FURP.ORG / PUBLIC DATA EXPLORER

SALEM HEALTH: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SALEM HEALTH (EIN 93-0579722)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-14
IRS object ID
201202279349303785
Schema version
2010v3.4
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)
Timestamp2012-08-14T18:05:34-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1AKT LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1680 HAWTHORNE AVE SE 140AddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN930579722EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SALEM HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSALENameControl
Phone5035615535Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameAARON R CRANEName
TitleCHIEF FINANCE & STRATEGY OFFICERTitle
Phone5035615150Phone
Date Signed2012-08-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOYLYN M ANKENEY CPAName
Phone5035857774Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonAARON R CRANENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts584158111GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SALEMHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1970YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionTO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVEActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees4304TotalNbrEmployees
Total Nbr Volunteers325TotalNbrVolunteers
Total Gross UBI2662679TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1312170ContributionsGrantsPriorYear
Contributions Grants Current Year1359173ContributionsGrantsCurrentYear
Program Service Revenue Prior Year533056532ProgramServiceRevenuePriorYear
Program Service Revenue CY571229821ProgramServiceRevenueCY
Investment Income Prior Year4936879InvestmentIncomePriorYear
Investment Income Current Year8871160InvestmentIncomeCurrentYear
Other Revenue Prior Year3092356OtherRevenuePriorYear
Other Revenue Current Year1268159OtherRevenueCurrentYear
Total Revenue Prior Year542397937TotalRevenuePriorYear
Total Revenue Current Year582728313TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year242960GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY313397GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year260454764SalariesEtcPriorYear
Salaries Etc Current Year279602377SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year257903734OtherExpensePriorYear
Other Expenses Current Year271553207OtherExpensesCurrentYear
Total Expenses Prior Year518601458TotalExpensesPriorYear
Total Expenses Current Year551468981TotalExpensesCurrentYear
Revenues Less Expenses Prior Year23796479RevenuesLessExpensesPriorYear
Revenues Less Expenses CY31259332RevenuesLessExpensesCY
Total Assets BOY852373971TotalAssetsBOY
Total Assets EOY861384227TotalAssetsEOY
Total Liabilities BOY397485365TotalLiabilitiesBOY
Total Liabilities EOY393996073TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY454888606NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY467388154NetAssetsOrFundBalancesEOY
Mission DescriptionTO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES WE SERVEMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense112459182Expense
Revenue317121582Revenue
DescriptionSALEM HOSPITAL IS ONE OF THE LARGEST OF OREGON'S 58 ACUTE CARE HOSPITALS AND OPERATES THE BUSIEST EMERGENCY DEPARTMENT IN OREGON. THERE ARE 442 PHYSICIANS ON THE ACTIVE MEDICAL STAFF, REPRESENTING 46 DIFFERENT SPECIALTIES, WHO ADMIT PATIENTS TO THE HOSPITAL. MORE THAN 447 VOLUNTEERS PROVIDE NON-MEDICAL SUPPORT FOR THE HOSPITAL. 2010 STATISTICS: BIRTHS - 3,199, DIAGNOSTIC IMAGING PROCEDURES - 168,414, ED AND URGENT CARE VISITS - 118,982, INPATIENT ADMISSIONS - 23,275, LABORATORY PROCEDURES - 1,494,514, SURGERIES - 13,545. THE PRIMARY SERVICE AREA IS THE GREATER WILLAMETTE VALLEY WITH APPROXIMATELY 500,000 RESIDENTS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense347108468Expense
Revenue243197076Revenue
DescriptionSALEM HOSPITAL PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. IN FY2011, PROVISION OF SERVICES TO INDIVIDUALS WHO CANNOT AFFORD TO PAY ACCOUNTED FOR THE LARGEST PORTION OF THE COMMUNITY BENEFIT, $103.9 MILLION. CHARITY CARE TOTALED $37.8 MILLION; MEDICARE UNDERPAID SALEM HOSPITAL BY $47.8 MILLION. MEDICAID UNDERPAID BY $18.3 MILLION. SALEM HOSPITAL 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.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense22455701Expense
Revenue9205424Revenue
DescriptionSALEM HOSPITAL ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN FY2011, SALEM HOSPITAL GAVE $9.1 MILLION 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. IN FY2011, SALEM HOSPITAL PROVIDED MORE THAN $786 THOUSAND IN CASH AND IN-KIND DONATIONS TO COMMUNITY HEALTH PROGRAMS SUCH AS MEDASSIST, SALEM FREE CLINIC AND NORTHWEST HUMAN SERVICES.Description
FieldValueIRS element (for citing)
Total Program Service Expense482023351TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
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 Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096369NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees4304NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
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 Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
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 Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
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 Number5035613500TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
KATHERINE KEENE
TRUSTEE10.00X000
GEORGE HAPP
TRUSTEE10.00X000
BRUCE CARTER MD
TRUSTEE10.00X000
KENNETH SHERMAN JR
CHAIRPERSON15.00X000X
DAVID ELMGREN MD
TRUSTEE10.00X000
CHUCK HUDKINS
TRUSTEE10.00X000
BONNIE DRIGGERS RN
TRUSTEE10.00X000
THERESA TAAFFE
TRUSTEE10.00X000
ALAN WYNN
SECRETARY/TREASURER10.00X000X
ALAN COSTIC
VICE-CHAIRPERSON15.00X000X
LANE SHETTERLY
TRUSTEE10.00X000
ROBERT WELLS
TRUSTEE10.00X000
NORMAN GRUBER
PRESIDENT40.00823665053837X
AARON CRANE
CHIEF FINANCIAL OFFICER40.00428267076871X
WILLIAM HOLLOWAY MD
CHIEF MEDICAL OFFICER40.00497067079878X
JACK CAYNON
GENERAL COUNSEL40.00319201067869X
BEVERLY BOW
VP HUMAN RESOURCES40.00268879052835X
CHERYL NESTER-WOLFE
CHIEF NURSING OFFICER40.00405815066235X
KENNETH KUDLA
CHIEF INFORMATION OFFICER40.00319357058981X
ANNE MARIE DIAMOND
VP SERVICE LINE OPR.40.0061230016259X
MARTIN MORRIS
EXEC DIR FOUNDATION40.00241504055208X
NICOLE VANDERHEYDEN MD
TRAUMA SURGEON40.00489992072899X
AHMED EBEID MD
PHYSICIAN40.00516751071603X
TRACY TAGGERT MD
GENERAL SURGEON40.00356493057449X
NANCY BOUTIN
PHYSICIAN40.00362417042699X
AMR HEGAZI
ANESTHESIOLOGIST40.00515898052126X
VIRGINIA POSEY
VP/PATIENT CARE40.00196379017543X
PATRICIA HARGER
VP STRATEGIC PLANNING40.00241043038902X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5982728TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation864935TotalOtherCompensation
Number Individuals GT100 K255NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
PHOENIX HEALTH SYSTEMS INC
1130 EAST ARAPAHO ROAD SUITE 500RICHARDSONTX75081IT SUPPORT SERVICES4598962
SOUND INPATIENT PHYSICIANS
1123 PACIFIC AVETACOMAWA98402HOSPITALIST COVERAGE1561079
CSC AMERICAS OUTSOURCING
3170 FAIRVIEW PARK DRIVEFALLS CHURCHVA22042IT SUPPORT SERVICES1435909
SHIFTWISE
1800 SW 1ST AVE SUITE 510PORTLANDOR97201CONTRACT LABOR1338610
OREGON ANESTHESIOLOGY GROUP
120 NW 14TH AVE SUITE 300PORTLANDOR97209ANESTHESIA COVERAGE1272371
FieldValueIRS element (for citing)
Number Of Contractors GT100 K45NumberOfContractorsGT100K
Related Organizations1281110RelatedOrganizations
All Other Contributions78063AllOtherContributions
Total Contributions1359173TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT PAYMENTS621110556069208556069208
PHARMACY44611058339694958864875105
NUTRITION SERVICES72221039602843960284
OTHER HOSPITAL SERVICE90009936135113462099151412
REGIONAL LAB62150017528491194181633431
FieldValueIRS element (for citing)
Total Program Service Revenue571229821TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column8098618TotalRevenueColumn
Exclusion$8,098,618ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1291713Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real980494Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real311219Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column311219TotalRevenueColumn
Exclusion$311,219ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities520202Securities
Other701644Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other449304Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities520202Securities
