieldValueIRS element (for citing)
Number Of Contractors GT100 K21NumberOfContractorsGT100K
Government Grants51315GovernmentGrants
All Other Contributions91658AllOtherContributions
Total Contributions142973TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
NET PATIENT SERVICES6221107676437876764378
OTHER REVENUE900099689165689165
CAFETERIA900099471814$471,814
DAYCARE900099230706$230,706
LOSS ON SUBSIDIARY446110-164197-164197
FieldValueIRS element (for citing)
Total Program Service Revenue77991866TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1455805TotalRevenueColumn
Exclusion$1,455,805ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1622732Securities
Other32340Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other74668Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1622732Securities
Other-42328Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1580404TotalRevenueColumn
Exclusion$1,580,404ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column81171048TotalRevenueColumn
Related Or Exempt Function Income77289346RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$3,738,729ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total301672Total
Program Services301672ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total5222Total
Program Services5222ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total783973Total
Management And General783973ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total26638911Total
Program Services25166220ProgramServices
Management And General1472691ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1100307Total
Program Services1081048ProgramServices
Management And General19259ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3959928Total
Program Services3816807ProgramServices
Management And General143121ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1614220Total
Program Services1488149ProgramServices
Management And General126071ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total33485Total
Management And General33485ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total55708Total
Management And General55708ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total254969Total
Management And General254969ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total10369953Total
Program Services9589562ProgramServices
Management And General780391ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total121338Total
Program Services112586ProgramServices
Management And General8752ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total10756319Total
Program Services10560025ProgramServices
Management And General196294ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total666154Total
Program Services666154ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total242517Total
Program Services182917ProgramServices
Management And General59600ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total205133Total
Management And General205133ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total518870Total
Program Services518870ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4140975Total
Program Services4140975ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total590289Total
Program Services590289ProgramServices

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionBAD DEBTSDescription
Total4978778Total
Program Services4978778ProgramServices

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total284274Total
Program Services284274ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total67622995Total
Program Services63483548ProgramServices
Management And General4139447ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1291757BOY
EOY4162250EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY9790119BOY
EOY11000597EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY5370439BOY
EOY6177119EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1365994BOY
EOY1512595EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY700641BOY
EOY709516EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis79896380LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec35758427LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY40798480BOY
EOY44137953EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY41528157BOY
EOY50555989EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY-9157005BOY
EOY-6112733EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3612066BOY
EOY4126830EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY95300648BOY
EOY116270116EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5663653BOY
EOY6734044EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY14945496BOY
EOY13927302EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
EOY500000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY175104BOY
EOY191084EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY20784253BOY
EOY21352430EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY74228136BOY
EOY94560726EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY288259BOY
EOY356960EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY74516395BOY
EOY94917686EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY95300648BOY
EOY116270116EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses13548053ReconcilationRevenueExpenses
Reconcilation Other Changes6853238ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis4670941InvestmentCostOrOtherBasis
Other Cost Or Other Basis741457OtherCostOrOtherBasis
Book Value5412398BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis38398646OtherCostOrOtherBasis
Depreciation14373456Depreciation
Book Value24025190BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis31554576OtherCostOrOtherBasis
Depreciation20383446Depreciation
