2020-06-01T18:38:27-05:00 2019-06-30 KPMG LLP 1918 Eighth Avenue Suite 2900 Seattle WA 98101 990 2018-07-01 930579722 SALEM HEALTH % SALEM HEALTH SALE 5038141938 890 OAK STREET SALEM OR 97301 JAMES PARR CFO 5038141938 2020-05-21 true LISA M MEYER P01490170 2069134000 2020-05-20 199.206.0.5 91023620201535000088 2020-06-01 P E05B3AD073E203267904F3052869CFD6C9DFEDC3 9105E6E520034E9B148D3B0F89283359AE297A20 2018 2021-01-29 14:40:06Z JAMES PARR 890 OAK STREET SALEM OR 97301 850697397 false X WWW.SALEMHEALTH.ORG X 1970 OR TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE 13 13 5454 505 2652476 477421 1056591 280398 783829055 817092478 31831446 29554053 542703 780603 817259795 847707532 807294 743743 0 0 412741884 442907802 0 0 0 321264712 327142462 734813890 770794007 82445905 76913525 1306434818 1399234388 385873792 392328484 920561026 1006905904 TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES WE SERVE. false false 119090106 367771664 SALEM HEALTH IS ONE OF THE LARGEST OF OREGON'S 59 ACUTE CARE HOSPITALS AND OPERATES THE BUSIEST EMERGENCY DEPARTMENT IN OREGON. THERE ARE 488 PRACTITIONERS, REPRESENTING 54 DIFFERENT SPECIALTIES. MORE THAN 505 VOLUNTEERS PROVIDE NON-MEDICAL SUPPORT FOR THE HOSPITAL. STATISTICS FOR THE 12 MONTH PERIOD ENDED 6/30/19: BIRTHS - 3,432, DIAGNOSTIC IMAGING PROCEDURES - 200,763, ED VISITS - 108,607, INPATIENT ADMISSIONS - 27,225, LABORATORY PROCEDURES - 1,450,292, SURGERIES - 14,053. THE PRIMARY SERVICE AREA IS MARION AND POLK COUNTIES WITH APPROXIMATELY 430,000 RESIDENTS. 535899306 424087165 SALEM HEALTH PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. IN THE 12 MONTH PERIOD ENDED 6/30/19, THE COST OF SERVICES PROVIDED AS A COMMUNITY BENEFIT TOTAL $111.8 MILLION. THIS FIGURE CONSISTED OF $19.2 MILLION IN COSTS TO PROVIDE CHARITY CARE TO INDIVIDUALS WHO CANNOT AFFORD TO PAY; $42.2 MILLION IN UNDERPAYMENT BY MEDICAID AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES; AND $50.4 MILLION IN UNDERPAYMENT BY MEDICARE AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES. 40510003 743743 23655409 SALEM HEALTH ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN THE 12 MONTH PERIOD ENDED 6/30/19, SALEM HEALTH GAVE $24.9 MILLION FOR UNFUNDED OR UNDERFUNDED HEALTH SERVICES, COMMUNITY HEALTH EDUCATION AND PREVENTION PROGRAMS. THE HOSPITAL HAS AN ACTIVE SPEAKERS BUREAU PROVIDING FREE HEALTH LECTURES TO COMMUNITY GROUPS. HEALTH SCREENINGS, SUPPORT GROUPS AND EDUCATION CLASSES ARE OFFERED ON AN ON-GOING BASIS. IN FY 2019, SALEM HEALTH PROVIDED MORE THAN $400,000 IN CASE AND IN-KIND DONATIONS TO COMMUNITY HEALTH PROGRAMS SUCH AS MEDASSIST AND PROJECT ACCESS, PSYCHIATRIC CRISIS CENTER AND THE SALEM FREE CLINIC. 695499415 true true false true false false false false false true true false false false true true false true false false false false false false false false true true true true true true false false false false false false false false false false false false false false true true true false false false true 334 0 true 5454 true true true false false false false false false false false false false false X 13 13 false false false false false false false true true false false true true true true true true true true false OR X SALEM HEALTH 5038141938 890 OAK STREET SE SALEM OR 97301 Katherine L Keene Chair 4.7 1.3 X X 0 0 0 Lane Shetterly Vice Chair 3.3 2.2 X X 0 0 0 Alan Wynn Secretary/Treasurer 3.1 0.9 X X 0 0 0 John Combes MD Trustee 2.7 0.8 X 0 0 0 Bonnie Driggers RN Past Chair 3.9 1.1 X 0 0 0 David Harrison MD Trustee 2.3 0.7 X 1465 0 0 Theresa Haskins Trustee 3.1 0.9 X 0 0 0 Phil Jackson Trustee 2.3 0.7 X 0 0 0 Robert Kelly MD Trustee 3.9 1.1 X 3660 0 0 John Lattimer Trustee 3.9 1.1 X 0 0 0 Ricardo Linares Trustee 2.0 0.5 X 0 0 0 Kenneth Sherman Jr Trustee 3.5 1.0 X 0 0 0 Robert Wells Trustee 2.3 0.7 X 0 0 0 Cheryl Nester Wolfe President & CEO 31.9 8.1 X 1089162 0 60230 James Parr Chief Financial Officer 34.9 5.1 X 586361 0 94858 Ralph Yates CMO Salem Health and SHMG 40.0 0.0 X 610012 0 82272 Leah Mitchell CIO/VP Kaizen Quality & Safety 40.0 0.0 X 548027 0 86980 Bahaa Wanly Chief Operating Officer 40.0 0.0 X 454461 0 78514 Laurie Barr Chief HR Officer - END 1/19/19 40.0 0.0 X 428628 0 81077 Sarah Horn Chief Nursing Officer 40.0 0.0 X 409682 0 80553 Christine Clarke General Surgeon 20.0 0.0 X 297395 0 37620 Andrew Furman VP Med Affairs - End 2/25/18 40.0 0.0 X 281830 0 19039 Denise Hoover VP Surgical Services 40.0 0.0 X 264317 0 64813 Shea Corum VP IT Operations 40.0 0.0 X 260909 0 63486 Zennia Ceniza VP Clinical Operations 40.0 0.0 X 241881 0 42016 Leilani Slama VP Community Engagement 39.0 1.0 X 236717 0 60345 Jaime Nichols Interim VP Human Resources 40.0 0.0 X 178568 0 46513 Bruce Rodgers VP Medical Group - END 1/5/19 20.0 20.0 X 138057 0 37984 Juan Oyarzun Dir Cardiothoracic Medicine 40.0 0.0 X 1183341 0 85299 Katherine Jones Cardiothoracic Surgeon 40.0 0.0 X 1017316 0 81544 Nervin Fanous Cardiothoracic Surgeon 40.0 0.0 X 1009720 0 76282 Nicole VanDerHeyden SHMG Chief Medical Officer 40.0 0.0 X 689629 0 93013 Daniel Chen Neurology Physician 40.0 0.0 X 616541 0 68711 10547679 0 1341149 783 false true false OREGON HEALTH SCIENCE UNIVERSITY 3181 SW SAM JACKSON PARK RD Portland OR 972393098 CONTRACT LABOR 5993095 EPIC SYSTEMS CORP PO BOX 88314 Milwaukee WI 532880314 CONSULTING SERVICES 3564911 INX LLC PO BOX 677638 Dallas TX 752677638 HARDWARE SUPPORT 2540787 ARUP LABORATORIES PO BOX 27964 Salt Lake City UT 84127 LABORATORY SERVICES 2030182 AMN LOS ANGELES PO BOX 56157 Los Angeles CA 900746157 CONTRACT LABOR 1927812 97 280398 0 280398 NET PATIENT SERVICE REVENUE 621110 795771113 795771113 Other Hospital services 900099 12513949 12382726 131223 PHARMACY 446110 6592292 5092129 1500163 REGIONAL LAB 621500 1349364 328274 1021090 NUTRITION/VALUE BASED CARE 722210 865760 865760 817092478 30336622 30336622 0 0 715153 1008786 -293633 0 -293633 -293633 1198510 1981079 -782569 -782569 -782569 0 0 0 0 0 0 0 0 0 Passthrough Income 541900 1074236 1074236 1074236 847707532 815514238 2652476 29260420 560767 560767 182976 182976 0 0 6479935 6479935 0 341208388 313157990 28050398 0 71021837 63968371 7053466 24197642 21794477 2403165 771284 771284 1355501 15168 1340333 424320 