SALEM HEALTH FOUNDATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SALEM HEALTH FOUNDATION (EIN 23-7002687)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-13
IRS object ID
201202269349301890
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)
Timestamp2012-08-13T16:12:47-05:00Timestamp
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 Line15665 SW MEADOWS RD SUITE 200AddressLine1
CityLAKE OSWEGOCity
StateORState
ZIP Code97035ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237002687EIN

Name Name

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

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameMARTIN A MORRISName
TitleVP & CHIEF DEVELOPMENT OFFICERTitle
Phone5035615576Phone
Date Signed2012-08-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOYLYN M ANKENEY CPAName
Phone5036204489Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2366456GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SALEMHOSPITAL.ORG/FOUNDATIONWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1968YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionDEDICATED TO RAISING, MANAGING AND DISTRIBUTING FUNDS TO HELP SALEM HOSPITAL ACHIEVE ITS MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY IT SERVES.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers15TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1212534ContributionsGrantsPriorYear
Contributions Grants Current Year840436ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year387545InvestmentIncomePriorYear
Investment Income Current Year587686InvestmentIncomeCurrentYear
Other Revenue Prior Year51882OtherRevenuePriorYear
Other Revenue Current Year53104OtherRevenueCurrentYear
Total Revenue Prior Year1651961TotalRevenuePriorYear
Total Revenue Current Year1481226TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1480531GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1526082GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year18952TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY21863TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year28343TotalFundrsngExpCurrentYear
Other Expense Prior Year323097OtherExpensePriorYear
Other Expenses Current Year370170OtherExpensesCurrentYear
Total Expenses Prior Year1822580TotalExpensesPriorYear
Total Expenses Current Year1918115TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-170619RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-436889RevenuesLessExpensesCY
Total Assets BOY9023685TotalAssetsBOY
Total Assets EOY7964385TotalAssetsEOY
Total Liabilities BOY82801TotalLiabilitiesBOY
Total Liabilities EOY51455TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8940884NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7912930NetAssetsOrFundBalancesEOY
Mission DescriptionTHE SALEM HOSPITAL FOUNDATION IS DEDICATED TO RAISING, MANAGING AND DISTRIBUTING FUNDS TO HELP SALEM HOSPITAL ACHIEVE ITS MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY IT SERVESMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense157800Expense
Grants157800Grants
DescriptionSCHOLARSHIPS: NURSING, MEDICAL SCHOOL AND OTHER HEALTHCARE PROGRAMS. RECIPIENTS OF HEALTH CARE RELATED ACADEMIC SCHOLARSHIPS AND THE AMOUNTS OF THE AWARDS ARE DETERMINED BY ANALYSES OF THE CANDIDATES' QUALIFICATIONS, SCHOLARSHIP AWARDS ALREADY AWARDED TO THEM FOR THE YEAR BY OTHER ORGANIZATIONS, AND THE COSTS OF THE SPECIFIC SCHOOLS THE VARIOUS CANDIDATES WISH TO ATTEND.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1273072Expense
Grants1273072Grants
DescriptionPROPOSALS TO FUND CAPITAL EQUIPMENT AND MEDICALLY-RELATED ACTIVITIES AT SALEM HOSPITAL ARE RECEIVED AND REVIEWED BY THE FOUNDATION'S CHIEF DEVELOPMENT OFFICER. PROPOSALS ARE FORWARDED TO THE FOUNDATION'S BOARD OF DIRECTORS FOR FURTHER REVIEW AND APPROVAL IF THEY ARE CONSIDERED TO BE CONSISTENT WITH THE FOUNDATION'S ARTICLES OF INCORPORATION, STATING THAT ITS FUNDS ARE TO BE USED FOR HEALTH CARE, CHARITABLE, AND SCIENTIFIC PURPOSES, AND FOR MEDICAL AND SCIENTIFIC EDUCATION AND RESEARCH FOR THE USE AND BENEFIT OF SALEM HOSPITAL.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense95210Expense
Grants95210Grants
DescriptionCERTAIN RESTRICTED FUNDS HAVE BEEN CREATED AND ARE USED FOR THE PURPOSE ASSISTING DIABETES AND CANCER PATIENTS WITH THE COSTS OF THEIR EDUCATIONAL, SUPPLY AND OTHER CARE-RELATED EXPENSES. IN ADDITION, FUNDS ARE DISTRIBUTED TO ASSIST LOW INCOME INDIVIDUALS MEDICAL REQUIREMENTS.Description
FieldValueIRS element (for citing)
Total Program Service Expense1526082TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising1ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10967NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
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 CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

