2012-03-30T11:05:28-07:00 2011-03-31 990 2010-04-01 331065485 LEGACY SALMON CREEK HOSPITAL LEGA 5034155600 2211 NE 139TH STREET VANCOUVER WA 98686 DAVID E EAGER 2012-03-30 2010 2016-02-24 21:20:13Z GEORGE J BROWN MD C/O 1919 NW LOVEJOY STREET PORTLAND OR 97209 187804964 false false X WWW.LEGACYHEALTH.ORG X 2002 WA Legacy Salmon Creek Hospital (LSCH), established in 2005, provides acute and critical care in Vancouver, with 165 licensed beds. LSCH operates adult, pediatric, and OB/GYN hospitalist programs, as well as four primary care physician practices and three specialty clinics. LSCH provides a comprehensive range of inpatient, clinical and diagnostic services in numerous medical specialties and subspecialties. LSCH is part of Legacy Health (Legacy).Our mission:Our legacy is good health for our people, our patients, our communities, and our world. We will work as a team to demonstrate our values:Respect - Treat all people with respect and compassion Service - Put the needs of our patients and their families first Quality - Deliver outstanding clinical services within healing environments Excellence - Set high standards and achieve them Responsibility - Be good stewards of our resources, ensuring access to care for all Innovation - Be progressive in our thinking and actions Leadership - Serve a 13 13 0 815 358881 -21135 124451 52348 184635764 186612744 8833 -144454 -2092732 -1621947 182676316 184898691 16300 16322 0 89857017 95439331 0 0 92515932 79086159 182389249 174541812 287067 10356879 258512415 240206340 24421966 -5197959 234090449 245404299 Legacy Salmon Creek Hospital (LSCH), established in 2005, provides acute and critical care in Vancouver, with 165 licensed beds. LSCH operates adult, pediatric, and OB/GYN hospitalist programs, as well as four primary care physician practices and three specialty clinics. LSCH provides a comprehensive range of inpatient, clinical and diagnostic services in numerous medical specialties and subspecialties. LSCH is part of Legacy Health (Legacy).Our mission:Our legacy is good health for our people, our patients, our communities, and our world. We will work as a team to demonstrate our values:Respect - Treat all people with respect and compassion Service - Put the needs of our patients and their families first Quality - Deliver outstanding clinical services within healing environments Excellence - Set high standards and achieve them Responsibility - Be good stewards of our resources, ensuring access to care for all Innovation - Be progressive in our thinking and actions Leadership - Serve a false false 125367962 16322 175269237 LSCH was the State of Washington's first new hospital construction since 1979. The hospital opened in August 2005 with 165 licensed beds, all of which are single occupancy. LSCH provides a full array of hospital services, including surgery, diagnostics, inpatient and outpatient medical services, neonatal intensive care unit, pediatric, obstetrical, and emergency services. LSCH utilizes an electronic information system for medical records and physician order entry. Physicians are able to complete their entire patient records electronically and can remotely access patient records, including diagnostic images.In support of its mission, LSCH voluntarily provides medically necessary patient care services that are discounted or free of charge to persons who have insufficient resources and/or who are uninsured. During fiscal year 2011, LSCH provided financial assistance on approximately 19,900 patient accounts (of which 49% received discounts totaling 100% of costs) and resulted in LSCH incurring roughly $10,388,000 in uncompensated costs associated with this program. In addition to charity care, LSCH provides services under various states' Medicaid programs for financially needy patients Medicare beneficiaries, and other government programs for which the cost of treating these patients exceeds the government payments received. During fiscal year 2011, LSCH incurred approximately $12,848,700, $6,124,500 in uncompensated costs attributable to Medicaid, Medicare respectively. LSCH also provides a variety of other community benefit activities such as medical education, donations to other charitable entities, research, and other health improvement services, which totaled roughly $762,900 during fiscal year 2011.LSCH is part of Legacy, which collectively provided over $78 million, $59 million, $48 million, and $2 million in uncompensated care attributable to its financial assistance, Medicaid, Medicare, and other government programs, respectively, in fiscal year 2011. In addition, Legacy provided over $19 million in other community benefit activities during fiscal year 2011. 17863956 11343506 LSCH operates adult, pediatric, and OB/GYN hospitalist programs, as well as four primary care physician practices and three specialty clinics in southwest Washington. LSCH utilizes an electronic information system for medical records and physician order entry. Physicians are able to complete their entire patient records electronically and can remotely access patient records, including diagnostic images. 