Other252340Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column772542TotalRevenueColumn
Exclusion$772,542ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionPASSTHROUGH INCOMEDescription
Business Code541900BusinessCode
Total Revenue Column956940TotalRevenueColumn
Related Or Exempt Function Income954209RelatedOrExemptFunctionIncome
Unrelated Business Revenue2731UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue956940TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column582728313TotalRevenueColumn
Related Or Exempt Function Income569524082RelatedOrExemptFunctionIncome
Unrelated Business Revenue2662679UnrelatedBusinessRevenue
Exclusion$9,182,379ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total313397Total
Program Services313397ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1530315Total
Management And General1530315ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total216352683Total
Program Services198227784ProgramServices
Management And General18124899ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total46023454Total
Program Services42138188ProgramServices
Management And General3885266ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total15695925Total
Program Services14295847ProgramServices
Management And General1400078ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1022489Total
Program Services1021989ProgramServices
Management And General500ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total923902Total
Program Services14805ProgramServices
Management And General909097ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total350752Total
Program Services25000ProgramServices
Management And General325752ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total115418Total
Management And General115418ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total23756576Total
Program Services19027568ProgramServices
Management And General4729008ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total536278Total
Program Services1788ProgramServices
Management And General534490ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total21948673Total
Program Services4053847ProgramServices
Management And General17894826ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total7016072Total
Program Services614408ProgramServices
Management And General6401664ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total12316085Total
Program Services10694184ProgramServices
Management And General1621901ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total952312Total
Program Services603852ProgramServices
Management And General348460ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total959641Total
Program Services731304ProgramServices
Management And General228337ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total12873767Total
Program Services12873719ProgramServices
Management And General48ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total41572280Total
Program Services41572280ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total3746861Total
Program Services3746861ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PATIENT SUPPLIES9049632689712121784205
LOSS ON EXTINGUISHMENT3366879733668797
OTHER PURCHASED SERVICE1474848278485706899912
RECRUITING2184233437062140527
SPECIAL EVENTS684157268505415652

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1680106Total
Program Services524831ProgramServices
Management And General1155275ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total551468981Total
Program Services482023351ProgramServices
Management And General69445630ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY23885BOY
EOY23955EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY10442917BOY
EOY335623EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY69787450BOY
EOY71683333EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY6574010BOY
EOY3902837EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY5688249BOY
EOY5943376EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY7003379BOY
EOY6208152EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis790739293LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec339518455LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY454726188BOY
EOY451220838EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY261587017BOY
EOY285573040EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY8371401BOY
EOY6074189EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY28169475BOY
EOY30418884EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY852373971BOY
EOY861384227EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY57284137BOY
EOY51339233EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY307894664BOY
EOY306208933EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3235865BOY
EOY2064133EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY29070699BOY
EOY34383774EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY397485365BOY
EOY393996073EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY452984797BOY
EOY465602946EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1903809BOY
EOY1785208EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY454888606BOY
EOY467388154EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY852373971BOY
EOY861384227EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses31259332ReconcilationRevenueExpenses
Reconcilation Other Changes-18759784ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

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 Balance1903809BeginningOfYearBalance
Investment Earnings Or Losses-118601InvestmentEarningsOrLosses
End Of Year Balance1785208EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance2363674BeginningOfYearBalance
Contributions527436Contributions
Investment Earnings Or Losses246579InvestmentEarningsOrLosses
Other Expenditures1233880OtherExpenditures
End Of Year Balance1903809EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3255208BeginningOfYearBalance
Contributions987591Contributions
Investment Earnings Or Losses57741InvestmentEarningsOrLosses
Other Expenditures1936866OtherExpenditures
End Of Year Balance2363674EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance1.00000BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis23127024OtherCostOrOtherBasis
Book Value23127024BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis16588634InvestmentCostOrOtherBasis
Other Cost Or Other Basis459941721OtherCostOrOtherBasis
Depreciation135410337Depreciation
Book Value341120018BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis272577513OtherCostOrOtherBasis
Depreciation200265653Depreciation
Book Value72311860BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis18504401OtherCostOrOtherBasis
Depreciation3842465Depreciation
Book Value14661936BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings451220838TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
FAIR VALUE INTEREST RATE SWAP AGREEMENT$17,912,224
ACCRUED POST RETIREMENT HEALTHCARE BENEFITS$7,920,595
ACCRUED MALPRACTICE INSURANCE$4,597,467
ESTIMATED LIABILITY TO MEDICARE$3,868,731
DUE TO SALEM HEALTH$49,141
OTHER LONG-TERM LIABILITIES$35,616
FieldValueIRS element (for citing)
Total Of Amounts34383774TotalOfAmounts
Total Revenue582728313TotalRevenue
Total Expenses551468981TotalExpenses
Excess Or Deficit For Year31259332ExcessOrDeficitForYear
Net Unrealized GL On Investments-11566383NetUnrealizedGLOnInvestments
Other-$7,193,401OtherAmount
Total Adjustments-18759784TotalAdjustments
Excess Or Deficit Per FS12499548ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt587896035TotRevenueEtcAuditedFinclStmt
Other Revenues5283140OtherRevenues
Revenue Not Rptd F9905283140RevenueNotRptdF990
Revenue Subtotal582612895RevenueSubtotal
Investment Expenses Not Included115418InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt115418RevenueNotRptdOnFinStmt
Total Revenue Per Form990582728313TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt575396487TotExpensesEtcAuditedFinclStmt
Other Expenses Included24042924OtherExpensesIncluded
Expenses Not Rptd F99024042924ExpensesNotRptdF990
Expenses Subtotal551353563ExpensesSubtotal
Investment Expenses Not Included2115418InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt115418ExpensesNotRptdOnFinStmt
Total Expenses Per Form990551468981TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:ENDOWMENT FUNDS ARE HELD BY SALEM HOSPITAL FOUNDATION FOR SALEM HOSPITAL SUPPORT.