349665 74655 75000 75000 0 0 25496724 22029526 3467198 103290 103290 7567107 4193625 3373482 6657250 1378752 5278498 0 22261680 12675195 9586485 1049310 661963 387347 0 796968 616056 180912 10535457 10535457 0 45469068 45469068 4261104 4261104 PATIENT SUPPLIES 113918140 113380637 537503 PROVIDER TAX 44011628 44011628 BAD DEBTS 23932066 23932066 Other Purchased Services 12113462 10346610 1766852 6343103 1207030 5136073 770794007 695499415 75294592 0 535623 454184 14572136 12555367 0 0 87867240 103925303 0 0 0 0 545456 632371 6689498 7525578 6274832 8790526 1016204892 518742955 477020355 497461937 674691909 729653923 0 0 15672505 24141214 0 0 22565264 14093985 1306434818 1399234388 83977757 93526918 0 0 525200 82780 278251740 272967121 0 0 0 0 164174 0 0 0 22954921 25751665 385873792 392328484 X 917643621 1003876479 2917405 3029425 0 0 920561026 1006905904 1306434818 1399234388 X 76913525 11676210 -2244857 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 90000 90000 695409415 695499415 1000000 250000 1000000 1000000 1000000 1000000 4000000 6000000 97242 135334 127723 90000 450299 250000 250000 250000 250000 1000000 1500000 SCHEDULE C, PART II-A SALEM HEALTH CONTRACTED WITH PUBLIC AFFAIRS COUNSEL TO KEEP THE HOSPITAL APPRISED OF BILLS IN THE STATE LEGISLATURE AND TO ENGAGE THE LEGISLATORS ON BEHALF OF THE HOSPITAL WHEN NECESSARY TO PROVIDE INFORMATION TO LEGISLATORS REGARDING THE IMPACT OF LEGISLATION ON THE HOSPITAL. ADDITIONALLY, THE HOSPITAL PAYS MEMBERSHIP DUES TO OREGON ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS (OAHHS) AND AMERICAN HOSPITAL ASSOCIATION (AHA). A PORTION OF THE DUES TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING ACTIVITY IN RELATION TO STATE AND NATIONAL HEALTHCARE ISSUES. 2910663 414192 82322 425435 2981742 2579755 458243 190571 317906 2910663 3345110 373134 -201146 937343 2579755 2619320 683999 655272 613481 3345110 2560192 318689 -66873 192688 2619320 1.00000 false true true 13075728 23124460 36200188 22305358 606315944 290150477 338470825 306011756 220246328 85765428 45371646 8346150 37025496 497461937 0 FAIR VALUE - INTEREST RATE SWAP 11982074 ACCRUED POST RETIREMENT BENEFIT 6631051 ACCRUED MALPRACTICE INSURANCE 4156390 DUE TO WVCH 2764172 LEASEHOLD INCENTIVES 91479 OTHER LIABILITIES 126499 25751665 X PART V, LINE 4: ENDOWMENT FUNDS ARE HELD BY SALEM HEALTH FOUNDATION FOR SALEM HEALTH SUPPORT. PART X, LINE 2: UNCERTAIN TAX POSITIONS FROM THE NOTES TO CONSOLIDATED FINANCIAL STATEMENTS ISSUED FOR SALEM HEALTH HOSPITALS AND CLINICS AND RELATED COMPANIES: THE CORPORATION (SALEM HEALTH HOSPITALS & CLINICS), SALEM HEALTH, SALEM HEALTH WEST VALLEY, SALEM HEALTH FOUNDATION, WEST VALLEY HOSPITAL FOUNDATION, SALEM HEALTH PROFESSIONAL SERVICES AND WILLAMETTE VALLEY INSURANCE CORPORATION ARE TAX-EXEMPT ORGANIZATIONS PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AS SUCH, ONLY UNRELATED BUSINESS INCOME IS SUBJECT TO FEDERAL OR STATE INCOME TAXES. MANAGEMENT HAS NOT RECORDED A PROVISION AS UNRELATED BUSINESS INCOME, IF ANY, IS IMMATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. 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, 2019 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 JURISDICTIONS; HOWEVER, 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 2016. true true X true X 300. true X true true true false true true 46470 19184794 19184794 0.02490 117861 177544445 135347733 42196712 0.05470 164331 196729239 135347733 61381506 0.07960 43245 3575539 89356 3486183 0.00450 567 1567955 1567955 0.00200 42815218 23558165 19257053 0.02500 188759 188759 0.00020 27330 428048 428048 0.00060 71142 48575519 23647521 24927998 0.03230 235473 245304758 158995254 86309504 0.11190 30976 30976 2139321 2139321 0.00280 2170297 2170297 0.00280 false 23932067 13658934 117281538 127268795 -9987257 X true true 1 1 Salem Health 890 Oak Street SE Salem OR 97301 14-1428 X X X SALEM HEALTH 1 false false true X X X X X X X X X 17 true true true true X www.salemhealth.org X www.co.marion.or.us/HLT X X true 18 true www.salemhealth.org/about/community false true X 300. 400. X X X X X true true X X X X true X see Section C X see Section C X See Section C X X X X X X true X false X X X X true X false false Part V, Section B, Line 5: A comprehensive needs assessment was conducted in the tax year 2017 in cooperation with the local public health department, coordinated care organizations and local non-profit organizations. The assessment was conducted by surveying community partners working in social, health, community, educational and correctional health settings and the community at large. Paper and electronic surveys were distributed throughout both counties and community forums were held as well to identify health needs and priorities. National surveillance data such as the Behavior Risk Surveillance survey and Oregon Healthy Teens was used, in addition to state and local data from birth and death certificates. Part V, Section B, Line 6a: The CHNA was conducted with cooperation and representatives from Santiam Hospital and Legacy Health. Part V, Section B, Line 6b: The hospital facility's CHNA was conducted with Community Action Agency, the Early Learning Hub, Marion County Health Department, Polk Co Health Department, Oregon State University Cooperative Extension, United Way, WVP Health Authority and Willamette Valley Community Health. Part V, Section B, Line 7d: The Hospital made the CHNA widely available to the community. All partners described in Section B, Line 6b were provided with executive summary documents for distribution to community members free of charge. The full assessment is posted to the hospital and county websites. Part V, Section B, Line 11: Priority areas addressed in the 2017 assessment include adolescent mental health, obesity, tobacco use, and sexually transmitted infections. Salem Health has chosen to focus on the first three areas. Adolescent Mental Health: Oregon's suicide rate in 2017 was more than twice as high as the national average. Suicide is the second leading cause of death for those ages 15-34 and the third leading cause for those ages 9-14. According to Oregon Health Plan (Medicaid) data, 31.5% of children ages 12-17 in Marion