2011-08-15T18:43:28-05:00 2010-09-30 AKT LLP 680 Hawthorne Ave SE 140 Salem OR 97301 990 2009-10-01 930579722 Salem Hospital SALE 5035615150 890 Oak Street SE Salem OR 97301 Aaron R Crane 5035615150 2011-08-11 1 Martin Moll 5035857774 2009 2016-02-24 21:20:13Z Aaron R Crane 890 Oak Street SE Salem OR 97301 543703724 0 X www.salemhospital.org X 1970 OR To improve the health and well being of the people in the communities we serve 15 12 4306 447 5142731 -4287707 2964282 1312170 476679235 533056532 13881535 4936879 252235 3092356 493777287 542397937 168357 242960 0 249024290 260454764 0 0 223901751 257903734 473094398 518601458 20682889 23796479 812419065 852373971 386170887 397485365 426248178 454888606 To improve the health and well-being of the people and communities we serve 0 0 102932686 286253379 Salem Hospital is one of the largest of Oregon's 57 acute care hospitals and operates the busiest emergency department in Oregon. There are 465 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 - 3,283, Diagnostic imaging procedures - 171,872, ED and urgent care visits - 121,125, Inpatient admissions - 22,964, Laboratory procedures - 1,500,607, Sleep disorder center procedures - 3,364, Surgeries - 12,336. The primary service area is the greater Willamette Valley with approximately 400,000 residents. 322833881 227066022 Salem Hospital provides healthcare to people in our community regardless of their ability to pay. In FY2010, provision of services to individuals who cannot afford to pay accounted for the largest portion of the community benefit, $95.8 million. Charity care totaled $36.0 million; Medicare underpaid Salem Hospital by $46.9 million. Medicaid underpaid by $12.9 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. 29895551 242960 17534559 Salem Hospital actively participates in community health improvement services. In FY2010, Salem Hospital gave $2.3 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. Salem Hospital subsidizes the cost of providing certain health services to the community at a financial loss in the amount of $5.9 million. In FY2010, Salem Hospital provided nearly $1 million in cash and in-kind donations to community health programs such as Medassist, Salem Free Clinic and Northwest Human Services. 455662118 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 397 0 4306 1 1 1 0 0 0 0 0 0 15 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 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 15.00 X X 0 0 0 THERESA TAAFFE 10.00 X 0 0 0 JENNIFER NEAHRING MD 10.00 X 0 0 0 ALAN WYNN 10.00 X X 0 0 0 ALAN COSTIC 15.00 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 735704 0 62177 AARON CRANE 40.00 X 352668 0 74347 WILLIAM HOLLOWAY MD 40.00 X 435793 0 82147 JACK CAYNON 40.00 X 284312 0 79090 BEVERLY BOW 40.00 X 209768 0 77356 CHERYL NESTER-Wolfe 40.00 X 318379 0 82463 KENNETH KUDLA 40.00 X 254286 0 81833 VIRGINIA POSEY 40.00 X 184927 0 52257 ERIC BUCKLAND 40.00 X 50619 0 10993 PATRICIA HARGER 40.00 X 183840 0 81698 ANNE DIAMOND 40.00 X 186360 0 50449 MARTIN MORRIS 40.00 X 182371 0 50442 LYNN CLAYTON 40.00 X 109369 0 8240 CHERYL A LUGENBILL MD 40.00 X 290133 0 82414 JUDY MARVIN MD 40.00 X 259510 0 77609 NICOLE VANDERHEYDEN MD 40.00 X 452157 0 86594 AMED EBEID MD 40.00 X 457622 0 81127 TRACY TAGGERT MD 40.00 X 282631 0 47343 5070461 0 1149346 232 0 1 0 Shiftwise 1800 SW 1st Ave Suite 510 Portland OR 97201 Contract Labor 10772559 Huron Consulting 4795 Paysphere Circle Chicago IL 60674 Revenue Cycle Consultants 3068000 OREGON ANESTHESIOLOGY