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -3,490,707. CHANGE IN NET BENEFIT COST -666,155. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION -118,601. GAIN ON DISCONTINUED OPERATIONS 388,729. EQUITY TRANSFERS -3,306,667.
PART XII, LINE 2D - OTHER ADJUSTMENTS:REIMBURSEMENTS TREATED AS REVENUE ON FINANCIAL STATEMENT 4,894,411. DISCONTINUED OPERATIONS 388,729.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 3,490,707. CHANGE IN POSTRETIREMENT BENEFIT OBLIGATION 666,155. NET UNREALIZED LOSS ON INVESTMENTS 11,566,383. EQUITY TRANSFERS 3,306,667. REIMBURSEMENTS TREATED AS REVENUE ON FINANCIAL STATEMENT 4,894,411. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 118,601.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served57498PersonsServed
Total Community Benefit Expense37609785TotalCommunityBenefitExpense
Net Community Benefit Expense37609785NetCommunityBenefitExpense
Percent Of Total Expense0.07260PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served69279PersonsServed
Total Community Benefit Expense81279716TotalCommunityBenefitExpense
Direct Offsetting Revenue63682316DirectOffsettingRevenue
Net Community Benefit Expense17597400NetCommunityBenefitExpense
Percent Of Total Expense0.03400PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served126777PersonsServed
Total Community Benefit Expense118889501TotalCommunityBenefitExpense
Direct Offsetting Revenue63682316DirectOffsettingRevenue
Net Community Benefit Expense55207185NetCommunityBenefitExpense
Percent Of Total Expense0.10660PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served577404PersonsServed
Total Community Benefit Expense2880195TotalCommunityBenefitExpense
Direct Offsetting Revenue68919DirectOffsettingRevenue
Net Community Benefit Expense2811276NetCommunityBenefitExpense
Percent Of Total Expense0.00540PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense1129577TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense1129577NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense15451687TotalCommunityBenefitExpense
Direct Offsetting Revenue9127713DirectOffsettingRevenue
Net Community Benefit Expense6323974NetCommunityBenefitExpense
Percent Of Total Expense0.01220PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense2199800TotalCommunityBenefitExpense
Net Community Benefit Expense2199800NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense794442TotalCommunityBenefitExpense
Direct Offsetting Revenue8792DirectOffsettingRevenue
Net Community Benefit Expense785650NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served577404PersonsServed
Total Community Benefit Expense22455701TotalCommunityBenefitExpense
Direct Offsetting Revenue9205424DirectOffsettingRevenue
Net Community Benefit Expense13250277NetCommunityBenefitExpense
Percent Of Total Expense0.02550PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served704181PersonsServed
Total Community Benefit Expense141345202TotalCommunityBenefitExpense
Direct Offsetting Revenue72887740DirectOffsettingRevenue
Net Community Benefit Expense68457462NetCommunityBenefitExpense
Percent Of Total Expense0.13210PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense417478TotalCommunityBuildingExpense
Net Community Building Expense417478NetCommunityBuildingExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense417478TotalCommunityBuildingExpense
Net Community Building Expense417478NetCommunityBuildingExpense
Percent Of Total Expense0.00080PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$15,012,638BadDebtExpenseAmount
Amount Reimbursed By Medicare77012846AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare94969246CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-17956400MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 OREGON COMMUNITY IMAGING LLCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityMEDICAL IMAGING COOPERATIVEDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.50000OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.00000OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.50000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1SALEM HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SALEM HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit Lien On ResidenceXPermitLienOnResidence
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities6NumberOfOtherFacilities

Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
REHAB
2561 CENTER STSALEMOR97301REHABILITATION
WILLAMETTE VALLEY MIDWIVES
1285 LIBERTY STSALEMOR97301MIDWIFERY
COMPREHENSIVE PAIN CENTER
280 LIBERTY STSALEMOR97301PAIN MANAGEMENT
REGIONAL LABORATORY
3300 STATE STSALEMOR97301LABORATORY SERVICES
WHP FAMILY MEDICINE KEIZER
550 DEITZ AVE NEKEIZEROR97303CLINIC
WHP FAMILY MEDICINE RIVER ROAD S
