2012-08-14T18:05:34-05:00 2011-09-30 AKT LLP 680 HAWTHORNE AVE SE 140 SALEM OR 97301 990 2010-10-01 930579722 SALEM HOSPITAL SALE 5035615535 890 OAK STREET SE SALEM OR 97301 AARON R CRANE 5035615150 2012-08-13 1 JOYLYN M ANKENEY CPA 5035857774 2010 2016-02-24 21:20:13Z AARON R CRANE 890 OAK STREET SE SALEM OR 97301 584158111 0 X WWW.SALEMHOSPITAL.ORG X 1970 OR TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE 12 10 4304 325 2662679 0 1312170 1359173 533056532 571229821 4936879 8871160 3092356 1268159 542397937 582728313 242960 313397 0 0 260454764 279602377 0 0 0 257903734 271553207 518601458 551468981 23796479 31259332 852373971 861384227 397485365 393996073 454888606 467388154 TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES WE SERVE 0 0 112459182 317121582 SALEM 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. 347108468 243197076 SALEM 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. 22455701 9205424 SALEM 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. 482023351 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 369 0 1 4304 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X X SALEM HOSPITAL 5035613500 890 OAK STREET SE SALEM OR 97301 KATHERINE KEENE 10.00 X 0 0 0 GEORGE HAPP 10.00 X 0 0 0 BRUCE CARTER MD 10.00 X 0 0 0 KENNETH SHERMAN JR 15.00 X X 0 0 0 DAVID ELMGREN MD 10.00 X 0 0 0 CHUCK HUDKINS 10.00 X 0 0 0 BONNIE DRIGGERS RN 10.00 X 0 0 0 THERESA TAAFFE 10.00 X 0 0 0 ALAN WYNN 10.00 X X 0 0 0 ALAN COSTIC 15.00 X X 0 0 0 LANE SHETTERLY 10.00 X 0 0 0 ROBERT WELLS 10.00 X 0 0 0 NORMAN GRUBER 40.00 X 823665 0 53837 AARON CRANE 40.00 X 428267 0 76871 WILLIAM HOLLOWAY MD 40.00 X 497067 0 79878 JACK CAYNON 40.00 X 319201 0 67869 BEVERLY BOW 40.00 X 268879 0 52835 CHERYL NESTER-WOLFE 40.00 X 405815 0 66235 KENNETH KUDLA 40.00 X 319357 0 58981 ANNE MARIE DIAMOND 40.00 X 61230 0 16259 MARTIN MORRIS 40.00 X 241504 0 55208 NICOLE VANDERHEYDEN MD 40.00 X 489992 0 72899 AHMED EBEID MD 40.00 X 516751 0 71603 TRACY TAGGERT MD 40.00 X 356493 0 57449 NANCY BOUTIN 40.00 X 362417 0 42699 AMR HEGAZI 40.00 X 515898 0 52126 VIRGINIA POSEY 40.00 X 196379 0 17543 PATRICIA HARGER 40.00 X 241043 0 38902 5982728 0 864935 255 1 1 0 PHOENIX HEALTH SYSTEMS INC 1130 EAST ARAPAHO ROAD SUITE 500 RICHARDSON TX 75081 IT SUPPORT SERVICES 4598962 SOUND INPATIENT PHYSICIANS 1123 PACIFIC AVE TACOMA WA 98402 HOSPITALIST COVERAGE 1561079 CSC AMERICAS OUTSOURCING 3170 FAIRVIEW PARK DRIVE FALLS CHURCH VA 22042 IT SUPPORT SERVICES 1435909 SHIFTWISE 1800 SW 1ST AVE SUITE 510 PORTLAND OR 97201 CONTRACT LABOR 1338610 OREGON ANESTHESIOLOGY GROUP 120 NW 14TH AVE SUITE 300 PORTLAND OR 97209 ANESTHESIA COVERAGE 1272371 45 1281110 78063 1359173 PATIENT PAYMENTS 621110 556069208 556069208 PHARMACY 