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

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
KELLY YUNKER
CHAIR1.00XX000
KATHY GORDON
VICE CHAIR1.00XX000
MARI BAILEY
SECRETARY/TREASURER1.00XX000
GARTH BRANDAW
DIRECTOR1.00X000
MICHAEL DELK
DIRECTOR1.00X000
BARBARA FURER
DIRECTOR1.00X000
PAUL GEHLAR
DIRECTOR1.00X000
JIM GRIGGS
DIRECTOR1.00X000
BARBARA HALSEY
DIRECTOR1.00X000
MARK LYMAN
DIRECTOR1.00X000
KRIS NORTON
DIRECTOR1.00X000
BUD PIERCE MD
DIRECTOR1.00X000
ROBERT PONEC MD
DIRECTOR1.00X000
JOHN ROSS MD
DIRECTOR1.00X000
JIM WASENMILLER MD
DIRECTOR1.00X000
MARTIN MORRIS
VP/CHIEF DEVELOPMENT OFFICER40.00X024150455208
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs241504TotalReportableCompFrmRltdOrgs
Total Other Compensation55208TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events3450FundraisingEvents
All Other Contributions836986AllOtherContributions
Noncash Contributions27809NoncashContributions
Total Contributions840436TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column205909TotalRevenueColumn
Exclusion$205,909ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real12174Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1725Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real10449Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column10449TotalRevenueColumn
Exclusion$10,449ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1237747Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities855970Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities381777Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column381777TotalRevenueColumn
Exclusion$381,777ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events70190GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events3450CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses27535FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column42655TotalRevenueColumn
Exclusion$42,655ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1481226TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$640,790ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1273072Total
Program Services1273072ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total253010Total
Program Services253010ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total17000Total
Management And General17000ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total21863Total
Fundraising21863Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total243Total
Management And General243ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total33787Total
Management And General33787ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3000Total
Fundraising3000Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total10797Total
Management And General7317ManagementAndGeneral
Fundraising3480Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total680Total
Management And General680ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total948Total
Management And General948ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
MANAGEMENT SERVICES294693294693
SOFTWARE/DATA PROCESS65616561
BANK FEES15091509
MISCELLANEOUS678678
PROFESSIONAL DEVELOPMEN224224

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total50Total
Management And General50ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1918115Total
Program Services1526082ProgramServices
Management And General363690ManagementAndGeneral
Fundraising28343Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY483294BOY
EOY125573EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1410000LandBuildingsEquipmentBasis

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1410000BOY
EOY1410000EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY7024642BOY
EOY6371830EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY56026BOY
EOY56982EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY49723BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9023685BOY
EOY7964385EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY354BOY
EOY4569EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY82447BOY
EOY46886EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY82801BOY
EOY51455EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4272145BOY
EOY3250366EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2464071BOY
EOY2451896EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2204668BOY
EOY2210668EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8940884BOY
EOY7912930EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9023685BOY
EOY7964385EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-436889ReconcilationRevenueExpenses
Reconcilation Other Changes-591065ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1523910CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2295581CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years934781CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1212534CurrentTaxYearMinus1Year
Current Tax Year809178CurrentTaxYear
Total6775984Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1523910CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2295581CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years934781CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1212534CurrentTaxYearMinus1Year
Current Tax Year809178CurrentTaxYear
Total6775984Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total1513955AmountsSubstContributorsTotal
Public Support Total1705262029PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years472204CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years293281CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years70592CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year52561CurrentTaxYearMinus1Year
Current Tax Year61625CurrentTaxYear
Total950263Total
FieldValueIRS element (for citing)
Total Support7726247TotalSupport
Public Support Pertcentage1700.68110PublicSupportPertcentage170
Public Support Pertcent Prior Year0.73970PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

Current Year CurrentYear

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

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2285949BeginningOfYearBalance
Contributions31343Contributions
Investment Earnings Or Losses50166InvestmentEarningsOrLosses
Other Expenditures22688OtherExpenditures
End Of Year Balance2344770EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.90000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.10000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