2925 RIVER RD SSALEMOR97302CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: IT IS THE POLICY OF SALEM HOSPITAL TO PROVIDE FINANCIAL COUNSELING TO PATIENTS REGARDING THEIR FINANCIAL OBLIGATION AT THE EARLIEST OPPORTUNITY POSSIBLE. SALEM HOSPITAL PROVIDES A VARIETY OF OPTIONS TO ASSIST PATIENTS IN RESOLVING THEIR ACCOUNTS, INCLUDING: OREGON HEALTH PLAN (OHP) SCREENING, CHARITY ASSISTANCE, MEDICAL FINANCING CARDS, LOANS, AND EXTENDED PAYMENT PLANS. DISCOUNTS MAY BE AVAILABLE ON THE NET BALANCE FOR PATIENTS AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL. PATIENTS AT OR BELOW 200% OF THE POVERTY LEVEL ARE ELIGIBLE FOR 100% CHARITY ASSISTANCE.THE HOSPITAL CONSIDERS BOTH INCOME AND/OR ASSETS AVAILABLE TO PAY PATIENT'S MEDICAL EXPENSES1.THE HOSPITAL WILL MULTIPLY THE FAMILY INCOME BY 30%2.THE HOSPITAL WILL DETERMINE THE PATIENT'S ALLOWABLE MEDICAL EXPENSES3.THE HOSPITAL WILL COMPARE 30% OF THE FAMILY INCOME TO THE TOTAL OF THE PATIENT'S ALLOWABLE MEDICAL EXPENSES. IF THE TOTAL OF THE ALLOWABLE MEDICAL EXPENSES IS GREATER THAN 30% OF THE FAMILY INCOME, THEN THE PATIENT MEETS THE CATASTROPHIC CHARITY CARE QUALIFICATION. THE HOSPITAL WILL LIMIT PATIENT LIABILITY FOR MEDICAL EXPENSES TO 30% OF THE FAMILY'S INCOME. AMOUNTS THAT EXCEED THIS LIMIT WILL BE ELIGIBLE FOR CHARITY CARE.FOR EXAMPLE: FAMILY INCOME OF $70,000 PER YEAR AND MEDICAL EXPENSES OF $45,000. THIRTY-PERCENT OF THE FAMILY'S ANNUAL INCOME IS $21,000; THE FAMILY'S MEDICAL EXPENSES OF $45,000 EXCEED THIS AMOUNT. THE FAMILY SHOULD THEREFORE BE ELIGIBLE FOR A CHARITY WRITE-OFF OF $24,000.ORASSET TESTASSETS CONSIDERED AVAILABLE TO PAY PATIENT'S MEDICAL EXPENSES1. EQUITY IN A REAL ESTATE, OTHER THAN THE PATIENT'S PERSONAL RESIDENCE, SECURITIES OR OTHER ASSETS (E.G.. RENTAL PROPERTY, AGRICULTURAL USE) IS CONSIDERED AVAILABLE TO PAY THE PATIENT'S MEDICAL EXPENSES.2. $201,000 REPRESENTS THE MEDIAN VALUE OF A HOME IN SALEM, OREGON AS OF AUGUST 2010. THE HOSPITAL CONSIDERS THIS AMOUNT TO BE PROTECTED FROM CONSIDERATION AS A FUNDING SOURCE. EQUITY IN A PATIENT'S PERSONAL RESIDENCE OVER AND ABOVE $201,000 WILL BE CONSIDERED AS AVAILABLE TO PAY MEDICAL LIABILITIES.3. THE CATASTROPHIC LIMIT UNDER THIS TEST WILL BE ESTABLISHED AT 100% OF THE EQUITY IN REAL PROPERTY OVER AND ABOVE THE FIRST $201,000 IN A PRIMARY RESIDENCE, AND 100% OF THE EQUITY IN OTHER REAL PROPERTY PRODUCING INCOME.FOR EXAMPLE: $280,000 (MARKET VALUE) - $100,000 (MORTGAGE) = $180,000 (NET VALUE); THEREFORE, $201,000 (PROTECTED SO EQUITY WOULD NOT BE CONSIDERED)
PART I, LINE 7: NET COMMUNITY BENEFIT EXPENSE IS CALCULATED BY TOTAL COSTS OF CARE PROVIDED LESS THE DIRECT, OFFSETTING NET REVENUES FOR THOSE SERVICES. THE COSTS TO PROVIDE CHARITY CARE AND MEDICAID SERVICES DISCLOSED IN LINE 7, COLUMN (C) LINES (A) AND (B), RESPECTIVELY, ARE DETERMINED BY APPLYING THE COST TO CHARGE RATIO AS DETERMINED IN WORKSHEET 2 TO THE FULL BILLED CHARGES FOR THE SERVICES RENDERED. NET COMMUNITY BENEFIT EXPENSE FOR THE COSTS FOR SUBSIDIZED HEALTH SERVICES DISCLOSED IN PART I, LINE 7(G) USES AN INTERNAL COSTING SYSTEM WHEREBY DIRECT AND INDIRECT EXPENSES ARE ALLOCATED TO DISCRETE OFFSETTING NET REVENUES FOR EACH SERVICE. OVERHEAD COSTS ARE ALLOCATED TO REVENUE GENERATING SERVICES BASED ON UTILIZATION STATISTICS SUCH AS SQUARE FOOTAGE FOR MAINTENANCE COSTS.
PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSE THAT WAS INCLUDED IN FORM 990, PART IX, LINE 25, COLUMN (A), BUT REMOVED FROM THIS FIGURE FOR THE PURPOSES OF CALCULATING THE PERCENTAGE IN SCHEDULE H, PART I, LINE 7, COLUMN (F) WAS $33,668,797.
PART II: IN 2011, SALEM HOSPITAL PROVIDED EXECUTIVE LEADERSHIP TO THE BOARD OF WALTON HOUSE, A RESPITE HOUSING PROVIDER. THE HEALTH EDUCATION DIVISION HOSTED AN ANNUAL UPDATE OF COMMUNITY BENEFIT ACTIVITIES FOR COMMUNITY PARTNERING AGENCIES. MARION AND POLK COUNTY MUA/HPSA DESIGNATION, HEALTH ASSESSMENT DATA SETS AND MARION POLK RESIDENT (2008) SURVEY RESULTS DEMONSTRATE HEALTHCARE ACCESS PROBLEMS, SPECIFICALLY LACK OF PHYSICIANS WILLING TO TAKE MEDICARE AND OREGON HEALTH INSURANCE (MEDICAID). LIKEWISE, ACCESS TO HEALTHCARE WAS ALSO ONE OF THE TOP THREE COMMUNITY HEALTH CONCERNS CITED BY PROVIDERS SURVEY RESPONDENTS. WHILE REGION 3, WHICH INCLUDES MARION, BENTON, LANE, LINN AND POLK COUNTIES, HAS 94 (OR 111) PRIMARY CARE PROVIDERS PER 100,000 POPULATION, ONLY 86 (OR 98) OF THOSE ACCEPT MEDICARE, AND OF THOSE 86, ONLY A PORTION ARE ACTUALLY ACCEPTING NEW PATIENTS. A SIMILAR SITUATION EXISTS FOR OREGON HEALTH PLAN; EVEN WHEN PEOPLE HAVE COVERAGE, THEY MAY NOT HAVE ACCESS TO ESTABLISHING CARE WITH A LOCAL MEDICAL PROVIDER. TO EASE THE BURDEN OF ACCESS TO CARE AND TO ENSURE A WELL TRAINED HEALTH PROFESSIONAL WORKFORCE, SALEM HOSPITAL CONTINUES TO MAKE A SIGNIFICANT INVESTMENT IN PHYSICIAN RECRUITMENT AND MEDICAL WORK FORCE DEVELOPMENT.