143231918 true true false true false false false false false true true false false false false false false true false false false false false false false false true true true false true false false false false false false true false false false false false false false false false true true false false false true 0 0 false 0 false true true false false false false false false false false false 0 false false false false false false false false false false false X 13 13 false true false false true true true true true false false false true true true true true true true true true true X X DAVID E EAGER 5034155600 1919 NW LOVEJOY STREET PORTLAND OR 97209 TRENT S GREEN 40.00 X 0 311012 92160 TIMOTHY J RODDY 40.00 X 314177 0 48443 STEPHEN NEWBERRY MD 3.00 X 0 6403 0 SONJA O STEVES 40.00 X 0 305491 118183 SCOTT H JOHNSON 40.00 X 0 306533 83716 SALLY E DOYLE 40.00 X 292851 0 41163 RT REV MICHAEL J HANLEY 4.00 X 0 0 0 RONALD S KING 4.00 X 0 427 0 ROBERT W BENTLEY MD 4.00 X 0 206 0 ROBERT L CORNIE 4.00 X 0 284 0 ROBERT J PALLARI 0.00 X 0 460485 25878 RICHARD F GIBSON MD 0.00 X 0 438532 43081 PAMELA S VUKOVICH 40.00 X 0 499553 206459 P CAMPBELL GRONER III 40.00 X 0 457351 161807 JONATHAN E AVERY 40.00 X 327493 0 92852 JOHN W WINTER JR 4.00 X 0 381 0 JEFFREY S GORDON 5.00 X X 0 0 0 JEFFREY D FULLMAN MD 3.00 X 0 268 0 JACK L ORCHARD 4.00 X 0 352 0 HOLLIS J HENDRICKS 4.00 X 0 0 0 GEORGE J BROWN MD 40.00 X 0 828524 225427 GEORGE A CIOFFI MD 40.00 X 0 347823 152103 FRED H COLEMAN 40.00 X 357471 0 27589 EVERETT NEWCOMB III 40.00 X 0 425947 96129 DUANE C MCDOUGALL 3.00 X 0 0 0 DEAN WILLIAM B LUPFER 3.00 X 0 72 0 CORLISS A MCKEEVER 3.00 X 0 298 0 COLLEEN A CAIN 7.00 X X 0 206 0 CHRISTOPHER S THOMING MD 3.00 X 0 289 0 CAROL A BRADLEY 40.00 X 0 335860 90018 CAREY L WINKLER 40.00 X 354042 0 50761 CARBER C HUANG 40.00 X 326814 0 48023 BISHOP DAVID BRAUER-RIEKE 3.00 X 0 0 0 BARBARA K FERRE MD 4.00 X 0 0 0 1972848 4726297 1603792 108 true true false THE VANCOUVER CLINIC INC 700 NE 87TH AVE VANCOUVER WA 98664 MEDICAL SERVICES 617233 MEDLINE INDUSTRIES PO BOX 121080 DEPT 1080 DALLAS TX 75312 MEDICAL UNIFORMS 630493 HURON CONSULTING LLC 8044 SOLUTIONS CTR CHICAGO IL 606778000 CONSULTANTS 784041 COLUMBIA ANESTHESIA GROUP PO BOX 5157 VANCOUVER WA 98668 MEDICAL SERVICES 662004 BAUGH SKANSKA INC PO BOX 767 BEAVERTON OR 97075 CONSTRUCTION 1117148 24 52348 14163 52348 RETAIL PHARMACY 358881 358881 PATIENT PROGRAM REV 460111906 460111906 CONVENIENCE OF MEMBERS 1221392 1221392 CONTRACTUAL ALLOWANCE -245470976 -245470976 CHARITY CARE -29608459 -29608459 186612744 11418 11418 0 0 1128454 2750401 -1621947 -1621947 -1621947 155872 -155872 -155872 -155872 0 0 0 0 184898691 185032471 358881 -545009 16322 16322 0 0 0 420345 357838 62507 0 75505083 66197093 9307990 3734648 3244030 490618 10308718 8926582 1382136 5470537 4768033 702504 0 14005 11184 2821 0 48000 48000 0 0 2861937 2861937 0 25562197 24298405 1263792 0 0 486490 388510 97980 79469 63464 16005 0 102918 82190 20728 0 0 16102761 12859645 3243116 1852127 1661530 190597 TAXES WA B&O, USE & SALES 3153004 2517985 635019 PROVIDER TAX 1035484 1035484 CONTRACT SERVICES 5080965 1806225 3274740 BAD DEBTS 8645698 8645698 ADMINISTRATIVE SERVICES 12383926 2242729 10141197 1677178 1247034 430144 174541812 143231918 31309894 0 218621 209636 0 0 22972873 25744693 6472 521 0 65957 64820 1890394 1649409 525152 544160 327866002 112061161 229394764 215804841 0 -7099317 0 0 3438182 3287577 258512415 240206340 13840998 14145171 10580968 -19343130 24421966 -5197959 X 234090449 245404299 234090449 245404299 258512415 240206340 X 10356879 956971 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false X 147180 202238 147180 202238 150175848 1084196168 150323028 1084398406 1000000 1000000 250000 250000 false 1000000 2000000 2000000 2000000 7000000 10500000 20000 59359 263925 349418 692702 250000 500000 500000 500000 1750000 2625000 Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description Schedule C, Part II-A, 501(h) election Listing of Affiliated Members Legacy Health, EIN 23-7426300, Lobby Exp $163,804Legacy Emanuel Hospital & Health Center, EIN 93-0386823, Lobby Exp $17,657Legacy Good Samaritan Hospital and Medical Center EIN 93-0386793, Lobby Exp $0Legacy Meridian Park Hospital, EIN 93-0618975, Lobby Exp $4,047Legacy Mount Hood Medical Center, EIN 93-0591528, Lobby Exp $16,730Legacy Salmon Creek Hospital, EIN 33-1065485, Lobby Exp $147,180 Legacy Visiting Nurse Assn, EIN 93-0848530, Lobby Exp $0There were no excess lobbying expenditures for any of the above affiliates. All affiliated entities addresses can be found on Schedule R. 136521 90600 -32055 259176 58038 152877 74394 136521 8321 86833 37116 58038 1.00000 false true true 10173635 10173635 239165269 60208086 178957183 30958 6448 24510 78044762 51846627 26198135 451378 451378 215804841 NONCURRENT WORKERS' COMP LIABILITY 259379 NONCURRENT PENSION LIABILITY 10051697 