2011-08-15T18:05:36-05:00 2010-09-30 AKT LLP 5665 SW Meadows Rd Suite 200 Lake Oswego OR 97035 990 2009-10-01 237002687 Salem Hospital Foundation SALE 5035615576 890 OAK STREET SE Salem OR 97301 Martin A Morris 5035615576 2011-08-10 1 Joylyn M Ankeney CPA 5036204489 2009 2016-02-24 21:20:13Z MARTIN A MORRIS 890 OAK STREET SE Salem OR 97301 2245073 0 X www.salemhospital.org/foundation X 1968 OR DEDICATED TO RAISING, MANAGING AND DISTRIBUTING FUNDS TO HELP SALEM HOSPITAL ACHIEVE ITS MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY IT SERVES. 15 15 0 15 0 0 1543785 1212534 0 -53106 387545 -13359 51882 1477320 1651961 3114059 1480531 0 0 18952 35088 415879 323097 3529938 1822580 -2052618 -170619 9597803 9023685 726232 82801 8871571 8940884 THE SALEM HOSPITAL FOUNDATION IS DEDICATED TO RAISING, MANAGING AND DISTRIBUTING FUNDS TO HELP SALEM HOSPITAL ACHIEVE ITS MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY IT SERVES 0 0 131818 131818 SCHOLARSHIPS: 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. 1267154 1267154 PROPOSALS 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. 81559 81559 CERTAIN 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. 1480531 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 11 0 0 0 0 0 0 0 0 0 0 0 0 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X Salem Hospital 5035611200 890 Oak Street SE Salem OR 97301 TIM ABRAHAMSON 1.00 X X 0 0 0 KELLY YUNKER 1.00 X X 0 0 0 KATHY GORDON 1.00 X X 0 0 0 MARI BAILEY 1.00 X 0 0 0 GARTH BRANDAW 1.00 X 0 0 0 JAN BUFFA PHD 1.00 X 0 0 0 PAUL GEHLAR 1.00 X 0 0 0 JIM GRIGGS 1.00 X 0 0 0 WILLIAM HANSEN 1.00 X 0 0 0 MARK LYMAN 1.00 X 0 0 0 JENNIFER NEAHRING MD 1.00 X 0 0 0 KRIS NORTON 1.00 X 0 0 0 BUD PIERCE MD 1.00 X 0 0 0 JOHN ROSS MD 1.00 X 0 0 0 JIM WASENMILLER MD 1.00 X 0 0 0 MARTIN MORRIS 40.00 X 0 182371 50443 0 182371 50443 0 0 1 0 0 3200 1209334 1212534 195919 195919 12054 628 11426 11426 11426 758931 567305 191626 191626 191626 65635 3200 25179 40456 40456 1651961 0 0 439427 1267154 1267154 213377 213377 16400 16400 18952 18952 4409 4409 5483 5483 21652 10999 10653 380 380 1957 1957 MANAGEMENT SERVICES 252981 252981 MISCELLANEOUS 13032 13032 SOFTWARE/DATA PROCESS 3326 3326 BANK FEES 1170 1170 PROFESSIONAL DEVELOPMEN 1170 1170 1137 1137 1822580 1480531 306961 35088 1921832 483294 1410000 1410000 1410000 6170859 7024642 44600 56026 50512 49723 9597803 9023685 3665 354 722567 82447 726232 82801 X 4150909 4272145 2517094 2464071 2203568 2204668 8871571 8940884 9597803 9023685 X 0 1 0 X 0 X 1951184 1523910 2295581 934781 1212534 7917990 1951184 1523910 2295581 934781 1212534 7917990 1209210 6708780 262953 472204 293281 70592 52561 1151591 9069581 0.73970 0.76930 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2344770 19335 167208 35521 2495792 2285949 31343 50166 22688 2344770 1.00000 0 0 1410000 1410000 1410000 LIABILITY FOR ANNUITY PAYMENTS TO DONORS 8512 DUE TO SALEM HOSPITAL 73935 82447 1651961 1822580 -170619 239932 239932 69313 2330888 239932 413188 25807 678927 1651961 0 1651961 