PART III, LINE 4: BAD DEBT EXPENSE IS RECORDED ON THE BASIS FOR FULL BILLED CHARGES THAT THE HOSPITAL WAS UNABLE TO COLLECT AFTER SUCH PAYOR ALLOWANCES, CHARITY REDUCTIONS AND SELF-PAY DISCOUNTS. COST OF BAD DEBT EXPENSE DISCLOSED IN LINES 2 AND 3 ARE CALCULATED BY APPLYING THE RATIO OF COSTS TO CHARGES AS DETERMINED IN WORKSHEET 2 TO THE FULL BILLED CHARGES WRITTEN OFF AS BAD DEBT EXPENSE AS REPORTED IN THE AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8: MEDICARE PAYORS PAY A SIGNIFICANTLY REDUCED AMOUNT FOR MEDICAL SERVICES RENDERED TO THEIR ENROLLEES SUCH THAT THE NET REIMBURSEMENT DOES NOT EVEN COVER THE EXPENSES INCURRED TO PROVIDE THE SERVICE. SALEM HOSPITAL CONSIDERS THE DIFFERENCE BETWEEN THE COSTS TO PROVIDE CARE FOR MEDICARE ENROLLEES AND THE NET REIMBURSEMENT AS A BENEFIT TO THE COMMUNITY. MEDICARE FEE-FOR-SERVICE COSTS ARE DETERMINED FROM SALEM HOSPITALS FILED MEDICARE COST REPORT. THE CALCULATION OF NET BENEFIT IS EQUAL TO TOTAL MEDICARE PAYMENTS LESS MEDICARE COSTS. IN ADDITION TO TRADITIONAL MEDICARE FEE-FOR-SERVICE, SALEM HOSPITAL PROVIDES SUBSTANTIAL SERVICES TO OTHER MEDICARE POPULATIONS PARTICIPATING IN MEDICARE ADVANTAGE PLANS AT SIGNIFICANTLY REDUCED REIMBURSEMENT. THE NET REVENUES FOR THESE PLANS ARE LESS THAN THE COST TO PROVIDE CARE AND ARE NOT DISCLOSED IN PART III, LINE 8. SALEM HOSPITAL ALSO CONSIDERS THE DIFFERENCE BETWEEN THE NET COST TO PROVIDE CARE FOR MEDICARE ADVANTAGE ENROLLEES AND THE NET REIMBURSEMENT AS A BENEFIT TO THE COMMUNITY. THESE NET COSTS HAVE BEEN DETERMINED BY APPLYING THE RATIO OF COSTS TO CHARGES AS DETERMINED IN WORKSHEET 2 TO THE FULL BILLED CHARGES. THE CALCULATION OF NET BENEFIT IS EQUAL TO TOTAL MEDICARE ADVANTAGE PAYMENTS OF $102,501,914 LESS MEDICARE ADVANTAGE COSTS OF $131,017,322 FOR A TOTAL ADDITIONAL COMMUNITY BENEFIT IN THE AMOUNT OF $28,515,408.
PART III, LINE 9B: IF THERE IS AN INDICATION THAT A PATIENT MAY BE UNABLE TO PAY THEIR BILL, A FINANCIAL QUESTIONNAIRE IS GIVEN OR SENT TO THE PATIENT. UPON RECEIPT OF THE COMPLETED QUESTIONNAIRE, THE PATIENT FINANCIAL COUNSELOR WILL DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE AND NOTIFY THE PATIENT REGARDING THEIR ELIGIBILITY FOR DISCOUNTS UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. ELIGIBILITY IS DETERMINED BASED ON THE QUESTIONNAIRE AND SUPPORTING DOCUMENTATION IN ACCORDANCE TO THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.
PART V, SECTION B, LINE 19D: IT IS THE POLICY OF SALEM HOSPITAL TO PROVIDE EMERGENCY OR OTHER MEDICALLY NECESSARY CARE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL WILL USE THE NORMAL BILLING RATES FOR SERVICES PROVIDED AT THE HOSPITAL FACILITY.SALEM HOSPITAL
PART V, SECTION B, LINE 21: IT IS THE POLICY OF SALEM HOSPITAL TO BILL ALL PATIENTS THE NORMAL BILLING RATE REGARDLESS OF THEIR ABILITY TO PAY.SALEM HOSPITAL
PART VI, LINE 2: A COMPREHENSIVE COMMUNITY NEEDS AND ASSET ANALYSIS IS COMPLETED EVERY THREE TO FIVE YEARS USING PRIMARY AND SECONDARY DATA SETS. THE 2008-2009 MARION AND POLK COUNTY HEALTH ASSESSMENTS, SALEM HOSPITAL SERVICE LINE PLANNING DOCUMENTS, DISEASE SPECIFIC AND EMERGENCY DEPARTMENT DATA SETS, AS WELL AS QUALITATIVE INFORMATION GATHERED FROM COMMUNITY FOCUS GROUPS WERE AMONG DATA REVIEWED IN PLANNING 2009-2011 COMMUNITY BENEFIT ACTIVITIES. SALEM HOSPITAL USES THESE DATA SETS TO DETERMINE POPULATION HEALTH NEEDS; ANALYZE HEALTHCARE DELIVERY SYSTEMS IN RELATION TO SERVICE DEMAND, AND INTEGRATES THESE ANALYSES, TO IDENTIFY GAPS AND SET PLANNING PRIORITIES. THE HOSPITAL IS CURRENTLY WORKING WITH THE COUNTIES TO UNDERTAKE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THIS NEW ASSESSMENT WILL TAKE INTO CONSIDERATION THE NEW CHNA AND RELATED RULES IMPLEMENTED UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. THE COMMUNITY BENEFIT PROGRAM SUPPORTS THE SALEM HOSPITAL MISSION, VISION, VALUES AND CORE COMMITMENTS THROUGH: - ENHANCING CLINICAL OUTCOMES FOR OUR UNDERSERVED POPULATIONS AND CREATING ACCESS TO CARE THAT PREVIOUSLY WAS NOT EASILY ATTAINABLE - INVESTING DOLLARS BACK INTO THE COMMUNITY AS A DEMONSTRATION OF OUR COMMITMENT TO THE COMMUNITY WE SERVE. - SUPPORTING COMMUNITY OUTREACH AND COMMUNITY EDUCATION RELATED TO SPECIFIC CLINICAL SERVICE LINES AND INTEGRATING ACTIVITIES PRIMARILY RELATED TO EARLY PREVENTION, DETECTION AND SCREENING AND MANAGEMENT OF CHRONIC DISEASE.- SUPPORTING COMMUNITY-BUILDING ACTIVITIES AND WORKFORCE DEVELOPMENT THAT ADDRESSES THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS, AND ACCESS TO CARE. THESE ACTIVITIES SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF THE HEALTH CARE ORGANIZATION.THE PLAN ALIGNS WITH A LONG TERM STRATEGY, TO ENSURE THAT SALEM HOSPITAL'S REACH, REPUTATION, AND CORPORATE CITIZENSHIP ARE LEVERAGED TO OPTIMIZE COMMUNITY BENEFIT. THE PLAN CONSISTS OF COMMUNITY-BASED ACTIVITIES WHOSE KEY FUNCTION IS SERVICE TO THOSE IN NEED, INCREASING ACCESS TO CARE AND HEALTH PROMOTION, PREVENTION, AND MANAGEMENT OF CHRONIC DISEASE.THE SALEM HOSPITAL 2009-2011 COMMUNITY BENEFIT PLAN IDENTIFIES THE FOLLOWING COMMUNITY BENEFIT PRIORITIES BASED ON THE 2008/2009 COMMUNITY NEEDS ASSESSMENT. - ADDRESS SOCIOECONOMIC INEQUALITIES IN HEALTH CARE DELIVERY - IMPROVE ACCESS TO CARE THROUGH PHYSICIAN RECRUITMENT AND FINANCIAL AND IN-KIND SUPPORT FOR PRIMARY AND PRENATAL CARE SERVICES.- PROMOTE HEALTH IMPROVEMENT AND PREVENTION OF INJURY AND CHRONIC DISEASE- PROVIDE EARLY DETECTION AND SCREENING AND ENABLE SELF-MANAGEMENT OF CHRONIC DISEASE - SUPPORT COMMUNITY AND PROFESSIONAL HEALTH EDUCATION AND CLINICAL AND COMMUNITY HEALTH RESEARCH- BUILD RELATIONSHIPS WITHIN OUR GREATER SERVICE AREA TO ENSURE THAT SALEM HOSPITAL IS IDENTIFIED AS THE COMMUNITY RESOURCE FOR HEALTH SERVICES BY ALL. HOSPITAL SENIOR LEADERSHIP, IN CONJUNCTION WITH THE BOARD OF TRUSTEES, REVIEWS AND APPROVES THE COMMUNITY BENEFIT PLAN AND BUDGET.