County have a mental health condition and fewer than half are receiving treatment. The numbers are even more stark for children under the age of 12: 27% have been identified as having a mental health condition and just 4% are receiving treatment. The number of patients seen in the Salem Hospital emergency room for suicidal ideation and intentional self-harm has increased neatly 80% since 2016. Salem Health has launched a community wide initiative to explore contributing factors to this increase along with Salem-Keizer Public Schools, the county health departments and other mental health care providers. The scope for the 2018-19 years is community prevention with plans to expand the work beyond this scope in 2020. Salem Health offers free Question, Persuade, Refer (QPR) training to community members and has partnered with several school districts, universities, non-profit organizations and the faith based community to increase the number of trainers available to offer the course. Tobacco: Tobacco is the agent most responsible for avoidable illness and death in America today. According to the Centers for Disease Control and Prevention, tobacco use brings premature death to almost half a million Americans each year and it contributes to profound disability and pain in many others. The World Health Organization states that approximately one-third of all tobacco users in this country will die prematurely because of their dependence on tobacco. Marion and Polk counties have continuously seen a significant increase in tobacco since 2011: 19% of Marion County residents and 16.4% of Polk County residents use tobacco. Tobacco use contributes to many diseases, including lung cancer. Marion and Polk county residents die at a higher rate from lung cancer than those in other parts of Oregon. With tobacco use comes a greater exposure to secondhand smoke for non-smokers, which may exacerbate a wide range of adverse health effects such as respiratory infections and asthma. Particularly concerning is the increase of tobacco use during pregnancy. Tobacco use during pregnancy has decreased in recent years, but at 10% is still far higher than the Health People 2020 goal of less than 2%. Salem Health is a smoke free campus and has worked with the City of Salem to expand smoke free zones to neighboring sidewalks and city parks. The hospital screens 100% of its patients for tobacco use and provides all tobacco users with community cessation resource information. The American Lung Association's Freedom From Smoking curriculum is offered at no cost through the Salem Health Community Health Education Center and the Health Education and Outreach teams provide community based education to schools related to tobacco prevention. Obesity: Obesity rates in Marion and Polk counties continue to climb at a rate higher than the rest of the state. Nearly 35% of adults in Marion county are considered to be obese and 18% of 11th graders in Marion county are obese, compared with 26% and 15% respectively statewide. In Polk county, 31.5% of adults are obese as are 17.5% of 11th graders. Obesity contributes to nearly every chronic medical condition, including heart disease, diabetes and cancer. Salem Health continues to focus on obesity prevention efforts through health outreach and education, support of partnering agencies with a shared goal to decrease obesity, medical provider BMI screenings and community health education center programming focused on health promotion and prevention of chronic disease. Obesity is also a priority for the Community Health Improvement Plan (CHIP) which is supported by Salem Health. The Marion County Public Health Department convenes community stakeholders to address obesity using a logic model and collective impact framework. Salem Health and other community partners' collective work impact is published annually on the Marion County Public Health website. Sexually transmitted infections: Marion County has experienced significant increases in sexually transmitted infections in the last five years, including a 7.8% increase in the incidence of Chlamydia, 186.7% increase in the incidence of Gonorrhea and a 490% increase in the incidence of Syphilis. Marion County is seeing an increase in rates of congenital Syphilis. Marion County is actively working with local providers to ensure accurate reporting, education to appropriate audiences and efficacy of treatment in tackling these diseases. Salem Health's providers are participating and a representative meets regularly with Marion County Public Health to assess the needs and progress made. PART V, SECTION B, LINE 13H: CRITERIA CONSIDERED IN DETERMINING ELIGIBILITY INCLUDE, BUT ARE NOT LIMITED TO: 1. HOUSEHOLD'S GROSS INCOME *THE DEFINITION OF 'HOUSEHOLD'S GROSS INCOME' INCLUDES THE COMBINED GROSS MONTHLY INCOME OF ALL PERSONS LEGALLY RESPONSIBLE FOR PATIENT BILL OR BALANCE. 2. HOUSEHOLD'S ASSETS OTHER THAN PRIMARY RESIDENCE * EQUITY IN A REAL ESTATE (OTHER THAN THE PATIENT/GUARANTOR'S PRIMARY RESIDENCE), SECURITIES OR OTHER ASSETS ARE CONSIDERED AVAILABLE TO PAY THE PATIENT'S MEDICAL EXPENSES AND SHOULD BE INCLUDED IN THE INCOME CALCULATION. * THE INCOME FROM INCOME-PRODUCING REAL PROPERTY SHOULD BE USED IN THE CALCULATION RATHER THAN THE EQUITY. * INDIVIDUAL RETIREMENT ACCOUNTS (IRAS) OR OTHER RETIREMENT FUNDS WILL NOT BE INCLUDED IN HOUSEHOLD ASSETS; HOWEVER DISTRIBUTIONS FROM THOSE FUNDS WILL BE CONSIDERED INCOME. 