SALEM HEALTH FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SALEM HEALTH FOUNDATION (EIN 23-7002687)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-09
IRS object ID
201342219349301129
Schema version
2011v1.5
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-09T15:06:45-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN930623286EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1AKT LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15665 SW MEADOWS RD SUITE 200AddressLine1
CityLAKE OSWEGOCity
StateORState
ZIP Code97035ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237002687EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SALEM HOSPITAL FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSALENameControl
Phone5035615576Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARTIN A MORRISName
TitleVP & CHIEF DEVELOPMENT OFFICERTitle
Phone5035615576Phone
Date Signed2013-07-22DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOYLYN M ANKENEY CPAName
PTINP00366587PTIN
Phone5036204489Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARTIN A MORRISNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4925909GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SALEMHOSPITAL.ORG/FOUNDATIONWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1968YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionDEDICATED TO RAISING, MANAGING AND DISTRIBUTING FUNDS TO HELP SALEM HOSPITAL ACHIEVE ITS MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY IT SERVES.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers14TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year840436ContributionsGrantsPriorYear
Contributions Grants Current Year961218ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year587686InvestmentIncomePriorYear
Investment Income Current Year633227InvestmentIncomeCurrentYear
Other Revenue Prior Year53104OtherRevenuePriorYear
Other Revenue Current Year60618OtherRevenueCurrentYear
Total Revenue Prior Year1481226TotalRevenuePriorYear
Total Revenue Current Year1655063TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1526082GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1276377GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year21863TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY16908TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year33788TotalFundrsngExpCurrentYear
Other Expense Prior Year370170OtherExpensePriorYear
Other Expenses Current Year377763OtherExpensesCurrentYear
Total Expenses Prior Year1918115TotalExpensesPriorYear
Total Expenses Current Year1671048TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-436889RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-15985RevenuesLessExpensesCY
Total Assets BOY7964385TotalAssetsBOY
Total Assets EOY9036981TotalAssetsEOY
Total Liabilities BOY51455TotalLiabilitiesBOY
Total Liabilities EOY551185TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7912930NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8485796NetAssetsOrFundBalancesEOY
Mission DescriptionTHE SALEM HOSPITAL FOUNDATION IS DEDICATED TO RAISING, MANAGING AND DISTRIBUTING FUNDS TO HELP SALEM HOSPITAL ACHIEVE ITS MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY IT SERVES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense158300Expense
Grants158300Grants
DescriptionSCHOLARSHIPS: NURSING, MEDICAL SCHOOL AND OTHER HEALTHCARE PROGRAMS. RECIPIENTS OF HEALTH CARE RELATED ACADEMIC SCHOLARSHIPS AND THE AMOUNTS OF THE AWARDS ARE DETERMINED BY ANALYSES OF THE CANDIDATES' QUALIFICATIONS, SCHOLARSHIP AWARDS ALREADY AWARDED TO THEM FOR THE YEAR BY OTHER ORGANIZATIONS, AND THE COSTS OF THE SPECIFIC SCHOOLS THE VARIOUS CANDIDATES WISH TO ATTEND.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1019770Expense
Grants1019770Grants
