2011-05-16T13:17:42-05:00 2010-06-30 Eide Bailly LLP 5601 Green Valley Drive Ste 700 Minneapolis MN 554371145 990 2009-07-01 930425580 Good Shepherd Health Care System GOOD 5416673400 610 NW 11th Street Hermiston OR 97838 Dennis Burke 5416673400 2011-05-09 1 Kim Hunwardsen CPA 9529446166 2011-05-09 2009 2016-02-24 21:20:13Z Good Shepherd Medical Center Dennis Burke 610 NW 11th Street Hermiston OR 97838 78150825 0 X www.gshealth.org X 1953 OR Hospital and health care services 12 11 594 150 0 0 505306 61052 69685685 75922610 -1816807 2167163 0 68374184 78150825 421351 457373 0 30805746 33556015 0 0 29873019 31440262 61100116 65453650 7274068 12697175 88154494 104457653 25221217 29941258 62933277 74516395 To provide compassionate, high quality, and accessible health care and to promote a healthy community 0 0 61328457 457373 75922610 Good Shepherd Health Care System (GSHCS) served 2,076 inpatients and 41,237 outpatients in fiscal year 2009-10, as well as 15,386 patients in our Emergency Center. Although reimbursement for services rendered is critical to the operations and stability of Good Shepherd Health Care System, not all individuals have the ability to purchase essential medical services. In recognition of this, during 2009-10 Good Shepherd wrote off to collection 6,039,214 valued at charges foregone as bad debt. Direct charity care to our community amounted to an additional 5,283,254, 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 2009-10 was 24,311,284 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. 61328457 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 132 0 1 594 1 0 0 0 0 0 0 0 0 0 12 11 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X Jan Peter 5416673416 610 NW 11th Street Hermiston OR 97838 Steve Eldrige 2.00 X X 0 0 0 Nancy Mabry 2.00 X X 0 0 0 Barbara Place 2.00 X X 0 0 0 Bill Elfering 2.00 X X 0 0 0 Bob Carlson 2.00 X 0 0 0 Richard Lindner 2.00 X 0 0 0 Tricia Fenley 2.00 X 0 0 0 Dr Derek Earl 2.00 X 0 0 0 Sue Daggett 2.00 X 0 0 0 Tom Wamsley 2.00 X 0 0 0 Dr Winn Gregory 2.00 X 0 0 0 Glenn Chowning 2.00 X 0 0 0 Dennis E Burke 40.00 X 337695 0 48793 William Alsdurf 40.00 X 190492 0 25728 David T Hughes 40.00 X 169447 0 16636 Dr Gary V Trupp 40.00 X 298606 0 27227 Dr Frederick G Tinio 40.00 X 237253 0 27630 Dr Kim A Peterson 40.00 X 173347 0 5945 Michael S Bergman 40.00 X 225997 0 23036 Josh S Jackson 40.00 X 209813 0 18115 1842650 0 193110 37 0 1 0 Rick Burrill 610 NW 11th Street Hermiston OR 97838 Physical Therapy 1028739 McCormick Construction Co 422 SW 6th Pendleton OR 97801 Construction 894865 Tualitin Imaging 6464 SW Boreland Rd Tualitin OR 97062 Imaging Services 739350 Weatherby Locums PO Box 972633 Dallas TX 75397 Physician Services 389618 Gilliland Construction 80601 N Ott Rd Hermiston OR 97838 Construction 295794 15 61052 61052 Net patient services 622110 74469649 74469649 Other revenue 900099 669510 669510 Cafeteria 900099 520688 520688 Daycare 900099 262763 262763 75922610 1557131 1557131 565870 44162 565870 44162 610032 610032 78150825 75922610 0 2167163 450000 450000 7373 7373 792978 792978 25894109 24527631 1366478 980298 948084 32214 4269188 3988951 280237 1619442 1493126 126316 54824 54824 55514 55514 159218 159218 8891022 7976108 914914 110901 100734 10167 9987045 9789818 197227 686580 686580 205466 169922 35544 99562 99562 447281 447281 3848063 3848063 685420 685420 Bad Debts 6039214 6039214 Miscellaneous 170152 170152 65453650 61328457 4125193 0 4605317 1291757 8737160 9790119 3031819 5370439 1185546 1365994 529489 700641 72629883 31831403 37585741 40798480 31642989 41528157 836433 3612066 88154494 104457653 5219054 5663653 15630877 14945496 4371286 9332109 25221217 29941258 X 62658573 74228136 274704 288259 62933277 74516395 88154494 104457653 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1949405 741457 2690862 39313077 13061136 26251941 28916670 17850603 11066067 1709274 919664 789610 40798480 Estimated cost report settlements payable 175104 Investment in subsidiary 9157005 9332109 78150825 65453650 12697175 148097 -726072 -536082 -1114057 11583118 80042876 148097 2160066 2308163 77734713 159218 256894 416112 78150825 67357808 2513376 2513376 64844432 159218 450000 609218 65453650 Part X: Description of Uncertain Tax Positions Under FIN 48: The Hospital has adopted the provisions of FASB Accounting Standards Codification Topic AS 740-10 (previously Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes), 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, 2010, 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 2006 and state examinations for years before 2006. Part XI, Line 8 - Other Adjustments: Intercompany Interest income eliminated on financial statements: -536082. Part XII, Line 2d - Other Adjustments: Revenues of consolidated subsidiary: 2610066. Charitable donations reclass to expenses: -450000. Part XII, Line 4b - Other Adjustments: Interest income eliminated for financial statements: 243339. Contributions recorded in fund balance for financial statements: 13555. Part XIII, Line 2d - Other Adjustments: Expenses of consolidated subsidiary: 2513376. Part XIII, Line 4b - Other Adjustments: Charitable donations reclass to expenses: 450000. 1 1 X 1 X 0 1 0 0 0 2722669 2722669 0.04630 9083851 11489583 -2405732 0.00000 11806520 11489583 316937 0.04630 264752 96594 168158 0.00290 258650 258650 0.00440 450000 450000 0.00770 973402 96594 876808 0.01500 12779922 11586177 1193745 0.06130 1 3112245 293020 12114798 12760675 -645877 X 0 Good Shepherd Health Care System