3. FAMILY SIZE (PERSONS LEGALLY RESPONSIBLE FOR THE PATIENT BILL AND THEIR DEPENDENTS) 4. THE FAMILY'S MONTHLY OUT OF POCKET EXPENSES FOR MEDICAL SUPPLIES AND SERVICES 5. ELIGIBILITY MAY BE CONTINGENT UPON PATIENT COOPERATION WITH THE APPLICATION PROCESS. HOUSEHOLD INCOMES UP TO 400% OF THE ANNUAL FEDERAL POVERTY GUIDELINES (FPG) WILL BE ELIGIBLE FOR FINANCIAL ASSISTANCE AS OUTLINED BELOW AND IN THE FPG FINANCIAL MATRIX: FINANCIAL MATRIX INCOME AS A PERCENTAGE OF FEDERAL POVERTY LEVEL PERCENTAGE DISCOUNT 0-300% 100% 301-400% 65% ALL OTHER UNINSURED ALL OTHER UNINSURED Part V, Section B, Line 15e: Supporting documentation may include the following: Patient must provide two of the following documents to support the income claims on the application. * Three months income verification in the form of pay stubs, bank deposits, etc. * Social Security determination letters * The prior year's tax returns or 4506T-EZ * A "Basic Needs" letter that indicates how persons with no income are meeting their day to day basic living needs. "Basic Needs" letter must only be considered a secondary supporting document after the Financial Counselor or Clerk validates the information. As outlined in Salem Health's Condition of Admission, a credit bureau report or a charity scoring vendor may be requested to validate information provided on the financial assistance application. Salem Health may accept information provided on an OHP application, OHP eligibility, Probate Estates determination, documentation of homeless status, or reliable third party credit information as a substitute for the financial forms. OHP information will be considered valid 30 days prior to admission and 90 days post discharge. Approved sources of documentation for homeless status include chart notes, discharge plans, or discharge summaries entered into our health information system by care providers or the patient indicating they are homeless during the registration process. Financial Assistance granted based on third party information rather than a Financial Assistance Application does not extend to future dates of service and would need to be reevaluated based on information available at that time. Application Process & Eligibility Determination A request for financial assistance may be made before, during, or after the provision of care. The Hospital has developed an application process for determining initial interest in and qualification for financial assistance. Requests for financial assistance will be accepted from the patient directly, or others on the patient's behalf. This could include but is not limited to, the patient's representative, or hospital staff. Part V, Section B, Line 16a: FAP website address: http://www.salemhealth.org/about/charity-care-and-financial-policy Part V, Section B, Line 16b: Financial assistance application website address: http://www.salemhealth.org/about/charity-care-and-financial-policy Part V, Section B, Line 16c: Plain language summary website address: http://www.salemhealth.org/about/charity-care-and-financial-policy 8 REHABILITATION CENTER 755 MISSION ST SE SALEM OR 97302 REHABILITATION LABORATORY PHILEBOTOMY SITE - HOPE 1600 STATE ST SALEM OR 97301 LABORATORY SERVICES COMPREHENSIVE PAIN CENTER 875 OAK STREET SALEM OR 97302 PAIN MANAGEMENT REGIONAL LABORATORY 3300 STATE ST SALEM OR 97301 LABORATORY SERVICES SALEM HEALTH MEDICAL CLINIC - KEIZER 550 DEITZ AVE NE KEIZER OR 97303 CLINIC SALEM HEALTH MEDICAL CLINIC - S SALEM 2925 RIVER RD S SALEM OR 97302 CLINIC SALEM HEALTH MEDICAL CLINIC - SALEM 966 12TH STREET SE SALEM OR 97301 CLINIC SALEM HEALTH MEDICAL CLINIC - W SALEM 1049 EDGEWATER ST NW SUITE 150 SALEM OR 97304 CLINIC Part I, LINE 3C: Criteria considered in determining eligibility include, but are not limited to: 1. Household's gross income *The definition of 'household's gross income' includes the combined gross monthly income of all persons legally responsible for patient bill or balance. 2. Household's assets other than primary residence * Equity in a real estate (other than the patient/guarantor's primary residence), securities or other assets are considered available to pay the patient's medical expenses and should be included in the income calculation. * The income from income-producing real property should be used in the calculation rather than the equity. * Individual Retirement Accounts (IRAs) or other retirement funds will not be included in household assets; however distributions from those funds will be considered income. 3. Family size (persons legally responsible for the patient bill and their dependents) 4. The family's monthly out of pocket expenses for medical supplies and services 5. Eligibility may be contingent upon patient cooperation with the application process. Part I, Line 6a &6b: A Community Benefit Report was published and is available at www.salemhealth.org. Part I, Line 7: WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, WAS USED TO CALCULATE THE RATIO OF PATIENT CARE COST TO CHARGES (CCR). THIS CCR WAS THEN APPLIED TO THE CHARITY CARE, MEDICAID AND OTHER COMMUNITY BENEFIT RELATED EXPENSES TO CALCULATE THE COST. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $23,932,067. PART II, COMMUNITY BUILDING ACTIVITIES: SALEM HEALTH IS DEEPLY EMBEDDED IN THE COMMUNITY AND HOSPITAL LEADERS WORK HAND IN HAND WITH REPRESENTATIVES FROM GOVERNMENT AGENCIES AND OTHER NON-PROFIT ORGANIZATIONS TO ASSESS AND ADDRESS COMMUNITY NEEDS. THREE AREAS CURRENTLY IDENTIFIED AS PRIORITIES ARE ADOLESCENT MENTAL HEALTH, OBESITY AND TOBACCO. COMMUNITY WIDE TASK FORCES ARE IN PLACE TO ADDRESS THESE HEALTH NEEDS, WHICH ARE DEEMED MOST CRITICAL IN THE TWO COUNTIES SERVED BY SALEM HEALTH. REPRESENTATIVES FROM APPROPRIATE AREAS OF THE HOSPITAL ATTEND TASK FORCE MEETINGS AND LEVERAGE HOSPITAL RESOURCES TO POSITIVELY IMPACT HEALTH OUTCOMES. HOSPITAL LEADERS VOLUNTEER TIME TO SERVE ON COMMUNITY NON-PROFIT BOARDS WHICH MIRROR THE MISSION OF SALEM HEALTH AND ATTEND REGIONAL COLLABORATIVE WORK GROUPS THAT ADDRESS SOCIAL DETERMINANTS OF HEALTH. EXAMPLES INCLUDE BOARD POSITIONS ON SALEM FREE CLINIC, FAMILY BUILDING BLOCKS, MARION POLK FOOD SHARE, THE BOYS AND GIRLS CLUB, UNITED WAY, UNION GOSPEL MISSION, AND LIBERTY HOUSE. THE HOSPITAL PROVIDES COMMUNITY BASES HEALTH IMPROVEMENT SERVICES AS REQUESTED IN MARION AND POLK COUNTIES. IN 2017, THESE INCLUDED HEALTH SCREENINGS, EDUCATION AND OUTREACH. THE COMMUNITY HEALTH EDUCATION CENTER OFFERS A HEALTH RELATED LENDING LIBRARY, DROP-IN NURSING CONSULTATION SERVICES AND GROUP INSTRUCTION. DIABETIC AND NUTRITION COUNSELING IS ALSO OFFERED FOR PATIENTS NEWLY DIAGNOSED AND UNABLE TO PAY FOR THESE SERVICES. THE CENTER PROVIDES SPACE FREE OF CHARGE TO COMMUNITY PARTNERS SEEKING TO IMPROVE HEALTH OUTCOMES. THE ROOMS HOST CLASSES, LECTURES, HEALTH FAIRS AND SUPPORT GROUPS THAT ARE COORDINATED IN PARTNERSHIP WITH COMMUNITY AGENCIES. SALEM HEALTH PROVIDED COMMUNITY PARTNER GRANTS IN 2018 TO ENHANCE EXISTING NON-PROFIT