SALEM HEALTH WEST VALLEY: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SALEM HEALTH WEST VALLEY (EIN 43-1960221)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-15
- IRS object ID
- 201841359349306384
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-15T12:35:20-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 930623286 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALDRICH CPAS AND ADVISORS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5665 SW MEADOWS RD SUITE 200 | AddressLine1Txt |
| City | LAKE OSWEGO | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97035 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431960221 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SALEM HEALTH WEST VALLEY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SALE | BusinessNameControlTxt |
| Phone | 5038141938 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 SOUTHEAST WASHINGTON ST | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97338 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES PARR | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 5038141938 | PhoneNum |
| Signature | 2018-05-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOYLYN M ANKENEY CPA | PreparerPersonNm |
| PTIN | P00366587 | PTIN |
| Phone | 5036204489 | PhoneNum |
| Preparation | 2018-04-30 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 69.30.50.66 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-05-08 | IPDt |
| IP Tm | 08:44:03 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 8DEF7001EF646B25FB6D4B1C1546779B4D96824C | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | DB5FA997F7011B499C38FB840EA7688578FDB970 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAMES PARR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 SOUTHEAST WASHINGTON ST | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97338 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,059,050 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SALEMHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | WE STRIVE TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE AND COMMUNITY WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 205 | TotalEmployeeCnt |
| Total Volunteers | 24 | TotalVolunteersCnt |
| Total Gross UBI | $37,625 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $18,761 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $20,515 | PYContributionsGrantsAmt |
| CY Contributions Grants | $100,432 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,060,474 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $29,956,551 | CYProgramServiceRevenueAmt |
| PY Investment Income | $965 | PYInvestmentIncomeAmt |
| CY Investment Income | -$25,706 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $22,081,954 | PYTotalRevenueAmt |
| CY Total Revenue | $30,031,277 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $15,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,432,993 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,826,949 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,662,218 | PYOtherExpensesAmt |
| CY Other Expenses | $12,266,351 | CYOtherExpensesAmt |
| PY Total Expenses | $19,095,211 | PYTotalExpensesAmt |
| CY Total Expenses | $27,108,300 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,986,743 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,922,977 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,155,305 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,433,845 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,560,774 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,843,842 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,594,531 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,590,003 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,830,254 | ExpenseAmt |
| Revenue | $24,246,695 | RevenueAmt |
| Desc | SALEM HEALTH WEST VALLEY IS A CRITICAL ACCESS HOSPITAL SERVING THE RURAL POLK COUNTY REGION WITH A POPULATION OF 98,000. SERVICES INCLUDE: DIAGNOSTIC IMAGING PROCEDURES 19,274, EMERGENCY DEPARTMENT VISITS 14,742, INPATIENT ADMISSIONS 137, LABORATORY TESTS/DRAWS 125,901, SURGERIES 720. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,942,640 | ExpenseAmt |
| Revenue | $4,844,757 | RevenueAmt |
| Desc | SALEM HEALTH WEST VALLEY PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. IN THE 12 MONTHS ENDED 6/30/17, THE COST OF SERVICES PROVIDED AS A COMMUNITY BENEFIT TOTALED $2,097,883. THIS FIGURE CONSISTED OF $388,577 IN COSTS TO PROVIDE CHARITY CARE TO INDIVIDUALS WHO CANNOT AFFORD TO PAY AND $1,709,306 IN UNDERPAYMENT BY MEDICAID AS THE AMOUNT PAID UNDER THE PROGRAM WAS LESS THAN THE COST TO PROVIDE THE SERVICES. SALEM HEALTH WEST VALLEY DOES NOT PURSUE LEGAL ACTION FOR NON-PAYMENT OF BILLS AGAINST CHARITY CARE PATIENTS WHO HAVE DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,055,264 | ExpenseAmt |
| Grant | $15,000 | GrantAmt |
| Revenue | $827,474 | RevenueAmt |
| Desc | SALEM HEALTH WEST VALLEY ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN THE 12 MONTHS ENDED 6/30/17, SALEM HEALTH WEST VALLEY GAVE $186,557 FOR UNFUNDED OR UNDERFUNDED HEALTH SERVICES, INCLUDING IMPROVING ACCESS TO CARE THROUGH PHYSICIAN RECRUITING, 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. SALEM HEALTH WEST VALLEY SUBSIDIZES THE COST OF PROVIDING SERVICES TO THE COMMUNITY AT A FINANCIAL LOSS IN THE AMOUNT OF OVER $1,018,795. SALEM HEALTH WEST VALLEY PROVIDES CASH AND IN-KIND DONATIONS TO COMMUNITY PROGRAMS, THE LARGEST OF WHICH IS THE CONNECTIONS VAN WHICH PROVIDES TRANSPORTATION SERVICES TO PATIENTS NEEDING MEDICAL SERVICES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $21,828,158 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 31 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 205 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SALEM HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5038141938 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 890 OAK STREET SE | AddressLine1Txt |
