2018-05-14T12:02:01-05:00 2017-06-30 930623286 ALDRICH CPAS AND ADVISORS LLP 5665 SW MEADOWS RD SUITE 200 LAKE OSWEGO OR 97035 990 2016-07-01 237002687 SALEM HEALTH FOUNDATION SALE 5038141938 890 OAK STREET SALEM OR 97301 JAMES PARR CHIEF FINANCIAL OFFICER 5038141938 2018-05-08 1 JOYLYN M ANKENEY CPA P00366587 5036204489 2018-04-30 2016 2022-09-23 18:48:47Z JAMES PARR 890 OAK STREET SALEM OR 97301 7908297 0 X WWW.SALEMHEALTH.ORG/FOUNDATION X 1968 OR DEDICATED TO RAISING, MANAGING AND DISTRIBUTING FUNDS TO HELP SALEM HEALTH ACHIEVE ITS MISSION. 15 15 0 15 0 0 1471945 1307518 0 0 515073 742314 -315 -24355 1986703 2025477 1113224 1274181 0 0 0 0 18131 19089 19089 417945 382238 1549300 1675508 437403 349969 7880344 8243385 59484 116163 7820860 8127222 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 163968 163968 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. 865927 865927 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. 244286 244286 CERTAIN RESTRICTED FUNDS HAVE BEEN CREATED AND ARE USED FOR THE PURPOSE 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. 1274181 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 OR X SALEM HEALTH 5038141938 890 OAK STREET SE SALEM OR 97301 KATHY GORDON CHAIR 1.00 X X 0 0 0 ALEX CASEBEER VICE CHAIR 1.00 X X 0 0 0 GARTH BRANDAW DIRECTOR 1.00 X 0 0 0 ERIC FISKUM DIRECTOR 1.00 X 0 0 0 BARBARA FURER DIRECTOR 1.00 X 0 0 0 DR MICHAEL HANSLITS DIRECTOR 1.00 X 0 0 0 RYAN ALBRITTON DIRECTOR 1.00 X 0 0 0 BARBARA HALSEY DIRECTOR 1.00 X 0 0 0 DR ROBERT PONEC DIRECTOR 1.00 X 0 0 0 TERRY WADE DIRECTOR 1.00 X 0 0 0 MIKE DELK DIRECTOR 1.00 X 0 0 0 STEVE ALTMAN DIRECTOR 1.00 X 0 0 0 ALEX RHOTEN DIRECTOR 1.00 X 0 0 0 BUD PIERCE MD DIRECTOR 1.00 X 0 0 0 RAGHU KAMINENI MD DIRECTOR 1.00 X 0 0 0 LEILANI SLAMA VP OF COMMUNITY ENGAGEMENT 20.00 20.00 X 0 151389 41623 JAMES PARR CHIEF FINANCIAL OFFICER 1.00 39.00 X 0 439052 81331 0 590441 122954 0 0 1 0 0 73658 347104 886756 1307518 32103 32103 6565156 5854945 710211 710211 710211 2320 73658 27275 -24955 -24955 1200 600 600 600 2025477 0 0 717959 865927 865927 408254 408254 297514 297514 9800 9800 19089 19089 14618 14618 3957 3957 39215 39215 5133 5133 21 21 166 166 2950 2950 MISCELLANEOUS 6297 0 6297 TAXES, LICENSES & FEES 2567 2567 1675508 1274181 382238 19089 711547 972535 99237 24776 692000 692000 692000 6319715 6507025 35538 47049 22307 0 7880344 8243385 0 14 59484 116149 59484 116163 X 1709924 2389310 3841968 3468644 2268968 2269268 7820860 8127222 7880344 8243385 349969 -43607 0 X X 0 1 X 1 0 X 894250 1326357 1356871 1471945 1307517 6356940 894250 1326357 1356871 1471945 1307517 6356940 573989 5782951 130095 122991 133323 108852 32103 527364 48637 50633 55955 0 0 155225 7039529 0.82150 0.75740 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2833952 64030 275990 192242 2981730 2693626 52175 131912 43761 2833952 2712832 52030 -16632 54604 2693626 2747398 1000 78662 114228 2712832 2752853 42410 281433 329298 2747398 0.76000 0.24000 0 0 685000 685000 7000 7000 692000 DUE TO SALEM HEALTH 116149 116149 X 2053352 27875 27875 2025477 0 2025477 1703383 27875 27875 1675508 0 1675508 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 IRS. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2017 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUE 27,875. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUE 27,875. X X X X 1 TIM THOMAS & ASSOCIATES 1590 BRATTLEBORO DRIVE WEBSTER NY 14580 DIRECT MAIL SOLICITATION 0 9685 31580 9685 9685 31580 9685 OR GOLF TOURNAMENT 75978 73658 2320 540 24844 1891 75978 73658 2320 540 24844 1891 27275 -24955 SCHEDULE G, PART I, LINE 2B, COLUMN (V) PAYMENT OF $31,580 MADE THROUGH 2 MAILINGS FOR 2016 AND 3 MAILINGS FOR 2017. 129 DONATIONS RECEIVED AS A RESULT OF MAILING, TOTAL CONTRIBUTIONS ATTRIBUTED TO MAILING WERE $9,685. 1 SALEM HEALTH 890 OAK STREET SE SALEM OR 97301 930579722 501(C)(3) 865927 N/A N/A TO PAY FOR GENERAL EXPENSES AND CAPITAL EXPENDITURES. 1 SCHOLARSHIPS FOR STUDENTS LIVING IN MARION/POLK OR YAMHILL COUNTY WHO ARE PURSUING A CAREER IN HEALTHCARE. PAYMENTS MADE DIRECTLY TO THE COLLEGE(S) 63 163968 N/A SMALL ONE-TIME CASH GRANTS ($150-$300) TO INDIGENT PATIENTS FOR EMERGENT NEEDS SUCH AS MEDICATION, UTILITIES, TRANSPORTATION, RENT, ETC 141 26685 N/A NON-CASH SUPPORT OF INDIGENT PATIENTS OF SALEM HEALTH AND/OR COMMUNITY MEMBERS INCLUDING PROVIDING MEDICATION, TRANSPORTATION, MEDICAL EQUIPMENT, CAR SEATS AND OTHER SUPPORT. 1920 217601 ACTUAL COST MEDICATIONS, TRANSPORTATION, DURABLE MEDICAL EQUIPMENT, NON-MEDICAL SAFETY/PREVENTION ITEMS (CAR SEATS, EMERGENCY CALL SYSTEM, ETC), REQUIRED HEALTH COUNSELING, EDUCATION. 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. X X X X 0 1 0 0 0 0 0 0 0 LEILANI SLAMA VP OF COMMUNITY ENGAGEMENT 0 137445 0 13591 0 353 0 12359 0 29264 0 193012 0 0 JAMES PARR CHIEF FINANCIAL OFFICER 0 398813 0 38832 0 1407 0 45500 0 35831 0 520383 0 0 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 $3,681 WHICH IS INCLUDED IN DEFERRED COMPENSATION. SCHEDULE J, PART 1, 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. 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 GOVERNING EXECUTIVE COMMITTEE REVIEWS THE IRS FORM 990 BEFORE FILING. 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 COMPENSATION OF THE V.P. & CHIEF DEVELOPMENT OFFICER 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. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C THERE HAVE NOT BEEN ANY CHANGES FROM THE PREVIOUS YEAR. HAMPSHIRE PROPERTIES LLC 890 OAK STREET SE SALEM OR 97301 870804582 REAL ESTATE HOLDING OR 12461 732049 SALEM HEALTH 890 OAK STREET SE SALEM OR 97301 930579722 HOSPITAL OR 501(C)(3) LINE 3 SALEM HEALTH HOSPITALS AND CLINICS 0 SALEM HOSPITAL AUXILIARY 890 OAK STREET SE SALEM OR 97301 931081113 SUPPORTS SALEM HEALTH OR 501(C)(3) LINE 10 N/A 0 SALEM HEALTH HOSPITAL & CLINICS 890 OAK STREET SE SALEM OR 97301 930823471 LEASES LAND TO SALEM HEALTH OR 501(C)(3) LINE 12A, I N/A 0 SALEM HEALTH WEST VALLEY 525 SOUTHEAST WASHINGTON STREET DALLAS OR 97338 431960221 HOSPITAL OR 501(C)(3) LINE 3 SALEM HEALTH HOSPITALS AND CLINICS 0 WEST VALLEY HOSPITAL FOUNDATION 525 SOUTHEAST WASHINGTON STREET DALLAS OR 97338 931298564 SUPPORTS SALEM HEALTH WEST VALLEY OR 501(C)(3) LINE 12A, I SALEM HEALTH HOSPITALS AND CLINICS 0 WILLAMETTE VALLEY INSURANCE COMPANY 745 FORT STREET HONOLULU HI 96813 201836190 CAPTIVE INSURANCE HI 501(C)(3) LINE 12A, I SALEM HEALTH HOSPITALS AND CLINICS 0 SALEM HEALTH PROFESSIONAL SERVICES 890 OAK STREET SE SALEM OR 97301 753175249 BILLING SERVICE FOR SALEM HEALTH, SALEM HEALTH WEST VALLEY, & SHHC OR 501(C)(3) LINE 3 SALEM HEALTH HOSPITALS AND CLINICS 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0