ORGANIZATIONS' WORK THAT ADDRESSES NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. ADDITIONAL FINANCIAL GRANTS ARE ISSUED TO NON-PROFITS THAT ADDRESS ACCESS TO HEALTH CARE FOR UN- AND UNDERINSURED POPULATIONS. LASTLY, THE HOSPITAL PROVIDES TRAINING FOR NURSING STUDENTS AND EMERGING HEALTH CARE PROFESSIONALS. ITS HEALTH CAREER EXPLORATION PROGRAMS FOR HIGH SCHOOL STUDENTS IN DISTRICTS THAT FALL WITHIN THE HOSPITAL CATCHMENT AREA SERVE HUNDREDS OF HIGH SCHOOL STUDENTS ASPIRING TO MEDICAL CAREERS. SALEM HEALTH HAS MORE THAN 450 VOLUNTEERS AND A STAFF OF THREE THAT COORDINATE COMMUNITY BUILDING ACTIVITIES. VOLUNTEERS RAISE MONEY FOR COMMUNITY SCHOLARSHIPS, COORDINATE JOB SHADOW OPPORTUNITIES AND ARRANGE FOR BLOOD DRIVES. IN 2017, SALEM HEALTH SPONSORED AN ORGANIZATION WIDE INITIATIVE TO ENCOURAGE EMPLOYEES TO VOLUNTEER IN THE LOCAL COMMUNITY. OVER THE COURSE OF THE YEAR, 83% OF DEPARTMENTS WITHIN THE HOSPITAL HAD AT LEAST ONE EMPLOYEE VOLUNTEER OUTSIDE THE HOSPITAL. GROUP VOLUNTEER OPPORTUNITIES WERE COORDINATED QUARTERLY, SUCH AS PARK BEAUTIFICATION AND SET UP OF LOCAL EVENTS. LEADERS AT ALL LEVELS WITHIN SALEM HEALTH SERVE ON COMMUNITY BOARDS AND TASK FORCES THAT ADDRESS COMMUNITY NEEDS. THE HOSPITAL WORKS WITH THE LOCAL MEDICAL COMMUNITY TO IDENTIFY GAPS IN CARE AND RECRUIT NEEDED PRIMARY CARE PROVIDERS AND SPECIALISTS TO IMPROVE ACCESS TO CARE. PHYSICIAN LEADERSHIP TRAINING IS OFFERED TO COMMUNITY PROVIDERS ACROSS THE SERVICE AREA. PART III, LINE 2: BAD DEBT EXPENSE IS PRIMARILY ESTIMATED BASED UPON THE HOSPITALS' HISTORICAL COLLECTION EXPERIENCE, THE AGE OF THE PATIENT'S ACCOUNT, THE PATIENT'S ECONOMIC ABILITY TO PAY, AND THE EFFECTIVENESS OF COLLECTION EFFORTS. PATIENT ACCOUNTS RECEIVABLE BALANCES ARE ROUTINELY REVIEWED IN CONJUNCTION WITH HISTORICAL COLLECTION RATES AND OTHER ECONOMIC CONDITIONS THAT MIGHT ULTIMATELY AFFECT THE COLLECTABILITY OF PATIENT ACCOUNTS WHEN CONSIDERING THE ADEQUACY OF THE AMOUNTS RECORDED IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ACTUAL WRITE-OFFS HISTORICALLY HAVE APPROXIMATED MANAGEMENT'S EXPECTATIONS. PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER SALEM HEALTH'S FINANCIAL ASSISTANCE POLICY IS ESTIMATED BASED ON DATA FROM OUR PATIENT ACCOUNTING SYSTEM. THIS DATA IS THEN COMPARED AND MATCHED TO MEDIAN HOUSEHOLD INCOME CENSUS DATA BY ZIP CODE TO DETERMINE THE ESTIMATED BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE. PART III, LINE 4: EFFECTIVE OCTOBER 1, 2011, THE HOSPITALS ADOPTED FASB ISSUED ACCOUNTING STANDARDS UPDATE (ASU) NO. 2011-07, HEALTH CARE ENTITIES (TOPIC 954): PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTHCARE ENTITIES. THE ADOPTION OF THIS ASU RESULTED IN A RECLASSIFICATION OF BAD DEBT EXPENSE FROM AN OPERATING EXPENSE TO BE A REDUCTION IN DERIVING NET PATIENT SERVICE REVENUE. THE ALLOWANCES FOR DOUBTFUL ACCOUNTS ARE PRIMARILY ESTIMATED BASED UPON THE HOSPITALS' HISTORICAL COLLECTION EXPERIENCE, THE AGE OF THE PATIENT'S ACCOUNT, THE PATIENT'S ECONOMIC ABILITY TO PAY, AND THE EFFECTIVENESS OF COLLECTION EFFORTS. PATIENT ACCOUNTS RECEIVABLE BALANCES ARE ROUTINELY REVIEWED IN CONJUNCTION WITH HISTORICAL COLLECTION RATES AND OTHER ECONOMIC CONDITIONS THAT MIGHT ULTIMATELY AFFECT THE COLLECTABILITY OF PATIENT ACCOUNTS WHEN CONSIDERING THE ADEQUACY OF THE AMOUNTS RECORDED IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ACTUAL WRITE-OFFS HISTORICALLY HAVE APPROXIMATED MANAGEMENT'S EXPECTATIONS. PART III, LINE 8: MEDICARE PAYS A SIGNIFICANTLY REDUCED AMOUNT FOR MEDICAL SERVICES RENDERED TO THEIR ENROLLEES SUCH THAT THE NET REIMBURSEMENT DOES NOT COVER THE EXPENSES INCURRED TO PROVIDE THE SERVICES. SALEM HEALTH CONSIDERS THE DIFFERENCE BETWEEN THE COSTS TO PROVIDE THE SERVICES FOR MEDICARE ENROLLEES AND THE NET REIMBURSEMENT AS A BENEFIT TO THE COMMUNITY. MEDICARE FEE-FOR-SERVICE COSTS ARE DETERMINED FROM SALEM HEALTH'S FILED MEDICARE COST REPORT. THE CALCULATION OF NET BENEFIT IS EQUAL TO TOTAL MEDICARE PAYMENTS LESS MEDICARE COSTS. IN ADDITION TO TRADITIONAL MEDICARE FEE-FOR-SERVICE, SALEM HEALTH PROVIDES SUBSTANTIAL SERVICES TO OTHER MEDICARE POPULATIONS PARTICIPATING IN MEDICARE ADVANTAGE PLANS AT SIGNIFICANTLY REDUCED REIMBURSEMENT. THE NET REVENUES FOR THESE PLANS ARE LESS THAN THE COST TO PROVIDE CARE AND ARE NOT DISCLOSED IN PART III, LINE 8. SALEM HEALTH ALSO CONSIDERS THE DIFFERENCE BETWEEN THE NET COST TO PROVIDE CARE FOR MEDICARE ADVANTAGE ENROLLEES AND THE NET REIMBURSEMENT AS A BENEFIT TO THE COMMUNITY. THESE NET COSTS HAVE BEEN DETERMINED BY APPLYING THE RATIO OF COSTS TO CHARGES AS DETERMINED IN WORKSHEET 2 TO THE FULL BILLED CHARGES. THE CALCULATION OF NET BENEFIT IS EQUAL TO TOTAL MEDICARE ADVANTAGE PAYMENTS OF $171,457,893 LESS MEDICARE ADVANTAGE COSTS OF $211,901,271 FOR A TOTAL ADDITIONAL COMMUNITY BENEFIT IN THE AMOUNT OF $40,443,378. PART III, LINE 9B: THE BILLING AND COLLECTIONS ADMINISTRATIVE HOUSE-WIDE POLICY AND PROCEDURE STATES, "IF A PATIENT SUBMITS A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, SALEM HEALTH WILL SUSPEND THE ECAS UNTIL THE PATIENT'S APPLICATION HAS BEEN PROCESSED AND NOTIFY THE PATIENT OF DETERMINATION. IF AN INDIVIDUAL IS FOUND TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, ANY ECAS WILL BE REVERSED. PART VI, LINE 2: AN UPDATED COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED IN 2017. THE NEEDS ASSESSMENT DESCRIBES THE COMMUNITY SERVED BY THE HOSPITAL AND THE DEMOGRAPHICS OF THE COMMUNITY. IT DOES NOT DESCRIBE THE EXISTING HEALTH CARE FACILITIES AND RESOURCES WITHIN THE COMMUNITY THAT ARE AVAILABLE TO RESPOND TO NEEDS. THE MARION AND POLK COUNTY HEALTH CARE SYSTEM CAPACITY AND ACCESS ASSESSMENT CONTAINS HEALTH CARE FACILITY AND RESOURCE INFORMATION. THE CAPACITY AND ACCESS ASSESSMENT IS UPDATED ANNUALLY. THE MOST RECENT CHNA AND HEALTH CARE SYSTEM CAPACITY AND ACCESS ASSESSMENTS ARE PUBLISHED TO THE SALEM HEALTH WEBSITE AT WWW.SALEMHEALTH.ORG. THE NATIONAL MODEL, MOBILIZATION FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) WAS USED AS THE FRAMEWORK FOR CHNA. THE FOUR ASSESSMENTS OF MAPP FRAMEWORK INCLUDE: COMMUNITY THEMES AND STRENGTHS, LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT, COMMUNITY HEALTH STATUS ASSESSMENT AND THE