| City | SALEM | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97301 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| BONNIE DRIGGERS RN | |||||||||
| CHAIRPERSON | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| KATHERINE KEENE | |||||||||
| VICE CHAIR | 4.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| ALAN K WYNN | |||||||||
| SECRETARY/TREASURER | 5.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| JOHN COMBES MD | |||||||||
| TRUSTEE | 5.25 | Yes (X) | $0 | $0 | $0 | ||||
| THERESA HASKINS | |||||||||
| TRUSTEE | 3.50 | Yes (X) | $0 | $0 | $0 | ||||
| ROB KELLY MD | |||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN LATTIMER | |||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | ||||
| KENNETH SHERMAN JR | |||||||||
| TRUSTEE | 7.00 | Yes (X) | $0 | $0 | $0 | ||||
| NANCY REYES-MOLYNEUX MD | |||||||||
| TRUSTEE | 5.25 | Yes (X) | $0 | $0 | $0 | ||||
| LANE SHETTERLY | |||||||||
| TRUSTEE | 7.00 | Yes (X) | $0 | $0 | $0 | ||||
| ROBERT WELLS | |||||||||
| PAST CHAIRMAN | 5.25 | Yes (X) | $0 | $0 | $0 | ||||
| CHERYL NESTER WOLFE | |||||||||
| CEO & PRESIDENT | 6.00 | Yes (X) | $0 | $730,298 | $72,614 | 34.00 | |||
| JAMES PARR | |||||||||
| CHIEF FINANCIAL OFFICER | 3.00 | Yes (X) | $0 | $439,053 | $81,331 | 37.00 | |||
| BRUCE RODGERS | |||||||||
| CHIEF ADMIN OFFICER | 40.00 | $203,140 | $0 | $48,383 | Yes (X) | ||||
| JENNIFER BROADUS | |||||||||
| DIR, WV CLINICAL OPERATIONS | 40.00 | $154,284 | $0 | $25,081 | Yes (X) | ||||
| ALISON SMITH MD | |||||||||
| GENERAL SURGEON | 40.00 | $430,772 | $0 | $53,362 | Yes (X) | ||||
| CHARLES ESSEX MD | |||||||||
| FAMILY PRACTITIONER | 40.00 | $279,529 | $0 | $61,251 | Yes (X) | ||||
| JOHN HADLEY MD | |||||||||
| FAMILY PRACTITIONER | 40.00 | $268,843 | $0 | $53,192 | Yes (X) | ||||
| CELIA WALLIS | |||||||||
| RN BSN STAFF NURSE | 36.00 | $146,523 | $0 | $35,807 | Yes (X) | ||||
| TIFFANY DUELL | |||||||||
| PHARMACIST | 40.00 | $140,273 | $0 | $33,123 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,623,364 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,169,351 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $464,144 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 25 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SALEM RADIOLOGY CONSULTANTS PC | |||||
| PO BOX 12989 | SALEM | OR | 97309 | CONTRACT LABOR | $777,348 |
| EMCARE INC | |||||
| 7032 COLLECTION CTR DR | CHICAGO | IL | 60693 | CONTRACT LABOR | $277,052 |
| CTM MANAGEMENT | |||||
| 476 NW HILLCREST LOOP | MCMINNVILLE | OR | 97128 | CONTRACT LABOR | $270,330 |
| AMN LOS ANGELES | |||||
| PO BOX 56157 | LOS ANGELES | CA | 900746157 | CONTRACT LABOR | $151,050 |
| WILLAMETTE ORTHOPEDIC GROUP LLC | |||||
| 1600 STATE ST | SALEM | OR | 97301 | CONTRACT LABOR | $132,967 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $42,910 | RelatedOrganizationsAmt |
| All Other Contributions | $57,522 | AllOtherContributionsAmt |
| Total Contributions | $100,432 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT REVENUE | 621110 | $18,494,786 | $18,494,786 | |
| LABORATORY | 621500 | $6,956,049 | $6,918,424 | $37,625 |
| PHARMACY | 621300 | $4,279,708 | $4,279,708 | |
| OTHER HOSPITAL SERVICES | 900099 | $127,455 | $127,455 | |
| NUTRITION SERVICES | 900099 | $98,553 | $98,553 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $29,956,551 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,067 | TotalRevenueColumnAmt |
| Exclusion | $2,067 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $27,773 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$27,773 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$27,773 | TotalRevenueColumnAmt |
| Exclusion | -$27,773 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,031,277 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $29,918,926 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $37,625 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$25,706 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Program Services | $15,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $469,811 | TotalAmt |
| Management And General | $469,811 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,549,185 | TotalAmt |
| Program Services | $9,730,262 | ProgramServicesAmt |
| Management And General | $1,818,923 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $652,846 | TotalAmt |
| Program Services | $528,527 | ProgramServicesAmt |
| Management And General | $124,319 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,356,716 | TotalAmt |
| Program Services | $1,098,361 | ProgramServicesAmt |
| Management And General | $258,355 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $798,391 | TotalAmt |
| Program Services | $646,356 | ProgramServicesAmt |
| Management And General | $152,035 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,966 | TotalAmt |
| Management And General | $25,966 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,408,067 | TotalAmt |
| Program Services | $1,377,431 | ProgramServicesAmt |
| Management And General | $30,636 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,901 | TotalAmt |
| Management And General | $10,901 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,661,104 | TotalAmt |
| Program Services | $513,760 | ProgramServicesAmt |
| Management And General | $2,147,344 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,964 | TotalAmt |
| Program Services | $2,298 | ProgramServicesAmt |
| Management And General | $40,666 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $754,692 | TotalAmt |
| Program Services | $729,488 | ProgramServicesAmt |
| Management And General | $25,204 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,020 | TotalAmt |
| Program Services | $25,579 | ProgramServicesAmt |
| Management And General | $41,441 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,691 | TotalAmt |
| Program Services | $16,800 | ProgramServicesAmt |