COMPANY AFFILIATE PAYABLE -29654206 -19343130 184898691 174541812 10356879 956971 956971 11313850 184696000 184696000 202691 202691 184898691 174344000 174344000 197812 197812 174541812 Part XIII, Line 4b Part XIII, Line 4b: Other revenue amounts included on 990 but not included in F/S MEDICAL STAFF EXPENSE $195391 FOUNDATION DONATION $38185 ROUNDING $-13864 OTHER EXPENSE $-143240 GAIN / LOSS OF SALE OF ASSETS $-155873 PROGRAM SERVICE REVENUE $263050 IN-KIND DONATION $14163 Part XII, Line 4b Part XII, Line 4b: Other revenue amounts included on 990 but not included in F/S MEDICAL STAFF INCOME $186406 FOUNDATION DONATION $38185 OTHER EXPENSE $-143240 ROUNDING $0 GAIN / LOSS OF SALE OF ASSETS $-155873 PROGRAM SERVICE REVENUE $263050 FOUNDATION CAPITAL CONTRIBUTION $0 IN KIND DONATION $14163 Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances CHANGE IN ADDITIONAL MINIMUM PENSION LIABILITY $0 ADMINISTRATIVE SERVICES $8303329 MEDICAL STAFF $ -0 IN KIND DONATIONS $ -14163 CHANGE IN ADDITIONAL MINIMUM PENSION LIABILITY $ -1362489 TRANSFER TO PHYSICIANS $ -5969704 ROUNDING $ -2 Part V, Line 4 Part V, Line 4: Intended uses of the endowment fund. Endowment funds disclosed in Part V are used to improve the healthcare of the community as designated by the donors. Salmon Creek Hospital Foundation (SCHF) maintains all charitable gifts including endowment funds for the benefit of LSCH and it's programs. Income from permanently restricted net assets is accounted for in accordance with the donors' instructions.Legacy follows the guidance in the Uniform Prudent Management of Institutional Funds Act (UPMIFA) in determining the net asset classification of all donor-restricted endowment funds. In accordance with UPMIFA and board policy, assets classified as permanent endowments in accordance with donor intent are only utilized for current period expenditures to the extent that earnings on the endowment exceed the original fair value of the donation. To the extent earnings on endowment funds exceed identified expenditures on which to apply those earnings, the earnings are classified as temporarily restricted net assets. Legacy has adopted investment and spending policies for endowment assets to provide a predictable stream of funding to programs supported by its endowment and to maintain the value of the endowment assets. Asset allocation is reviewed quarterly with respect to: i) Legacy's tolerance for risk based on its financial condition and need for cash from investments to support operations; ii) expected asset class return, risk and correlation characteristics; iii) changes in accounting guidance or tax law and iv) changes in bond covenants or other restrictions.Legacy's spending practices are intended to comply with donor's wishes and meet all applicable laws and regulations. Spending must be for a purpose that is consistent with the documented intent of the donor, and may not exceed the amounts annually determined by Legacy. Factors that are considered in addressing the annual spending allocation are: i) market value of the fund relative to the principal of the gift and ii) the level of spending in prior years.From time to time, the fair value of assets associated with individual donor-restricted endowment funds may fall below the level that the donor or UPMIFA requires Legacy to retain as a fund of perpetual duration. Deficiencies of this nature are reported as a reduction to unrestricted net assets and are excluded from the performance indicator. true true X true X true X true true true false true true 10388026 10388026 0.05950 39335589 26486918 12848671 0.07360 49723615 26486918 23236697 0.13310 150776 25793 124983 0.00070 469031 469031 0.00270 168878 168878 0.00100 788685 25793 762892 0.00440 50512300 26512711 23999589 0.13750 false 3098618 2929620 30238299 32210854 -1972555 X true true 1 0 LEGACY SALMON CREEK HOSPITAL

2211 NE 139TH STREET VANCOUVER WA 98686

X X X LEGACY SALMON CREEK HOSPITAL 1 Part VI - Affilated Health Care System Roles and Promotion LSCH is a subsidiary of Legacy Health (Legacy). Legacy is an integrated health system based in Portland, Oregon and primarily operates five acute care hospitals and related services (e.g. physician practices, hospice, preferred provider network) in the greater Portland, Oregon and southwest Washington area.The Legacy Board is comprised of community and business leaders as well as representatives of the medical staff. The LSCH medical staff is open, with physicians submitting credentialing information reviewed according to LSCH policies and standards. While there is investment in a variety of community-based activities and programs as a part of its non-profit status, an overwhelming majority of Legacy and LSCH's community benefit comes in the form of providing uncompensated care. Legacy's policy of providing care regardless of the ability to pay makes it one of the region's largest providers of uncompensated care in the four-county metropolitan area.In 1999, the Legacy Board allocated $10 million to establish a Community Health Fund from operating revenue to address major community health issues. For more than a decade, about $500,000 has been granted annually to community-based projects addressing racial and ethnic inequities and root causes. These dollars are in addition to Legacy's other charitable contributions. The Community Health Fund has provided 40 grants since 1999 totaling more than $5.8 million. Recognizing that education, employment and income inequities exist for communities of diversity, and that health professions are lacking in diversity, Legacy established the Youth Employment in Summer program. African American and Hispanic youth receive paid summer employment in departments where they worked with health professionals and earned college scholarships between $2,500 and $5,000 annually. Students can remain in the program as long as they stay in school and pursued healthcare careers. Some students have remained in this program for as long as seven years and graduated with degrees in a variety of healthcare fields. Legacy encourages and supports employee volunteerism. Legacy donates $100 to nonprofit health, human service or education organizations in honor of employees who volunteer on personal time 50 hours a year. Employees may receive paid time when volunteering in one or two week time periods in local nonprofit organizations through Legacy's community service leave program.Non-cash donations of resources include clinical and non-clinical services and items, e.g., screenings and support services, internships, information and referral services and health fairs. Legacy's warehouse is open to nonprofit organizations to obtain surplus equipment and furniture. In addition, conference room space is made available to local nonprofits for Board and community meetings.LSCH has recognized that nonprofit organizations spend valuable dollars on office space and infrastructure - dollars better spent on meeting their missions. As a result, LSCH has provided free office space and other infrastructure services to nonprofit organizations on its campus. Additionally, LSCH provides meeting space to a variety of not for profit organizations free of charge to further their respective missions within the community. These activities are reported as "in-kind contributions." Part VI - Community Information Legacy Salmon Creek is located in rural/suburban north Clark County and includes the largest city in the area, Vancouver. Clark County is among the fastest growing in all of Washington and the area is among the top in the entire United States. Developments are consuming much of the farmland. While this is changing the population, the towns within the SW Washington area continue to pride themselves on their hometown community environments.Legacy Salmon Creek was the first totally new hospital in the area in the last 25 years-opening in August 2005. Prior to its opening, Clark County had one hospital located in the service area.The primary service area includes roughly 162,000 residents. The primary service area, by ethnicity: non-Hispanic White: 88%, Hispanic: 6%, African American: 1%, Asian: 2%, American Indian/Alaskan: 1%, and other: 2%. Census numbers do not represent the true and changing picture. Formerly a non-Hispanic white community, the area is experiencing an increase in the SE Asian, Slavic and Hispanic populations. Schools that were high-income and low-minority are now experiencing higher English-as-a-Second-Language rates and percents of students receiving reduced-cost or free lunches.The current economic crisis has hit SW Washington hard; unemployment is higher than the state average. SW Washington continues to work to build the employment base locally; a very high portion of the population commutes to Oregon for work. Part VI - Patient Education of Eligibility for Assistance LSCH employs financial counselors and social workers that assist patients in obtaining coverage for their healthcare needs. This includes assistance with workers compensation, motor vehicle accident policies, COBRA, veterans' assistance, LSCH's financial assistance program, and public assistance programs, such as Medicaid. The criteria for financial assistance under LSCH's program is determined based on eligibility for insurance coverage, household income, qualified assets, catastrophic medical events, or other information supporting a patient's inability to pay for medically necessary services provided. Specifically, the LSCH Financial Assistance Program provides an uninsured discount of 15% to patients who have resided within LSCH's primary service area for a period of six months, are uninsured for hospital care, and have a household income of less than $100,000 annually. Further discounts are available for patients, on a sliding scale, whose household income is less than 400% of the federal poverty level or roughly $89,000 for a family of four in Portland, Oregon. For patients whose household income is at or below 200% of the