446110 5833969 4958864 875105 NUTRITION SERVICES 722210 3960284 3960284 OTHER HOSPITAL SERVICE 900099 3613511 3462099 151412 REGIONAL LAB 621500 1752849 119418 1633431 571229821 8098618 8098618 1291713 980494 311219 311219 311219 520202 701644 449304 520202 252340 772542 772542 PASSTHROUGH INCOME 541900 956940 954209 2731 956940 582728313 569524082 2662679 9182379 313397 313397 1530315 1530315 216352683 198227784 18124899 46023454 42138188 3885266 15695925 14295847 1400078 1022489 1021989 500 923902 14805 909097 350752 25000 325752 115418 115418 23756576 19027568 4729008 536278 1788 534490 21948673 4053847 17894826 7016072 614408 6401664 12316085 10694184 1621901 952312 603852 348460 959641 731304 228337 12873767 12873719 48 41572280 41572280 3746861 3746861 PATIENT SUPPLIES 90496326 89712121 784205 LOSS ON EXTINGUISHMENT 33668797 33668797 OTHER PURCHASED SERVICE 14748482 7848570 6899912 RECRUITING 2184233 43706 2140527 SPECIAL EVENTS 684157 268505 415652 1680106 524831 1155275 551468981 482023351 69445630 0 23885 23955 10442917 335623 69787450 71683333 6574010 3902837 5688249 5943376 7003379 6208152 790739293 339518455 454726188 451220838 261587017 285573040 8371401 6074189 28169475 30418884 852373971 861384227 57284137 51339233 307894664 306208933 3235865 2064133 29070699 34383774 397485365 393996073 X 452984797 465602946 1903809 1785208 454888606 467388154 852373971 861384227 X 31259332 -18759784 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1903809 -118601 1785208 2363674 527436 246579 1233880 1903809 3255208 987591 57741 1936866 2363674 1.00000 0 1 1 23127024 23127024 16588634 459941721 135410337 341120018 272577513 200265653 72311860 18504401 3842465 14661936 451220838 FAIR VALUE INTEREST RATE SWAP AGREEMENT 17912224 ACCRUED POST RETIREMENT HEALTHCARE BENEFITS 7920595 ACCRUED MALPRACTICE INSURANCE 4597467 ESTIMATED LIABILITY TO MEDICARE 3868731 DUE TO SALEM HEALTH 49141 OTHER LONG-TERM LIABILITIES 35616 34383774 582728313 551468981 31259332 -11566383 -7193401 -18759784 12499548 587896035 5283140 5283140 582612895 115418 115418 582728313 575396487 24042924 24042924 551353563 115418 115418 551468981 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 57498 37609785 37609785 0.07260 69279 81279716 63682316 17597400 0.03400 126777 118889501 63682316 55207185 0.10660 577404 2880195 68919 2811276 0.00540 1129577 0 1129577 0.00220 15451687 9127713 6323974 0.01220 2199800 2199800 0.00420 794442 8792 785650 0.00150 577404 22455701 9205424 13250277 0.02550 704181 141345202 72887740 68457462 0.13210 417478 417478 0.00080 417478 417478 0.00080 0 15012638 77012846 94969246 -17956400 X 1 1 1 OREGON COMMUNITY IMAGING LLC MEDICAL IMAGING COOPERATIVE 0.50000 0.00000 0.50000 1 1 SALEM HOSPITAL