FORCES OF CHANGE ASSESSMENT. THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT WAS CONDUCTED BY SURVEYING COMMUNITY PARTNERS WORKING IN SOCIAL, EDUCATIONAL, COMMUNITY AND CORRECTIONAL HEALTH SETTING AND THE COMMUNITY AT LARGE. THE SURVEYS USED IN BOTH COUNTIES HAS THE SAME QUESTIONS AND WERE BASED ON PAST SURVEYS. PAPER AND ELECTRONIC SURVEYS WERE ALLOCATED BASED ON POPULATION DISTRIBUTION THROUGHOUT THE TWO COUNTIES. THE COMMUNITY HEALTH STATUS ASSESSMENT WAS CONDUCTED BY COMPILING DATA FROM NATIONAL SURVEILLANCE SYSTEMS LIKE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY AND OREGON HEALTHY TEENS, AS WELL AS STATE AND LOCAL DATA FROM BIRTH AND DEATH CERTIFICATES. IN ADDITION, A SERIES OF COMMUNITY FORUMS WERE CONDUCTED ACROSS MARION AND POLK COUNTIES TO IDENTIFY HEALTH PRIORITIES. THE MARION AND POLK COUNTY HEALTH ASSESSMENT UPDATES WERE PUBLISHED IN DECEMBER 2017 AND CAN BE FOUND ON THE SALEM HEALTH WEBSITE AT WWW.SALEMHEALTH.ORG. THE DOCUMENT INFORMED THE DEVELOPMENT OF THE COMMUNITY BENEFIT IMPLEMENTATION STRATEGY FOR THE YEARS 2018-2020, ALSO AVAILABLE ON THE WEBSITE. THE IMPACT OF ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE HOSPITAL FACILITIES' PRIOR CHNAS CAN BE FOUND ON THE COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) ANNUAL REPORT. THE CHIP IS COORDINATED BY MARION COUNTY PUBLIC HEALTH DEPARTMENT AND IS PUBLISHED ON THEIR WEBSITE AT WWW.CO.MARION.OR.US/HLT/CHIP/PAGES/DEFAULT.ASPX PART VI, LINE 3: SALEM HEALTH SCREENS UNINSURED PATIENTS FOR ELIGIBILITY THROUGH THE OREGON HEALTH PLAN (OHP/MEDICAID), WORKERS COMPENSATION, THIRD PARTY LIABILITIES, CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA) OR ANY OTHER POTENTIAL FUNDING SOURCE AT THE POINT OF SCHEDULING, PATIENT REGISTRATION, OR WHILE INPATIENT. THE HOSPITAL OR ITS REPRESENTATIVE WILL REVIEW THE PATIENT'S CURRENT RESOURCES AND WORK WITH HIM/HER TO GAIN ELIGIBILITY FOR ANY OF THESE PROGRAMS AS APPROPRIATE. PATIENTS NOT ELIGIBLE FOR OHP OR THE OTHER PROGRAMS LISTED ABOVE WHO HAVE FINANCIAL CONSTRAINTS THAT INHIBIT THEIR ABILITY TO PAY, WILL BE ASSESSED FOR FINANCIAL ASSISTANCE. 1. NOTICES ARE POSTED IN KEY AREAS OF THE HOSPITAL, INCLUDING ADMITTING, THE EMERGENCY DEPARTMENT, OUTPATIENT DEPARTMENT REGISTRATION AREAS AND PATIENT FINANCIAL SERVICES. 2. THE CONDITIONS OF ADMISSION FORM INFORMS THE PATIENT OF THEIR RIGHT TO APPLY FOR FINANCIAL ASSISTANCE. 3. WRITTEN INFORMATION IS AVAILABLE IN ENGLISH, SPANISH, RUSSIAN AND VIETNAMESE. THE HOSPITAL WILL PROVIDE THE APPROPRIATE INTERPRETATION SERVICES FOR PATIENTS/GUARANTORS WHO DO NOT SPEAK ENGLISH. 4. FRONT LINE STAFF ARE TRAINED TO ANSWER FINANCIAL ASSISTANCE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY THAT CANNOT BE ANSWERED TO FINANCIAL COUNSELORS IN A TIMELY MANNER. 5. THIS POLICY IS POSTED ON SALEM HEALTH'S WEBSITE. WRITTEN INFORMATION ABOUT THIS POLICY WILL BE MADE AVAILABLE UPON REQUEST. 6. ALL PATIENT BILLING STATEMENTS INCLUDE A NOTICE THAT FINANCIAL ASSISTANCE IS AVAILABLE AND CONTACT INFORMATION IF THEY WANT TO LEARN MORE. PART VI, LINE 4: Marion and Polk County are located in the Willamette Valley and are the 5th and 13th most populous counties in Oregon respectively. This community spans about 1,950 square miles, of which 1,200 are in Marion and 750 are in Polk. In Marion, the five largest cities are Keizer, Salem, Silverton, Stayton, and Woodburn, which are home to 66% of the County's total population. The remaining 34% live in one of the smaller 15 cities or on unincorporated land. In Polk, the largest cities are Dallas, Falls City, Independence, Monmouth, West Salem, and Willamina, in which about 84% of Polk's population resides. Those who live outside of the major population areas in the community may experience greater difficulty accessing resources like health care services and healthy foods. Given the limited public transportation in these rural areas, access to a vehicle is likely required to live a healthy lifestyle. As of 2017, there were about 424,982 people living in the community, which is about 10% of the total state population. Of those, it is estimated that 341,286 people live in Marion and 83,696 live in Polk. Since 2010, the population has increased by 8% in Marion and 11% in Polk, which was similar to the increase in the state as a whole. There were also a larger number of people living per square mile in this community compared to the state and this was especially true for Marion. Just over half of community members identified as female, which was similar to the state. The community had a larger proportion of members between the ages of 0-24 years old than Oregon. There was also a smaller proportion of working age adults (25-64) in the community than the state. In 2016, the median age was lower in Marion (36.4 years) compared to Polk (37.7 years) and the state (39.2 years.) Additionally, more people have been migrating into this community as opposed to leaving, which is expected to continue during the forecast period. Between 2017 and 2035, growth will initially occur at a slightly higher pace and then will begin to slow down, tapering off towards the end of the forecast. It is estimated that this community will exceed 500,000 members by 2035. Polk will be growing at a faster rate than Marion. Shifts in age groups will be occurring over the next 50 year forecast period in this community, with a greater proportion of members falling into older age groups. This change is important, as it highlights the need to expand and prepare for the growing health needs of an aging population. About 26% of community members in Marion identified as Hispanic or Latina(o), which was higher than Polk (13%) and Oregon (12%). Marion had a smaller proportion of members who identified as White, non-Hispanic/Latina(o) than Polk and the state. Marion also had a larger proportion of members who identified as Native Hawaiian or Pacific Islander than Polk and the state. About 1 out of 4 households (25%) in Marion spoke a language other than other than English at home than Polk (14%) and the state (15%). Just over 15% of people in this community were living with a disability, which was greater than the state. The proportion of people living