Book Value11171130BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4530760OtherCostOrOtherBasis
Depreciation1001525Depreciation
Book Value3529235BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings44137953TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionESTIMATED COST REPORT SETTLEMENTS PAYABLEDescription
Amount$191,084Amount
FieldValueIRS element (for citing)
Total Of Amounts191084TotalOfAmounts
Total Revenue81171048TotalRevenue
Total Expenses67622995TotalExpenses
Excess Or Deficit For Year13548053ExcessOrDeficitForYear
Net Unrealized GL On Investments3644769NetUnrealizedGLOnInvestments
Other$3,208,469OtherAmount
Total Adjustments6853238TotalAdjustments
Excess Or Deficit Per FS20401291ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt87019928TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments3644769NetUnrealizedGainsInvestments
Other Revenues2574498OtherRevenues
Revenue Not Rptd F9906219267RevenueNotRptdF990
Revenue Subtotal80800661RevenueSubtotal
Investment Expenses Not Included254969InvestmentExpensesNotIncluded
Other Revenues Not Included115418OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt370387RevenueNotRptdOnFinStmt
Total Revenue Per Form99081171048TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt69895807TotExpensesEtcAuditedFinclStmt
Other Expenses Included2829453OtherExpensesIncluded
Expenses Not Rptd F9902829453ExpensesNotRptdF990
Expenses Subtotal67066354ExpensesSubtotal
Investment Expenses Not Included2254969InvestmentExpensesNotIncluded2
Other Expenses Not Included301672OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt556641ExpensesNotRptdOnFinStmt
Total Expenses Per Form99067622995TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE HOSPITAL HAS ADOPTED THE PROVISIONS OF FASB ACCOUNTING STANDARDS CODIFICATION TOPIC AS 740-10, ON JULY 1, 2009. THE IMPLEMENTATION OF THIS STANDARD HAD NO IMPACT ON THE FINANCIAL STATEMENTS. AS OF BOTH THE DATE OF ADOPTION, AND AS OF JUNE 30, 2011, THE UNRECOGNIZED TAX BENEFIT ACCRUAL WAS ZERO. THE HOSPITAL WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS IN INCOME TAX EXPENSE IF INCURRED. THE HOSPITAL IS NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2007 AND STATE EXAMINATIONS FOR YEARS BEFORE 2007.
PART XI, LINE 8 - OTHER ADJUSTMENTS:INTERCOMPANY ELIMINATION ENTRY ON FINANCIAL STATEMENTS 3,208,469.
PART XII, LINE 2D - OTHER ADJUSTMENTS:REVENUES OF CONSOLIDATED SUBSIDIARY 2,876,170. CHARITABLE DONATIONS RECLASS TO EXPENSES -301,672.
PART XII, LINE 4B - OTHER ADJUSTMENTS:INTEREST INCOME ELIMINATED FOR FINANCIAL STATEMENTS 210,914. CONTRIBUTIONS RECORDED IN FUND BALANCE FOR FINANCIAL STATEMENTS 68,701. LOSS IN SUBSIDIARY -164,197.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:EXPENSES OF CONSOLIDATED SUBSIDIARY 2,829,453.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:CHARITABLE DONATIONS RECLASS TO EXPENSES 301,672.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage150.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3938501TotalCommunityBenefitExpense
Net Community Benefit Expense3938501NetCommunityBenefitExpense
Percent Of Total Expense0.06290PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense10004527TotalCommunityBenefitExpense
Direct Offsetting Revenue10262190DirectOffsettingRevenue
Net Community Benefit Expense-257663NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense13943028TotalCommunityBenefitExpense
Direct Offsetting Revenue10262190DirectOffsettingRevenue
Net Community Benefit Expense3680838NetCommunityBenefitExpense
Percent Of Total Expense0.06290PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense269786TotalCommunityBenefitExpense
Direct Offsetting Revenue17937DirectOffsettingRevenue
Net Community Benefit Expense251849NetCommunityBenefitExpense
Percent Of Total Expense0.00410PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense175313TotalCommunityBenefitExpense
Direct Offsetting Revenue16266DirectOffsettingRevenue
Net Community Benefit Expense159047NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense251672TotalCommunityBenefitExpense
Net Community Benefit Expense251672NetCommunityBenefitExpense
Percent Of Total Expense0.00410PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense696771TotalCommunityBenefitExpense
Direct Offsetting Revenue34203DirectOffsettingRevenue
Net Community Benefit Expense662568NetCommunityBenefitExpense
Percent Of Total Expense0.01080PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense14639799TotalCommunityBenefitExpense
Direct Offsetting Revenue10296393DirectOffsettingRevenue
Net Community Benefit Expense4343406NetCommunityBenefitExpense
Percent Of Total Expense0.07370PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$2,538,351BadDebtExpenseAmount
Amount Attributable To248939AmountAttributableTo
Amount Reimbursed By Medicare8458732AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare8759068CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-300336MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1GOOD SHEPHERD HEALTH CARE SYSTEMBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1610 NW 11TH STREETAddressLine1
CityHERMISTONCity
StateORState
ZIP Code97838ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIREDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities3NumberOfOtherFacilities

Other Facilities OtherFacilities (3 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
GOOD SHEPHERD MEDICAL GROUP
610 NW 11TH STREETHERMISTONOR97838CLINIC
VANGE JOHN MEMORIAL HOSPICE
610 NW 11TH STREETHERMISTONOR97838HOSPICE
TLC HOME HEALTH
610 NW 11TH STREETHERMISTONOR97838HOME HEALTH

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: THE ORGANIZATION PROVIDES DISCOUNTS ON A SLIDING SCALE FROM 10% TO 100% BASED ON AN INDIVIDUAL'S INCOME LEVEL.