| Management And General | $2,891 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140 | TotalAmt |
| Management And General | $140 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,367,815 | TotalAmt |
| Program Services | $1,367,815 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,386 | TotalAmt |
| Program Services | $167,386 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| UBI TAX | $5,600 | $5,600 | |
| PATIENT SUPPLIES | $2,574,865 | $13,027 | $2,561,838 |
| BAD DEBT | $2,380,276 | $2,380,276 | |
| OTHER PURCHASED SERVICE | $704,480 | $37,499 | $666,981 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,384 | TotalAmt |
| Management And General | $75,384 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,108,300 | TotalAmt |
| Program Services | $21,828,158 | ProgramServicesAmt |
| Management And General | $5,280,142 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $300 | BOYAmt |
| EOY | $301 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $278,117 | BOYAmt |
| EOY | $212,009 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,116,523 | BOYAmt |
| EOY | $3,564,260 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $367,033 | BOYAmt |
| EOY | $423,388 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,696 | BOYAmt |
| EOY | $73,787 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $24,617,027 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,420,165 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,312,982 | BOYAmt |
| EOY | $14,196,862 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $275,900 | BOYAmt |
| EOY | $275,900 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,754,754 | BOYAmt |
| EOY | $2,687,338 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,155,305 | BOYAmt |
| EOY | $21,433,845 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,603,456 | BOYAmt |
| EOY | $2,466,694 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $957,318 | BOYAmt |
| EOY | $1,377,148 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,560,774 | BOYAmt |
| EOY | $3,843,842 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,553,776 | BOYAmt |
| EOY | $17,546,946 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,755 | BOYAmt |
| EOY | $43,057 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,594,531 | BOYAmt |
| EOY | $17,590,003 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,155,305 | BOYAmt |
| EOY | $21,433,845 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,922,977 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $72,495 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $40,755 | BeginningYearBalanceAmt |
| Contributions | $2,302 | ContributionsAmt |
| End Year Balance | $43,057 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $45,073 | BeginningYearBalanceAmt |
| Contributions | $1,503 | ContributionsAmt |
| Investment Earnings Or Losses | -$5,821 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $40,755 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $47,636 | BeginningYearBalanceAmt |
| Contributions | $13,814 | ContributionsAmt |
| Investment Earnings Or Losses | -$9,077 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $7,300 | OtherExpendituresAmt |
| End Year Balance | $45,073 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $40,908 | BeginningYearBalanceAmt |
| Contributions | $3,808 | ContributionsAmt |
| Investment Earnings Or Losses | $2,920 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $47,636 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $122,681 | BeginningYearBalanceAmt |
| Contributions | $4,345 | ContributionsAmt |
| Investment Earnings Or Losses | $3,956 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $90,074 | OtherExpendituresAmt |
| End Year Balance | $40,908 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $342,155 | OtherCostOrOtherBasisAmt |
| Book Value | $342,155 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,048,591 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,561,613 | DepreciationAmt |
| Book Value | $11,486,978 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,188,879 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,829,876 | DepreciationAmt |
| Book Value | $2,359,003 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $37,402 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,676 | DepreciationAmt |
| Book Value | $8,726 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,196,862 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BENEFICIAL INTEREST IN FOUNDATION | $43,057 |
| DUE FROM SALEM HEALTH | $2,532,134 |
| OTHER LONG TERM ASSETS | $112,147 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,687,338 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO MEDICARE/MEDICAID | $425,719 |
| OTHER LONG-TERM ACCRUALS | $14,482 |
| LIABILITY FOR MALPRACTICE INSURANCE | $150,488 |
| POST-RETIREMENT BENEFITS | $236,459 |
| DUE TO SALEM HEALTH HOSPITALS & CLINICS | $550,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,377,148 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $30,101,469 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $70,192 | OtherRevenueAmt |
| Revenue Not Reported | $70,192 | RevenueNotReportedAmt |
| Revenue Subtotal | $30,031,277 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $30,031,277 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $27,105,997 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$2,303 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$2,303 | ExpensesNotReportedAmt |