DescriptionPROPOSALS TO FUND CAPITAL EQUIPMENT AND MEDICALLY-RELATED ACTIVITIES AT SALEM HOSPITAL ARE RECEIVED AND REVIEWED BY THE FOUNDATION'S CHIEF DEVELOPMENT OFFICER. PROPOSALS ARE FORWARDED TO THE FOUNDATION'S BOARD OF DIRECTORS FOR FURTHER REVIEW AND APPROVAL IF THEY ARE CONSIDERED TO BE CONSISTENT WITH THE FOUNDATION'S ARTICLES OF INCORPORATION, STATING THAT ITS FUNDS ARE TO BE USED FOR HEALTH CARE, CHARITABLE, AND SCIENTIFIC PURPOSES, AND FOR MEDICAL AND SCIENTIFIC EDUCATION AND RESEARCH FOR THE USE AND BENEFIT OF SALEM HOSPITAL.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense98307Expense
Grants98307Grants
DescriptionCERTAIN RESTRICTED FUNDS HAVE BEEN CREATED AND ARE USED FOR THE PURPOSE ASSISTING DIABETES AND CANCER PATIENTS WITH THE COSTS OF THEIR EDUCATIONAL, SUPPLY AND OTHER CARE-RELATED EXPENSES. IN ADDITION, FUNDS ARE DISTRIBUTED TO ASSIST LOW INCOME INDIVIDUALS MEDICAL REQUIREMENTS.Description
FieldValueIRS element (for citing)
Total Program Service Expense1276377TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising1ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10966NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SALEM HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5035611200TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
KELLY YUNKER
CHAIR1.00XX000
KATHY GORDON
VICE CHAIR1.00XX000
MARI BAILEY
SECRETARY/TREASURER1.00XX000
GARTH BRANDAW
DIRECTOR1.00X000
MICHAEL DELK
DIRECTOR1.00X000
BARBARA FURER
DIRECTOR1.00X000
JIM GRIGGS
DIRECTOR1.00X000
BARBARA HALSEY
DIRECTOR1.00X000
BUD PIERCE MD
DIRECTOR1.00X000
ROBERT PONEC MD
DIRECTOR1.00X000
JIM WASENMILLER MD
DIRECTOR1.00X000
ALEX CASEBEER
DIRECTOR1.00X000
LARRY GOODREAU
DIRECTOR1.00X000
ERIC FISKUM
DIRECTOR1.00X000
MARTIN MORRIS
CHIEF DEVELOP OFFICER/VP COMM OUTREACH40.00X028366159289
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs283661TotalReportableCompFrmRltdOrgs
Total Other Compensation59289TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events4900FundraisingEvents
All Other Contributions956318AllOtherContributions
Total Contributions961218TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column188310TotalRevenueColumn
Exclusion$188,310ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real12020Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real12020Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column12020TotalRevenueColumn
Exclusion$12,020ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3689671Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities3244754Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities444917Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column444917TotalRevenueColumn
Exclusion$444,917ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events74690GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events4900CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses26092FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column48598TotalRevenueColumn
Exclusion$48,598ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1655063TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$693,845ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1019770Total
Program Services1019770ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total256607Total
Program Services256607ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2072Total
Management And General2072ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total17300Total
Management And General17300ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total16908Total
Fundraising16908Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total8685Total
Management And General8685ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total16880Total
Fundraising16880Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total5164Total
Management And General5164ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total50Total
Management And General50ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1733Total
Management And General1733ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
MANAGEMENT SERVICES299349299349
MISCELLANEOUS1823318233
SOFTWARE/DATA PROCESS41524152
BANK FEES18771877