PART I, LINE 7: THE CHARITY CARE INCLUDED IN PART I, LINE 7A IS BASED ON THE COST TO CHARGE RATIO USING WORKSHEET 2.THE UNREIMBURSED MEDICAID IN PART I, LINE 7B IS BASED ON GROSS CHARGES AND CLAIMS FROM THE MEDICAID COST REPORT.THE COMMUNITY HEALTH SERVICES, EDUCATION AND CONTRIBUTIONS IN PART I, LINES 7E, 7F AND 7I ARE BASED ON ACTUAL EXPENSES.
PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATION ON PART 1, LINE 7, COLUMN F WAS $4,978,778.
PART III, LINE 4: FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE:RECEIVABLES ARISING FROM REVENUES FROM SERVICES TO PATIENTS ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND CONTRACTUAL ADJUSTMENTS BASED ON EXPERIENCE, THIRD-PARTY CONTRACTUAL REIMBURSEMENT ARRANGEMENTS, AND ANY UNUSUAL CIRCUMSTANCES WHICH MAY AFFECT THE ABILITY OF PATIENTS TO MEET THEIR OBLIGATIONS. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. RECEIVABLES ARE STATED IN THE BALANCE SHEET LESS SUCH ALLOWANCES.THE BAD DEBT EXPENSE WAS CONVERTED TO COST USING THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2.THE ORGANIZATION ESTIMATES THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY PATIENTS TO BE $248,939. THIS ESTIMATE IS BASED ON AN OVERALL CHARITY CARE PERCENTAGE OF GROSS REVENUE.
PART III, LINE 8: MEDICARE ALLOWABLE COST IS BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES & REGULATIONS SET FORTH BY CMS. THE ORGANIZATION BELIEVES THE ENTIRE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT AS THEY PROVIDE SERVICES TO MEDICARE PATIENTS KNOWING THEY WILL NOT RECOVER THE ENTIRE COST OF THE SERVICES. HOWEVER, THEY CONTINUE TO PROVIDE THESE SERVICES AS THE ELDERLY ARE CONSIDERED A CHARITABLE CLASS.
PART III, LINE 9B: THE ORGANIZATION'S COLLECTION PROCEDURES REQUIRES A FINANCIAL ADVISOR TO WORK WITH ANY PATIENT WHO IS IDENFITIED AS POTENTIALLY BEING ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SENDING THE ACCOUNT TO COLLECTION. IF DURING THE COURSE OF THE COLLECTION PROCESS THE COLLECTION AGENCY DETERMINES AN ACCOUNT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, IT IS REFERRED BACK TO THE HOSPITAL FOR FURTHER DISCUSSION WITH THE PATIENT OR FOR WRITE OFF. ALL FURTHER COLLECTION ACTION IS CEASED.