with disabilities has been increasing in all regions in recent years. Community members in Marion had lower household median incomes and a higher percentage living in poverty, especially children, than Polk and the state. Roughly 25% of children were living in poverty in Marion, compared to 17% in Polk and 20% in Oregon. In the community, a higher proportion of females were living in poverty than males, and members who identified as a race or ethnicity other than White, non-Hispanic/Latina(o) had higher poverty rates as well. Overall, poverty rates have been decreasing in this community and the state recently, likely due in part to improving economic conditions. Educational achievement has been improving in recent years as a higher percentage of community members have a high school diploma/GED. However, educational achievement in Marion was lower than Polk and the state, especially with regard to college graduates. In Marion, 22% of people had a Bachelor's degree or higher, compared to 30% in Polk and 31% in Oregon. Educational achievement differed by sex, race and ethnicity, geography, and disability status. About 1 out of 5 children were food insecure in this community. It was also difficult for some community members to obtain healthy foods due to affordability and low access to stores that sell them. PART VI, LINE 5: In addition to the work described in the above narrative, Salem Health has a Community Health Education Center that offers no and low cost health education to the general public in the form of classes, outreach and access to research materials, online and in print. A full time librarian is on staff to assist clinicians with the latest research and treatment options. A staff of health educators presents to the public on various community health topics on request and attends wellness fairs, providing biometrics and health information. The Salem Cancer Institute offers free screenings several times a year for various cancers, including breast, colon, lung and skin cancer. Staff and clinicians participate in dozens of health improvement committees, addressing social determinants of health such as homelessness, food insecurity, education and access to care. true AMERICAN CANCER SOCIETY 0330 SW CURRY ST PORTLAND OR 97239 131788491 501(C)(3) 11500 RELAY FOR LIFE OF GREATER SALEM SPONSORSHIP/TOAST TO CANCER SURVIVORS SPONSORSHIP/IMPROVE SOCIAL DETERMINATE OF HEALTH CASA OF MARION COUNTY PO BOX 20298 Keizer OR 97307 270560943 501(C)(3) 8500 GOLD SPONSORSHIP2018/2019 SUPERHERO RACE SPONSORSHIP/2019 LIGHT OF HOPE SPONSORSHIP/IMPROVE SOCIAL DETERMINATE OF HEALTH COMMUNITY ACTION AGENCY HOME 625 Union St NE SALEM OR 97301 237056987 501(C)(3) 15000 Adolescent health goals achieved by the agency's Taylor's House/IMPROVE SOCIAL DETERMINATE OF HEALTH FAMILY BUILDING BLOCKS 2425 LANCASTER DR NE SALEM OR 97305 931233373 501(C)(3) 6000 2019 SUSTAINERS HAPPY HOUR SPONSORSHIP/RIVERFEST SPONSORSHIP/IMPROVE SOCIAL DETERMINATE OF HEALTH KRIS KNOX LLV FOUNDATION 4742 Liberty St S PMB 270 SALEM OR 97302 931328274 501(C)(3) 6500 2018 PLAY FOR A CURE OREGON SPONSORSHIP/IMPROVE SOCIAL DETERMINATE OF HEALTH NORTHWEST FAMILY SERVICES 6200 SE King Rd PORTLAND OR 97222 930841022 501(C)(3) 30461 PROJECT ACCESS NOW/2018 DISCOVERY PINK WALK SPONSORSHIP/IMPROVE SOCIAL DETERMINATE OF HEALTH POLK COUNTY FAMILY & OUTREACH 182 SW ACADEMY SUITE 220 Dallas OR 97338 936002310 POLK COUNTY 6000 MID VALLEY SUICIDE PREVENTION COALTION WEBSITE UPGRADES/DISEASE PREVENTION POLK COUNTY SERVICE INTEGRATION 182 SW ACADEMY SUITE 220 Dallas OR 97338 936002310 POLK COUNTY 15000 2018-2019 INTEGRATION SERVICES/IMPROVE SOCIAL DETERMINATE OF HEALTH SALEM ART ASSOCIATION 600 MISSION ST S SALEM OR 97302 930421613 501(C)(3) 6250 2019 SALEM ART FAIR & FESTIVAL SPONSORSHIP/2019 GOLD SPONSORSHIP FOR CLAY BALL/IMPROVE SOCIAL DETERMINATE OF HEALTH SALEM FREE CLINIC 1300 BROADWAY ST NE SALEM OR 97301 203549992 501(C)(3) 79000 SALEM FREE CLINIC SUPPORT/ 2018 BINATIONAL HEALTH FAIR PRESENTING SPONSOR / OREGON BI-NATIONAL HEALTH FAIR & PROVIDER SPONSORSHIP/ DISEASE PREVENTION AND IMPROVE SOCIAL DETERMINATE OF HEALTH SALEM HEALTH FOUNDATION PO Box 14001 SALEM OR 97309 237002687 501(C)(3) 6000 WELLNESS CLASSIC SPONSORSHIP/IMPROVE SOCIAL DETERMINATE OF HEALTH SALEM KEIZER EDUC FOUNDATION 233 Commerical Street NE SALEM OR 97301 930831467 501(C)(3) 21000 AWESOME YOUTH SPORTS SPONSORSHIP/2019 AWESOME 3000 SPONSORSHIP/IMPROVE SOCIAL DETERMINATE OF HEALTH SALEM KEIZER SCHOOL DISTRICT 2450 Lancaster Dr NE SALEM OR 97305 936000763 OREGON 5400 MEALS FOR SUICIDE PREVENTION/DISEASE PREVENTION SALEM LEADERSHIP FOUNDATION PO BOX 7384 SALEM OR 97303 931215089 501(C)(3) 6000 BRIDGE BUILDERS SUMMER CHALLENGE SPONSORSHIP/ OPEN STREETS SALEM EVENT SPONSORSHIP/COMMUNITY HOMELESS CONNECT SUPPORT/IMPROVE SOCIAL DETERMINATE OF HEALTH SALEM POLICE FOUNDATION PO BOX 2631 SALEM OR 97308 271899059 501(C)(3) 10000 SUICIDE AWARENESS SPONSORSHIP/CHIEF'S CIRCLE TITLE SPONSORSHIP/DISEASE PREVENTION & IMPROVE SOCIAL DETERMINATE OF HEALTH SALVATION ARMY 1901 Front St SALEM OR 97301 941156347 501(C)(3) 25000 LIGHTHOUSE SHELTER/DRUG & ALCOHOL MENTOR/IMPROVE SOCIAL DETERMINATE OF HEALTH PSYCHIATRIC CRISIS CENTER PO BOX 14500 SALEM OR 97309 936002307 MARION COUNTY 23367 OVERHEAD COSTS USE OF SPACE ACCESS TO MEDICAL SERVICES 17 0 Cash Assistance to patients 7003 182976 PART I, LINE 2: GRANTS ARE ONLY MADE TO QUALIFIED EXEMPT ORGANIZATIONS. BECAUSE DOCUMENTATION AND AUTHORIZATION IS CAREFULLY EXAMINED BEFORE A GRANT IS GIVEN, AND THE PURPOSES FOR A GRANT ARE KNOWN BEFORE IT IS AWARDED, NO ADDITIONAL FOLLOW UP IS PERFORMED TO FIND OUT HOW THE GRANT WAS USED. PART III, COLUMN A CASH ASSISTANCE IS PROVIDED TO PATIENTS IN NEED FOR PRESCRIPTIONS, LIFELINE SUPPORT, REHABILITATION AND OTHER URGENT NEEDS. X X X X true true false false false false false false false Cheryl Nester Wolfe President & CEO 820803 0 249393 0 18966 0 20625 0 39605 0 1149392 0 0 0 James Parr Chief Financial Officer 493482 0 91079 0 1800 0 55475 0 39383 0 681219 0 0 0 Ralph Yates CMO Salem Health and SHMG 488863 0 96469 0 24680 0 49519 0 32753 0 692284 0 0 0 Leah Mitchell CIO/VP Kaizen Quality & Safety 441476 0 104311 0 2240 0 50588 