2023-05-15T09:16:21-05:00 2022-06-30 135565207 KPMG LLP 1300 SW 5TH AVENUE SUITE 3800 PORTLAND OR 97201 990 2021-07-01 431960221 SALEM HEALTH WEST VALLEY SALE 5038141938 525 SOUTHEAST WASHINGTON ST DALLAS OR 97338 JAMES PARR EVP OF OPERATIONS & CFO 5038141938 2023-05-14 1 JAMES PARR 999009999 JAMES LANCASTER P00742579 5032216500 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JAMES PARR 525 SOUTHEAST WASHINGTON ST DALLAS OR 97338 52515863 0 X WWW.SALEMHEALTH.ORG X 2002 OR WE STRIVE TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE AND COMMUNITY WE SERVE. 14 14 302 24 58064 24620 55357 23694 43991498 52482870 14637 2943 0 0 44061492 52509507 0 5000 0 0 20140992 23954638 0 0 0 15268320 16643909 35409312 40603547 8652180 11905960 43856584 57929206 5814551 7487725 38042033 50441481 TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE. 0 0 15742483 42626205 SALEM HEALTH WEST VALLEY IS A CRITICAL ACCESS HOSPITAL SERVING THE RURAL POLK COUNTY REGION WITH A POPULATION OF 89,164. SERVICES INCLUDE: DIAGNOSTIC IMAGING PROCEDURES 33,513 EMERGENCY DEPARTMENT VISITS 18,251, INPATIENT ADMISSIONS 154, LABORATORY TESTS / DRAWS 288,250, SURGERIES 349. 15503445 5000 8804394 SALEM HEALTH WEST VALLEY PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. IN THE 12 MONTHS ENDED 06/30/2022, THE COST OF SERVICES PROVIDED AS A COMMUNITY BENEFIT TOTALED $7,000,000. THIS FIGURE CONSISTED OF $3,900,000 IN COSTS TO PROVIDE CHARITY CARE TO INDIVIDUALS WHO CANNOT AFFORD TO PAY AND $3,100,000 IN UNDERPAYMENT BY MEDICAID AS THE AMOUNT PAID UNDER THE PROGRAM WAS LESS THAN THE COST TO PROVIDE THE SERVICES. 1944690 1052271 SALEM HEALTH WEST VALLEY ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN THE 12 MONTHS ENDED 06/30/2022, SALEM HEALTH WEST VALLEY GAVE $82,012 FOR UNFUNDED OR UNDERFUNDED HEALTH SERVICES, INCLUDING 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. 33190618 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 35 0 1 302 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X SALEM HEALTH 5038141938 890 OAK STREET SE SALEM OR 97301 LANE SHETTERLY CHAIR 0.80 5.20 X X 0 0 0 ALAN WYNN SECRETARY/TREASURER 0.40 2.70 X X 0 0 0 JOHN COMBES MD CHAIR-ELECT 0.60 3.40 X 0 0 0 KATHERINE L KEENE PAST-CHAIR 0.70 4.30 X 0 0 0 ANGELICA VEGA TRUSTEE 0.30 4.70 X 0 0 0 ANNETTE CAMPISTA TRUSTEE 0.20 3.30 X 0 0 0 DAVID HARRISON MD TRUSTEE 0.40 2.60 X 0 0 0 JENN COLUMBUS TRUSTEE 0.40 2.50 X 0 0 0 KENNETH SHERMAN JR TRUSTEE 0.90 4.70 X 0 0 0 MARK ZOOK TRUSTEE 0.70 4.20 X 0 0 0 PHIL JACKSON TRUSTEE 0.40 2.60 X 0 0 0 RICARDO LINARES TRUSTEE 0.40 2.60 X 0 0 0 ROBERT KELLY MD TRUSTEE 0.70 3.80 X 0 0 0 THERESA HASKINS TRUSTEE 0.50 3.00 X 0 0 0 CHERYL NESTER WOLFE PRESIDENT & CEO 6.00 34.00 X 0 1489354 37763 JAMES PARR EVP OF OPERATIONS & CFO 3.00 37.00 X 0 968668 93184 BRANDON SCHMIDGALL CHIEF ADMIN