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

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO SALEM HOSPITALDescription
Amount$46,886Amount
FieldValueIRS element (for citing)
Total Of Amounts46886TotalOfAmounts
Total Revenue1481226TotalRevenue
Total Expenses1918115TotalExpenses
Excess Or Deficit For Year-436889ExcessOrDeficitForYear
Net Unrealized GL On Investments-591065NetUnrealizedGLOnInvestments
Total Adjustments-591065TotalAdjustments
Excess Or Deficit Per FS-1027954ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt1818713TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-591065NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities450487DonatedSrvcAndUseOfFacilities
Other Revenues478065OtherRevenues
Revenue Not Rptd F990337487RevenueNotRptdF990
Revenue Subtotal1481226RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9901481226TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2397862TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities450487DonatedServicesUseOfFacilities
Other Expenses Included29260OtherExpensesIncluded
Expenses Not Rptd F990479747ExpensesNotRptdF990
Expenses Subtotal1918115ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9901918115TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:SALEM HOSPITAL FOUNDATION HOLDS ENDOWMENT FUNDS FOR THE BENEFIT OF SALEM HOSPITAL AND FOR USE TOWARDS THE FOUNDATION'S MISSION.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES NETTED WITH REVENUE 1,725. SPECIAL EVENT EXPENSES NETTED WITH REVENUE 27,535. ASSETS RELEASED FROM RESTRICTION INCLUDED IN REVENUE 448,805.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES NETTED WITH REVENUE 1,725. SPECIAL EVENT EXPENSES NETTED WITH REVENUE 27,535.

Schedule G IRS990ScheduleG

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

Fundraiser Activity Information FundraiserActivityInformation

Name Of Organization NameOfOrganization

FieldValueIRS element (for citing)
Business Name Line1ADVANCED MARKETINGBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line199 THIELMAN DRIVEAddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14206ZIPCode
FieldValueIRS element (for citing)
ActivityDIRECT MAIL SOLICITATIONActivity
Fundraiser Control Of Funds0FundraiserControlOfFunds
Gross Receipts90496GrossReceipts
Amount Retained By Contractor21863AmountRetainedByContractor
Net To Organization68633NetToOrganization
FieldValueIRS element (for citing)
Total Gross Receipts90496TotalGrossReceipts
Total Retained By Contractors21863TotalRetainedByContractors
Total Net To Organization68633TotalNetToOrganization
Licensed StatesORLicensedStates

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event173640GrossReceiptsEvent1
Charitable Contributions Event13450CharitableContributionsEvent1
Gross Revenue Event170190GrossRevenueEvent1
Cash Prizes Event1640CashPrizesEvent1
Non Cash Prizes Event12688NonCashPrizesEvent1
Rent Facility Costs Event115084RentFacilityCostsEvent1
Other Direct Expenses Event19123OtherDirectExpensesEvent1
Gross Receipts Total73640GrossReceiptsTotal
Charitable Contributions Total3450CharitableContributionsTotal
Gross Revenue Total Events70190GrossRevenueTotalEvents
Cash Prizes Total Events640CashPrizesTotalEvents
Non Cash Prizes Total Events2688NonCashPrizesTotalEvents
Rent Facility Costs Total Events15084RentFacilityCostsTotalEvents
Other Direct Expenses Total Events9123OtherDirectExpensesTotalEvents
Direct Expense Summary Events27535DirectExpenseSummaryEvents
Net Income Summary42655NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1SALEM HOSPITALBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient930579722EINOfRecipient
IRC Section503(C)(3)IRCSection
Amount Of Cash Grant1273072AmountOfCashGrant
Method Of ValuationN/AMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance
Purpose Of GrantTO PAY FOR GENERAL EXPENSES AND CAPITAL EXPENDITURES.PurposeOfGrant

Form990 Schedule I Part III Form990ScheduleIPartIII (3 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationAmount Of Non Cash AssistanceAmountOfNonCashAssistanceDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
SCHOLARSHIPS FOR STUDENTS LIVING IN MARION/POLK OR YAMHILL COUNTY WHO ARE PURSUING A CAREER IN HEALTHCARE. PAYMENTS MADE DIRECTLY TO THE COLLEGE(S)93157800N/A
SMALL ONE-TIME CASH GRANTS ($150-$300) TO INDIGENT PATIENTS FOR EMERGENT NEEDS SUCH AS MEDICATION, UTILITIES, TRANSPORTATION, RENT, ETC10641401N/A
NON-CASH SUPPORT OF INDIGENT PATIENTS OF SALEM HOSPITAL AND/OR COMMUNITY MEMBERS897ACTUAL COST53809MEDICATIONS, TRANSPORTATION, DURABLE MEDICAL EQUIPMENT, NON-MEDICAL SAFETY/PREVENTION ITEMS (CAR SEATS, EMERGENCY CALL SYSTEM, ETC), REQUIRED HEALTH COUNSELING, EDUCATION.