PART VI, LINE 2: OUR COMMUNITY HEALTHCARE NEEDS ASSESSMENT PROCESS HAS FIVE COMPONENTS THAT ARE CONDUCTED EVERY OTHER YEAR:1. THE ONGOING COLLECTION AND EVALUATION OF COMMUNITY FEEDBACK FROM PATIENT SURVEYS AND COMMENT FORMS.2. PATIENT AND COMMUNITY-MEMBER HEALTHCARE NEEDS FOCUS GROUPS.3. A HEALTHCARE NEEDS SURVEY COMPLETED BY EMPLOYERS AND OTHER COMMUNITY LEADERS.4. A FORMAL TELEPHONE SURVEY.5. A DEMOGRAPHIC STUDY CONDUCTED BY THE OREGON OFFICE OF RURAL HEALTH.
PART VI, LINE 3: OUR FINANCIAL COUNSELORS INFORM AND EDUCATE THE PEOPLE WE SERVE WITH RESPECT TO CHARITY CARE AND GOVERNMENTAL ASSISTANCE PROGRAMS. ALL PATIENTS AND RESPONSIBLE PARTIES, WHERE POSSIBLE, ARE APPRISED OF THE AVAILABILITY OF FINANCIAL COUNSELING SERVICES AT THE TIME AND POINT OF SERVICE. WE HAVE ARRANGED OUR PATIENT FLOW TO MAXIMIZE THE CONVENIENCE OF VISITING OUR FINANCIAL COUNSELORS AS PART OF THE GOOD SHEPHERD TREATMENT REGIME.IN ADDITION, THE FINANCIAL ASSISTANCE POLICY IS PROVIDED, IN WRITING TO THE PATIENTS UPON ADMISSION TO THE HOSPITAL FACILITY. IT IS ALSO POSTED IN THE EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICES. A COPY OF THE POLICY IS ALSO ATTACHED TO BILLING INVOICES AND AVAILABLE UPON REQUEST.
PART VI, LINE 4: GOOD SHEPHERD HEALTH CARE SYSTEM (GSHCS) IS THE CORPORATE NAME FOR AN ORGANIZATION MADE UP OF SEVERAL ENTITIES, INCLUDING GOOD SHEPHERD MEDICAL CENTER, VANGE JOHN MEMORIAL HOSPICE, TLC HOME HEALTH, GOOD SHEPHERD MEDICAL GROUP, GOOD SHEPHERD CLINIC PHARMACY, GOOD SHEPHERD MEDICAL FOUNDATION, AND GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION. GOOD SHEPHERD SERVES A CORE POPULATION OF ALMOST 50,000 PEOPLE IN THE CITY OF HERMISTON, OREGON AND IN 14 OUTLYING SMALLER TOWNS WITHIN A ROUGH 50-MILE RADIUS. THIS POPULATION IS LARGELY RURAL, WITH AGRICULTURE DOMINATING INDUSTRIAL ENTERPRISES.THE AVERAGE HOUSEHOLD INCOME IN HERMISTON IS $35,865.17.1% OF RESIDENTS HAVE INCOMES BELOW FEDERAL POVERTY GUIDELINES.31.3% OF RESIDENTS IDENTIFY AS NON-WHITE HISPANIC ETHNICITY, WITH A SIZABLE NUMBER OF SPANISH-PRIMARY SPEAKERS.
