2022-05-13T12:15:19-05:00 2021-06-30 135565207 KPMG LLP 1918 EIGHTH AVENUE SUITE 2900 SEATTLE WA 98101 990 2020-07-01 237002687 SALEM HEALTH FOUNDATION SALE 5038141938 890 OAK STREET SALEM OR 97301 JAMES PARR EVP OF OPERATIONS & CFO 5038141938 2022-05-13 1 JAMES PARR 999009999 SUE ROBISON P00560072 2069134000 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JAMES PARR 890 OAK STREET SALEM OR 97301 867892 0 X WWW.SALEMHEALTH.ORG/FOUNDATION X 1968 OR DEDICATED TO RAISING, MANAGING AND DISTRIBUTING FUNDS TO HELP SALEM HEALTH ACHIEVE ITS MISSION. 12 12 0 0 0 0 1206307 451593 0 0 1575 402845 13777 13454 1221659 867892 837354 424952 0 0 0 0 0 0 0 492660 671567 1330014 1096519 -108355 -228627 10268673 11591979 346050 417196 9922623 11174783 THE SALEM HEALTH FOUNDATION IS DEDICATED TO RAISING, MANAGING AND DISTRIBUTING FUNDS TO HELP SALEM HEALTH ACHIEVE ITS MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY IT SERVES. 0 0 305690 305690 PROPOSALS TO FUND CAPITAL EQUIPMENT AND MEDICALLY RELATED ACTIVITIES AT SALEM HEALTH ARE RECEIVED AND REVIEWED BY THE FOUNDATION'S CHIEF DEVELOPMENT OFFICER. PROPOSALS ARE FORWARDED TO THE FOUNDATION'S BOARD OF DIRECTORS FOR FURTHER REVIEW AND APPROVAL IF THEY ARE CONSIDERED TO BE CONSISTENT WITH THE FOUNDATION'S ARTICLES OF INCORPORATION, STATING THAT ITS FUNDS ARE TO BE USED FOR HEALTH CARE, CHARITABLE,AND SCIENTIFIC PURPOSES, AND FOR MEDICAL AND SCIENTIFIC EDUCATION AND RESEARCH FOR THE USE AND BENEFIT OF SALEM HEALTH. 107078 107078 SCHOLARSHIPS: NURSING, MEDICAL SCHOOL AND OTHER HEALTHCARE PROGRAMS. RECIPIENTS OF HEALTH CARE RELATED ACADEMIC SCHOLARSHIPS AND THE AMOUNTS OF THE AWARDS ARE DETERMINED BY ANALYSES OF THE CANDIDATES' QUALIFICATIONS, SCHOLARSHIP AWARDS ALREADY AWARDED TO THEM FOR THE YEAR BY OTHER ORGANIZATIONS, AND THE COSTS OF THE SPECIFIC SCHOOLS THE VARIOUS CANDIDATES WISH TO ATTEND. 12184 12184 CERTAIN RESTRICTED FUNDS HAVE BEEN CREATED AND ARE USED FOR THE PURPOSE OF ASSISTING DIABETES AND CANCER PATIENTS WITH THE COSTS OF THEIR EDUCATIONAL, SUPPLY AND OTHER CARE-RELATED EXPENSES. IN ADDITION, FUNDS ARE DISTRIBUTED TO ASSIST LOW INCOME INDIVIDUALS MEDICAL REQUIREMENTS. 424952 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 OR X SALEM HEALTH 5038141938 890 OAK STREET SALEM OR 97301 ALEX CASEBEER CHAIR 1.00 0.00 X X 0 0 0 ALEX RHOTEN VICE CHAIR 1.00 0.00 X X 0 0 0 PAT FORCE SECRETARY/TREASURER 1.00 0.00 X 0 0 0 KATHY GORDON PAST CHAIR 1.00 0.00 X 0 0 0 STEVE ALTMAN DIRECTOR 1.00 0.00 X 0 0 0 RYAN ALLBRITTON DIRECTOR 1.00 0.00 X 0 0 0 GARTH BRANDAW DIRECTOR 1.00 0.00 X 0 0 0 TIM DUENAS MD DIRECTOR 1.00 0.00 X 0 0 0 ERIC FISKUM DIRECTOR 1.00 0.00 X 0 0 0 RAGHU KAMINENI MD DIRECTOR 1.00 0.00 X 0 0 0 JOHN POLLINO DIRECTOR 1.00 0.00 X 0 0 0 ROBERT PONEC MD DIRECTOR 1.00 0.00 X 0 0 0 JAMES PARR EVP OF OPERATIONS & CFO 1.00 39.00 X 0 810561 88591 LEILANI SLAMA VP OF COMMUNITY ENGAGEMENT 1.00 39.00 X 0 326384 59733 CHERYL NESTER WOLFE CEO & PRESIDENT 1.00 39.00 X 0 1421603 37584 JIM BAUER VP OF DEVELOPMENT 1.00 39.00 X 0 0 0 0 2558548 185908 0 0 1 0 0 276758 174835 451593 402845 402845 HAMPSHIRE PROPERTIES R 