federal poverty level, a full subsidy is available. In addition to the household income criteria, the patients' qualified assets (e.g. 25% of household assets), and other catastrophic or economic circumstances are considered in determining eligibility. In addition to financial counselors and social workers, LSCH makes every effort to communicate its Financial Assistance Program to patients. This includes signage in main admitting areas of each hospital and brochures explaining financial assistance in all patient care areas, as well as in appropriate languages. Financial counselors are available to assist patients in understanding and applying for available resources, including the LSCH Financial Assistance Program. LSCH's website also has information about the availability of financial assistance. LSCH offers financial assistance customer service Monday through Friday, as well as the availability of voice mail so patients can leave confidential, detailed messages during non-business hours. Finally all of Legacy's billing statements include information regarding the availability of financial assistance. If LSCH requires the use of a collection agency, those agencies are required to provide a telephone number that patients can call to request financial assistance.In 2010, Legacy Health established the CLEAR initiative. CLEAR stands for Communication, Literacy, Education and Achieve Results. CLEAR is becoming a part of Legacy's culture as nearly all departments have a direct impact on how we deliver patient care. CLEAR will be rolled out in four stages: awareness, education, practice and culture. The first stage focuses on building awareness, educating staff in health literacy and developing department action plans. The second stage will include continuing education and putting health literacy tools into consistent practice. In the third stage, CLEAR will be practiced within all departments and become a part of Legacy's culture. Quality, safety and cost are all affected by a patient's inability to understand medical instructions and to explain their symptoms/issues. Understanding health literacy is essential. Annual education is provided to all billing and admitting staff so they can be kept informed of and speak with knowledge about current financial assistance policies and options. LSCH provides copies of the latest policies in main admitting areas, as well as through newsletters and other publications. Since 2008, the four county metro area health delivery systems (encompassing all hospitals in the area) and safety net clinics have partnered to establish a seamless, coordinated program to provide care for the low income uninsured, Project Access. This program enables low income uninsured patients to receive continuity of care in earlier stages of acuity due to the collaboration among 2800 providers and all health systems. Part VI - Needs Assessment Senior leadership, in conjunction with the Board of Directors, continually assesses the needs of the communities it serves through a compilation of primary and secondary market research (qualitative and quantitative), medical staff input, reviewing national trends and practices, working with local foundations and funders regarding their assessments, and working with local community-based partners to understand their needs. The goal is to understand the needs and develop programs specific to the community. Involvement is both proactive and responsive - a leadership role in initiating programs as well as being readily available as a collaborative partner when the community asks. The outcome of these assessments is the development of both long-term and fiscal year plans that are supported by a yearly budget that is proposed by staff and approved by the Board of Directors. During 2010, Legacy Health conducted a community needs assessment. The results of the assessment were available in July of 2011 and can be found at www.LegacyHealth.org. The region served by Legacy Salmon Creek Hospital (LSCH), along with most of Washington, is experiencing significant challenges in population growth, economic development, education and health care. Recognizing that social and economic determinants impact health, LSCH has been and will remain committed to addressing these issues to improve the health of all residents in the community, including equity among ethnically diverse populations. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients Legacy provides care without charge or at amounts less than its established rates to patients who meet certain criteria under its financial assistance policy. Since Legacy does not pursue collection of amounts determined to qualify as charity care, they are excluded from net patient service revenues. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The entire Medicare shortfall should be considered a community benefit. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in the community served by the hospital. The hospital provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. The Medicare amounts listed in Part III Section B. on lines 5, 6, and 7 do not represent all of the organization's revenues and costs associated with its participation in Medicare programs. The methodology used in reporting in Part III Section B Medicare is inconsistent with the other sections in Schedule H, as the instructions limit Medicare revenues and allowable cost to those from only the Medicare Cost Report. Revenue and costs from Medicare Part C patients, Part B physician services billed by the organization, and clinical laboratory services weren't included. In addition, hospitals incur other costs to provide care that Medicare does not allow in the cost report, such as Physician Call pay to ensure adequate physician coverage for the ED. The total revenues and costs attributable to all Medicare services are $52,269,141 and $58,393,640 respectively. This results in a total Medicare shortfall of $6,124,499.Costing Methodology (Part III, Line 8).Medicare allowable costs were calculated using the costing methodologies in the Medicare Cost Report. The cost report arrives at total allowable hospital cost through a cost finding process that includes direct cost allocations and a step-down allocation of indirect or overhead costs. Inpatient operating costs are composed of general inpatient routine and ICU unit costs derived from cost per diems, as well as inpatient ancillary service costs that utilize cost to charge ratios to arrive at cost. Apportionment of cost applicable to hospital outpatient services is through the application of cost to charge ratios. This excludes other costs incurred to provide services of the hospital to the community that the cost report deems as unallowable costs, such as Physician on-call pay. Part III, Line 4 - Bad Debt Expense The bad debt expense at cost was determined by using the same cost charge ratio as used for the charity care calculation. The estimated amount of bad debt expenses attributable to charity care policy was calculated using the demographic profile of household income and average household size in the zip code areas around the hospital. 66% of Households in the LEHHC service area would qualify for financial assistance with incomes under 400% of the Federal Poverty Guidelines.LEHHC uses many different approaches to inform and educate patients on the availability of financial assistance as is described later in Part VI of Schedule H. Still, many patients do not respond to requests for information or provide appropriate documentation to benefit from financial assistance. As a result, LEHHC must report these amounts as bad debt. A portion of bad debt expense should be considered as charity care, using reasonable methodologies to analyze the information. true MEDICAL TEAMS INTERNATIONAL 14150 SW MILTON CT TIGARD OR 97224 930878944 0 16322 COST SUPPLIES FOR DISASTER ASSISTANCE 1 0 Grantmaker's Description of How Grants are Used Legacy reviews all organizations prior to donating cash or supplies to ensure their 501(c)(3) status. Legacy regularly donates supplies to Medical Teams International for disaster relief. Several Legacy medical staff members, volunteer for Medical Teams International. X X X X X true true false true true true true false true true TRENT S GREEN 308620 2392 67399 24761 403172 TIMOTHY J RODDY 181030 125193 7954 26117 22326 362620 SONJA O STEVES 273706 31785 87567 30616 423674 31196 SCOTT H JOHNSON 271308 35225 47421 36295 390249 14568 SALLY E DOYLE 255554 37297 18689 22474 334014 ROBERT J PALLARI 460485 25878 486363 132478 RICHARD F GIBSON MD 98351 340181 24309 18772 481613 45988 PAMELA S VUKOVICH 441515 58038 179774 26685 706012 6874 P CAMPBELL GRONER III 364852 92499 124696 37111 619158 88308 JONATHAN E AVERY 289259 38234 68501 24351 420345 27730 GEORGE J BROWN MD 766346 62178 181121 44306 1053951 33019 GEORGE A CIOFFI MD 342133 5690 125999 26104 499926 FRED H COLEMAN 336086 16154 5231 21139 6450 385060 EVERETT NEWCOMB III 385476 30000 10471 72357 23772 522076 CAROL A BRADLEY 310003 20000 5857 61146 28872 425878 CAREY L WINKLER 332208 16154 5680 35650 15111 404803 CARBER C HUANG 295694 33596 -2476 22032 25991 374837 Sch J, Part III, Additional Information Part III, Additional Information Sch J, Part 1, Question 3 Regarding Compensation PracticesDirectors for Legacy are not compensated, but receive expense reimbursements related to their duties. Any expense reimbursements to board members require review and approval by the Director of Management Audit. During 2010, the board meeting included spouses or a guest. Any reimbursed expense related to the spouse or guest's travel is reported on part VII of the form 990. Compensation received by Dr. Newberry during 2010 related to his responsibilities as Past President of the Medical Staff at Legacy Meridian Park Hospital. Executive compensation for Legacy is designed to recruit, retain and motivate qualified senior management personnel. The comprehensive compensation plan is designed for positions that have a