PART VI, LINE 3: IT IS THE POLICY OF SALEM HOSPITAL TO PROVIDE FINANCIAL COUNSELING TO PATIENTS REGARDING THEIR FINANCIAL OBLIGATION AT THE EARLIEST OPPORTUNITY POSSIBLE. SALEM HOSPITAL PROVIDES A VARIETY OF OPTIONS TO ASSIST PATIENTS IN RESOLVING THEIR ACCOUNTS, INCLUDING: OREGON HEALTH PLAN (OHP) SCREENING, CHARITY ASSISTANCE, LOANS, AND EXTENDED PAYMENT PLANS. DISCOUNTS MAY BE AVAILABLE ON THE NET BALANCE FOR PATIENTS AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL. PATIENTS AT OR BELOW 200% OF THE POVERTY LEVEL ARE ELIGIBLE FOR 100% CHARITY ASSISTANCE.ALL UNINSURED PATIENTS WITH BALANCES OVER $500 ARE SCREENED FOR ELIGIBILITY THROUGH THE OREGON HEALTH PLAN (OHP), CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA) ELIGIBILITY, AND/OR ELIGIBILITY INTO THE FAMILY HEALTH INSURANCE ASSISTANCE PLAN (FHIAP) PROGRAM.SALEM 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 EITHER CHARITY CARE OR A FINANCIAL DISCOUNT.INFORMATION ON THE HOSPITAL'S CHARITY CARE & FINANCIAL POLICY SHALL BE MADE PUBLICLY AVAILABLE IN THE FOLLOWING MANNER:- NOTICES ARE POSTED IN KEY AREAS OF THE HOSPITAL, INCLUDING ADMITTING, THE EMERGENCY DEPARTMENT, OUTPATIENT DEPARTMENT REGISTRATION AREAS, AND THE BUSINESS OFFICE. - THE CONDITIONS OF ADMISSION FORM INFORMS THE PATIENT OF THEIR RIGHT TO APPLY FOR CHARITY CARE. - WRITTEN INFORMATION SHALL BE AVAILABLE IN ENGLISH AND SPANISH. THE HOSPITAL WILL PROVIDE THE APPROPRIATE INTERPRETATION SERVICES FOR ALL PATIENTS WHO DO NOT SPEAK ENGLISH. - FRONT-LINE STAFF IS TRAINED TO ANSWER CHARITY CARE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY QUESTIONS THAT CANNOT BE ANSWERED TO BUSINESS OFFICE STAFF IN A TIMELY MANNER. - THIS POLICY IS POSTED ON SALEM HOSPITAL'S WEB SITE. WRITTEN INFORMATION ABOUT THIS POLICY IS MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION. - THE FIRST PATIENT STATEMENT WILL INCLUDE A NOTICE THAT CHARITY CARE AND/OR FINANCIAL ASSISTANCE IS AVAILABLE.
PART VI, LINE 4: SALEM HOSPITAL SERVES THE COMMUNITIES WITHIN MARION AND POLK COUNTIES IN THE UPPER WILLAMETTE VALLEY IN THE STATE OF OREGON. THE CITIES INCLUDE SALEM (THE CAPITAL OF OREGON), KEIZER, SILVERTON, STAYTON, DALLAS, WOODBURN, MILL CITY, AUMSVILLE, INDEPENDENCE, GRANDE RONDE, MONMOUTH, SUBLIMITY, MT. ANGEL AND JEFFERSON. THE FOLLOWING ARE SOME OF THE KEY DEMOGRAPHICS IN 2008-2009 MARION AND POLK COUNTIES:GENERAL DEMOGRAPHICS:- POPULATION: 362,990 - POLK COUNTY IS THE 3RD FASTEST GROWING COUNTY IN OREGON. - 63% OF THIS GROWTH IS RELATED TO BIRTHS EXCEEDING DEATHS - 37% OF THE GROWTH IS RELATED TO MIGRATION TO MARION/POLK COUNTIES. - TOTAL BIRTHS PER YEAR: APPROXIMATELY 9,000 - MEDIAN HOUSEHOLD INCOME IS $40,314, SLIGHTLY LOWER THAN THE STATE AVERAGE OF $40,916. - HOME OWNERSHIP RATE IS 62.9% COMPARED TO THE STATE AVERAGE OF 64.3% - LAND AREA FOR MARION AND POLK COUNTIES COMBINED IS 1,925 SQUARE MILES. HEALTHCARE DEMOGRAPHICS:- 15% OF THE POPULATION HAS HEALTHCARE COVERAGE PROVIDED BY MEDICARE - 13% OF THE POPULATION HAVE HEALTHCARE COVERAGE PROVIDED BY MEDICAID - 15% OF THE POPULATION HAS NO HEALTHCARE COVERAGE AT ALL! HEALTHCARE ACCESS (MEDICAL, DENTAL AND BEHAVIOR HEALTH) IS A SIGNIFICANT CHALLENGE IN MARION AND POLK COUNTY. COST OF CARE, LACK OF INSURANCE AND LIMITED PROVIDERS ACCEPTING MEDICAID AND MEDICARE WERE IDENTIFIED IN THE NEEDS ASSESSMENT. DATA ANALYSIS IDENTIFIED CHILDHOOD OBESITY, HIGH TEEN PREGNANCY RATES, EARLY TEEN TOBACCO AND ALCOHOL USE, AND THE NEED TO PROVIDE SERVICES THAT SUPPORT FATHERS TO DEVELOP AND STRENGTHEN PARENTING SKILLS, AS OPPORTUNITIES FOR COMMUNITY-BASED INITIATIVES AND ON-GOING PARTNERSHIPS.
PART VI, LINE 6: SALEM HOSPITAL IS GOVERNED BY AN ALL-VOLUNTEER COMMUNITY-BASED BOARD OF TRUSTEES (BOARD). HOSPITAL LEADERSHIP AND EXECUTIVE STAFF SERVE ON COMMUNITY NON-PROFIT ADVISORY BOARDS AND PROFESSIONAL ASSOCIATIONS. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN ITS COMMUNITY AND PROVIDES FREE OFFICE SPACE AND OTHER IN-KIND SUPPORT SERVICES TO NON-PROFIT ORGANIZATIONS. SALEM HOSPITAL PROVIDES FINANCIAL SUPPORT AND SPONSORSHIP TO NONPROFIT ORGANIZATIONS. BY LEVERAGING HOSPITAL RESOURCES AND WORKING IN COLLABORATIVE PARTNERSHIPS, SALEM HOSPITAL IS ABLE TO PROVIDE BENEFITS THAT REACH BEYOND HEALTHCARE DELIVERY AND POSITIVELY IMPACT THE SOCIAL DETERMINANTS OF HEALTH.