Form990 Schedule I Part IV Form990ScheduleIPartIV

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

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonMARTIN MORRISNamePerson
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs226518CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs10929BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs4057OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs30338DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs24870NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs296712TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BMARTIN MORRIS RECEIVED DEFERRED COMPENSATION UNDER A 457(F) NONQUALIFIED PLAN. THIS COMPENSATION IS INCLUDED IN COMPENSATION REPORTED IN PART II UNDER DEFERRED COMPENSATION. THE TOTAL NONQUALIFIED PORTION REPORTED IS $14,850.
PART IIICOMPENSATION OF THE V.P. & CHIEF DEVELOPMENT OFFICER IS DETERMINED BY THE CEO OF SALEM HEALTH, IN CONJUNCTION WITH OTHER SALARY SURVEY OR PUBLIC INFORMATION AND INDEPENDENT CONSULTANTS TO ENSURE THE COMPENSATION IS COMPETITIVE IN THE MARKET FOR SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS.SUPPLEMENTAL INFORMATION

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99027809NoncashContribsRptdF990
Method Of Determining RevenuesTRADING VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Number Of8283 Received0NumberOf8283Received
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION'S GOVERNING EXECUTIVE COMMITTEE REVIEWS THE IRS FORM 990 BEFORE FILING.
ON AN ANNUAL BASIS THE SECRETARY SHALL SEND TO EACH PERSON WHO IS A TRUSTEE, OFFICER, OR MEMBER OF A COMMITTEE A COPY OF THE POLICY REGARDING CONFLICTS OF INTEREST, TOGETHER WITH A QUESTIONNAIRE INQUIRING AS TO CONFLICTS, TO BE COMPLETED AND RETURNED TO THE SECRETARY BY THE TRUSTEE, OFFICER OR COMMITTEE MEMBER PRIOR TO THE BEGINNING OF EACH CALENDAR YEAR.FORM 990, PART VI, SECTION B, LINE 12C
NO DOCUMENTS AVAILABLE TO THE PUBLIC.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -591,065.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1HAMPSHIRE PROPERTIES LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1890 OAK STREET SEAddressLine1
CitySALEMCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
EIN870804582EIN
Primary ActivitiesREAL ESTATE HOLDINGPrimaryActivities
Legal Domicile StateORLegalDomicileState
Total Income12174TotalIncome
EOY Assets1410000EOYAssets
Direct Controlling Entity NAN/ADirectControllingEntityNA

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
SALEM HOSPITAL
890 OAK STREET SESALEMOR97301930579722HOSPITALOR501(C)(3)3SALEM HEALTH0
SALEM HOSPITAL AUXILIARY
890 OAK STREET SESALEMOR97301931081113SUPPORTS SALEM HOSPITALOR501(C)(3)90N/A
SALEM HEALTH
890 OAK STREET SESALEMOR97301930823471LEASES LAND TO SALEM HOSPITALOR501(C)(3)11 TYPE 10N/A
WEST VALLEY HOSPITAL
525 SOUTHEAST WASHINGTON STREETDALLASOR97338431960221HOSPITALOR501(C)(3)3SALEM HEALTH0
WEST VALLEY HOSPITAL FOUNDATION
525 SOUTHEAST WASHINGTON STREETDALLASOR97338931298564SUPPORTS WEST VALLEY HOSPITALOR501(C)(3)11 TYPE 1SALEM HEALTH0
WILLAMETTE VALLEY INSURANCE COMPANY
745 FORT STREETHONOLULUHI96813201836190CAPTIVE INSURANCEHI501(C)(3)11 TYPE 1SALEM HEALTH0
WILLAMETTE VALLEY PROFESSIONAL SERVICES
890 OAK STREET SESALEMOR97301753175249BILLING SERVICE FOR SALEM HOSPITAL, WEST VALLEY HOSPITAL, & SALEM HEALTHOR501(C)(3)3SALEM HEALTH0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1SALEM HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeBTransactionType
Amount Involved1273072AmountInvolved

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