OFFICER 40.00 0.00 X 368006 0 66681 JENNIFER BROADUS DIRECTOR, CLINICAL OPS 40.00 0.00 X 196603 0 20811 JOHN HADLEY MD FAMILY PRACTITIONER 40.00 0.00 X 234502 0 25593 SEVEN J HILL WVH IMAGING LEAD 40.00 0.00 X 215338 0 22895 MARGIE L HUGGINS CLINICAL NURSE BSN 40.00 0.00 X 184744 0 23003 MARY S PLACEK FAMILY PRACTITIONER 40.00 0.00 X 313647 0 0 MIA H BISHOP WVH OUTPATIENT SVCS NURSE MGR 40.00 0.00 X 191224 0 28117 1704064 2458022 318047 53 0 1 0 AYA HEALTHCARE INC DEPT 3519 PO BOX 123519 DALLAS TX 753123519 CONTRACT LABOR 339895 MAXIM STAFFING SOLUTIONS 12558 COLLECTIONS CENTER DR CHICAGO IL 60693 CONTRACT LABOR 291128 TODD HIXSON 490 LEFFELLE ST S SALEM OR 97302 CONTRACT LABOR 282716 TOWNE PARK LLC PO BOX 79349 BALTIMORE MD 212790349 VALET & PARKING SERVICES 273505 JANI-KING EUGENE SALEM 11851 NE GLENN WIDING DR PORTLAND OR 97220 CONTRACT LABOR 153450 6 23694 23694 REGIONAL LAB 621300 24058922 24051963 6959 PATIENT SERVICE REV. 621500 22162413 22162413 PHARMACY 621110 5871342 5820237 51105 OTHER HOSPITAL SERVICE 900099 239918 239918 NUTRITION SERVICES 722210 150275 150275 52482870 9299 9299 6356 -6356 -6356 -6356 52509507 52424806 58064 2943 5000 5000 666128 666128 18024190 16257945 1766245 61877 61877 3915326 3408130 507196 1287117 1119605 167512 22500 22500 35270 35270 1873907 1749433 124474 47318 47318 3225764 721817 2503947 -1566 -1566 2349591 1164788 1184803 32634 20351 12283 17010 9351 7659 488108 488108 66388 66388 PATIENT SUPPLIES 3760495 3760495 PROVIDER TAX 2644312 2644312 OTHER PURCHASED SERVICE 1045732 851600 194132 BAD DEBT 926926 926926 109520 -2065 111585 40603547 33190618 7412929 0 300 300 435316 309344 5682672 6063126 548558 722633 110509 190037 10190895 5010963 2012879 5179932 275900 275900 34790450 45187934 43856584 57929206 3322748 3328243 42465 17820 2449338 4141662 5814551 7487725 X 37993661 50395308 48372 46173 38042033 50441481 43856584 57929206 X 11905960 493488 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 48372 -1231 47141 47747 625 48372 48090 -343 47747 43057 2773 45830 40755 2302 43057 1.00000 0 1 1 6947678 5010963 1936715 3243217 3243217 5179932 DUE FROM OAHHS 649073 DUE FROM PAC-MED 11079377 DUE FROM SALEM HEALTH 33252428 LEASED RENTAL SPACE 160883 BENEFICIAL INTEREST IN FOUNDATION 46173 45187934 OTHER LONG-TERM ACCRUALS 8792 LIAB. FOR MALPRACTICE INSURANCE 163092 POST-RETIREMENT BENEFITS 89164 DUE TO OAHHS 655954 DUE TO MEDICARE/MEDICAID 1502704 DUE TO PHH 1721956 4141662 X PART V, LINE 4: ENDOWMENT FUNDS ARE HELD BY WEST VALLEY HOSPITAL FOUNDATION FOR SALEM HEALTH WEST VALLEY SUPPORT. PART X, LINE 2: THE CORPORATION, SALEM WEST VALLEY, SHF, WVHF, SHPS, AND WVIC ARE TAX-EXEMPT ORGANIZATIONS PURSUANT TO INTERNAL REVENUE SECTION 5041(C)(3). AS SUCH, ONLY UNRELATED BUSINESS INCOME IS SUBJECT TO FEDERAL OR STATE INCOME TAXES. THE PROVISION