890 OAK STREET SE SALEM OR 97301

X X X SALEM HOSPITAL 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X X 1 X X 1 X X X X X X 1 X 0 1 6 REHAB

2561 CENTER ST SALEM OR 97301

REHABILITATION WILLAMETTE VALLEY MIDWIVES

1285 LIBERTY ST SALEM OR 97301

MIDWIFERY COMPREHENSIVE PAIN CENTER

280 LIBERTY ST SALEM OR 97301

PAIN MANAGEMENT REGIONAL LABORATORY

3300 STATE ST SALEM OR 97301

LABORATORY SERVICES WHP FAMILY MEDICINE KEIZER

550 DEITZ AVE NE KEIZER OR 97303

CLINIC WHP FAMILY MEDICINE RIVER ROAD S

2925 RIVER RD S SALEM OR 97302

CLINIC 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. SALEM HOSPITAL 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. 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. REPORTS FILED WITH STATES PART VI, LINE 7 OR 1 MEDICAL FOUNDATION OF MARION & POLK COUNTIES 2995 RYAN DRIVE STE 100 SALEM OR 97301 930504197 501(C)(3) 12500 N/A N/A IMPROVE ACCESS TO HEALTHCARE SALEM FREE MEDICAL CLINIC 3850 PORTLAND ROAD NE SALEM OR 97301 203549992 501(C)(3) 44000 N/A N/A ACCESS TO CARE MARION COUNTY TREASURER 3180 CENTER STREET NE SALEM OR 97301 936002307 MARION COUNTY 78654 N/A N/A ACCESS TO PRENATAL CARE AMERICAN CANCER SOCIETY 2120 1ST AV N SEATTLE WA 98121 841316555 501(C)(3) 7500 N/A N/A RELAY FOR LIFE SPONSORSHIP KEIZER CHAMBER OF COMMERCE 980 CHEMAWA RD NE KEIZER OR 97303 936030759 501(C)(6) 5000 N/A N/A KEIZER IRIS FESTIVAL RUN SPONSORSHIP SALEM KEIZER EDUCATION FOUNDATION 233 COMMERCIAL ST NE SALEM OR 97301 930831467 501(C)(3) 5000 N/A N/A AWESOME 3000 SPONSORSHIPS CHEMEKETA COMMUNITY COLLEGE CAMP PROGRAM 4000 LANCASTER DR NE SALEM OR 973097070 930585134 170(C)(1) 5000 N/A N/A SCHOLARSHIP FUNDRAISER SPONSORSHIP WILLAMETTE FAMILY MEDICAL CENTER 755 MEDICAL CENTER DR SALEM OR 97301 931180397 501(C)(3) 278866 FAIR MARKET VALUE FREE RENT ACCESS TO MEDICAL SERVICES PSYCHIATRIC CRISIS CENTER PO BOX 14500 SALEM OR 97309 936002307 MARION COUNTY 97524 FAIR MARKET VALUE FREE RENT ACCESS TO MEDICAL SERVICES MEDASSIST AND PROJECT ACCESS 2995 RYAN DRIVE STE 100 SALEM OR 97301 931261633 501(C)(3) 20880 FAIR MARKET VALUE FREE RENT ACCESS TO MEDICAL SERVICES OHSU FOUNDATION DEPT SURGERY 1121 SW SALMON ST PORTLAND OR 97205 237083114 501(C)(3) 10000 N/A N/A CHARITABLE CONTRIBUTION GOLF TOURNAMENT SPONSORSHIP TRINITY LUTHERAN CHURCH 450 SE WASHINGTON DALLAS OR 97338 930712329 501(C)(3) 5000 N/A N/A DALLAS FREE CLINIC 12 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS ARE ONLY MADE TO QUALIFIED EXEMPT ORGANIZATIONS. NO MONITORING IS REQUIRED. X X X X 0 1 0 0 0 1 0 1 0 NORMAN GRUBER 719931 0 89166 0 14568 0 15925 0 37912 0 877502 0 57667 0 AARON CRANE 397412 0 19999 0 10856 0 44135 0 32736 0 505138 0 0 0 WILLIAM HOLLOWAY MD 470954 0 23475 0 2638 0 46661 0 33217 0 576945 0 0 0 JACK CAYNON 301590 0 15011 0 2600 0 37155 0 30714 0 387070 0 0 0 BEVERLY BOW 250185 0 13250 0 5444 0 33750 0 19085 0 321714 0 0 0 CHERYL NESTER-WOLFE 382213 0 19999 0 3603 0 40356 0 25879 0 472050 0 0 0 KENNETH KUDLA 290501 0 14578 0 14278 0 34083 0 24898 0 378338 0 0 0 MARTIN MORRIS 226518 0 10929 0 4057 0 30338 0 24870 0 296712 0 0 0 NICOLE VANDERHEYDEN MD 458036 0 0 0 31956 0 41173 0 31726 0 562891 0 0 0 AHMED EBEID MD 480218 0 35000 0 1533 0 37571 0 34032 0 588354 0 0 0 TRACY TAGGERT MD 348679 0 6750 0 1064 0 33193 0 24256 0 413942 0 0 0 NANCY BOUTIN 359871 0 0 0 2546 0 17191 0 25508 0 405116 0 0 0 AMR HEGAZI 459733 0 55500 0 665 0 19550 0 32576 0 568024 0 0 0 VIRGINIA POSEY 162743 0 14449 0 19187 0 0 0 17543 0 213922 0 0 0 PATRICIA HARGER 206450 0 20333 0 14260 0 11048 0 27854 0 279945 0 0 0 PART I, LINE 4B SOME OF THE HOSPITAL'S EMPLOYEES RECEIVE DEFERRED COMPENSATION UNDER A 457(F) NONQUALIFIED