2012-08-15T15:10:46-05:00 2011-09-30 BKD LLP 2800 POST OAK BLVD STE 3200 HOUSTON TX 77056 990 2010-10-01 751041154 THE GOOD SHEPHERD HOSPITAL INC GOOD 9033152000 700 E MARSHALL AVENUE LONGVIEW TX 75601 PAT KEEL 9033151820 2012-08-15 1 7134994600 2010 2016-02-24 21:20:13Z GOOD SHEPHERD MEDICAL CENTER PAT KEEL 700 EAST MARSHALL AVENUE LONGVIEW TX 75601 365914604 0 X WWW.GSMC.ORG X 1959 TX GOOD SHEPHERD MEDICAL CENTER IS A NOT-FOR-PROFIT COMMUNITY HOSPITAL DEDICATED TO CREATING A HEALTHIER FUTURE FOR THE RESIDENTS OF LONGVIEW AND NORTHEAST TEXAS. TO ENSURE THE CONTINUED WELL-BEING OF THE COMMUNITY, THE MEDICAL CENTER STRIVES TO PROVIDE QUALITY, COMPASSIONATE AND COMPREHENSIVE HEALTHCARE SERVICES TO THE WHOLE PERSON: BODY, MIND AND SPIRIT.GOOD SHEPHERD EXISTS TO CARE FOR ALL THOSE WHO PRESENT THEMSELVES, WHATEVER THEIR NEED, REGARDLESS OF RACE, CREED OR GENDER. THE MEDICAL CENTER PROVIDES HEALTH SERVICES TO THE MEDICALLY UNDERSERVED AS FAR AS RESOURCES PROVIDE, WHILE MAINTAINING THE LONG-TERM INTEGRITY OF SERVICE TO THE COMMUNITY.THE LEADERSHIP WILL REMAIN EVER COGNIZANT OF THE MEDICAL CENTER'S INTEGRAL ROLE IN THE COMMUNITY AND ITS RESPONSIBILITY TO DEMONSTRATE GOOD STEWARDSHIP OF THE HEALTH OF ITS RESIDENTS WHILE PROVIDING SERVICES AT COMPETITIVE COSTS. INHERENT WITHIN THIS MISSION IS A RESPONSIBILITY TO MAINTAIN THE ORGANIZATION'S FINANCIAL SOLVENCY. 14 13 2523 160 9944692 -255212 1029239 1062766 357686699 361528374 347493 -1371673 -35294 1681200 359028137 362900667 0 0 0 0 103998751 111659850 0 0 0 247333967 232810295 351332718 344470145 7695419 18430522 159034605 165107526 176091053 176601958 -17056448 -11494432 X GOOD SHEPHERD MEDICAL CENTER PROVIDES SERVICES TO PATIENTS QUALIFYING UNDER THE CHARITY POLICY AND PROVIDES QUALITY TERTIARY HEALTH SERVICES TO THE RESIDENTS OF NORTHEAST TEXAS. 0 0 274276224 361528374 GOOD SHEPHERD MEDICAL CENTER IS IMPACTED BY THE SIGNIFICANT CHANGES IN HEALTHCARE TODAY. TO ENSURE THAT GOOD SHEPHERD MEDICAL CENTER IS STRONGLY POSITIONED FOR THE FUTURE, THE FOLLOWING MAJOR STRATEGIES HAVE BEEN ADOPTED:- IMPROVE CLINICAL QUALITY OUTCOMES AND CUSTOMER SERVICE- IMPROVE OPERATING PERFORMANCE AND REDUCE COSTS- DEVELOP A HEALTH SYSTEM THAT PROVIDES A FULL CONTINUUM OF HOSPITAL, PHYSICIAN AND INSURANCE SERVICES- IMPROVE THE HEALTH STATUS OF THE SERVICE AREA- IMPROVE THE CAPABILITY AND ADAPTABILITY OF EMPLOYEESGOVERNED BY A VOLUNTARY BOARD OF DIRECTORS, GOOD SHEPHERD MEDICAL CENTER HAS A DIRECT LINK TO SOLICIT COMMUNITY INVOLVEMENT IN DECISION MAKING. THE BOARD OF DIRECTORS IS COMPOSED OF GOOD SHEPHERD MEDICAL CENTER'S PRESIDENT AND CHIEF EXECUTIVE OFFICER AND TWELVE MEMBERS OF THE COMMUNITY WHO SERVE ON A VOLUNTARY BASIS TO FURTHER THE MISSION OF GOOD SHEPHERD MEDICAL CENTER. THESE MEMEBERS REPRESENT LOCAL BUSINESS, INDUSTRY, EDUCATION, MEDICAL SERVICES AND CONSUMERS-AT-LARGE. THE BOARD OF DIRECTORS PROVIDES PERPETUAL COMMUNICATION OF THE CONCERNS AND HEALTHCARE NEEDS OF THE GREATER LONGVIEW COMMUNITY.AS PART OF OUR ONGOING COMMITMENT TO THE