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2268Total
Management And General2268ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1671048Total
Program Services1276377ProgramServices
Management And General360883ManagementAndGeneral
Fundraising33788Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY125573BOY
EOY743801EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1410000LandBuildingsEquipmentBasis

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1410000BOY
EOY1410000EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY6371830BOY
EOY6833741EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY56982BOY
EOY49439EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7964385BOY
EOY9036981EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4569BOY
EOY125EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY46886BOY
EOY551060EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY51455BOY
EOY551185EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3250366BOY
EOY3293704EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2451896BOY
EOY2931424EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2210668BOY
EOY2260668EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7912930BOY
EOY8485796EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7964385BOY
EOY9036981EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-15985ReconcilationRevenueExpenses
Reconcilation Other Changes588851ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2295581CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years934781CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1212534CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year809178CurrentTaxYearMinus1Year
Current Tax Year956318CurrentTaxYear
Total6208392Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2295581CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years934781CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1212534CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year809178CurrentTaxYearMinus1Year
Current Tax Year956318CurrentTaxYear
Total6208392Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total1909779AmountsSubstContributorsTotal
Public Support Total1704298613PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years293281CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years70592CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years52561CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year61625CurrentTaxYearMinus1Year
Current Tax Year43799CurrentTaxYear
Total521858Total
FieldValueIRS element (for citing)
Total Support6730250TotalSupport
Public Support Pertcentage1700.63870PublicSupportPertcentage170
Public Support Pertcent Prior Year0.68110PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2450432BeginningOfYearBalance
Contributions79019Contributions
Investment Earnings Or Losses324539InvestmentEarningsOrLosses
Other Expenditures101137OtherExpenditures
End Of Year Balance2752853EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance2498792BeginningOfYearBalance
Contributions18333Contributions
Investment Earnings Or Losses-33888InvestmentEarningsOrLosses
Other Expenditures32805OtherExpenditures
End Of Year Balance2450432EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2344770BeginningOfYearBalance
Contributions19335Contributions
Investment Earnings Or Losses167208InvestmentEarningsOrLosses
Other Expenditures32521OtherExpenditures
End Of Year Balance2498792EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2285949BeginningOfYearBalance
Contributions31343Contributions
Investment Earnings Or Losses50166InvestmentEarningsOrLosses
Other Expenditures22688OtherExpenditures
End Of Year Balance2344770EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.82000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.18000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1410000InvestmentCostOrOtherBasis
Book Value1410000BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1410000TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO SALEM HOSPITALDescription
Amount$551,060Amount
FieldValueIRS element (for citing)
Total Of Amounts551060TotalOfAmounts
Total Revenue1655063TotalRevenue
Total Expenses1671048TotalExpenses
Excess Or Deficit For Year-15985ExcessOrDeficitForYear
Net Unrealized GL On Investments588851NetUnrealizedGLOnInvestments
Total Adjustments588851TotalAdjustments
Excess Or Deficit Per FS572866ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt2918263TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments588851NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities326787DonatedSrvcAndUseOfFacilities
Other Revenues347562OtherRevenues
Revenue Not Rptd F9901263200RevenueNotRptdF990
Revenue Subtotal1655063RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9901655063TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2345397TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities326787DonatedServicesUseOfFacilities
Other Expenses Included347562OtherExpensesIncluded
Expenses Not Rptd F990674349ExpensesNotRptdF990
Expenses Subtotal1671048ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9901671048TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:SALEM HOSPITAL FOUNDATION HOLDS ENDOWMENT FUNDS FOR THE BENEFIT OF SALEM HOSPITAL AND FOR USE TOWARDS THE FOUNDATION'S MISSION.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSES NETTED WITH REVENUE 26,092. ASSETS RELEASED FROM RESTRICTION INCLUDED IN REVENUE 321,470.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSES NETTED WITH REVENUE 26,092. ASSETS RELEASED FROM RESTRICTION INCLUDED IN EXPENDITURES 321,470.

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
In Person SolicitationsXInPersonSolicitations
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref Fundraising1AgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation

Name Of Organization NameOfOrganization

FieldValueIRS element (for citing)
Business Name Line1ADVANCED MARKETINGBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line199 THIELMAN DRIVEAddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14206ZIPCode
FieldValueIRS element (for citing)
ActivityDIRECT MAIL SOLICITATIONActivity
Fundraiser Control Of Funds0FundraiserControlOfFunds
Gross Receipts0GrossReceipts
Amount Retained By Contractor16908AmountRetainedByContractor
Net To Organization0NetToOrganization
FieldValueIRS element (for citing)
Total Retained By Contractors16908TotalRetainedByContractors
Licensed StatesORLicensedStates