900099 13454 13454 13454 867892 0 0 416299 188028 188028 236924 236924 578085 578085 25527 25527 870 870 26958 26958 23905 23905 HAMPSHIRE PROPERTIES 12109 12109 EQUIPMENT & INSTRUMENTS 3515 3515 LICENSES AND PERMITS 485 485 DUES 113 113 1096519 424952 671567 0 2627036 2139340 59737 79111 25421 5258 692000 692000 692000 6864479 8648120 0 28150 10268673 11591979 30 0 346020 417196 346050 417196 X 2448515 3416814 7474108 7757969 9922623 11174783 10268673 11591979 X -228627 1179279 301508 X 0 1 X 1 0 X 1307517 1323209 964296 1206307 451593 5252922 1307517 1323209 964296 1206307 451593 5252922 1710345 3542577 32103 119306 184976 1575 402845 740805 5993727 0.59100 0.66470 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3414730 20925 216671 188677 3463649 3470860 53207 -1810 107527 3414730 3330813 54838 111368 26158 3470861 2981730 135764 257803 44484 3330813 2833952 64030 275990 192242 2981730 0.65524 0.34476 0 0 685000 685000 7000 7000 692000 DUE TO SALEM HEALTH 417196 417196 X PART V, LINE 4: SALEM HEALTH FOUNDATION HOLDS ENDOWMENT FUNDS FOR THE BENEFIT OF SALEM HEALTH AND FOR USE TOWARDS THE FOUNDATION'S MISSION. PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE CORPORATION TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE CORPORATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2021 THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURSIDCTIONS; THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE CORPORATION MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO FISCAL YEAR 2018. 1 SALEM HEALTH 890 OAK STREET SALEM OR 97301 930579722 3 188028 N/A N/A TO PAY FOR GENERAL EXPENSES AND CAPITAL EXPENDITURES 1 1 SCHOLARSHIPS FOR STUDENTS 23 107078 N/A N/A THE FOUNDATION'S PATIENT ASSISTANCE PROGRAM 63 12184 N/A PART I, LINE 2: DECISIONS ON GRANTS TO SALEM HEALTH ARE MADE BY THE SALEM HEALTH FOUNDATION BOARD OF DIRECTORS. MINUTES OF THE MEETINGS OF THE FOUNDATION BOARD ARE SHARED WITH THE SALEM HEALTH BOARD OF TRUSTEES EACH MONTH. SCHOLARSHIPS ARE GRANTED TO COLLEGE STUDENTS THAT RESIDE IN MARION, POLK OR YAMHILL COUNTIES AND ARE PURSUING A HEALTHCARE RELATED CAREER. A SCHOLARSHIP COMMITTEE REVIEWS INDIVIDUAL APPLICATIONS AND RECOMMENDS TO THE BOARD RECIPIENT AWARDS FOR APPROVAL. SCHOLARSHIPS AWARDED ARE PAID DIRECTLY TO THE EDUCATIONAL INSTITUTIONS FOR TUITION OR RELATED COSTS. 0 1 0 0 0 0 0 0 0 CHERYL NESTER WOLFE CEO & PRESIDENT 0 1003683 0 252189 0 165731 0 21375 0 16209 0 1459187 0 0 JAMES PARR EVP OF OPERATIONS & CFO 0 592723 0 170353 0 47485 0 65022 0 23569 0 899152 0 0 LEILANI SLAMA VP OF COMMUNITY ENGAGEMENT 0 246947 0 71130 0 8307 0 36500 0 23234 0 386118 0 0 PART I, LINE 3 COMPENSATION OF THE OFFICERS IS DETERMINED BY THE CEO OF SALEM HEALTH, IN CONJUNCTION WITH OTHER SALARY SURVEY OR PUBLIC INFORMATION AND INDEPENDENT CONSULTANTS TO ENSURE THE COMPENSATION IS COMPETITIVE IN THE MARKET FOR SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS. PART I, LINE 4B LEILANI SLAMA RECEIVED DEFERRED COMPENSATION UNDER A 457(F) NONQUALIFIED PLAN. THIS COMPENSATION IS INCLUDED IN COMPENSATION REPORTED IN PART II. THE TOTAL NONQUALIFIED