UNDERSERVED POPULATION OF GOOD SHEPHERD'S SERVICE AREA, THE BOARD OF DIRECTORS ESTABLISHED CRITERIA FOR FINANCIAL ASSISTANCE CONSISTENT WITH THE ORGANIZATION'S MISSION AND FINANCIAL RESOURCES.FINANCIAL ASSISTANCE IS PROVIDED TO ALL PATIENTS, WITHOUT REGARD TO RACE, CREED, GENDER OR NATIONAL ORIGIN, WHO ARE CLASSIFIED AS FINANCIALLY INDIGENT ACCORDING TO GOOD SHEPHERD'S ELIGIBILITY GUIDELINES AND WHO PRESENT THEMSELVES FOR CARE AT GOOD SHEPHERD MEDICAL CENTER AND ITS REGIONAL SYSTEM OF SERVICES. MANY FACTORS SUCH AS ALL SOURCES OF INCOME, EMPLOYMENT STATUS, FAMILY SIZE, AMOUNT OF THE PATIENT'S ACCOUNT AND HEALTHCARE NEEDS ARE ALL TAKEN INTO CONSIDERATION WHEN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. GOOD SHEPHERD MEDICAL CENTER MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF FINANCIAL ASSISTANCE IT PROVIDES TO THE COMMUNITIES IT SERVES.- IN FISCAL YEAR 2011, CHARITY CARE BASED ON ESTABLISHED RATES WAS RENDERED IN THE AMOUNT OF $81,079,000. THIS AMOUNT ENCOMPASSES THE CARE OF MORE THAN 11,920 PATIENT VISITS AND REPRESENTS APPROXIMATELY 23 PERCENT OF NET PATIENT REVENUE.- GOOD SHEPHERD PROVIDED CHARITY CARE, GOVERNMENT-SPONSORED INDIGENT HEALTHCARE AND OTHER COMMUNITY BENEFITS COSTING $85,634,000 OR MORE THAN 25 PERCENT OF THE TOTAL OPERATING EXPENSES.- GOOD SHEPHERD'S BAD DEBT EXPENSE FOR 2011 WAS MORE THAN $96,283,000 OR ALMOST 27 PERCENT OF NET PATIENT REVENUE.GOOD SHEPHERD MEDICAL CENTER ALSO PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS, AS WELL AS OTHER FEDERAL, STATE AND LOCAL HEALTHCARE REIMBURSEMENT PROGRAMS FOR THOSE IN FINANCIAL NEED. THESE PROGRAMS ACCOUNT FOR MORE THAN 59 PERCENT OF THE MEDICAL CENTER'S GROSS PATIENT REVENUE. 274276224 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 109 0 1 2523 1 1 1 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JANET ANDERSEN 9033155177 700 E MARSHALL AVE LONGVIEW TX 75601 EDWARD D BANOS 2.00 X X 0 695940 8409 MARK BOON 2.00 X X 0 0 0 MICHAEL BURNS 2.00 X 0 0 0 JOHN DIPASQUALE MD 2.00 X 0 0 0 KELLYN DRAYER 2.00 X 0 0 0 DAN ECKERMAN 2.00 X 0 0 0 PAT FLORENCE 2.00 X 0 0 0 WILLIAM M HOLDA EDD 2.00 X X 0 0 0 CR MARTIN MD 2.00 X 0 0 0 LES MENDICELLO 2.00 X 0 0 0 HOMER ROCKMORE 2.00 X 0 0 0 LAWRENCE ROE MD 2.00 X 0 0 0 THOMAS P TIBILETTI 2.00 X 0 0 0 STAN UPCHURCH MD 2.00 X 0 0 0 PAT KEEL 2.00 X 0 346520 4153 MARION BENSON 2.00 X 0 199754 8834 KENNETH CUNNINGHAM 2.00 X 0 262724 16074 TROY THIBODEAUX 2.00 X 0 327812 6125 KAREN WATTS 2.00 X 0 308153 5337 BETH CHRISMER 2.00 X 0 146281 7434 RUBY BREWER 2.00 X 0 204432 16444 RICHARD LEE HOLLADAY 40.00 X 291063 0 12846 ALAN GUEDRY 40.00 X 280957 0 12370 JOHN COX 40.00 X 241202 0 15627 JOHN E MOBLEY III 40.00 X 238956 0 12490 DAVID BARKER 40.00 X 216727 0 8460 1268905 2345335 127169 37 0 1 0 GSHS ADMINISTRATIVE SERVICES ORG 700 MARSHALL AVE LONGVIEW TX 75601 ADMINISTRATIVE SERVICES 38987376 LONGVIEW EMERGENCY MEDICINE 9229 LBJ FREEWAY DALLAS TX 75243 ER PHYSICIANS 9889446 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 5331524 