2261575 413188 25807 438995 1822580 0 1822580 Part V, Line 4: Description of Intended Use of Endowment Funds: 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: 628. special event expenses netted with revenue: 25179. Part XIII, Line 2d - Other Adjustments: rental expenses netted with revenue: 628. special event expenses netted with revenue: 25179. X X X X 1 Advanced Marketing Direct mail solicitation 0 40114 18952 21162 40114 18952 21162 GOLF TOURNAMENT 68835 3200 65635 340 6462 15600 914 1863 68835 3200 65635 340 6462 15600 914 1863 25179 40456 1 SALEM HOSPITAL 890 OAK STREET SE SALEM OR 97301 930579722 503(c)(3) 1267154 n/a n/a TO PAY FOR GENERAL EXPENSES AND CAPITAL EXPENDITURES. 1 SCHOLARSHIPS TO COLLEGE STUDENTS 82 131818 N/A SCHOLARSHIPS PAID DIRECTLY TO COLLEGES FOR STUDENTS WHO ARE PURSUING A CAREER IN HEALTHCARE. MUST HAVE A PERMANENT RESIDENCE IN MARION, POLK, OR YAMHILL COUNTY AND BE ACCEPTED AT LEAST 1/2 TIME TO FORMAL PROGRAM. SMALL EMERGENCY CASH GRANTS($150-$300/MAX) TO INDIGENT PATIENTS 106 28081 N/A GRANTS GIVEN TO PATIENTS TO MEET EMERGENCY NEEDS SUCH AS MEDICATION, UTILITIES, TRANSPORTATION, RENT, ETC. (NO INDIVIDUAL GRANT EXCEEDS $300) NON-CASH SUPPORT OF INDIGENT PATIENTS OF SALEM HOSPITAL AND/OR COMMUNITY MEMBERS 897 53478 ACTUAL COST MEDICATIONS, TRANSPORTATION, DURABLE MEDICAL EQUIPMENT, NON-MEDICAL SAFETY/PREVENTION ITEMS (CAR SEATS, EMERGENCY CALL SYSTEM, ETC), REQUIRED HEALTH COUNSELING, EDUCATION. Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule 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. X X X X 0 0 0 0 0 0 0 0 0 MARTIN MORRIS 0 179249 0 0 0 3122 0 26363 0 24080 0 232814 0 0 Supplemental Information Part III Compensation 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. Form 990, Part VI, Section B, line 11 THE ORGANIZATION'S GOVERNING EXECUTIVE COMMITTEE REVIEWS THE IRS FORM 990 BEFORE FILING. Form 990, Part VI, Section B, line 12c 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 C, line 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. HAMPSHIRE PROPERTIES LLC 890 OAK STREET SE SALEM OR 97301 870804582 REAL ESTATE HOLDING OR 12054 1410000 N/A SALEM HOSPITAL 890 OAK STREET SE SALEM OR 97301 930579722 HOSPITAL OR 501(c)(3) 3 Salem Health SALEM HOSPITAL AUXILIARY 890 OAK STREET SE SALEM OR 97301 931081113 SUPPORTS SALEM HOSPITAL OR 501(c)(3) 9 N/A SALEM HEALTH 890 OAK STREET SE SALEM OR 97301 930823471 LEASES LAND TO SALEM HOSPITAL OR 501(c)(3) 11 Type 1 N/A WEST VALLEY HOSPITAL 525 SOUTHEAST WASHINGTON STREET DALLAS OR 97338 431960221 HOSPITAL OR 501(c)(3) 3 Salem Health 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 WILLAMETTE VALLEY INSURANCE COMPANY 745 FORT STREET HONOLULU HI 96813 201836190 CAPTIVE INSURANCE HI 501(c)(3) 11 Type 1 Salem Health WILLAMETTE VALLEY PROFESSIONAL SERVICES 890 OAK STREET SE SALEM OR 97301 753175249 BILLING SERVICE FOR SALEM HOSPITAL, WEST VALLEY HOSPITAL, & SALEM HEALTH OR 501(c)(3) 3 salem Health 0 1 0 0 1 0 0 0 0 0 1 1 1 1 0 0 0 0 SALEM HOSPITAL B 1267154 SALEM HOSPITAL E 73935