significant impact on the high-level strategic and policy direction of Legacy and its affiliates.Base pay and total compensation (including incentive compensation) for similar positions is established at a level comparable to market compensation for healthcare organizations. External consultants are regularly used to review published compensation surveys of comparable organizations and comparable benchmark positions in the market. The Compensation Committee of the Board of Directors, none of whom is a Legacy employee, reviews the compensation for executive positions. The Committee oversees the system's governance procedures with respect to intermediate sanctions legislation and the evaluation of reasonableness of compensation. The Committee reports to the Board in sufficient detail to enable the entire Board to take such actions as are required to obtain the rebuttable presumption of reasonableness. The Compensation Committee also reviews tax-reporting disclosures.Sch J, Part II, Column Breakdown Of W-2 Or Misc-1099:Column B(i) - Base compensation consists of regular base pay including employee elected deferrals for retirement plans (403(b) and 457(b) plans).Column B(ii) - The incentive compensation program for Legacy is based on predetermined criteria and reviewed and approved by the Board. Bonuses are paid to key employees for interim duties outside their primary responsibilities (e.g. Acting in Capacity).Column B(iii) - Other compensation consists of deferred compensation amounts paid to executives during the current year and were reported on prior form 990 returns. These amounts include arrangements that contain elements of a substantial risk of forfeiture conditioned on continued employment, vesting and/or a noncompete provision upon termination of employment. In addition, imputed income for insurance, cell phone and other benefits is included in other compensation as well as any severance related payments. Column C - Deferred compensation includes the value of defined benefit plans, contributions to defined contribution plans, amounts deferred under the 457(f) plan including earnings, earnings in the 457(b) plan, and the value of the pension restoration plan. Earnings on the 457(f) and 457(b) include gains and losses on the underlying investments. The defined contribution and benefit plans are available to all employees as they become qualified to participate. The pension restoration plan provides executive pension benefits in excess of IRS mandated limits on eligible compensation to key executives. The benefits are unfunded and subject to forfeiture. Executive pension benefits are intended to make the executive's retirement benefit, as a proportion of their final average salary, comparable to all other employees, and are treated as income when paid.Column D - Nontaxable benefits include company paid health and welfare and long term care and disability benefits under group plans.Column F - Current year compensation reported as deferred in prior years. Sch J, Part I, Line 8 Part I, Line 8: Amounts reported on 990 VII pursuant to initial contract exemption described in Regs Legacy enters into initial employment agreements with executives that qualify under the initial contract exception. The Compensation Committee of the Board of Directors, none of whom is a Legacy employee, reviews the compensation for key executive positions. The Committee relies on comparable market data and all decisions are documented. Sch J, Part I, Line 6b Part I, Line 6b: Explanation of organization compensation contingent on net earnings from related or Legacy has an at-risk incentive compensation plan for management. The plan is based on meeting goals related to employee engagement, work processes, customer service, clinical quality, financial management, and certain key strategic tactics. In order to payout any at-risk incentive compensation, Legacy must exceed operating margin targets. Sch J, Part I, Line 5b Part I, Line 5b: Explanation of organization compensation based on revenues of related organization Physicians employed by Legacy affiliates are paid a bonus contingent upon their revenue generated during the year measured by industry standard relative value units (RVU). Timothy Roddy Malpractice X 21000 521 false true true 521 Form 990, Part X LSCH participates in the Legacy investment pooled funds which include professionally managed equity and fixed income securities in both separately managed portfolios and commingled investment accounts. Investment returns are prorated according to each affiliate's share of the pool. Form 990, Part VI, question 2 Legacy Health System CPC, LLC (CPC) is a common pay agent for Legacy and its affiliates. The CPC files all required federal employment tax returns for Legacy and its affiliates. The number of employees reported on Form W-3 for LSCH is 278. Form 990, Part IV, question 12 Legacy has an audit of its consolidated financial statement which includes consolidating schedules highlighting LSCH's financial results. Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Legacy Health's audited and interim consolidated financial statements are publicly available on the Electronic Municipal Market Access(EMMA) (www.emma.msrb.org) and DAC Bond (www.dacbond.com) websites. Legacy's audited consolidated financial statements include consolidating schedules which highlights LSCH's financial results.When changes are made to the LSCH Articles or Bylaws, LSCH discloses and attaches copies to the IRS Form 990, which are publicly available by request or on various public websites such as Guidestar(www.guidestar.org). Other governing documents are not available to the public. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The following describes the compensation practices of Legacy and its affiliates.Executive compensation for Legacy is designed to recruit, retain and motivate qualified senior management personnel. The comprehensive compensation plan is designed for positions that have a significant impact on the high-level strategic and policy direction of Legacy and its affiliates.Base pay and total compensation (including incentive compensation) for similar positions is established at a level comparable to market compensation for healthcare organizations. External consultants are regularly used to review published compensation surveys of comparable organizations and comparable benchmark positions in the market. The Compensation Committee of the Board of Directors, none of whom is a Legacy employee, reviews the compensation for key executive positions. The Committee oversees the system's governance procedures with respect to the evaluation of reasonableness of compensation. The Committee reports to the Board in sufficient detail to enable the entire Board to take such actions as are required to obtain the rebuttable presumption of reasonableness. The Compensation Committee also reviews tax-reporting disclosures. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts The following is a summary of Legacy's policy and procedures for conflict of interest disclosure, monitoring and resolution.All Legacy employees and non-employees in leadership positions (e.g., Board members, Foundation Trustees, Medical Directors) are required to disclose potential conflicts of interest as the conflict arises. All employees attest to proper conflict of interest disclosure during their annual review. Certain groups have annual formal disclosure requirements, Executives and non-employees in leadership positions complete the Conflict Disclosure Statement from the Standards of Conduct policy annually. Officers, Directors, Trustees, Key and Highly Compensated employees are also required to complete a questionnaire covering business relationships, business transactions with interested parties, loans and grants. Conflict Disclosure Statements and questionnaires are returned to Legacy Management Audit for review of the disclosures. If a conflict is disclosed, or identified through any other means, Management Audit ensures that management mitigates the risk (e.g., discontinues relationship with vendor, segregates responsibilities, recuses Board member from voting in area of conflict) and that the conflict and mitigation steps are reported to the appropriate level (e.g., Compliance Committee, Audit Committee of the Board). Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process The Legacy Board received a copy of the 990 return prior to filing. At the direction of the entire Board, the Board Compensation Committee reviewed the compensation disclosures and the Board Audit Committee reviewed the 990 returns for Legacy and Legacy Emanuel Hospital & Health Center with Management prior to filing. Any key differences in disclosure for other affiliated entities, including Legacy Salmon Creek Hospital were discussed with the Board Audit Committee. Form 990, Part VI, Line 7a Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body The Board of Directors includes the following members: (a) The Bishop of the Oregon Synod of the Evangelical Lutheran Church inAmerica (the "Oregon Synod") or the Bishop's designee, who shall serve ex officio;(b) The Bishop of the Episcopal Diocese of Oregon (the "Episcopal Diocese")or the Bishop's designee, who shall serve ex officio;(c) One (1) person appointed by election of the Oregon Synod Council;(d) One (1) person appointed by election of the Convention of the EpiscopalDiocese. Form 990, Part VI, Line 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Legacy Health is the sole member of Legacy Salmon Creek Hospital. Form 990, Part VI, Line 3 Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company Legacy Health provides management services for all of its affiliated companies which includes, accounting, purchasing, contracting, legal, human resources, information technology, billing, facilities, budgeting, transcription, security, public relations, strategic planning, organization development. 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