HOSPITAL HOUSEKEEPING SYSTEMS LTD PO BOX 826 SAN ANTONIO TX 78293 HOUSEKEEPING SERVICES 5181973 AMERICAN EXPRESS 2976 W CORPORATE LAKES BLVD WESTON FL 33331 CREDIT CARD SERVICES 4522701 58 1062766 1062766 NET PATIENT REVENUE 621110 335604772 335604772 GOVERNMENT DSH AND TRA 900099 10183838 10183838 LAB OUTREACH REVENUE 621500 9544931 9544931 WELLNESS CENTER REVENU 624100 3422186 3022425 399761 LEASE REVENUE 532420 1725252 1725252 1047395 1047395 361528374 272853 272853 384000 557380 -173380 -173380 -173380 812031 2456557 -1644526 -1644526 -1644526 CAFETERIA 722210 1792993 1792993 VENDING 722210 58091 58091 3496 3496 1854580 362900667 353434766 9944692 -1541557 93497652 71311464 22186188 899673 701745 197928 10489270 8181631 2307639 6773255 5283139 1490116 12500092 12500092 29248 29248 100618 100618 53079170 37084761 15994409 2230278 2801 2227477 1310387 917271 393116 3669681 3669681 2182009 1507841 674168 97912 68538 29374 5063036 5063036 7828390 5888348 1940042 193995 135342 58653 PROVISION FOR BAD DEBTS 96282726 96282726 MEDICAL SUPPLIES & EQUI 43801984 43801984 LEASES AND RENTALS 3144377 2201064 943313 GAS & OIL 196949 137864 59085 EDUCATION EXPENSES 98182 68727 29455 1001261 700978 300283 344470145 274276224 70193921 0 -1715664 -1374386 5047036 11779589 42147616 38634770 7264954 7982049 1443261 1215461 176013763 113313486 68273081 62700277 25264771 25760172 6551661 7008576 3046075 2787015 1711814 8614003 159034605 165107526 19454880 24108435 128727745 122515292 1606359 27908428 28371872 176091053 176601958 X -23046506 -17007353 5990058 5512921 -17056448 -11494432 159034605 165107526 X 18430522 -12868506 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2885 0 0 0 2885 0 18635 614744 633379 93122254 51701868 41420386 5560306 5001161 559145 75207967 56610457 18597510 1489857 1489857 62700277 INTERCOMPANY RECEIVABLES 8614003 8614003 INTERCOMPANY PAYABLES 4889573 ESTIMATED SELF-INSURANCE COSTS, CURRENT 213189 ESTIMATED SELF-INSURANCE COSTS 3431992 INTEREST RATE SWAP AGREEMENT 18075456 DUE TO AFFILIATES 1761662 28371872 362900667 344470145 18430522 -392136 -12476370 -12868506 5562016 267480732 557380 557380 266923352 95977315 95977315 362900667 248744798 557380 557380 248187418 96282726 96282726 344470144 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MEDICAL CENTER HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE MEDICAL CENTER IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE MEDICAL CENTER FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. WITH A FEW EXCEPTIONS, THE MEDICAL CENTER IS NO LONGER SUBJECT TO U.S. FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2008. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -3,077,546. TRANSFERS TO AFFILIATES -8,633,804. CONTRIBUTIONS OF OR FOR PROPERTY AND EQUIPMENT 774,883. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION -477,137. CONTRIBUTIONS IN NET ASSETS -1,062,766. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 557,380. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 96,282,726. INTEREST RATE SWAP -228,677. CONTRIBUTIONS 1,062,766. SHARE OF LOSSES IN JOINT VENTURE -1,661,604. GAIN ON SALE 17,077. INVESTMENT RETURN 501,530. OTHER REVENUE 3,497. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 557,380. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 96,282,726. 1 1 1 X 225.000000000000 1 X 225.000000000000 1 1 1 0 1 1 16440690 309198 16131492 0.06500 34532148 34638878 -106730 0.00000 2849169 2659565 189604 0.00080 53822007 37607641 16214366 0.06580 42 2635 882318 882318 0.00360 122 5959 1269225 1269225 0.00510 164 8594 2151543 2151543 0.00870 164 8594 55973550 37607641 18365909 0.07450 1 19526137 97195138 71742439 25452699 X 1 1 1 GOOD SHEPHERD ASC AMBULATORY SURGICAL 0.31300 2 LONGVIEW ER ASSOC EMERGENCY ROOM COVERAGE 1.00000 3 ACOL ANESTHESIA SERVICES 1.00000 4 DCOL DIAGNOSTIC SERVICES 1.00000 1 1 GOOD SHEPHERD MEDICAL CENTER

700 EAST MARSHALL AVE LONGVIEW TX 75601

X X X NOT REQUIRED 1 PART I, L7 COL(F): BAD DEBT EXPENSE IN THE AMOUNT OF $96,282,726 WAS NOT INCLUDED IN TOTAL EXPENSE USED TO COMPUTE THE PERCENTAGE REPORTED IN PART I, LINE 7, COL(F).PART III, LINE 2:LINE 2 IS BAD DEBT EXPENSE FROM OUR AUDITED FINANCIAL STATEMENTS MULTIPLIED BY THE COMPUTED COST TO CHARGE RATIO. WE DID NOT INCLUDE ANY BAD DEBT AMOUNTS IN COMMUNITY BENEFIT. PART II: GOOD SHEPHERD MEDICAL CENTER MAINTAINS A PRESENCE TO PROVIDE HEALTHCARE INFORMATION TO COMMUNITIES THROUGHOUT THE REGION. IN ADDITION, THE ORGANIZATION HOSTS AN ANNUAL HEALTH FAIR OFFERING FREE HEALTH SCREENINGS. GOOD SHEPHERD ALSO OFFERS DISCOUNTED MAMMOGRAMS EACH MONTH, FREE PROSTRATE SCREENINGS ANNUALLY, AND WAS INTEGRALLY INVOLVED IN ESTABLISHING THE MAYOR'S FITNESS COUNCIL. THROUGH THIS FITNESS COUNCIL'S ACTIVITIES AND SUPPORTED BY GOOD SHEPHERD, LONGVIEW HAS BEEN NAMED THE "FITTEST CITY IN TEXAS" FOR THE PAST TWO YEARS. THE COUNCIL PROMOTES ACTIVE LIFESTYLES AND FITNESS THROUGH WALKING AND REGULAR EXERCISE. PART III, LINE 4: IN 2011, THE MEDICAL CENTER CHANGED ITS METHOD OF PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR UNCOLLECTIBLE ACCOUNTS AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN ACCORDANCE WITH ACCOUNTING STANDARDS UPDATE (ASU) 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES. THE MAJOR CHANGES ASSOCIATED WITH ASU 2011-07 ARE TO RECLASSIFY THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO PATIENT SERVICE REVENUE TO A DEDUCTION FROM PATIENT SERVICE REVENUE AND TO PROVIDE ENHANCED DISCLOSURES AROUND THE MEDICAL CENTERS POLICIES RELATED TO UNCOLLECTIBLE ACCOUNTS. THE CHANGE HAD NO EFFECT ON PRIOR YEAR NET ASSETS. SEE THE TABLES BELOW FOR CHANGES IN THE STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS (DEFICIT) AS A RESULT OF ADOPTING ASU 2011-07. PART III, LINE 8: SOURCE OF INFORMATION ON LINE 6 IS THE FYE 09/30/11 MEDICARE COST REPORT. THE SUM OF MEDICARE PART A ALLOWABLE COSTS REPORTED ON WORKSHEET D-1, PART II (FOR BOTH INPATIENT ACUTE PPS AND INPATIENT REHAB FACILITY) AND WORKSHEET DV, COLUMN 9.01 FOR MEDICARE OUTPATIENT