| Expenses Subtotal | $27,108,300 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $27,108,300 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | ENDOWMENT FUNDS ARE HELD BY WEST VALLEY HOSPITAL FOUNDATION FOR SALEM HEALTH WEST VALLEY 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 AND CLINICS"), SALEM HEALTH, SALEM HEALTH WEST VALLEY, SHF, WVHF, SHPS, AND WVIC 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. THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES IN ACCORDANCE WITH FASB ASC 740-10, INCOME TAXES-IMPLEMENTATION GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES AND DISCLOSURE AMENDMENTS FOR NONPUBLIC ENTITIES. MANAGEMENT HAS NOT RECORDED A PROVISION AS UNRELATED BUSINESS INCOME, IF ANY, IS IMMATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES 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. 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 2011. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN POST RETIREMENT BENEFIT OBLIGATION 70,192. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN BENEFICIAL INTEREST IN FOUNDATION -2,303. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3126 | PersonsServedCnt |
| Total Community Benefit Expns | $388,577 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $388,577 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01570 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 14723 | PersonsServedCnt |
| Total Community Benefit Expns | $6,554,063 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,844,757 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,709,306 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06910 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 17849 | PersonsServedCnt |
| Total Community Benefit Expns | $6,942,640 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,844,757 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,097,883 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08480 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6683 | PersonsServedCnt |
| Total Community Benefit Expns | $132,827 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $31,309 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $101,518 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 42 | PersonsServedCnt |
| Total Community Benefit Expns | $85,039 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $85,039 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,814,960 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $796,165 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,018,795 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04120 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 40 | PersonsServedCnt |
| Total Community Benefit Expns | $22,438 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,438 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6765 | PersonsServedCnt |
| Total Community Benefit Expns | $2,055,264 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $827,474 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,227,790 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04960 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 24614 | PersonsServedCnt |
| Total Community Benefit Expns | $8,997,904 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,672,231 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,325,673 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13440 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,452 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,452 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,452 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,452 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,380,276 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,866,065 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,831,456 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,762,036 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $69,420 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SALEM HEALTH WEST VALLEY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 SOUTHEAST WASHINGTON ST | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97338 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 14-1461 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SALEM HEALTH WEST VALLEY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.SALEMHEALTH.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.SALEMHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Other Actions | Yes (X) | PermitOtherActionsInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Other Actions | Yes (X) | OtherActionsInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 3J: A POLK COUNTY COMPREHENSIVE NEEDS ASSESSMENT WAS CONDUCTED IN TAX YEAR 2015. 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 LATEST 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 OR MAPP WAS USED AS THE FRAMEWORK FOR THE COMMUNITY HEALTH ASSESSMENT. THE FOUR ASSESSMENTS OF THE 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, HEALTH, COMMUNITY, EDUCATIONAL AND CORRECTIONAL HEALTH SETTINGS AND THE COMMUNITY-AT-LARGE. THE SURVEYS USED IN POLK COUNTY CONSISTED OF THE SAME QUESTIONS AND USED THE 2011 COUNTY SURVEY AS A TEMPLATE. PAPER AND ELECTRONIC SURVEYS WERE ALLOCATED BASED ON POPULATION DISTRIBUTION THROUGHOUT OUR COMMUNITIES. THE COMMUNITY HEALTH STATUS ASSESSMENT WAS CONDUCTED BY COMPILING DATA FROM NATIONAL SURVEILLANCE SYSTEMS LIKE THE BEHAVIOR 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 CAFES WERE CONDUCTED ACROSS POLK COUNTY TO IDENTIFY HEALTH PRIORITIES.SALEM HEALTH WEST VALLEY HOSTED COMMUNITY CAFES AND REPRESENTATIVES FROM POLK COUNTY PUBLIC HEALTH, PRESENTED CHNA FINDINGS TO THE SALEM HEALTH COMMUNITY BENEFIT COMMITTEE OF THE BOARD OF TRUSTEES IN NOVEMBER 2015. THE POLK COUNTY HEALTH REPORTS WAS PUBLISHED IN DECEMBER 2015 AND CAN BE FOUND ON THE SALEM HEALTH WEBSITE. WWW.SALEMHEALTH.ORG. THE DOCUMENT INFORMED THE DEVELOPMENT OF THE COMMUNITY BENEFIT IMPLEMENTATION STRATEGY FOR REPORTING YEARS 2015 - 2017, 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) ANNUALLY REPORT. THE CHIP IS COORDINATED BY THE POLK COUNTY PUBLIC HEALTH DEPARTMENT AND IS PUBLISHED ON THEIR WEBPAGE AT HTTP://WWW.CO.POLK.OR.US/PH/CHA/CHIP. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 5: THE NATIONAL MODEL, MOBILIZATION FOR ACTION THROUGH PLANNING AND PARTNERSHIPS OR MAPP WAS USED AS THE FRAMEWORK FOR THE COMMUNITY HEALTH ASSESSMENT. THE FOUR ASSESSMENTS OF THE 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, HEALTH, COMMUNITY, EDUCATIONAL AND CORRECTIONAL HEALTH SETTINGS AND THE COMMUNITY-AT-LARGE. THE SURVEYS USED IN POLK COUNTIES CONSISTED OF THE SAME QUESTIONS AND USED THE 2011 MARION COUNTY SURVEY AS A TEMPLATE. PAPER AND ELECTRONIC SURVEYS WERE ALLOCATED BASED ON POPULATION DISTRIBUTION THROUGHOUT OUR COMMUNITIES. THE COMMUNITY HEALTH STATUS ASSESSMENT WAS CONDUCTED BY COMPILING DATA FROM NATIONAL SURVEILLANCE SYSTEMS LIKE THE BEHAVIOR RISK FACTOR SURVEILLANCE SURVEY AND OREGON HEALTHY TEENS AS WELL AS STATE AND LOCAL DATA FROM BIRTH AND DEATH CERTIFICATES. IN ADDITION, AS SERIES OF COMMUNITY CAFES WERE CONDUCTED ACROSS POLK COUNTY TO IDENTIFY HEALTH PRIORITIES.SALEM HEALTH WEST VALLEY HOSPITAL HOSTED COMMUNITY CAFES AND REPRESENTATIVES FROM POLK COUNTY PUBLIC HEALTH, PRESENTED CHNA FINDINGS TO THE SALEM HEALTH COMMUNITY BENEFIT COMMITTEE OF THE BOARD OF TRUSTEES IN NOVEMBER 2015. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 6A: SALEM HEALTH WEST VALLEY IS A CRITICAL ACCESS HOSPITAL AND THE ONLY HOSPITAL POLK COUNTY. SALEM HEALTH SERVES BOTH MARION AND POLK COUNTY, THEREFORE, SALEM HEALTH PARTICIPATED IN THE CHNA AND DEVELOPMENT OF THE COMMUNITY BENEFIT IMPLEMENTATION PLAN. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH COMMUNITY ACTION AGENCY, THE EARLY LEARNING HUB, INC, MARION COUNTY HEALTH DEPARTMENT, POLK COUNTY HEALTH DEPARTMENT, OREGON STATE UNIVERSITY, COOPERATIVE EXTENSION, UNITED WAY, WVP HEALTH AUTHORITY AND WILLAMETTE VALLEY COMMUNITY HEALTH. |
| SALEM HEALTH WEST VALLEY | 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 ARE POSTED TO HOSPITAL AND COUNTY WEBSITES. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 2: THE HOSPITAL WAS NOT ACQUIRED OR PLACED INTO SERVICE AS A TAX-EXEMPT HOSPITAL IN THE CURRENT TAX YEAR OR THE IMMEDIATELY PRECEDING TAX YEAR 2016. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 11: PRIORITY AREAS ADDRESSED IN THE 2015 ASSESSMENT INCLUDE: EARLY PRENATAL CARE, DEPRESSION SCREENING, OBESITY AND TOBACCO USE.SALEM HEALTH WEST VALLEY HOSPITAL IS AN ACTIVE MEMBER OF THE COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP AND HAS REPRESENTATION ON THE PRENATAL CARE TASK FORCE ADDRESSING EARLY PRENATAL CARE. BABIES BORN TO MOTHERS WHO DO NOT RECEIVE PRENATAL CARE ARE THREE TIMES MORE LIKELY TO HAVE A LOW BIRTH WEIGHT AND FIVE TIMES MORE LIKELY TO DIE THAN THOSE BORN TO MOTHERS WHO DO GET CARE. EARLY PRENATAL CARE (I.E. CARE IN THE FIRST TRIMESTER OF A PREGNANCY) ALLOWS WOMEN AND THEIR HEALTH CARE PROVIDERS TO IDENTIFY AND, WHEN POSSIBLE, TREAT OR CORRECT HEALTH PROBLEMS AND HEALTH-COMPROMISING BEHAVIORS THAT CAN BE PARTICULARLY DAMAGING DURING THE INITIAL STAGES OF FETAL DEVELOPMENT. INCREASING THE NUMBER OF WOMEN WHO RECEIVE PRENATAL CARE, AND WHO DO SO EARLY IN THEIR PREGNANCIES, CAN IMPROVE BIRTH OUTCOMES AND LOWER HEALTH CARE COSTS BY REDUCING THE LIKELIHOOD OF COMPLICATIONS DURING PREGNANCY AND CHILDBIRTH.THE HEALTHY PEOPLE 2020 NATIONAL HEALTH TARGET IS TO INCREASE THE PROPORTION OF PREGNANT WOMEN WHO RECEIVE PRENATAL CARE IN THE FIRST TRIMESTER TO 77.9%. POLK COUNTY MEETS THE TARGET AT 79.7%. ADULT OBESITY RATES IN POLK COUNTIES REMAIN ABOVE STATE AND NATIONAL AVERAGES AND ABOVE THE HP2020 GOAL OF 30.5%. LATEST RATES IN POLK COUNTY ARE 31.4%. SALEM HEALTH WEST VALLEY, PARTNERS WITH THE POLK COUNTY PUBLIC HEALTH DEPARTMENT AND OFFERS 5210, AN OBESITY PREVENTION PROGRAM AND SCHOOLS ACROSS POLK COUNTY.PSYCHOLOGICAL DISTRESS CAN AFFECT ALL ASPECTS OF OUR LIVES. OCCASIONAL DOWN DAYS ARE NORMAL, BUT PERSISTENT MENTAL/EMOTIONAL HEALTH PROBLEMS SHOULD BE EVALUATED AND TREATED BY A QUALIFIED PROFESSIONAL. FOR THIS REASON, SALEM HEALTH WEST VALLEY PROVIDES DEPRESSION SCREENING IN INPATIENT AND EMERGENCY ROOM SETTINGS. PRIMARY CARE CLINICS CONDUCT THE PHQ 9. POLK COUNTY RESIDENTS ON AVERAGE EXPERIENCE 4.4 POOR MENTAL HEALTH DAYS PER MONTH, WHICH IS HIGHER THAN THE US AVERAGE VALUE OF 3.7 DAYS.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. POLK COUNTY HAS SEEN A SIGNIFICANT INCREASE IN TOBACCO USE FROM 2010 TO 2013. WITH A HIGH SMOKING PREVALENCE THERE IS ALSO A GREATER EXPOSURE TO SECONDHAND SMOKE FOR NON-SMOKERS, WHICH CAN CAUSE OR EXACERBATE A WIDE RANGE OF ADVERSE HEALTH EFFECTS SUCH AS CANCER, RESPIRATORY INFECTIONS, AND ASTHMA.THE HEALTHY PEOPLE 2020 NATIONAL HEALTH TARGET IS TO REDUCE THE PROPORTION OF ADULTS AGED 18 YEARS AND OLDER WHO SMOKE CIGARETTES TO 12.0%. LATEST POLK COUNTY DATA SHOWS A RATE OF 16.4% COUNTY OF ITS RESIDENTS REPORTING TOBACCO USE. SALEM HEALTH WEST VALLEY IS A SMOKE FREE CAMPUS. THE HOSPITAL SCREENS 100% OF PATIENTS FOR TOBACCO USE AND PROVIDES ALL TOBACCO USERS WITH COMMUNITY CESSATION RESOURCE INFORMATION. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 13B: SALEM HEALTH FINANCIAL MATRIX IS BASED ON INCOME AS A PERCENT OF FEDERAL POVERTY LEVEL. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 13H: CRITERIA CONSIDERED IN DETERMINING ELIGIBILITY INCLUDE, BUT ARE NOT LIMITED TO: 1. THE HOUSEHOLD'S GROSS INCOME. 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. *THE DEFINITION OF 'HOUSEHOLD'S GROSS INCOME' INCLUDES THE COMBINED GROSS MONTHLY INCOME OF ALL PERSONS LEGALLY RESPONSIBLE FOR PATIENT BILL OR BALANCE.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 SEE OTHER SELF-PAY DISCOUNT POLICY |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 15E: 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 WEST VALLEY 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. -FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATIONS MAY BE DOWNLOADED FROM OUR WEBSITE: HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY -PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATIONS ARE AVAILABLE IN THE EMERGENCY DEPARTMENT, IN REGISTRATION AREAS AND AT PATIENT FINANCIAL SERVICES, 550 HAWTHORNE AVE SE, SUITE 200, SALEM OR 97301 -PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATIONS MAY BE REQUESTED BY MAIL FROM: FINANCIAL COUNSELING, SALEM HEALTH, PO BOX 14001, SALEM OR 97309-9976 OR VIA TELEPHONE BY CALLING 503-562-4357 |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 16J: INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE IS BE MADE PUBLICLY AVAILABLE FREE OF CHARGE IN THE FOLLOWING MANNER: 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 COUNSELOR'S IN A TIMELY MANNER. 