PART VI, LINE 7: SALEM HOSPITAL IS AN OREGON NONPROFIT CORPORATION AND A TAX-EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE. SALEM HEALTH IS THE "PARENT" CORPORATION AND SOLE CORPORATE MEMBER OF THE CORPORATION, SALEM HOSPITAL FOUNDATION, WEST VALLEY HOSPITAL, WEST VALLEY HOSPITAL FOUNDATION, WILLAMETTE VALLEY INSURANCE CORPORATION, AND WILLAMETTE VALLEY PROFESSIONAL SERVICES. ALL ENTITIES WITHIN THE PARENT CORPORATION ARE SEPARATE NONPROFIT CORPORATIONS.SALEM HOSPITAL IS AN OREGON NONPROFIT CORPORATION AND A TAX-EXEMPT ORGANIZATION. THE CORPORATION ALSO DOES BUSINESS UNDER THE NAME "SALEM HOSPITAL, A PART OF SALEM HEALTH." SALEM HOSPITAL IS ONE OF THE LARGEST ACUTE CARE HOSPITALS IN OREGON. LICENSED FOR 454 BEDS, SALEM HOSPITAL OFFERS A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES AN AREA OF OVER 500,000 PEOPLE, INCLUDING ALL OF MARION AND POLK AND PORTIONS OF LINN AND YAMHILL COUNTIES INCLUDING THE RESIDENTS OF THE CITY OF SALEM, THE STATE CAPITAL OF OREGON.SALEM HOSPITAL IS THE LARGEST PRIVATE EMPLOYER IN SALEM, OREGON, WITH APPROXIMATELY 3,300 FULL AND PART-TIME EMPLOYEES (AS OF JUNE 30, 2008). THE MEDICAL STAFF IS COMPRISED OF APPROXIMATELY 500 PHYSICIANS REPRESENTING MORE THAN 50 SPECIALTIES AND SUBSPECIALTIES, AND MORE THAN 400 VOLUNTEERS PROVIDE NON-MEDICAL SUPPORT FOR SALEM HOSPITAL.SALEM HOSPITAL, AS PART OF SALEM HEALTH IS GOVERNED BY AN ALL-VOLUNTEER COMMUNITY-BASED BOARD OF TRUSTEES (BOARD). THE BOARD HAS THE RESPONSIBILITY FOR THE DEVELOPMENT AND OVERSIGHT OF SALEM HEALTH VALUES, VISION, PURPOSE AND LONG-TERM STRATEGY. THROUGH THESE DOCUMENTS, THE COMMUNITY BENEFIT STEERING COMMITTEE ASSESSES AND REAFFIRMS SALEM HOSPITAL'S COMMUNITY BENEFIT COMMITMENTS AND CONNECTIONS WITH COMMUNITY NEEDS AND PRIMARY CONSTITUENCIES. THE COMMUNITY BENEFIT PLAN ASSURES MEASUREMENT AND COMPARISON OF SALEM HOSPITAL'S COMMUNITY ACTIVITIES TO EVOLVING NORMS AND OVERSEES THE CLEAR AND ACCURATE COMMUNICATION OF THESE ACTIVITIES TO KEY CONSTITUENCIES.
ORREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (12 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistancePurpose Of GrantPurposeOfGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistance
MEDICAL FOUNDATION OF MARION & POLK COUNTIES
2995 RYAN DRIVE STE 100SALEMOR97301930504197501(C)(3)12500N/AN/AIMPROVE ACCESS TO HEALTHCARE
SALEM FREE MEDICAL CLINIC
3850 PORTLAND ROAD NESALEMOR97301203549992501(C)(3)44000N/AN/AACCESS TO CARE
MARION COUNTY TREASURER
3180 CENTER STREET NESALEMOR97301936002307MARION COUNTY78654N/AN/AACCESS TO PRENATAL CARE
AMERICAN CANCER SOCIETY
2120 1ST AV NSEATTLEWA98121841316555501(C)(3)7500N/AN/ARELAY FOR LIFE SPONSORSHIP
KEIZER CHAMBER OF COMMERCE
980 CHEMAWA RD NEKEIZEROR97303936030759501(C)(6)5000N/AN/AKEIZER IRIS FESTIVAL RUN SPONSORSHIP
SALEM KEIZER EDUCATION FOUNDATION
233 COMMERCIAL ST NESALEMOR97301930831467501(C)(3)5000N/AN/AAWESOME 3000 SPONSORSHIPS
CHEMEKETA COMMUNITY COLLEGE CAMP PROGRAM
4000 LANCASTER DR NESALEMOR973097070930585134170(C)(1)5000N/AN/ASCHOLARSHIP FUNDRAISER SPONSORSHIP
WILLAMETTE FAMILY MEDICAL CENTER
755 MEDICAL CENTER DRSALEMOR97301931180397501(C)(3)FAIR MARKET VALUEFREE RENTACCESS TO MEDICAL SERVICES278866
PSYCHIATRIC CRISIS CENTER
PO BOX 14500SALEMOR97309936002307MARION COUNTYFAIR MARKET VALUEFREE RENTACCESS TO MEDICAL SERVICES97524
MEDASSIST AND PROJECT ACCESS
2995 RYAN DRIVE STE 100SALEMOR97301931261633501(C)(3)FAIR MARKET VALUEFREE RENTACCESS TO MEDICAL SERVICES20880
OHSU FOUNDATION DEPT SURGERY
1121 SW SALMON STPORTLANDOR97205237083114501(C)(3)10000N/AN/ACHARITABLE CONTRIBUTION GOLF TOURNAMENT SPONSORSHIP
TRINITY LUTHERAN CHURCH
450 SE WASHINGTONDALLASOR97338930712329501(C)(3)5000N/AN/ADALLAS FREE CLINIC
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants12TotalNbrOf501C3AndGovtGrants

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: GRANTS ARE ONLY MADE TO QUALIFIED EXEMPT ORGANIZATIONS. NO MONITORING IS REQUIRED.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 Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
NORMAN GRUBER
71993108916601456801592503791208775020576670
AARON CRANE
3974120199990108560441350327360505138000
WILLIAM HOLLOWAY MD
470954023475026380466610332170576945000
JACK CAYNON
301590015011026000371550307140387070000
BEVERLY BOW
250185013250054440337500190850321714000
CHERYL NESTER-WOLFE
382213019999036030403560258790472050000
KENNETH KUDLA
2905010145780142780340830248980378338000
MARTIN MORRIS
226518010929040570303380248700296712000
NICOLE VANDERHEYDEN MD
458036000319560411730317260562891000
AHMED EBEID MD
480218035000015330375710340320588354000
TRACY TAGGERT MD
34867906750010640331930242560413942000
NANCY BOUTIN
35987100025460171910255080405116000
AMR HEGAZI
45973305550006650195500325760568024000
VIRGINIA POSEY
162743014449019187000175430213922000
PATRICIA HARGER