PPS SERVICES. SINCE ALLOWABLE COSTS ARE NOT DETERMINED FOR SERVICES RENDERED TO MEDICARE PATIENTS ENROLLED IN MEDICARE ADVANTAGE (MEDICARE PART C) OR FOR PHYSICIAN SERVICES (SUCH AS EMERGENCY ROOM DOCTORS) BILLED UNDER MEDICARE PART B, NEITHER THE REVENUES OR COSTS RELATED TO THESE SERVICES HAVE BEEN INCLUDED ON LINES 5 OR 6.MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE FYE 9/30/2011 FILED COST REPORT. THE COST REPORT USES FINANCIAL AND STATISTICAL DATA TO DEVELOP PER DIEMS AND COST TO CHARGE RATIOS THAT ULTIMATELY DETERMINE ALLOWABLE MEDICARE INPATIENT AND OUTPATIENT COSTS AND REIMBURSEMENTS. PART III, LINE 9B: ALL PATIENTS WHO ARE UNDERINSURED OR UNINSURED WILL BE EVALUATED FOR GOVERNMENT PROGRAMS, PAYMENT PLANS, AND FINANCIAL ASSISTANCE. IF ALL ATTEMPTS FAIL, WE WILL CONSIDER EACH ACCOUNT MEETING CERTAIN CRITERIA FOR FINANCIAL ASSISTANCE. ANY ACCOUNT THAT HAS A BALANCE GREATER THAN $10,000 AND HAS NOT QUALIFIED FOR MEDICAID OR COUNTY PROGRAMS WILL BE REVIEWED ON A CASE BY CASE BASIS FOR CHARITY CONSIDERATION. CREDIT REPORTS WILL BE RUN AND SUBMITTED FOR REVIEW. IF THE PATIENT HAS A CREDIT SCORE BELOW 650, AND THE BALANCE IS COMPLETELY OWED BY TEH GUARANTOR/PATIENT ON ANY ONE ACCOUNT, CHARITY WILL BE CONSIDERED AT 100%. WRITE-OFFS WILL BE MONITORED THROUGH A SPECIFIC CODE, TO MONITOR AND EVALUATE AS NEEDED FOR CHANGES OR UPDATES. IF AT ANYTIME RECOVERIES ARE OBTAINED AFTER WRITE-OFF, THE CHARITY ADJUSTMENT WILL BE REVERSED AND ADDITIONAL REVIEW OF THE ACCOUNT WILL BE REQUIRED. PART VI, LINE 2: THE UNITED WAY CONDUCTS A NEEDS ASSESSMENT SURVEY EVERY TWO YEARS TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY. GOOD SHEPHERD USES THIS DATA TO AUGMENT INFORMATION GATHERED BASED ON UTILIZATION OF SERVICES. PART VI, LINE 3: AS PATIENTS ENTER OUR FACILITY, SIGNAGE IS POSTED IN DESIGNATED AREAS WHICH STATE OUR POLICY TO PROVIDE CHARITY CARE TO THOSE PATIENTS WHO MEET ELIGIBILITY REQUIREMENTS. BUSINESS OFFICE AND REGISTRATION STAFF DISCUSS PAYMENT OPTIONS AND FINANCIAL ASSISTANCE AVAILABLE TO PATIENTS USING VERBAL AND WRITTEN COMMUNICATION. PATIENTS ARE CONTACTED PRIOR TO SERVICES WITH AN ESTIMATED COST AND OUT OF POCKET EXPENSES. CASH PRICES AND PAYMENT OPTIONS ARE DISCUSSED AND FINANCIAL ASSISTANCE SCREENING IS AVAILABLE UPON REQUEST. GOOD SHEPHERD MEDICAL CENTER EVALUATES PATIENT APPLICATIONS AND UTILIZES A SLIDING SCALE TO QUALIFY PATIENTS BASED ON GOVERNMENT POVERTY GUIDELINES. ADDITIONALLY, OUR ELIGIBILITY VENDOR SCREENS FOR GOVERNMENT AGENCY PROGRAMS AND OFFERS FINANCIAL ASSISTANCE APPLICATIONS TO THOSE WHO DO NOT QUALIFY FOR GOVERNMENT PROGRAMS. BUSINESS OFFICE AND REGISTRATION PERSONNEL ARE AVAILABLE TO ANSWER ANY FINANCIAL QUESTIONS AND ASSIST THE PUBLIC WITH THEIR FINANCIAL OBLIGATIONS. PART VI, LINE 4: GOOD SHEPHERD MEDICAL CENTER SERVES AN 11-COUNTY REGION INCLUDING THE FOLLOWING COUNTIES: GREGG, HARRISON, MARION, MORRIS, PANOLA, RUSK, UPSHUR, CAMP, CASS, WOOD, AND TITUS. GOOD SHEPHERD MEDICAL CENTERS IN LONGVIEW, LINDEN, AND MARSHALL OFFER