5. THIS POLICY IS POSTED ON SALEM HEALTH'S WEB SITE. WRITTEN INFORMATION ABOUT THIS POLICY WILL BE MADE AVAILABLE UPON REQUEST. 6. ALL PATIENT BILLING STATEMENTS INCLUDES A NOTICE THAT FINANCIAL ASSISTANCE IS AVAILABLE AND CONTACT INFORMATION IF THEY WANT TO LEARN MORE. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 18E: IT IS THE POLICY OF SALEM HEALTH WEST VALLEY TO PURSUE COLLECTION OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR SERVICES. SALEM HEALTH WEST VALLEY MAKES REASONABLE EFFORTS TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. COLLECTION PROCEDURES ARE APPLIED CONSISTENTLY AND FAIRLY FOR ALL PATIENTS REGARDLESS OF INSURANCE STATUS. ALL COLLECTION PROCEDURES WILL COMPLY WITH APPLICABLE LAWS AND WITH SALEM HEALTH'S MISSION. FOR THOSE PATIENTS UNABLE TO PAY ALL OR A PORTION OF THEIR OPEN BALANCES, THE FINANCIAL ASSISTANCE POLICY WILL BE FOLLOWED. COLLECTION AGENCIES AND/OR LAW FIRMS MAY BE ENLISTED AFTER REASONABLE COLLECTION AND PAYMENT OPTIONS HAVE BEEN EXHAUSTED. AGENCIES MAY HELP RESOLVE ACCOUNTS WHERE PATIENTS ARE UNCOOPERATIVE IN MAKING PAYMENTS, HAVE NOT MADE APPROPRIATE PAYMENTS, OR HAVE BEEN UNWILLING TO PROVIDE REASONABLE FINANCIAL AND OTHER DATA TO SUPPORT THEIR REQUEST FOR FINANCIAL ASSISTANCE. COLLECTION AGENCY AND LAW FIRM STAFF WILL UPHOLD THE CONFIDENTIALITY AND INDIVIDUAL DIGNITY OF EACH PATIENT. ALL AGENCIES AND LAW FIRMS WILL COMPLY WITH ALL APPLICABLE LAWS INCLUDING HIPAA REQUIREMENTS FOR HANDLING PROTECTED HEALTH INFORMATION. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 19E: SALEM HEALTH WEST VALLEY WILL NOTIFY INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS AT LEAST 30 DAYS PRIOR TO PURSUING EXTRAORDINARY COLLECTIONS ACTIONS (EAC) AS TO OBTAIN PAYMENT FOR THE CARE PROVIDED BY THE HOSPITAL. ECAS FOR HOSPITAL SERVICES WILL NOT COMMENCE FOR A PERIOD OF AT LEAST 240 DAYS AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT AND 30 DAYS AFTER THE HOSPITAL OR AUTHORIZED THIRD PARTY PROVIDES WRITTEN NOTICE OF ECAS THE HOSPITAL PLANS TO INITIATE FOR THE APPLICABLE MEDICALLY NECESSARY OR EMERGENCY MEDICAL CARE. |
| SALEM HEALTH WEST VALLEY | PART V, SECTION B, LINE 20E: SALEM HEALTH WEST VALLEY WILL NOTIFY INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS AT LEAST 30 DAYS PRIOR TO PURSUING EXTRAORDINARY COLLECTIONS ACTIONS AS TO OBTAIN PAYMENT FOR THE CARE PROVIDED BY THE HOSPITAL BY DOING THE FOLLOWING: 1. PROVIDE WRITTEN NOTICE TO THE INDIVIDUAL INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS, INDICATING THAT SALEM HEALTH, WEST VALLEY INTENDS TO INITIATE OR HAVE A THIRD PARTY INITIATE TO OBTAIN PAYMENT FOR THE CARE, AND PROVIDES A DEADLINE AFTER WHICH ECAS MAY BE PURSUED AND WHICH IS NO LATER THAN 30 DAYS AFTER THE DATE OF THIS WRITTEN NOTICE 2. PROVIDE THE INDIVIDUAL A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WITH THE WRITTEN NOTICE 3. MAKE REASONABLE EFFORTS TO ORALLY NOTIFY INDIVIDUALS ABOUT THE SALEM HEALTH'S FINANCIAL ASSISTANCE POLICY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - MONMOUTH MEDICAL CENTER | ||||
| 512 E MAIN ST 300 | MONMOUTH | OR | 97361 | CLINIC |
| 2 - SALEM HEALTH WEST VALLEY MEDICAL CLINIC | ||||
| 555 SE WASHINGTON ST | DALLAS | OR | 97338 | CLINIC |
| 3 - CENTRAL SCHOOL-HEALTH CLINIC | ||||
| 1601 MONMOUTH ST STE 100 | INDEPENDENCE | OR | 97351 | CLINIC |
| 4 - SALEM HEALTH WEST VALLEY SPECIALTY CLIN | ||||
| 591 SE CLAY ST | DALLAS | OR | 97338 | CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | CRITERIA CONSIDERED IN DETERMINING ELIGIBILITY INCLUDE, BUT ARE NOT LIMITED TO: -THE HOUSEHOLD'S* GROSS INCOME. -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. -FAMILY SIZE (PERSONS LEGALLY RESPONSIBLE FOR THE PATIENT BILL AND THEIR DEPENDENTS) -THE FAMILY'S MONTHLY OUT OF POCKET EXPENSES FOR MEDICAL SUPPLIES AND SERVICES. -ELIGIBILITY MAY BE CONTINGENT UPON PATIENT COOPERATION WITH THE APPLICATION PROCESS. *THE DEFINITION OF 'HOUSEHOLD'S GROSS INCOME' INCLUDES THE COMBINED GROSS MONTHLY INCOME OF ALL PERSONS LEGALLY RESPONSIBLE FOR PATIENT BILL OR BALANCE.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 WEST VALLEY 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. |
| PART I, LINE 7: | FINANCIAL ASSISTANCE, MEDICAID AND COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS ACCOUNT FOR A LARGE PORTION OF SALEM HEALTH WEST VALLEY'S COMMUNITY BENEFIT CONTRIBUTION. ENSURING THAT COMMUNITY MEMBERS HAVE ACCESS TO EMERGENCY, PRIMARY CARE AND OTHER HEALTH SERVICES REGARDLESS OF ABILITY TO PAY, ALIGNS WITH THE HOSPITAL MISSION AND COMMITMENT TO SERVE THOSE LIVING IN POLK COUNTIES. SALEM HEALTH WEST VALLEY IS DEEPLY EMBEDDED IN THE TIGHT KNIT COMMUNITIES OF POLK COUNTY. HOSPITAL LEADERS WORK HAND IN HAND WITH REPRESENTATIVES FROM GOVERNMENT AGENCIES AND OTHER NON-PROFITS TO ASSESS AND ADDRESS COMMUNITY NEEDS. FOUR COMMUNITY WIDE TASK FORCES ARE IN PLACE TO ADDRESS THE FOUR HEALTH NEEDS DEEMED MOST CRITICAL IN POLK COUNTY. THOSE ARE EARLY CHILDHOOD HEALTH INCLUDING PRENATAL CARE, TOBACCO AND SUBSTANCE ABUSE, DEPRESSION SCREENING AND OBESITY PREVENTION. THE HOSPITAL'S DIRECTOR OF COMMUNITY BENEFIT ATTENDS TASK FORCE MEETINGS AND LOOKS FOR WAYS TO LEVERAGE HOSPITAL RESOURCES TO IMPACT HEALTH OUTCOMES. HOSPITAL LEADERS VOLUNTEER TIME TO SERVE ON COMMUNITY NON-PROFIT BOARDS AND ATTEND REGIONAL COLLABORATIVE WORKGROUPS THAT ADDRESS SOCIAL DETERMINANTS OF HEALTH. EXAMPLES INCLUDE, BOARD POSITIONS ON THE EARLY LEARNING HUB, WITH A FOCUS ON KINDERGARTEN READINESS; THE MID-WILLAMETTE VALLEY HOMELESS INITIATIVE; AND SALEM KEIZER SPECIAL TRANSPORTATION ADVISORY GROUP, WHICH PROVIDES GRANT FUNDS TO SUPPORT THE SALEM HEALTH WEST VALLEY CONNECTIONS VAN PROGRAM.THE HOSPITAL PROVIDES TRAINING FOR NURSING STUDENTS AND EMERGING HEALTH CARE PROFESSIONS. ITS HEALTH CAREER EXPLORATION PROGRAMS PROVIDES A LEARNING OPPORTUNITY FOR HIGH SCHOOL STUDENTS IN DISTRICTS THAT FALL WITHIN THE HOSPITAL CATCHMENT AREA IN POLK COUNTIES. SCHOLARSHIPS ARE AWARDED TO HIGH SCHOOL STUDENTS ANNUALLY. |