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event179590GrossReceiptsEvent1
Charitable Contributions Event14900CharitableContributionsEvent1
Gross Revenue Event174690GrossRevenueEvent1
Cash Prizes Event1300CashPrizesEvent1
Non Cash Prizes Event1979NonCashPrizesEvent1
Rent Facility Costs Event117295RentFacilityCostsEvent1
Other Direct Expenses Event17518OtherDirectExpensesEvent1
Gross Receipts Total79590GrossReceiptsTotal
Charitable Contributions Total4900CharitableContributionsTotal
Gross Revenue Total Events74690GrossRevenueTotalEvents
Cash Prizes Total Events300CashPrizesTotalEvents
Non Cash Prizes Total Events979NonCashPrizesTotalEvents
Rent Facility Costs Total Events17295RentFacilityCostsTotalEvents
Other Direct Expenses Total Events7518OtherDirectExpensesTotalEvents
Direct Expense Summary Events26092DirectExpenseSummaryEvents
Net Income Summary48598NetIncomeSummary

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF FUNDRAISING PAYMENTSIdentifier
Return ReferenceSCHEDULE G, PART I, LINE 2B, COLUMN (V)ReturnReference
ExplanationPAYMENT WAS FOR A 42,000 PIECE DIRECT MAIL SOLICITATION.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1SALEM HOSPITALBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient930579722EINOfRecipient
IRC Section503(C)(3)IRCSection
Amount Of Cash Grant1019770AmountOfCashGrant
Amount Of Non Cash Assistance0AmountOfNonCashAssistance
Method Of ValuationN/AMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance
Purpose Of GrantTO PAY FOR GENERAL EXPENSES AND CAPITAL EXPENDITURES.PurposeOfGrant

Form990 Schedule I Part III Form990ScheduleIPartIII (4 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
SCHOLARSHIPS FOR STUDENTS LIVING IN MARION/POLK OR YAMHILL COUNTY WHO ARE PURSUING A CAREER IN HEALTHCARE. PAYMENTS MADE DIRECTLY TO THE COLLEGE(S)94158300N/A
SMALL ONE-TIME CASH GRANTS ($150-$300) TO INDIGENT PATIENTS FOR EMERGENT NEEDS SUCH AS MEDICATION, UTILITIES, TRANSPORTATION, RENT, ETC14540250N/A
NON-CASH SUPPORT OF INDIGENT PATIENTS OF SALEM HOSPITAL AND/OR COMMUNITY MEMBERS INCLUDING PROVIDING MEDICATION, TRANSPORTATION, MEDICAL EQUIPMENT, CAR SEATS AND OTHER SUPPORT.336156688ACTUAL COSTMEDICATIONS, TRANSPORTATION, DURABLE MEDICAL EQUIPMENT, NON-MEDICAL SAFETY/PREVENTION ITEMS (CAR SEATS, EMERGENCY CALL SYSTEM, ETC), REQUIRED HEALTH COUNSELING, EDUCATION.
CASH SUPPORT FOR INJURY PREVENTION PROGRAM2001200N/A