A TRUE SYSTEM OF HEALTHCARE THAT ENCOMPASSES THE REACH OF OUR REGION. TO MEET THE EVERYDAY HEALTHCARE NEEDS OF THE RESIDENTS IN OUR REGION, GOOD SHEPHERD MEDICAL CENTER OPERATES FAMILY HEALTH CENTERS IN THE COMMUNITIES OF LONGVIEW, GLADEWATER, HENDERSON, KILGORE, JEFFERSON, LINDEN, AND HUGHES SPRINGS. PART VI, LINE 6: GOVERNED BY A VOLUNTARY BOARD OF DIRECTORS, GOOD SHEPHERD MEDICAL CENTER HAS A DIRECT LINK TO SOLICIT COMMUNITY INVOLVEMENT IN DECISION MAKING. THE BOARD OF DIRECTORS IS COMPOSED OF GOOD SHEPHERD MEDICAL CENTER'S PRESIDENT AND CHIEF EXECUTIVE OFFICER AND TWELVE MEMBERS OF THE COMMUNITY WHO SERVE ON A VOLUNTARY BASIS TO FURTHER THE MISSION OF GOOD SHEPHERD MEDICAL CENTER. THESE MEMBERS REPRESENT LOCAL BUSINESS, INDUSTRY, EDUCATION, MEDICAL SERVICES, AND CONSUMERS-AT-LARGE. THE BOARD OF DIRECTORS PROVIDES PERPETUAL COMMUNICATION OF THE CONCERNS AND HEALTHCARE NEEDS OF THE GREATER LONGVIEW COMMUNITY. PART VI, LINE 7: GOOD SHEPHERD HEALTH SYSTEM OPERATES HOSPITALS IN LONGVIEW, LINDEN, AND MARSHALL. IN EACH OF THE COMMUNITIES, THE HOSPITAL OFFERS FREE SCREENINGS TO IDENTIFY EARLY DISEASE, EDUCATIONAL OFFERINGS FEATURING PHYSICIAN SPEAKERS AND CONTINUOUSLY PARTICIPATE IN COMMUNITY ACTIVITIES WHERE PREVENTION AND WELLNESS INFORMATION CAN BE SHARED. X X 0 0 0 0 0 0 0 0 0 EDWARD D BANOS 0 495128 0 200812 0 0 0 6125 0 2284 0 704349 0 0 PAT KEEL 0 311519 0 35001 0 0 0 0 0 4153 0 350673 0 0 MARION BENSON 0 155354 0 44400 0 0 0 7696 0 1138 0 208588 0 0 KENNETH CUNNINGHAM 0 202922 0 59802 0 0 0 7853 0 8221 0 278798 0 0 TROY THIBODEAUX 0 265312 0 62500 0 0 0 6125 0 0 0 333937 0 0 KAREN WATTS 0 237610 0 70543 0 0 0 4546 0 791 0 313490 0 0 RUBY BREWER 0 164052 0 40380 0 0 0 8484 0 7960 0 220876 0 0 RICHARD LEE HOLLADAY 288997 0 2066 0 0 0 10472 0 2374 0 303909 0 0 0 ALAN GUEDRY 279160 0 1797 0 0 0 6568 0 5802 0 293327 0 0 0 JOHN COX 239468 0 1734 0 0 0 9667 0 5960 0 256829 0 0 0 JOHN E MOBLEY III 237181 0 1775 0 0 0 9140 0 3350 0 251446 0 0 0 DAVID BARKER 215105 0 1622 0 0 0 0 0 8460 0 225187 0 0 0 SUPPLEMENTAL INFORMATION PART III EDWARD D. BANOS 40 HOURS KAREN WATTS 40 HOURS KENNETH CUNNINGHAM 40 HOURS MARION BENSON 40 HOURS TROY THIBODEAUX 40 HOURS RUBY BREWER 40 HOURS PAT KEEL 40 HOURS GREGG COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION 751865828 39753MDT2 2004-05-27 21770000 FINANCING 0 0 0 GREGG COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION 751865828 39753MDU9 2006-11-08 99276418 ADVANCE REFUNDING OF BONDS 0 0 0 21770000 21770000 0 0 1 1 99276418 96480044 636501 2159873 0 1 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 GOOD SHEPHERD HEALTH SYSTEM, INC. IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B A NUMBER OF DECISIONS OF THE ORGANIZATION ARE SUBJECT TO APPROVAL OF THE MEMBER OF THE ORGANIZATION. THESE RESERVED POWERS ARE STATED BELOW: A) BEGINNING JANUARY 1, 2007, APPROVE THE MEMBERS OF THE BOARD; B) BEGINNING JANUARY 1, 2007, REMOVE MEMBERS FROM THE BOARD AND SET SIZE OF BOARD; C) APPROVE THE ELECTION AND REMOVAL