PART VI, LINE 6: GOOD SHEPHERD MAINTAINS OPEN ACTIVE, AFFILIATE, AND COURTESY MEDICAL STAFFS, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED AND INTERESTED PHYSICIANS IN THE COMMUNITIES WE SERVE. GSHCS IS GOVERNED BY A TWELVE-MEMBER BOARD OF TRUSTEES. THE BOARD IS COMPRISED OF INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WITH AN EMPHASIS ON MAINTAINING A TRUE CROSS-SECTION OF CORE POPULATION COMMUNITIES WITHIN ITS MEMBERSHIP.OUR SURPLUS FUNDS ARE USED TO FUND COMMUNITY HEALTH EDUCATION CLASSES, AS WELL AS FUNDING BUILDING AND EQUIPMENT UPGRADES TO MAINTAIN THE HIGHEST QUALITY HEALTHCARE FOR OUR COMMUNITY. SURPLUS FUNDS ARE ALSO APPLIED TO ONGOING PROFESSIONAL EDUCATION AMONG OUR CLINICAL STAFF TO REMAIN CURRENT IN THE BEST PRACTICES OF MODERN HEALTHCARE. WE OPERATE A FULLY-STAFFED 24-HOUR EMERGENCY ROOM, AVAILABLE TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. GOOD SHEPHERD OPERATES TWO FOUNDATIONS THAT PROVIDE FUNDS TO APPROPRIATE COMMUNITY GROUPS AND ACTIVITIES, AS WELL AS PROVIDING SCHOLARSHIP FUNDS TO LOCAL RESIDENTS ESTABLISHING OR FURTHERING HEALTHCARE-RELATED EDUCATION. WE LIVE OUR MISSION TO PROMOTE A HEALTHY COMMUNITY. GOOD SHEPHERD IS THE HOST AND DRIVING FORCE BEHIND THE GOOD SHEPHERD WELLNESS COALITION, A GRASS-ROOTS GROUP OF COMMUNITY LEADERS THAT IDENTIFY, ANALYZE, AND ADDRESS PRESSING HEALTHCARE ISSUES IN THE COMMUNITY.WE MAINTAIN A DIALOGUE WITH THE PEOPLE WE SERVE THROUGH A BIWEEKLY RADIO SHOW, WITH AN EMPHASIS ON WELLNESS AND PREVENTATIVE CARE.GOOD SHEPHERD HOSTS AN ANNUAL FAMILY HEALTH AND FITNESS DAY, WITH FREE ACCESS TO HEALTHCARE PROFESSIONALS, FREE SCREENINGS, AND A WEALTH OF HEALTH AND WELLNESS INFORMATION AVAILABLE TO THE PUBLIC.WE ARE ACTIVE IN COMMUNITY HEALTH-RELATED ACTIVITIES, INCLUDING THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE, THE MARCH OF DIMES' MARCH FOR BABIES, AND THE UMATILLA COUNTY FAIR, WHERE WE PROVIDE HEALTH INFORMATION AND HEALTHCARE-RELATED GIVEAWAYS.
ORREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1GOOD SHEPHERD COMMUNITY HEALTH FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1610 NW 11TH STREETAddressLine1
CityHERMISTONCity
StateORState
ZIP Code97838ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient931170546EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant250000AmountOfCashGrant
Purpose Of GrantCOMMUNITY SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients10NumberOfRecipients
Amount Of Cash Grant5222AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: GRANTS ARE AWARDED TO EMPLOYEES TO HELP FURTHER THEIR EDUCATION IN A FIELD THAT WOULD POTENTIALLY BENEFIT THE ORGANIZATION IN THE FUTURE ONCE THE EMPLOYEE HAS COMPLETED THEIR EDUCATION. EACH EMPLOYEE MUST REPORT BACK WITH A GRADE REPORT SHOWING THEIR PROGRESS/COMPLETION OF THEIR COURSE OF STUDY. GRANTS ARE ALSO AWARDED TO GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION, A RELATED ORGANIZATION WHICH IS TAX EXEMPT UNDER SECTION 501(C)(3).Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DENNIS E BURKE
2782410187500252020277220263030376218000
JAN D PETER
1223280817900084000263030165210000
WILLIAM ALSDURF
1846100192680000056850209563000
DAVID T HUGHES
160219014728000107810193700205098000
DR GARY V TRUPP
2454100481900000150550265284000
DR FREDERICK G TINIO
3193870794700000132200340554000
DR THOMAS L FARNEY
2168380747900023151000247468000
DR THOMAS J HOLT
212853000000083770221230000
DR JACK M BERTMAN
2446370000000289460273583000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1THE HOSPITAL FACILITY AUTHORITY OF UMATILLA COUNTY OREGONBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN930425580IssuerEIN
Date Issued2007-08-29DateIssued
Issue Price17786918IssuePrice
Description Of PurposeNEW CONSTRUCTION, EXPANSION AND MAJOR EQUIPMENT PURCHASESDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds17786918TotalProceeds
Capital Expenditures13813512CapitalExpenditures
Amount Unspent3973397AmountUnspent
Year Of Subst Completion2010YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs0PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested1GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CREDITS INCBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipCOMPANY IS OWNED 100% BY A BOARD MEMBERRelationship
Amount Of Transaction463934AmountOfTransaction
Description Of TransactionCHARGES FOR COLLECTION SERVICESDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
NEW PROGRAM SERVICESFORM 990, PART III, LINE 2TELEMEDICINE SERVICES BEGAN JULY 2010. TELEMEDICINE IS THE USE OF MEDICAL INFORMATION EXCHANGED FROM ONE SITE TO ANOTHER VIA ELECTRONIC COMMUNICATIONS TO IMPROVE PATIENTS' HEALTH STATUS. THIS IS RELATED TO THEIR EXEMPT PURPOSE OF PROVIDING QUALITY HEALTH CARE SERVICES TO THE COMMUNITY IT SERVES.