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: DECISIONS ON GRANTS TO SALEM HOSPITAL ARE MADE BY THE SALEM HOSPITAL FOUNDATION BOARD OF DIRECTORS. MINUTES OF THE MEETINGS OF THE FOUNDATION BOARD ARE SHARED WITH THE SALEM HEALTH BOARD OF TRUSTEES EACH MONTH. SCHOLARSHIPS ARE GRANTED TO COLLEGE STUDENTS THAT RESIDE IN MARION, POLK OR YAMHILL COUNTIES AND ARE PURSUING A HEALTHCARE RELATED CAREER. A SCHOLARSHIP COMMITTEE REVIEWS INDIVIDUAL APPLICATIONS AND RECOMMENDS TO THE BOARD RECIPIENT AWARDS FOR APPROVAL. SCHOLARSHIPS AWARDED ARE PAID DIRECTLY TO THE EDUCATIONAL INSTITUTIONS FOR TUITION OR RELATED COSTS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonMARTIN MORRISNamePerson
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs243065CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs33936BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs6660OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs33204DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs26085NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs342950TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BMARTIN MORRIS RECEIVED DEFERRED COMPENSATION UNDER A 457(F) NONQUALIFIED PLAN. THIS COMPENSATION IS INCLUDED IN COMPENSATION REPORTED IN PART II UNDER DEFERRED COMPENSATION. THE TOTAL NONQUALIFIED PORTION REPORTED IS $15,855.
PART IIICOMPENSATION OF THE V.P. & CHIEF DEVELOPMENT OFFICER IS DETERMINED BY THE CEO OF SALEM HEALTH, IN CONJUNCTION WITH OTHER SALARY SURVEY OR PUBLIC INFORMATION AND INDEPENDENT CONSULTANTS TO ENSURE THE COMPENSATION IS COMPETITIVE IN THE MARKET FOR SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS. COMPENSATION AND BENEFITS REPORTED FOR MARTIN MORRIS ON SCHEDULE J, LINE 1, (II) ARE PAID BY SALEM HOSPITAL. THE FOUNDATION HAS A MANAGEMENT AGREEMENT TO REIMBURSE SALEM HOSPITAL FOR A PORTION OF HIS COMPENSATION AND BENEFITS WHICH TOTALED $78,981. THIS AMOUNT IS INCLUDED IN ON FORM 990 PART IX; LINE 24A UNDER MANAGEMENT SERVICES.SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION'S GOVERNING EXECUTIVE COMMITTEE REVIEWS THE IRS FORM 990 BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CON AN ANNUAL BASIS THE SECRETARY SHALL SEND TO EACH PERSON WHO IS A TRUSTEE, OFFICER, OR MEMBER OF A COMMITTEE A COPY OF THE POLICY REGARDING CONFLICTS OF INTEREST, TOGETHER WITH A QUESTIONNAIRE INQUIRING AS TO CONFLICTS, TO BE COMPLETED AND RETURNED TO THE SECRETARY BY THE TRUSTEE, OFFICER OR COMMITTEE MEMBER PRIOR TO THE BEGINNING OF EACH CALENDAR YEAR.
FORM 990, PART VI, SECTION C, LINE 19NO DOCUMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 588,851.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1HAMPSHIRE PROPERTIES LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
EIN870804582EIN
Primary ActivitiesREAL ESTATE HOLDINGPrimaryActivities
Legal Domicile StateORLegalDomicileState
Total Income12020TotalIncome
EOY Assets1410000EOYAssets
Direct Controlling Entity NAN/ADirectControllingEntityNA

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
SALEM HOSPITAL
890 OAK STREET SESALEMOR97301930579722HOSPITALOR501(C)(3)3SALEM HEALTH0
SALEM HOSPITAL AUXILIARY
890 OAK STREET SESALEMOR97301931081113SUPPORTS SALEM HOSPITALOR501(C)(3)90N/A
SALEM HEALTH
890 OAK STREET SESALEMOR97301930823471LEASES LAND TO SALEM HOSPITALOR501(C)(3)11 TYPE 10N/A
WEST VALLEY HOSPITAL
525 SOUTHEAST WASHINGTON STREETDALLASOR97338431960221HOSPITALOR501(C)(3)3SALEM HEALTH0
WEST VALLEY HOSPITAL FOUNDATION
525 SOUTHEAST WASHINGTON STREETDALLASOR97338931298564SUPPORTS WEST VALLEY HOSPITALOR501(C)(3)11 TYPE 1SALEM HEALTH0
WILLAMETTE VALLEY INSURANCE COMPANY
745 FORT STREETHONOLULUHI96813201836190CAPITIVE INSURANCEHI501(C)(3)11 TYPE 1SALEM HEALTH0
WILLAMETTE VALLEY PROFESSIONAL SERVICES
890 OAK STREET SESALEMOR97301753175249BILLING SERVICE FOR SALEM HOSPITAL, WEST VALLEY HOSPITAL, & SALEM HEALTHOR501(C)(3)3SALEM HEALTH0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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