OF OFFICERS OF THE CORPORATION AND ESTABLISH, TERMINATE AND/OR REVISE ALL EMPLOYMENT CONTRACTS, COMPENSATION, AND BENEFIT PACKAGES OF THE OFFICERS OF THE CORPORATION; D) DESIGNATE THE FISCAL YEAR; E) APPROVE THE SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, OUTSIDE GENERAL LEGAL COUNSEL, AND OUTSIDE INVESTMENT ADVISORS; F) AMEND THE ARTICLES OF INCORPORATION; G) AMEND OR REPEAL THE BYLAWS; H) APPROVAL OF ALL MERGERS, ACQUISITIONS, CONSOLIDATIONS, OR AFFILIATIONS WITH OTHER ENTITIES, THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE SALE, MORTGAGE, OR ENCUMBRANCE OF ANY REAL PROPERTY OWNED BY THE CORPORATION; I) APPROVE THE DISSOLUTION OR LIQUIDATION OF THE CORPORATION; J) APPROVE CAPITAL PLANS, STRATEGIC PLANS, AND ANNUAL OPERATING AND CAPITAL BUDGETS; K) APPROVE ANY EXCEPTION TO THE CAPITAL BUDGET FOR A SINGLE ITEM OR RELATED ITEM THAT IS $500,000 OR MORE, AND APPROVE ANY OPERATING EXPENSE THAT EXCEEDS THE BUDGET BY $500,000 OR MORE; L) SELECT OFFICIAL DEPOSITORIES FOR THE CORPORATION'S FUNDS; M) CREATING OR INVESTING IN ANY SUBSIDIARY ENTITY OR ENTERING ANY PARTNERSHIP OR JOINT VENTURE; N) AUTHORIZATION OF ANY LOANS, GUARANTEES, OR INCURRENCE OF DEBT; O) THE COMMENCEMENT OF ANY LITIGATION OR OTHER LEGAL PROCEEDING, OR THE SETTLEMENT, DISPOSITION, OR TERMINATION OF ANY SUCH LITIGATION OR OTHER LEGAL PROCEEDING OR OF ANY CLAIM OR THREAT OF LITIGATION OR OTHER LEGAL PROCEEDING NOT FULLY COVERED BY INSURANCE; AND P) APPROVAL OF THE ADMISSION OF ADDITIONAL MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION ENGAGES AN OUTSIDE FIRM TO AUDIT THE FINANCIALS. AN INTERNAL ACCOUNTANT PREPARES THE 990S AND THE RETURNS ARE REVIEWED EXTERNALLY. ONCE REVIEWED BY AN EXTERNAL ACCOUNTING FIRM, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DISCLOSURES ARE OBTAINED ANNUALLY. THE BOARD REVIEWS AND APPROVES THE BOARD MEMBERS' DISCLOSURES, AND THE CEO REVIEWS AND APPROVES THE EMPLOYEES' DISCLOSURES. BOARD MINUTES REFLECT WHEN A BOARD MEMBER DECLARES A CONFLICT AND DOES NOT VOTE. FORM 990, PART VI, SECTION B, LINE 15 A COMPENSATION SUBCOMMITTEE OF THE BOARD NEGOTIATES CONTRACTS WITH EXECUTIVES THROUGH HAY GROUP. THIS SUBCOMMITTEE OF THE BOARD REVIEWS AND APPROVES COMPENSATION AND BONUSES. FORM 990, PART VI, SECTION C, LINE 19 GOOD SHEPHERD MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -392,136. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -3,077,546. TRANSFERS TO AFFILIATES -8,633,804. CONTRIBUTIONS OF OR FOR PROPERTY AND EQUIPMENT 774,883. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION -477,137. CONTRIBUTIONS IN NET ASSETS -1,062,766. TOTAL TO FORM 990, PART XI, LINE 5: -12,868,506. COMMUNITY BENEFITS BUDGET FY 2012 UNREIMBURSED COST OF PROVIDING CARE TO THE FINANCIALLY AND MEDICALLY INDIGENT $22,900,000 UNREIMBURSED COST OF PROVIDING MEDICARE, CHAMPUS AND OTHER GOVERNMENT-SPONSORED HEALTHCARE $49,600,000 UNREIMBURSED COST OF PROVIDING GOVERNMENT SPONSORED INDIGENT HEALTHCARE $19,000,000 EDUCATION OF PHYSICIANS, NURSES AND OTHER