FOR UNRELATED BUSINESS INCOME TAXES IS IMMATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE CORPORATION TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATIONAND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE CORPORATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2022 THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE CORPORATION MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO FISCAL YEAR 2019. 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 6414 3895323 3895323 0.09600 25840 11937469 8804394 3133075 0.07720 32254 15832792 8804394 7028398 0.17320 370 82012 119 81893 0.00200 6813 6813 0.00020 1810632 1052271 758361 0.01870 45233 45233 0.00110 370 1944690 1052390 892300 0.02200 32624 17777482 9856784 7920698 0.19520 0 1256270 217819 4108367 3985614 122753 X 1 1 1 NONE 1 1 SALEM HEALTH WEST VALLEY 525 SOUTHEAST WASHINGTON ST DALLAS OR 97338 14-1461 X X X SALEM HEALTH WEST VALLEY 0 0 1 X X X X X X X X X 19 1 1 1 1 X WWW.SALEMHEALTH.ORG/ABOUT/COMMUNITY X SEE PART V, SECTION C X X 1 19 1 WWW.SALEMHEALTH.ORG/ABOUT/COMMUNITY 0 1 X 300.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY X HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY X HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY X X X X X X X 1 X 0 X X X X X 1 X 0 0 SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 5: A COMPREHENSIVE NEEDS ASSESSMENT WAS CONDUCTED IN THE TAX YEAR 2019, SUBSTANTIALLY UPDATED IN 2021. PARTNERS INCLUDING MARION COUNTY HEALTH & HUMAN SERVICES, POLK COUNTY HEALTH DEPARTMENT, WILLAMETTE VALLEY COMMUNITY HEALTH (WVCH), LOCAL HEALTH PROFESSIONALS, AND COMMUNITY PARTNERS BEGAN A NEW MAPP (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) CYCLE TO ASSESS AND IMPROVE THE HEALTH OF THE COMMUNITY. MAPP IS A FLEXIBLE, EVIDENCED BASED FRAMEWORK, CREATED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO). EACH COMMUNITY THAT UTILIZES MAPP CONDUCTS A COMMUNITY HEALTH ASSESSMENT (CHA), WHICH CASTS A WIDE NET COLLECTING DATA IN VARIOUS WAYS TO UNDERSTAND LOCAL HEALTH AND WHY HEALTH CONDITIONS OCCUR. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH COOPERATION AND REPRESENTATIVES FROM SALEM HEALTH, KAISER PERMANENTE, SANTIAM HOSPITAL AND LEGACY HEALTH. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH THE BEHAVIORAL CARE NETWORK, CHEMEKETA COMMUNITY COLLEGE, CHERRIOTS, CITY OF WOODBURN, COMMUNITY ACTION AGENCY, COMMUNITY ADVISORY COUNCIL , EARLY LEARNING HUB, KAISER PERMANENTE, LEGACY HEALTH SILVERTON , MARION COUNTY HEALTH & HUMAN SERVICES, NORTHWEST SENIOR & DISABILITY SERVICES, POLK COUNTY HEALTH DEPARTMENT, SANTIAM HOSPITAL, WESTERN OREGON UNIVERSITY, WILLAMETTE VALLEY COMMUNITY HEALTH.PART V, SECTION B, LINE 7B:WWW.CO.POLK.OR.US/PH/COMMUNITY-HEALTH-ASSESSMENT-CHA SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 7D: THE HOSPITAL MADE THE CHNA WIDELY AVAILABLE TO THE COMMUNITY. THE FULL ASSESSMENT IS POSTED TO THE HOSPITAL AND COUNTY WEBSITES. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 11: PRIORITY AREAS DETERMINED IN THE 2019 ASSESSMENT AND 2021 UPDATE ARE BEHAVIORAL HEALTH SUPPORT, HOUSING, AND SUBSTANCE USE. BEHAVIORAL HEALTH CONTINUES TO BE AN AREA OF FOCUS AND CONCERN FOR OUR COMMUNITY, PREVENTING/INTERVENING IN MENTAL ILLNESS SUCH AS ANXIETY OR DEPRESSION AND SUICIDE PREVENTION. A CDC REPORT IN 2020 RANKED OREGON THE 13TH IN THE COUNTRY FOR DEATHS BY SUICIDE, TWO SPOTS WORSE THAN 2017. SUICIDE CONTINUES TO BE THE 2ND LEADING CAUSE OF DEATH FOR AGES 10-24. MARION AND POLK COUNTIES CONTINUE TO HAVE HIGH RISK FACTORS FOR YOUTH. IN THE MOST RECENT DATA FROM 2019, 33.8% OF POLK COUNTY 11TH GRADERS REPORTED SYMPTOMS OF DEPRESSION AND IN MARION COUNTY, 38.3% OF 11TH GRADERS REPORTED SYMPTOMS. ELEVENTH GRADE STUDENTS SURVEYED IN POLK COUNTY REPORTED THAT 20.4% WERE SERIOUSLY CONSIDERING SUICIDE AND 7.7% HAD ACTUALLY ATTEMPTED SUICIDE. IN MARION COUNTY, 19.9% OF 11TH GRADERS SERIOUSLY CONSIDERED SUICIDE AND ATTEMPTS INCREASED FROM 2017 TO 10%. OUR COMMUNITY CONTINUES TO BE AT OR ABOVE THE OREGON AVERAGES IN DEPRESSION AND SUICIDE MARKERS. ABOUT 1 IN 4 ADULTS HAS BEEN DIAGNOSED WITH DEPRESSION IN THE COMMUNITY, WHICH WAS SIMILAR TO THE STATE. A HIGHER PERCENTAGE OF FEMALES HAVE BEEN DIAGNOSED WITH DEPRESSION THAN MALES. ABOUT 13% OF ADULTS IN MARION EXPERIENCED FREQUENT MENTAL DISTRESS, COMPARED TO 12% IN POLK AND 14% IN THE STATE. MALE COMMUNITY MEMBERS AND THOSE WHO IDENTIFIED AS AMERICAN INDIAN/ALASKA NATIVE OR WHITE, NON-HISPANIC HAD HIGHER MORTALITY RATES THAN THEIR PEERS. SALEM HEALTH WEST VALLEY EMERGENCY ROOM CONDUCTS A SUICIDE PREVENTION SCREENING ON EVERY PERSON THAT PRESENTS THEMSELVES TO THE HOSPITAL. WE ALSO PROVIDE SUPPORTS TO OUR COMMUNITY INCLUDING QPR TRAININGS (QUESTION, PERSUADE, REFER) AND ENGAGEMENT IN THE MID-VALLEY SUICIDE PREVENTION COALITION.WEST VALLEY SUPPORTS THE POLK COUNTY SERVICE INTEGRATION TEAM (SIT), BOTH FINANCIALLY AND SERVING AS MEMBERS ON THE TEAM. THE PURPOSE OF SIT IS TO FACILITATE COLLABORATION AMONG COMMUNITY PARTNERS TO PROVIDE COORDINATED RESOURCES AND INFORMATION FOR INDIVIDUALS AND FAMILIES. WE ARE AGENCY AND COMMUNITY PARTNERS EXPEDITING SOLUTIONS BY MATCHING RESOURCES TO CLEARLY DEFINED NEEDS, WHILE AVOIDING DUPLICATION OF SERVICE. SIT IS ABLE TO INTERVENE IN A VARIETY OF CIRCUMSTANCES AND PROVIDE MULTIPLE RESOURCES, CONNECTING INDIVIDUALS AND FAMILIES AND MINIMIZING TOXIC STRESS.SUBSTANCE USE AND ABUSE, INCLUDING ALCOHOL, TOBACCO, AND DRUGS, REMAIN PRIMARY SOURCES OF PREVENTABLE DEATH IN THE COMMUNITY, STATE, AND THE COUNTRY. IN 2014, 20.2 MILLION ADULTS IN THE UNITED STATES (8.4%) HAD A SUBSTANCE USE DISORDER AND OF THOSE 7.9 MILLION HAD