GRoup 120 NW 14th Ave Suite 300 Portland OR 97209 Anesthesia Coverage 1242091 Sound Inpatient Physicians 1123 Pacific Ave Tacoma WA 97402 Hospitalist Coverage 1164016 Salem Emergency Physicians 890 oak street building A Salem OR 97301 Urgent Care Coverage 1064149 82 1267154 45016 1312170 PATIENT PAYMENTS 621110 519530567 519530567 PHARMACY 446110 5704790 4620880 1083910 NUTRITION SERVICES 722210 3827242 1870485 1956757 REGIONAL LAB 621500 2062954 2062954 OTHER HOSPITAL SERVICE 900099 1930979 1930979 533056532 4980494 4980494 1149628 997431 152197 152197 152197 264741 308356 -43615 -43615 -43615 Passthrough Income 900099 2940159 2901049 39110 2940159 542397937 530853960 5142731 5089076 242960 242960 4800144 4800144 199166598 186476352 12690246 41860428 39097880 2762548 14627594 13422472 1205122 1165765 1100765 65000 696384 68367 628017 403231 20155 383076 20879663 17902445 2977218 543832 1431 542401 19331661 4370625 14961036 7030548 747645 6282903 11744126 10013566 1730560 501185 283830 217355 630839 457385 173454 13547754 13547754 39198793 39198793 4274350 4274350 PATIENT SUPPLIES 85489653 84838471 651182 Loss on Extinguishment 31051057 31051057 OTHER PURCHASED SERVICE 16444818 7724763 8720055 RECRUITING 3050875 22096 3028779 SPECIAL EVENTS 672151 239683 432468 1247049 559273 687776 518601458 455662118 62939340 0 20510 23885 3714444 10442917 62547150 69787450 5496367 6574010 5570748 5688249 4476861 7003379 751662827 296936639 475972838 454726188 228000875 261587017 26619272 36540876 812419065 852373971 47303691 57284137 309630032 307894664 3847163 3235865 25390001 29070699 386170887 397485365 X 423884504 452984797 2363674 1903809 426248178 454888606 812419065 852373971 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2363674 527436 246579 1233880 1903809 3255208 987591 57741 1936866 2363674 1.00000 0 1 1 16091087 16091087 17332772 442725817 117787770 342270819 257101550 175992622 81108928 18411601 3156247 15255354 454726188 FAIR VALUE INTEREST RATE SWAP AGREEMENT 14421517 ACCRUED POST RETIREMENT HEALTHCARE BENEFITS 7565877 ACCRUED MALPRACTICE INSURANCE 4075818 ESTIMATED LIABILITY TO MEDICARE 2913525 DUE TO SALEM HEALTH 32456 Other long-term liabilities 61506 29070699 542397937 518601458 23796479 8120552 -3276604 4843948 28640427 555372553 8120552 4854064 12974616 542397937 0 542397937 526272260 7670802 7670802 518601458 0 518601458 Part V, Line 4: Description of Intended Use of Endowment Funds: 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: -4955486. Change in net benefit cost: 2407296. Change in Beneficial Interest in Foundation: -459865. Loss on discontinued operations: -268549. Part XII, Line 2d - Other Adjustments: Expenses netted with revenues: 2446767. Change in postretirement benefit obligation: 2407297. Part XIII, Line 2d - Other Adjustments: Change in fair value of interest rate swap agreement: 4955486. Loss on discontinued Operations: 268549. Expenses netted with revenues: 2446767. 1 1 X 1 X 1 X 1 1 1 0 1 1 54508 35959314 35959314 0.06930 43926 68996286 56095121 12901165 0.02490 98434 104955600 56095121 48860479 0.09420 2361187 97368 2263819 0.00440 661741 661741 0.00130 23320504 17368954 5951550 0.01150 2494983 2494983 0.00480 1057136 68237 988899 0.00190 29895551 17534559 12360992 0.02390 98434 134851151 73629680 61221471 0.11810 31051057 14789627 71869686 90195371 -18325685 X 1 1 Oregon Community Imaging LLC Medical Imaging Cooperative 0.50000 0.00000 0.50000 Salem Cardio Diagnostics Cardio Diagnostics 0.50000 0.00000 0.50000 Building A