PROFESSIONAL HEALTHCARE PROVIDERS $1,400,000 EDUCATION OF PATIENTS $60,000 COMMUNITY HEALTH EDUCATION $820,000 TOTAL 2012 BUDGET FOR PROVIDING COMMUNITY HEALTH BENEFITS $93,786,000 GOOD SHEPHERD HEALTH SYSTEM INC 700 E MARSHALL AVE LONGVIEW TX 75601 752027157 SUPPORT GSMC TX 501(C)(3) 11B N/A 0 CHAMPION EMS 2201 S MOBBERLY AVE LONGVIEW TX 75604 752747708 MED TRANSPORT TX 501(C)(3) 11B GOOD SHEPHERD HOSPITAL INC 1 GOOD SHEPHERD HOSPITAL AUXILIARY 700 E MARSHALL AVE LONGVIEW TX 75601 237203364 SUPPORT TX 501(C)(3) 11B GOOD SHEPHERD HOSPITAL INC 1 GOOD SHEPHERD FOUNDATION INC 700 E MARSHALL AVE LONGVIEW TX 75601 752056700 SUPPORT TX 501(C)(3) 11B GOOD SHEPHERD HOSPITAL INC 1 GSHS ADMINISTRATIVE SERVICES ORGANIZATION 700 E MARSHALL AVE LONGVIEW TX 75601 861132471 ADMIN SUPPORT TX 501(C)(3) 11B GOOD SHEPHERD HEALTH SYSTEM INC 0 GOOD SHEPHERD MEDICAL CENTER - MARSHALL 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 752605699 HEALTHCARE TX 501(C)(3) 11B GOOD SHEPHERD HEALTH SYSTEM INC 0 GOOD SHEPHERD MEDICAL CENTER - LINDEN 404 N KAUFMAN STREET LINDEN TX 75563 010829282 HEALTHCARE TX 501(C)(3) 11B GOOD SHEPHERD HEALTH SYSTEM INC 0 GSMC - LINDEN FOUNDATION INC 404 N KAUFMAN STREET LINDEN TX 75563 200845127 SUPPORT TX 501(C)(3) 11B GOOD SHEPHERD MEDICAL CENTER - LINDEN INC 0 MARSHALL HOSPITAL FOUNDATION INC 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 752605699 SUPPORT TX 501(C)(3) 11B HARRISON COUNTY HOSPITAL ASSOCIATION 0 MARSHALL HEALTH SERVICES INC 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 752580686 HEALTHCARE TX 501(C)(3) 11B HARRISON COUNTY HOSPITAL ASSOCIATION 0 GS AMBULATORY SURGICAL CENTER 700 E MARSHALL AVE LONGVIEW TX 75601 SURGERY TX GSHS ENTERPRISES OPERATING #2 INC RELATED 0 0 0.00000 GSHS ENTERPRISES INC 700 E MARSHALL AVE LONGVIEW TX 75601 752027162 HEALTHCARE TX GOOD SHEPHERD HEALTH SYSTEM INC C GOOD SHEPHERD HEALTH NETWORK 700 E MARSHALL AVE LONGVIEW TX 75601 752554695 INACTIVE TX GOOD SHEPHERD HOSPITAL INC C NORTHEAST TEXAS PHYSICIAN SE 700 E MARSHALL AVE LONGVIEW TX 75601 752712245 MGMT SERVICES TX GSHS ENTERPRISES INC C GS PHYSICIAN SERVICES INC 700 E MARSHALL AVE LONGVIEW TX 75601 752762417 MEDICAL SERVICES TX GSHS ENTERPRISES INC C GSHS ENTERPRISES HOLDING INC 700 E MARSHALL AVE LONGVIEW TX 75601 510412465 HOLDING COMPANY DE GSHS ENTERPRISES INC C GSHS ENTERPRISES OPERATING 1 700 E MARSHALL AVE LONGVIEW TX 75601 752954772 HEALTHCARE DE GSHS ENTERPRISES INC C GSHS ENTERPRISES OPERATING 2 700 E MARSHALL AVE LONGVIEW TX 75601 752954777 HEALTHCARE DE GSHS ENTERPRISES INC C GSHS ENTERPRISES OPERATING 3 700 E MARSHALL AVE LONGVIEW TX 75601 710896512 HEALTHCARE DE GSHS ENTERPRISES INC C GSHS MEDICAL PLAZA LTD 700 E MARSHALL AVE LONGVIEW TX 75601 752955157 HEALTHCARE TX GSHS ENTERPRISES OPERATING #1 INC C GSHS MEDICAL PLAZA III LTD 700 E MARSHALL AVE LONGVIEW TX 75601 731654263 HEALTHCARE TX GSHS ENTERPRISES OPERATING #3 INC C 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 1 1 GOOD SHEPHERD FOUNDATION INC C 881391 CASH METHOD