PORTION REPORTED IS $17,975 WHICH IS INCLUDED IN DEFERRED COMPENSATION. JAMES PARR RECEIVED DEFERRED COMPENSATION UNDER A 457(F) NONQUALIFIED PLAN. THIS COMPENSATION IS INCLUDED IN COMPENSATION REPORTED IN PART II. THE TOTAL NONQUALIFIED PORTION REPORTED IS $41,869 WHICH IS INCLUDED IN DEFERRED COMPENSATION. SCHEDULE J, PART II, LINE 1: COMPENSATION AND BENEFITS REPORTED FOR OFFICERS ON SCHEDULE J ARE PAID BY SALEM HEALTH. THE FOUNDATION HAS A MANAGEMENT AGREEMENT TO REIMBURSE SALEM HEALTH FOR A PORTION OF OFFICER COMPENSATION AND BENEFITS. THIS AMOUNT IS INCLUDED ON FORM 990 PART IX; LINE 24B UNDER MANAGEMENT SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S ACCOUNTING & FINANCE TEAM WORKS CLOSELY WITH THE OUTSIDE ACCOUNTING FIRM IT ENGAGES TO PREPARE AND REVIEW THE RETURN. THE CONTROLLER AND CFO REVIEW A DRAFT OF THE FORM 990 BEFORE IT IS PRESENTED TO THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES. FINANCE ADMINISTRATION ADDRESSES AND RESPONDS TO QUESTIONS RAISED BY MEMBERS OF THE GOVERNANCE COMMITTEE. AFTER IT IS REVIEWED BY THE GOVERNANCE COMMITTEE, THE FINAL FORM 990 IS FORWARDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS THE SECRETARY SHALL SEND TO EACH PERSON WHO IS A TRUSTEE, OFFICER, OR MEMBER OF A COMMITTEE A COPY OF THE POLICY REGARDING CONFLICTS OF INTEREST, TOGETHER WITH A QUESTIONNAIRE INQUIRING AS TO CONFLICTS, TO BE COMPLETED AND RETURNED TO THE SECRETARY BY THE TRUSTEE, OFFICER OR COMMITTEE MEMBER PRIOR TO THE BEGINNING OF EACH CALENDAR YEAR. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION AT SALEM HEALTH (SH) IS DESIGNED TO ALLOW THE ORGANIZATION TO RECRUIT AND RETAIN QUALIFIED SENIOR LEADERS. ONE OR MORE INDEPENDENT CONSULTANTS ARE RETAINED TO REVIEW EXECUTIVE COMPENSATION. THE SH CEO, IN CONJUNCTION WITH THE INDEPENDENT CONSULTANTS, ENSURES THAT EACH EXECUTIVE'S COMPENSATION IS COMPETITIVE IN THE MARKET FOR SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS. THE CEO ALSO PROVIDES INFORMATION TO THE BOARD GOVERNANCE COMMITTEE ON THE LEVELS OF EXECUTIVE COMPENSATION. FORM 990, PART VI, LINES 15A AND 15B ALL COMPENSATION IS PAID BY A RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT PUBLICLY AVAILABLE. FORM 990, PART XI, LINE 9: ASSETS RELEASED FROM RESTRICTION 301,508. HAMPSHIRE PROPERTIES LLC 890 OAK STREET SALEM OR 97301 870804582 REAL ESTATE OR 13454 769445 SHF SALEM HEALTH 890 OAK STREET SALEM OR 97301 930579722 HOSPITAL OR 501(C)(3) LINE 3 SHHC 0 SALEM HEALTH HOSPITAL & CLINICS 890 OAK STREET SALEM OR 97301 930823471 LEASES LAND OR 501(C)(3) LINE 12A, I N/A 0 SALEM HEALTH WEST VALLEY 525 SOUTHEAST WASHINGTON ST DALLAS OR 97338 431960221 HOSPITAL OR 501(C)(3) LINE 3 SHHC 0 WEST VALLEY HOSPITAL FOUNDATION 525 SOUTHEAST WASHINGTON ST DALLAS OR 97338 931298564 SUPPORT SHWV OR 501(C)(3) LINE 12A, I SHHC 0 WILLAMETTE VALLEY INSURANCE COMPANY 745 FORT STREET HONOLULU HI 96813 201836190 CAPTIVE INS HI 501(C)(3) LINE 12A, I SHHC 0 SALEM HEALTH PROFESSIONAL SERVICES 890 OAK STREET SALEM OR 97301 753175249 BILLING OR 501(C)(3) LINE 12A, I SHHC 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0