FORM 990, PART VI, SECTION A, LINE 8BTHERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11THE RETURN IS REVIEWED BY THE CFO AND CONTROLLER AND PRESENTED ON A HIGH LEVEL TO THE BOARD OF DIRECTORS. A FINAL COPY IS PROVIDED TO THE BOARD BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES WITH CONFLICTS ARE EXPECTED TO DISCLOSE CONFLICTS OF INTEREST ON A VOLUNTARY BASIS AND REFRAIN FROM DISCUSSION AND/OR VOTING ON RELATED MATTERS AS NECESSARY. THESE DISCLOSURES ARE REVIEWED AND DETERMINED TO EXIST OR NOT TO EXIST BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15ATHE CEO'S COMPENSATION IS APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS BASED ON SURVEY INFORMATION. THIS PROCESS IS COMPLETED ANNUALLY IN THE MONTH OF OCTOBER. THE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES IS DETERMINED BY THE CEO BASED ON SURVEY INFORMATION. THIS PROCESS IS COMPLETED ANNUALLY ON THE ANNIVERSARY DATE OF THE INDIVIDUAL'S HIRE DATE.
FORM 990, PART VI, SECTION C, LINE 19THESE DOCUMENTS ARE NOT AVAILABLE TO THE GENERAL PUBLIC.
FORM 990, PART VII, COLUMN (B)IN ADDITION TO THE HOURS REPORTED ON FORM 990, PART VII, THE FOLLOWING INDIVIDUALS DEVOTED TIME TO GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION, A RELATED ORGANIZATION, EACH WEEK. GLENN CHOWNING - 1 HOUR TRICIA FENLEY - 1 HOUR RICHARD LINDNER - 2 HOURS TOM WAMSLEY - 1 HOUR
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 3,644,769. INTERCOMPANY ELIMINATION ENTRY ON FINANCIAL STATEMENTS 3,208,469. TOTAL TO FORM 990, PART XI, LINE 5: 6,853,238.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION
610 NW 11TH STREETHERMISTONOR97838931170546FUNDRAISINGOR501(C)(3)LINE 11A, IGOOD SHEPHERD HEALTH CARE SYSTEM1
GOOD SHEPHERD MEDICAL FOUNDATION
610 NW 11TH STREETHERMISTONOR97838930844485FUNDRAISINGOR501(C)(3)LINE 7GOOD SHEPHERD HEALTH CARE SYSTEM1

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1GOOD SHEPHERD MEDICAL SERVICE CORPBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1610 NW 11TH STREETAddressLine1
CityHERMISTONCity
StateORState
ZIP Code97838ZIPCode
FieldValueIRS element (for citing)
EIN930688940EIN
Primary ActivityRETAIL PHARMACYPrimaryActivity
Legal Domicile StateORLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Share Of Total Income-375111ShareOfTotalIncome
Share Of EOY Assets3286520ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
GOOD SHEPHERD MEDICAL SERVICE CORP
A210914BOOK VALUE
GOOD SHEPHERD MEDICAL SERVICE CORP
N374120BOOK VALUE
GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION
B250000BOOK VALUE
GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION
C
GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION
M
GOOD SHEPHERD COMMUNITY HEALTH FOUNDATION
O