| 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 $ 2,380,276. |
| 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 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 WEST VALLEY 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: | A COMPREHENSIVE NEEDS ASSESSMENT WAS CONDUCTED IN TAX YEAR 2015. THE NEEDS ASSESSMENT DESCRIBES THE COMMUNITY SERVED BY THE HOSPITAL AND THE DEMOGRAPHICS OF THE COMMUNITY. IN ADDITION TO THE NEEDS ASSESSMENT, 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 CHNA AND HEALTH CARE SYSTEM CAPACITY AND ACCESS ASSESSMENTS ARE PUBLISHED TO THE SALEM HEALTH WEBSITE AT WWW.SALEMHEALTH.ORG. THE HOSPITAL EXECUTIVE TEAM MEMBERS INTENTIONALLY SERVE ON NON-PROFIT BOARDS AND ATTEND COALITION MEETINGS THAT AIM TO IMPROVE THE SOCIAL DETERMINANTS OF HEALTH IN POLK COUNTY. THESE ORGANIZATIONS AND TEAMS SERVE VULNERABLE POPULATIONS AND PROVIDE CRITICAL INSIGHT INTO THE NEEDS OF THE COMMUNITY FROM THOSE THAT PROVIDE DIRECT CARE AND SERVICES. |
| PART VI, LINE 3: | SALEM HEALTH WEST VALLEY 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 THAT ARE NOT ELIGIBLE FOR OHP OR THE OTHER PROGRAMS LISTED ABOVE, AND HAVE FINANCIAL CONSTRAINTS THAT INHIBIT THEIR ABILITY TO PAY, WILL BE ASSESSED FOR A FINANCIAL ASSISTANCE. INFORMATION REGARDING THE HOSPITAL'S FINANCIAL ASSISTANCE IS MADE PUBLICLY AVAILABLE IN THE FOLLOWING MANNER: 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 SHALL BE 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 WILL BE TRAINED TO ANSWER FINANCIAL ASSISTANCE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY THAT CANNOT BE ANSWERED TO FINANCIAL COUNSELOR'S IN A TIMELY MANNER. 5. THIS POLICY WILL BE POSTED ON SALEM HEALTH'S WEB SITE. WRITTEN INFORMATION ABOUT THIS POLICY WILL BE MADE AVAILABLE UPON REQUEST. 6. ALL PATIENT BILLING STATEMENTS WILL INCLUDE A NOTICE THAT FINANCIAL ASSISTANCE IS AVAILABLE AND CONTACT INFORMATION IF THEY WANT TO LEARN MORE. |
| PART VI, LINE 4: | SALEM HEALTH WEST VALLEY SERVES POLK COUNTYIN 2016, THERE WERE 79,291 PEOPLE AND 28,458 HOUSEHOLDS RESIDING IN THE POLK COUNTY. THE RURAL COMMUNITY HAD A POPULATION DENSITY OF 101.8 INHABITANTS PER SQUARE MILE (39.3/KM2). THERE WERE 31,166 HOUSING UNITS. THE RACIAL MAKEUP OF THE COUNTY WAS 90.7% WHITE, 2.6% AMERICAN INDIAN, 2.0% ASIAN, 0.9% BLACK OR AFRICAN AMERICAN, 0.4% PACIFIC ISLANDER AND 3.5% FROM TWO OR MORE RACES. THOSE OF HISPANIC OR LATINO ORIGIN MADE UP 13% OF THE POPULATION. 7.5% OF THE POPULATION IS FOREIGN BORN. THE AVERAGE HOUSEHOLD SIZE WAS 2.62. 5.9% OF THE POPULATION ARE UNDER THE AGE OF 5 YEARS, 23.5% ARE UNDER THE AGE OF 18 AND 16.4% ARE OVER THE AGE OF 65 YEARS. THE MEDIAN INCOME FOR A HOUSEHOLD IN POLK COUNTY IS $52,821. THE PER CAPITA INCOME FOR THE COUNTY WAS $23,967. ABOUT 13.7% OF THE POPULATION LIVE BELOW THE POVERTY LINE. ACCORDING TO THE U.S. CENSUS BUREAU, MARION COUNTY HAS A TOTAL AREA OF 744 SQUARE MILES (1,930 KM2), OF WHICH 741 SQUARE MILES (1,920 KM2) IS LAND AND 3.1 SQUARE MILES (8.0 KM2) (0.4%) IS WATER. THE MAJOR INDUSTRIES OF THE COUNTY ARE AGRICULTURE, FOREST PRODUCTS, MANUFACTURING, AND EDUCATION. POLK COUNTY HAS THE SECOND-LARGEST AREA DEVOTED TO VITICULTURE IN OREGON, AT 1,322 ACRES (5.35 KM2). |
| PART VI, LINE 5: | SALEM HEALTH WEST VALLEY SUPPORTS THE CONNECTIONS VAN PROGRAM. IN 2016, THE HOSPITAL PURCHASED A NEW VAN TO HELP PATIENTS IN RURAL COMMUNITIES' ACCESS HEALTH SERVICES. PAID STAFF COORDINATE RIDES AND AT TIMES WILL DRIVE THE VAN, WHEN THE VOLUNTEER DRIVERS ARE UNAVAILABLE. THE VAN PROVIDES RIDES FREE OF CHARGE TO LOW INCOME, MEDICALLY FRAGILE COMMUNITY MEMBERS. SALEM HEALTH WEST VALLEY, FUNDS POLK COUNTY SERVICE INTEGRATION. SERVICE INTEGRATION TEAMS (SITS) AIM TO TRANSFORM HEALTH BY COORDINATING AND ALIGNING SERVICES THAT ADDRESS THE NEEDS OF INDIVIDUALS, FAMILIES AND COMMUNITY, THUS IMPROVING THE CONTEXT IN WHICH PEOPLE LIVE. SALEM HEALTH WEST VALLEY STAFF AND LEADERS ROUTINELY ATTEND SERVICE INTEGRATION TEAM MEETINGS AND THE HOSPITAL PROVIDES FUNDING TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH IN POLK COUNTY. |
| PART VI, LINE 6: | SALEM HEALTH WEST VALLEY, AS PART OF SALEM HEALTH HOSPITALS AND CLINICS, WAS AFFILIATED WITH OREGON HEALTH SCIENCE UNIVERSITY (OHSU) AND TUALITY HEALTHCARE. CHANGES IN PRIORITIES AND PROCESSES REQUIRING COURSE CORRECTIONS ARE COMMON IN THE FIRST YEARS OF AN AFFILIATION AND THE CONCLUSION WAS REACHED BY BOTH THE CORPORATION AND OHSU THAT THE JMA WAS NOT WORKING IN THE WAY ORIGINALLY INTENDED. THE PARTIES RECOGNIZED THE NEED FOR A TRANSITION. AS A RESULT, THE CORPORATION AND OHSU ENTERED IN TO A TRANSITION AGREEMENT THAT TERMINATED THE JMA EFFECTIVE MAY 4, 2017 WITH EACH PARTY REASSUMING OVERSIGHT AND FULL MANAGEMENT OF THEIR OWN CLINICAL ENTERPRISES AND THE CORPORATION TRANSFERRING ITS INTEREST IN OHSU PARTNERS TO OHSU. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | OR |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POLK COUNTY SERVICE INTEGRATION TEAMS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 182 SW ACADEMY STREET 220 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97338 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 936002310 | RecipientEIN |
| IRC Section | GOVERNMENT | IRCSectionDesc |
| Cash Grant | $15,000 | CashGrantAmt |
| Purpose Of Grant | IMPROVE SOCIAL DETERMINATES OF HEALTH | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | SERVICE INTEGRATION TEAM FUNDS ARE RESTRICTED TO BE USED FOR COMMUNITY BENEFIT ELIGIBLE EXPENSES THAT ARE LINKED TO AN ESTABLISHED COMMUNITY NEED THAT HAS BEEN IDENTIFIED IN THE CHNA. IN THIS CASE, THE NEED IS SOCIAL DETERMINANTS OF HEALTH AND THE HOSPITAL PUBLISHED COMMUNITY BENEFIT IMPLEMENTATION PLAN CALLS FOR SUPPORT OF SITS IN POLK COUNTY. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHERYL NESTER WOLFE | ||||||||||||||