610 NW 11th Street Hermiston OR 97838

X X X X clinic 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, Line 7g: Part I, Line 7f: The amount of bad debt expense removed from the denominator of the calculation on Part 1, Line 7, column f was $6,039,214. 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 293,020. 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 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. 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 $34,834.15.9% of residents have incomes below federal poverty guidelines.28.1% of residents identify as non-white Hispanic ethnicity, with a sizable number of Spanish-primary speakers.We are a Critical Access Hospital, and the primary healthcare resource for our community. Part VI, Line 5: 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.We operate a fully-staffed 24-hour emergency room, available to the public regardless of ability to pay.Our twelve-member Board of Trustees reserves positions for all interested community members. All of our trustees reside in our service area. Good Shepherd operates two CareVans, a complimentary transportation service for our community members. Our CareVans transport hundreds of community members to and from medical appointments each month.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.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. 1 Good Shepherd Community Health Foundation 610 NW 11th Street Hermiston OR 97838 931170546 501(c)(3) 450000 Community Support Scholarships 14 7373 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule 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). X X X X 0 1 0 0 0 0 0 0 0 Dennis E Burke 240605 0 22500 0 74590 0 26631 0 22223 0 386549 0 0 0 William Alsdurf 156841 0 18651 0 15000 0 9482 0 16308 0 216282 0 0 0 David T Hughes 148572 0 13371 0 7504 0 0 0 16698 0 186145 0 0 0 Dr Gary V Trupp 293535 0 5071 0 0 0 12250 0 15039 0 325895 0 0 0 Dr Frederick G Tinio 229168 0 8085 0 0 0 14427 0 13266 0 264946 0 0 0 Dr Kim A Peterson 168347 0 5000 0 0 0 0 0 5945 0 179292 0 0 0 Michael S Bergman 215197 0 0 0 10800 0 0 0 23098 0 249095 0 0 0 Josh S Jackson 209813 0 0 0 0 0 0 0 18178 0 227991 0 0 0 Part I, Line 4a Dennis Burke - 50,379 The President is eligible for benefits under a nonqualified deferred compensation plan. He receives annual contributions into the plan equal to 11% of his base wage. The amounts in the plan vest annually. Banner Bank 911645638 2007-08-29 17786918 new construction, expansion and major equipment purchases 0 0 17786918 3973397 13813521 2010 0 0 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 1 0 Credits Inc Company is owned 100% by a board member 391761 Charges for collection services 0 Form 990, Part VI, Section A, line 6 All members of the community who make contributions to the organization are eligible to become members of the organization if approved by the Board of Directors. Membership does not include any voting rights. Form 990, Part VI, Section B, line 11 The return is reviewed by the CFO and Controller and presented on a high level to the Board of Directors. A final copy is made available to the Board before filing. Form 990, Part VI, Section B, line 12c All officers, directors, and key employees with conflicts are expected to disclose conflicts of interest on a voluntary basis and refrain from discussion and/or voting on related matters as necessary. Form 990, Part VI, Section B, line 15a The CEO's compensation is approved by the compensation committee of the Board of Directors based on survey information. The compensation of other officers or key employees is determined by the CEO based on survey information. Form 990, Part VI, Section C, line 19 These documents are not available to the general public. Good Shepherd Community Health Foundation 610 NW 11th Street Hermiston OR 97838 931170546 fundraising OR 501(c)(3) 11a N/A Good Shepherd Medical Foundation 610 NW 11th Street Hermiston OR 97838 930844485 fundraising OR 501(c)(3) 7 N/A Good Shepherd Medical Service Corp 610 NW 11th Street Hermiston OR 97838 930688940 retail pharmacy OR N/A C 2610066 2328178 1.00000 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 Good Shepherd Medical Service Corp A 200000 Good Shepherd Medical Service Corp N 343006 Good Shepherd Community Health Foundation B 450000