2064500203330142600110480278540279945000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BSOME 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: NORMAN GRUBER 34,199 (INCLUDED IN CURRENT YEAR TAXABLE INCENTIVE COMPENSATION) AARON CRANE 28,210 (INCLUDED IN DEFERRED COMPENSATION) WILLIAM HOLLOWAY 33,186 (INCLUDED IN DEFERRED COMPENSATION) CHERYL NESTER WOLFE 26,881 (INCLUDED IN DEFERRED COMPENSATION) KENNETH KUDLA 20,608 (INCLUDED IN DEFERRED COMPENSATION) JACK CAYNON 21,230 (INCLUDED IN DEFERRED COMPENSATION) BEVERLY BOW 17,887 (INCLUDED IN DEFERRED COMPENSATION) MARTIN MORRIS 14,850 (INCLUDED IN DEFERRED COMPENSATION) PATRICIA HARGER 5,780 (INCLUDED IN DEFERRED COMPENSATION) AHMED EBEID 29,078 (INCLUDED IN DEFERRED COMPENSATION) AMR HEGAZI 18,577 (INCLUDED IN DEFERRED COMPENSATION) NICOLE VANDERHEYDEN 27,698 (INCLUDED IN DEFERRED COMPENSATION) NANCY BOUTIN 14,498 (INCLUDED IN DEFERRED COMPENSATION) TRACY TAGGART 19,718 (INCLUDED IN DEFERRED COMPENSATION)
PART I, LINE 6CERTAIN PHYSICIANS RECEIVE INCENTIVE COMPENSATION IN ACCORDANCE WITH THEIR EMPLOYMENT AGREEMENTS WITH SALEM HOSPITAL. AMOUNTS NOTED ON SCHEDULE J PART II COLUMN (II) REFLECT PAYMENTS EARNED BY THESE PHYSICIAN EMPLOYEES IN SUCH AGREEMENTS.
PART I, LINE 7THE 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.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS
521542796794458CL12006-11-15123122698QUALIFIED HOSPITAL BOND000
THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS
521542796794458CZ02008-11-13125000000QUALIFIED HOSPITAL BOND000
THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS
521542796794458CX52008-10-0860487711QUALIFIED HOSPITAL BOND000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCredit EnhancementCreditEnhancementOther Spent ProceedsOtherSpentProceedsAmount In Reserve FundAmountInReserveFund
1460000128355347110500012725034720090011
1250217646330049260268200910011153592113975
60529178837899616085920091011475250006005354

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersTotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
001110.044000.044001
001110.002000.002001
001110.018000.018001

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line2NameOfGICProvider/BusinessNameLine2Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminated
WELLS FARGO BANK
0001NA2.000000000000101
UBS AG
01100125.80000000000000
(no name)
000000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE 990. IT IS THEN FORWARDED TO THE ENTIRE BOARD OF TRUSTEES.
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 A 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 12C
EXECUTIVE COMPENSATION AT SALEM HOSPITAL IS DESIGNED TO ALLOW THE ORGANIZATION TO RECRUIT AND RETAIN QUALIFIED SENIOR LEADERS. THE GOVERNANCE COMMITTEE OF THE SALEM HOSPITAL BOARD OF TRUSTEES, NONE OF WHOM IS A SALEM HOSPITAL EMPLOYEE, ENGAGES ONE OR MORE INDEPENDENT CONSULTANTS TO PROVIDE MARKET DATA ON EXECUTIVE COMPENSATION, INCLUDING BENEFITS, FOR THE CEO AND OTHER EXECUTIVES IN SIMILAR ROLES AT COMPARABLE ORGANIZATIONS. THIS INFORMATION IS USED BY THE GOVERNANCE COMMITTEE IN ITS DISCUSSIONS AND DECISIONS ON CEO COMPENSATION. THE CEO, IN CONJUNCTION WITH OTHER SALARY SURVEY OR PUBLIC INFORMATION AND THE INDEPENDENT CONSULTANT, ENSURES THAT EACH EXECUTIVE'S COMPENSATION IS COMPETITIVE IN THE MARKET FOR SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS.FORM 990, PART VI, SECTION B, LINE 15
THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE ON THE HOSPITAL WEBSITE.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -11,566,383. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -3,490,707. CHANGE IN NET BENEFIT COST -666,155. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION -118,601. GAIN ON DISCONTINUED OPERATIONS 388,729. EQUITY TRANSFERS -3,306,667. TOTAL TO FORM 990, PART XI, LINE 5: -18,759,784.FORM 990, PART XI, LINE 5:
NO CHANGE FROM PRIOR YEAR.FORM 990, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1MWVP INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1570 LIBERTY ST SE STE 200AddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
EIN123456789EIN
Primary ActivitiesHOLDS LANDPrimaryActivities
Legal Domicile StateORLegalDomicileState
Total Income0TotalIncome
EOY Assets5128708EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1SALEM HEALTHBusinessNameLine1

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 FOUNDATION
890 OAK STREET SESALEMOR97301237002687SUPPORTS SALEM HOSPITALOR501(C)(3)7SALEM 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 STREETHONOLULUHI96813201836190CAPTIVE INSURANCEHI501(C)(3)11 TYPE 1SALEM HEALTH0
WILLAMETTE VALLEY PROFESSIONAL SERVICES
890 OAK STREET SESALEMOR97301753175249BILLING SERVICE FOR PROFESSIONAL FEESOR501(C)(3)3SALEM HEALTH0

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
OREGON COMMUNITY IMAGING LLC
2925 RYAN DR SESALEMOR97301202683062MEDICAL IMAGING COOPERATIVEORSALEM HOSPITALRELATED-3142019263010.50000
SALEM CARDIO DIAGNOSTICS
665 WINTER STREET SESALEMOR97301930579722CARDIO DIAGNOSTICSORSALEM HOSPITALRELATED011.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
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 Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
SALEM HOSPITAL FOUNDATION
C1281110
WILLAMETTE VALLEY PROFESSIONAL SERVICES
O1198993
WEST VALLEY HOSPITAL
D3902837
WEST VALLEY HOSPITAL
P1687821
SALEM HOSPITAL FOUNDATION
P450486
WILLAMETTE VALLEY PROFESSIONAL SERVICES
Q3306667
WILLAMETTE VALLEY INSURANCE COMPANY
P292826
WILLAMETTE VALLEY INSURANCE COMPANY
Q2000000