| CEO & PRESIDENT | $0 | $579,665 | $0 | $143,292 | $0 | $7,341 | $0 | $57,385 | $0 | $15,229 | $0 | $802,912 | $0 | $0 |
| JAMES PARR | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $398,813 | $0 | $38,833 | $0 | $1,407 | $0 | $45,500 | $0 | $35,831 | $0 | $520,384 | $0 | $0 |
| BRUCE RODGERS | ||||||||||||||
| CHIEF ADMIN OFFICER | $182,863 | $0 | $19,438 | $0 | $839 | $0 | $24,252 | $0 | $24,131 | $0 | $251,523 | $0 | $0 | $0 |
| JENNIFER BROADUS | ||||||||||||||
| DIR, WV CLINICAL OPERATIONS | $139,915 | $0 | $14,240 | $0 | $129 | $0 | $13,110 | $0 | $11,971 | $0 | $179,365 | $0 | $0 | $0 |
| ALISON SMITH MD | ||||||||||||||
| GENERAL SURGEON | $394,543 | $0 | $31,704 | $0 | $4,525 | $0 | $38,937 | $0 | $14,425 | $0 | $484,134 | $0 | $0 | $0 |
| CHARLES ESSEX MD | ||||||||||||||
| FAMILY PRACTITIONER | $264,081 | $0 | $11,455 | $0 | $3,993 | $0 | $29,125 | $0 | $32,126 | $0 | $340,780 | $0 | $0 | $0 |
| JOHN HADLEY MD | ||||||||||||||
| FAMILY PRACTITIONER | $246,787 | $0 | $17,949 | $0 | $4,107 | $0 | $28,484 | $0 | $24,708 | $0 | $322,035 | $0 | $0 | $0 |
| CELIA WALLIS | ||||||||||||||
| RN BSN STAFF NURSE | $146,039 | $0 | $0 | $0 | $484 | $0 | $12,595 | $0 | $23,212 | $0 | $182,330 | $0 | $0 | $0 |
| TIFFANY DUELL | ||||||||||||||
| PHARMACIST | $140,128 | $0 | $0 | $0 | $145 | $0 | $9,896 | $0 | $23,227 | $0 | $173,396 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | 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: CHERYL NESTER WOLFE $79,653 ($39,493 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $40,160 INCLUDED IN DEFERRED COMPENSATION) JAMES PARR $28,275 (INCLUDED IN DEFERRED COMPENSATION) ALISON SMITH $49,424 ($27,712 INCLUDED IN OTHER REPORTABLE COMPENSATION AND $21,712 INCLUDED IN DEFERRED COMPENSATION) CHARLES ESSEX 23,355 ($11,455 INCLUDED IN OTHER REPORTABLE COMPENSATION AND $11,900 INCLUDED IN DEFERRED COMPENSATION) JOHN HADLEY 27,025 ($14,948 INCLUDED IN OTHER REPORTABLE COMPENSATION AND $12,077 INCLUDED IN DEFERRED COMPENSATION) BRUCE RODGERS 11,367 (INCLUDED IN DEFERRED COMPENSATION) |
| PART I, LINE 6 | CERTAIN PHYSICIANS RECEIVE INCENTIVE COMPENSATION IN ACCORDANCE WITH THEIR EMPLOYMENT AGREEMENTS WITH SALEM HEALTH. AMOUNTS NOTED ON SCHEDULE J PART II COLUMN (II) REFLECT PAYMENTS EARNED BY THESE PHYSICIAN EMPLOYEES IN SUCH AGREEMENTS. ADDITIONALLY, FOR KEY EMPLOYEES AND MANAGEMENT OF SALEM HEALTH THE BOARD OF TRUSTEES HAS APPROVED AN ANNUAL LEADERSHIP INCENTIVE PROGRAM THAT PROVIDES FOR INCENTIVE PAYMENTS BASED ON OBJECTIVE CRITERIA RELATED TO QUALITY AND SAFETY, ENGAGEMENT, PATIENT SATISFACTION AND FINANCIAL PERFORMANCE. AMOUNTS NOTED ON SCHEDULE J PART II COLUMN (II) REFLECT PAYMENTS EARNED UNDER THE LEADERSHIP INCENTIVE PLAN. |
| PART I, LINE 7 | THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES, IN CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, REVIEWS CEO TOTAL COMPENSATION AND PERFORMANCE ANNUALLY. AS PART OF THE COMMITTEE'S ACTIONS, A NON-FIXED BONUS MAY BE AWARDED TO THE CEO. IN THIS YEAR THE NON-FIXED PAYMENT WAS PAID UNDER THE 457(F) NONQUALIFIED PLAN AND IS INCLUDED IN DEFERRED COMPENSATION REPORTED IN PART II. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | ARTICLES WERE AMENDED, EFFECTIVE AS OF JULY 1, 2016, IN ORDER TO CHANGE ORGANIZATION'S NAME. UPDATED NAME WAS REFLECTED ON THE PRIOR YEAR FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE 990. IT IS THEN FORWARDED TO THE ENTIRE BOARD OF TRUSTEES. |
| 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 | COMPENSATION FOR THE CEO IS REVIEWED ON AN ANNUAL BASIS. THE GOVERNANCE COMMITTEE ENGAGES AN OUTSIDE CONSULTANT TO DO A MARKET REVIEW AND COMPARISON. THE CONSULTANT WORKS DIRECTLY WITH THE GOVERNANCE COMMITTEE CHAIR AS WELL AS HUMAN RESOURCES TO COMPLETE THE ASSESSMENT AND MAKE A RECOMMENDATION. THE FINAL RECOMMENDATION IS BROUGHT BEFORE THE BOARD IN EXECUTIVE SESSION FOR FINAL APPROVAL. |
| 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: | CHANGE IN BENEFICIAL INTEREST (FAS 136) 2,303. CHANGE IN POST RETIREMENT BENEFIT 70,192. |
| FORM 990, PART XII, LINE 2C | THERE HAVE NOT BEEN ANY CHANGES FROM THE PREVIOUS YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SALEM HEALTH | |||||||||||
| 890 OAK STREET SE | SALEM | OR | 97301 | 930579722 | HOSPITAL | OR | 501(C)(3) | LINE 3 | SALEM HEALTH HOSPITALS AND CLINICS | 0 | |
| SALEM HEALTH FOUNDATION | |||||||||||
| 890 OAK STREET SE | SALEM | OR | 97301 | 237002687 | SUPPORTS SALEM HOSPITAL | OR | 501(C)(3) | LINE 12A, I | SALEM HEALTH HOSPITALS AND CLINICS | 0 | |
| SALEM HOSPITAL AUXILIARY | |||||||||||
| 890 OAK STREET SE | SALEM | OR | 97301 | 931081113 | SUPPORTS SALEM HOSPITAL | OR | 501(C)(3) | LINE 10 | 0 | N/A | |
| SALEM HEALTH HOSPITALS AND CLINICS | |||||||||||
| 890 OAK STREET SE | SALEM | OR | 97301 | 930823471 | LEASES LAND TO SALEM HOSPITAL | OR | 501(C)(3) | LINE 12A, I | 0 | N/A | |
| WEST VALLEY HOSPITAL FOUNDATION | |||||||||||
| 525 SOUTHEAST WASHINGTON STREET | DALLAS | OR | 97338 | 931298564 | SUPPORTS WEST VALLEY HOSPITAL | 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 PROFESSIONAL SERVICES | OR | 501(C)(3) | LINE 3 | SALEM HEALTH HOSPITALS AND CLINICS | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| OHSU PARTNERS | |||||||
| 3303 SW BOND AVE STE 6100 | PORTLAND | OR | 97239 | 475584608 | HEALTHCARE SYSTEM MANAGEMENT | OR | N/A |
| POPULATION HEALTH ALLIANCE | |||||||
| 601 SW 2ND AVE STE 1940 | PORTLAND | OR | 97204 | 471546023 | POPULATION HEALTH DATA MANAGEMENT | OR | N/A |
| WILLAMETTE VALLEY COMMUNITY HEALTH | |||||||
| 2995 RYAN DRIVE SE STE 200 | SALEM | OR | 97301 | 455540852 | COORDINATED CARE ORGANIZATION | OR | N/A |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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