0 36392 0 635007 0 0 0 Bahaa Wanly Chief Operating Officer 377966 0 75133 0 1362 0 41912 0 36602 0 532975 0 0 0 Laurie Barr Chief HR Officer - END 1/19/19 342771 0 83617 0 2240 0 44086 0 36991 0 509705 0 0 0 Sarah Horn Chief Nursing Officer 342054 0 66284 0 1344 0 43727 0 36826 0 490235 0 0 0 Christine Clarke General Surgeon 295902 0 0 1493 0 22996 0 14624 0 335015 0 0 0 Andrew Furman VP Med Affairs - End 2/25/18 124442 0 0 157388 0 3165 0 15874 0 300869 0 0 0 Denise Hoover VP Surgical Services 218497 0 44848 0 972 0 35806 0 29007 0 329130 0 0 0 Shea Corum VP IT Operations 217081 0 42987 0 841 0 29988 0 33498 0 324395 0 0 0 Zennia Ceniza VP Clinical Operations 217460 0 23094 0 1327 0 15771 0 26245 0 283897 0 0 0 Leilani Slama VP Community Engagement 195737 0 38718 0 2262 0 27561 0 32784 0 297062 0 0 0 Jaime Nichols Interim VP Human Resources 161019 0 17403 0 146 0 14609 0 31904 0 225081 0 0 0 Bruce Rodgers VP Medical Group - END 1/5/19 86569 0 50577 0 911 0 25098 0 12886 0 176041 0 0 0 Juan Oyarzun Dir Cardiothoracic Medicine 1152177 0 25000 0 6164 0 44916 0 40383 0 1268640 0 0 0 Katherine Jones Cardiothoracic Surgeon 1016026 0 0 1290 0 43617 0 37927 0 1098860 0 0 0 Nervin Fanous Cardiothoracic Surgeon 947153 0 60417 0 2150 0 43617 0 32665 0 1086002 0 0 0 Nicole VanDerHeyden SHMG Chief Medical Officer 613489 0 68658 0 7482 0 52239 0 40774 0 782642 0 0 0 Daniel Chen Neurology Physician 588269 0 26564 0 1708 0 29189 0 39522 0 685252 0 0 0 PART I, LINES 4A-B: SOME OF THE HOSPITAL'S EMPLOYEES RECEIVE DEFERRED COMPENSATION UNDER A 457(F) NONQUALIFIED PLAN. THIS COMPENSATION IS INCLUDED IN COMPENSATION REPORTED IN PART II. THE TOTAL NONQUALIFIED PORTION OF EACH PERSONS DEFERRED COMPENSATION IS: BAHAA WANLY $26,787 BRUCE RODGERS $17,080 CHRISTINE CLARKE $7,871 DANIEL CHEN $14,064 DENISE HOOVER $15,724 JAMES PARR $34,850 JUAN OYARZUN $29,791 KATHERINE JONES $28,492 LAURIE BARR $23,461 LEAH MITCHELL $29,963 LEILANI SLAMA $14,388 MATTHEW BOLES $4,005 NERVIN FANOUS $28,492 NICHOLE VANDERHEYDEN $31,614 RALPH YATES $34,394 SARAH HORN $23,102 SHEA CORUM $15,469 A HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM 521542796 794458CY3 2008-11-13 125000000 REFUND SERIES 2004AB AND 2006B false false false B HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM 521542796 794458EL9 2016-11-01 215638877 REFUND SERIES 2013AB AND 2008A false false false A 50000000 0 125021764 0 0 0 633004 1153492 0 9260268 113975000 0 2009 true false true true B 14580000 0 216071505 0 0 0 1649486 0 0 0 214380232 41788 true true true true A false true true true true true 0.00500 0.00100 0.00600 false false false true B false true true true true true 0.01000 0.00200 0.01200 false false false true A false false true true true true UBS AG 25.8 false false false 0 false true B false true true false false false 0 false 0 false true A true B true COLUMN A: THE DIFFERENCE BETWEEN PART I (E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS IN THE PROJECT FUND. PART I (A): THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM, OREGON REVENUE BONDS PART I (F): PROCEEDS WERE USED TO REFUND SERIES 2004AB AND SERIES 2006B BONDS, FINANCE THE CONTRUCTION OF THE PATIENT TOWER AND OTHER IMPROVEMENTS. PART II, LINE 1: BONDS REFUNDING SERIES 2008C: SERIES 2013AB (ISSUED JUNE 27, 2013). PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENTS TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. PART IV, LINE 2(B): THE REFUNDING AND NEW MONEY PORTIONS OF THE BONDS HAVE MET THE 6-MONTH EXCEPTION TO REBATE. PART IV, LINE 2(C): PROCEEDS OF THE BONDS MET A SPENDING EXCEPTION TO REBATE AND, THEREFORE, NO PAYMENT WILL EVER BE DUE ON THE BONDS. COLUMN B: THE DIFFERENCE BETWEEN PART I(E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS ON BOND PROCEEDS. PART I (A): THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM, OREGON REVENUE BONDS PART I (F): BONDS PROCEEDS WERE EXPENDED TO REFUND THE 2013AB BONDS (ISSUED ON JUNE 27, 2013), TO REFUND THE 2008A BONDS (ISSUED ON OCTOBER 8, 2008) TO REFUND THE 2006A BONDS (ISSUED ON NOVEMBER 15, 2006) AND TO PAY COSTS OF ISSUANCE RELATING TO THE BONDS. PART II, LINE 13: SINCE THE PROCEEDS OF THE BONDS WERE USED FOR REFUNDING PURPOSES, THE YEAR OF SUBSTANTIAL COMPLETION IS NOT APPLICABLE. PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. PART IV, LINE 2(B): THE PORTION OF BOND PROCEEDS USED FOR CURRENT REFUNDING HAS MET THE 6-MONTH EXCEPTION TO REBATE. 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 OF THE HOSPITAL SHALL SEND TO EACH PERSON WHO IS A TRUSTEE, OFFICER, OR MEMBER OF A COMMITTEE, AND TO THOSE EMPLOYEES OF THE HOSPITAL AS THE BOARD MAY DETERMINE, 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, COMMITTEE MEMBER OR EMPLOYEE PRIOR TO THE BEGINNING OF EACH CALENDAR YEAR. FORM 990, PART VI, SECTION B, LINE 15: EXECUTIVE COMPENSATION AT SALEM HEALTH IS DESIGNED TO ALLOW THE ORGANIZATION TO RECRUIT AND RETAIN QUALIFIED SENIOR LEADERS. THE GOVERNANCE COMMITTEE OF THE SALEM HEALTH BOARD OF TRUSTEES, NONE OF WHOM IS A SALEM HEALTH EMPLOYEE, ENGAGES ONE OR MORE INDEPENDENT CONSULTANTS TO PROVIDE MARKET DATA ON CEO COMPENSATION, INCLUDING BENEFITS, FOR THE CEOS AT COMPARABLE ORGANIZATIONS. THIS INFORMATION IS USED BY THE GOVERNANCE COMMITTEE AND BOARD OF TRUSTEES IN THEIR DISCUSSIONS AND DECISIONS ON CEO COMPENSATION. COMPENSATION FOR THE CEO IS REVIEWED ON AN ANNUAL BASIS. THE MOST RECENT REVIEW TOOK PLACE IN JULY/AUGUST 2019. THE COMPENSATION DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN THE GOVERNANCE COMMITTEE AND BOARD MINUTES FOR THIS MEETING. ONE OR MORE INDEPENDENT CONSULTANTS ARE ALSO RETAINED TO REVIEW EXECUTIVE COMPENSATION SEPARATE FROM THE CEO. THE 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, SECTION C, LINE 19: THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE ON THE HOSPITAL WEBSITE. FORM 990, PART XI, LINE 9, CHANGES IN NET ASSETS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -2,823,233. CHANGE IN NET BENEFIT COST -1,794,648. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 112,020. Book/Tax Difference in Partnership Income 2,261,004. TOTAL TO FORM 990, PART XI, LINE 9 -2,244,857. 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