PLAN. THIS COMPENSATION IS INCLUDED IN COMPENSATION REPORTED IN PART II. THE TOTAL NONQUALIFIED PORTION OF EACH PERSONS DEFERRED COMPENSATION IS: 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 6 CERTAIN 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 7 THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES, IN CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, REVIEWS CEO TOTAL COMPENSATION AND PERFORMANCE ANNUALLY. AS PART OF THE COMMITTEE'S ACTIONS, A NON-FIXED BONUS MAY BE AWARDED TO THE CEO. THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS 521542796 794458CL1 2006-11-15 123122698 QUALIFIED HOSPITAL BOND 0 0 0 THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS 521542796 794458CZ0 2008-11-13 125000000 QUALIFIED HOSPITAL BOND 0 0 0 THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS 521542796 794458CX5 2008-10-08 60487711 QUALIFIED HOSPITAL BOND 0 0 0 1460000 128355347 1105000 127250347 2009 0 0 1 1 125021764 633004 1153592 9260268 113975 2009 1 0 0 1 60529178 6005354 837899 6160859 47525000 2009 1 0 1 1 0 0 1 1 1 0.04400 0.04400 1 0 0 1 1 1 0.00200 0.00200 1 0 0 1 1 1 0.01800 0.01800 1 0 0 0 1 WELLS FARGO BANK NA 2.000000000000 1 0 1 0 1 1 UBS AG 25.800000000000 0 0 0 0 1 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE 990. IT IS THEN FORWARDED TO THE ENTIRE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS THE SECRETARY OF THE HOSPITAL SHALL SEND TO EACH PERSON WHO IS A TRUSTEE, OFFICER, OR MEMBER OF A COMMITTEE, AND TO THOSE EMPLOYEES OF THE HOSPITAL AS THE BOARD MAY DETERMINE, A COPY OF THE POLICY REGARDING CONFLICTS OF INTEREST, TOGETHER WITH A QUESTIONNAIRE INQUIRING AS TO CONFLICTS, TO BE COMPLETED 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 15 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 C, LINE 19 THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE ON THE HOSPITAL WEBSITE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: 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 XII, LINE 2C NO CHANGE FROM PRIOR YEAR. MWVP INC 570 LIBERTY ST SE STE 200 SALEM OR 97301 123456789 HOLDS LAND OR 0 5128708 SALEM HEALTH SALEM HOSPITAL FOUNDATION 890 OAK STREET SE SALEM OR 97301 237002687 SUPPORTS SALEM HOSPITAL OR 501(C)(3) 7 SALEM HEALTH 0 SALEM HOSPITAL AUXILIARY 890 OAK STREET SE SALEM OR 97301 931081113 SUPPORTS SALEM HOSPITAL OR 501(C)(3) 9 N/A 0 SALEM HEALTH 890 OAK STREET SE SALEM OR 97301 930823471 LEASES LAND TO SALEM HOSPITAL OR 501(C)(3) 11 TYPE 1 N/A 0 WEST VALLEY HOSPITAL 525 SOUTHEAST WASHINGTON STREET DALLAS OR 97338 431960221 HOSPITAL OR 501(C)(3) 3 SALEM HEALTH 0 WEST VALLEY HOSPITAL FOUNDATION 525 SOUTHEAST WASHINGTON STREET DALLAS OR 97338 931298564 SUPPORTS WEST VALLEY HOSPITAL OR 501(C)(3) 11 TYPE 1 SALEM HEALTH 0 WILLAMETTE VALLEY INSURANCE COMPANY 745 FORT STREET HONOLULU HI 96813 201836190 CAPTIVE INSURANCE HI 501(C)(3) 11 TYPE 1 SALEM HEALTH 0 WILLAMETTE VALLEY PROFESSIONAL SERVICES 890 OAK STREET SE SALEM OR 97301 753175249 BILLING SERVICE FOR PROFESSIONAL FEES OR 501(C)(3) 3 SALEM HEALTH 0 OREGON COMMUNITY IMAGING LLC 2925 RYAN DR SE SALEM OR 97301 202683062 MEDICAL IMAGING COOPERATIVE OR SALEM HOSPITAL RELATED -31420 19263 0 1 0.50000 SALEM CARDIO DIAGNOSTICS 665 WINTER STREET SE SALEM OR 97301 930579722 CARDIO DIAGNOSTICS OR SALEM HOSPITAL RELATED 0 1 1.00000 1 1 1 1 0 0 0 0 0 1 0 0 1 1 1 1 1 1 SALEM HOSPITAL FOUNDATION C 1281110 WILLAMETTE VALLEY PROFESSIONAL SERVICES O 1198993 WEST VALLEY HOSPITAL D 3902837 WEST VALLEY HOSPITAL P 1687821 SALEM HOSPITAL FOUNDATION P 450486 WILLAMETTE VALLEY PROFESSIONAL SERVICES Q 3306667 WILLAMETTE VALLEY INSURANCE COMPANY P 292826 WILLAMETTE VALLEY INSURANCE COMPANY Q 2000000