890 Oak St SE Salem OR 97301

X X X Building B

665 Winter St SE Salem OR 97301

X X Building C

875 Oak St SE Salem OR 97301

X X Building D

939 Oak St SE Salem OR 97301

X X Building E

1127 Oak St SE Salem OR 97301

X X Urgent Care

1002 Bellevue Salem OR 97301

X Rehab

2561 Center St Salem OR 97301

X Willamette Valley Midwives

1285 Liberty St Salem OR 97301

X Pain Management Center

280 Liberty St Salem OR 97301

X Regional Laboratory

3300 State St Salem OR 97301

X 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, Line 7g: 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 this access burden, Salem Hospital has subsidized physician practices and reports these subsidies in Part 1, line 7, column (f). Part I, Line 7f: 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 $31,051,057. 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 line 4 is calculating by applying the ratio of costs to charges as determined in Worksheet 2 to the full billed charges written off as bad debt expense. 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 $99,101,215 less Medicare Advantage costs of $127,682,910 for a total additional community benefit in the amount of $28,581,895. 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 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 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 Hospitals 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 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 5: Salem Hospital supports advocacy activities that address the root causes of health problems, such as poverty, homelessness, and environmental problems. 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 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 390,000 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. OR 1 Medical Foundation of Marion & Polk Counties 698 1th ST 230 Salem OR 97309 930504197 501(c)(3) 12718 n/a n/a improve access to healthcare Salem Hospital Foundation 890 Oak Street SE Salem OR 97301 237002687 501(c)(3) 36352 n/a n/a community health education Salem Free Medical Clinic 3850 Portland Road NE Salem OR 97301 203549992 501(c)(3) 20218 n/a n/a access to care Marion County Treasurer 3180 Center Street NE Salem OR 97301 936002307 Marion County 82635 n/a n/a access to medical services MARCH OF DIMES Foundation 1275 Mamaroneck Avenue White Plains NY 10605 131846366 501(c)(3) 5000 community health education KEIZER Chamber of Commerce 980 Chemawa Rd NE Keizer OR 97303 936030759 501(c)(6) 5218 N/A N/A Keizer Iris Festival run sponsorship MEDICAL TEAMS INTERNATIONal 14150 SW Milton CT Tigard OR 97224 930878944 501(c)(3) 10000 N/A N/A access to medical services SALEM KEIZER EDUCATION FOUNDATION 233 Commercial ST NE Salem OR 97301 930831467 501(c)(3) 5218 N/A N/A community health education AMERICAN HEART ASSOCIATION 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 5218 N/a N/a community health education Willamette Family Medical Center 755 Medical Center Dr Salem OR 97301 931180397 501(c)(3) 557732 Fair Market Value Free Rent Access to Medical Services 8 2 X X X X 0 1 0 0 0 1 0 1 0 NORMAN GRUBER 581199 0 65000 0 89505 0 27500 0 34677 0 797881 0 0 0 AARON CRANE 350319 0 0 0 2349 0 39166 0 35181 0 427015 0 0 0 WILLIAM HOLLOWAY MD 433323 0 0 0 2470 0 49920 0 32227 0 517940 0 0 0 JACK CAYNON 282553 0 0 0 1759 0 46829 0 32261 0 363402 0 0 0 BEVERLY BOW 203368 0 0 0 6400 0 52951 0 24405 0 287124 0 0 0 CHERYL NESTER-Wolfe 313913 0 0 0 4466 0 59917 0 22546 0 400842 0 0 0 KENNETH KUDLA 247523 0 0 0 6763 0 55838 0 25995 0 336119 0 0 0 VIRGINIA POSEY 179573 0 0 0 5354 0 34103 0 18154 0 237184 0 0 0 PATRICIA HARGER 177972 0 0 0 5868 0 51751 0 29947 0 265538 0 0 0 ANNE DIAMOND 184979 0 0 0 1381 0 21998 0 28451 0 236809 0 0 0 MARTIN MORRIS 179249 0 0 0 3122 0 26363 0 24079 0 232813 0 0 0 CHERYL A LUGENBILL MD 237068 0 51332 0 1733 0 50988 0 31426 0 372547 0 0 0 JUDY MARVIN MD 245150 0 13440 0 920 0 47700 0 29909 0 337119 0 0 0 NICOLE VANDERHEYDEN MD 450477 0 0 0 1680 0 56105 0 30489 0 538751 0 0 0 AMED EBEID MD 444160 0 12071 0 1391 0 58201 0 22926 0 538749 0 0 0 TRACY TAGGERT MD 204035 0 77912 0 684 0 23350 0 23993 0 329974 0 0 0 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 THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS 521542796 794458CZ0 2008-11-13 125000000 QUALIFIED HOSPITAL BOND 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 128355347 1105000 127250347 2009 0 0 0 1 125021764 633004 9260268 2009 1 0 0 1 60586069 6069298 837899 6153872 2009 1 0 0 1 0 0 1 1 1 0.00070 0.00000 0.00070 1 0 0 1 1 1 0.00020 0.00000 0.00020 1 0 0 1 1 1 0.00010 0.00000 0.00010 1 0 0 0 1 WELLS FARGO BANK NA 2.000000000000 0 0 0 0 1 1 UBS Ag 25.800000000000 0 0 0 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. 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 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 Professional Fees OR 501(c)(3) 3 Salem Health Oregon Community Imaging LLC 2925 Ryan DR SE Salem OR 97301 202683062 Medical Imaging Cooperative OR Salem Hospital Related 594173 19263 0 1 Salem Cardio Diagnostics 665 Winter Street SE Salem OR 97301 930579722 Cardio Diagnostics OR Salem Hospital Related 2216946 1578661 0 0 1 1 1 1 0 0 0 0 0 1 0 0 1 1 1 1 0 1 Salem Hospital Foundation C 1267154 Willamette Valley Professional Services D 2059122 West Valley Hospital D 4514888 West Valley Hospital P 1365953 Salem Cardio Diagnostics I 249613 Salem Cardio Diagnostics P 432638 Salem Hospital Foundation P 413188 Willamette Valley Professional Services P 931754 Willamette Valley Insurance Company P 177174 Willamette Valley Insurance Company O 2800000