BOTH A MENTAL DISORDER AND A SUBSTANCE USE DISORDER. THIS SIGNIFICANT OVERLAP BETWEEN SUBSTANCE ABUSE AND MENTAL HEALTH UNDERSCORES THE IMPORTANCE OF CAPTURING WHO IS ENGAGING IN BEHAVIORS INDICATIVE OF THESE DISORDERS IN THE COMMUNITY. WHILE IT IS DIFFICULT TO CAPTURE DRUG USE AND OVERDOSE DATA SPECIFIC TO POLK COUNTY, THE STATE OF OREGON HAS SEEN AN 8.6% INCREASE IN DRUG RELATED DEATHS SINCE AUGUST 2021. THE GROWING OPIOID EPIDEMIC IS FUELED BY FENTANYL AND OTHER SYNTHETIC MANUFACTURED OPIOIDS. OVER 700,000 PEOPLE DIED IN THE UNITED STATES (U.S.) FROM DRUG OVERDOSES BETWEEN 1999 AND 2017, WITH OPIOIDS BEING INVOLVED IN 70% OF DRUG OVERDOSE DEATHS IN 2018. RECENT PROVISIONAL DATA FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), 2019 SHOW THAT THERE WERE AN ESTIMATED 100,306 REPORTED OVERDOSES DURING THE12-MONTH PERIOD ENDING IN APRIL 2021 (AHMAD ET AL., 2021). AS THE OPIOID OVERDOSE MORTALITY CRISIS CONTINUES, ATTENTION HAS FOCUSED ON HOW LAW ENFORCEMENT CAN SAVE INDIVIDUALS WHO ARE OVERDOSING BY EQUIPPING OFFICERS WITH THE OVERDOSE REVERSAL DRUG NALOXONE. THE FOOD AND DRUG ADMINISTRATION APPROVED NALOXONE FOR TREATING OPIOID OVERDOSES IN 1971. NALOXONE IS A SAFE OPIOID ANTAGONIST MEDICATION THAT CAN RAPIDLY REVERSE AN OPIOID OVERDOSE. BECAUSE IT IS SAFE AND EFFECTIVE AT REVERSING OVERDOSES AND HAS NO POTENTIAL FOR ABUSE, STATES HAVE PASSED LAWS FACILITATING LAY PERSON ACCESS AND THE FEDERAL GOVERNMENT HAS CALLED FOR INCREASED ACCESS TO ALL APPROVED FORMS OF NALOXONE. WEST VALLEY HOSPITAL PROVIDES A GRANT TO LOCAL LAW ENFORCEMENT SO THEY MAY CARRY NARCAN (BRAND NAME FOR NALOXONE) IN THEIR VEHICLES. HOUSING AND HEALTH CARE WORK ARE CRITICAL PARTNERS IN PREVENTING AND ENDING HOMELESSNESS. HEALTHCARE SERVICES ARE MORE EFFECTIVE AND BETTER DELIVERED WHEN A PATIENT IS STABLY HOUSED. THE RATE OF HOMELESSNESS HAS BEEN INCREASING BOTH IN THE COMMUNITY AND THE STATE IN RECENT YEARS, INCLUDING GROWING NUMBERS OF STUDENTS IN K-12 EXPERIENCING HOMELESSNESS. THIS LEADS TO INADEQUATE CARE, DIFFICULT CONNECTING TO SERVICES, AND CONTRIBUTING TO CHRONIC DISEASE. EXPOSURE TO COMMUNICABLE DISEASE INCREASES, AND CHRONIC HEALTH CONDITIONS SUCH AS HIGH BLOOD PRESSURE AND DIABETES BECOME WORSE DUE TO MEDICATION STORAGE ISSUES AND DIFFICULTY MAINTAINING A HEALTHY DIET. BEHAVIORAL HEALTH ISSUES SUCH AS DEPRESSION, ALCOHOLISM, OR OTHER SUBSTANCE USE DISORDERS CAN DEVELOP AND/OR ARE MADE WORSE IN SUCH DIFFICULT SITUATIONS.WEST VALLEY SUPPORTS COMMUNITY PARTNERS AND THEIR EFFORTS TO ADDRESS HOUSING AND HEALTH RELATED SOCIAL NEEDS. A COMMUNITY HEALTH FAIR WAS HELD QUARTERLY IN FALLS CITY DURING THE 2021-22 FISCAL YEAR, OFFERING VACCINATIONS, HEALTH SCREENINGS, AND CONNECTION TO OTHER COMMUNITY RESOURCES INCLUDING SHELTER AND FOOD. WEST VALLEY CONTRIBUTES TO ELLA CURRAN FOOD BANK, WHICH IS A FOOD PANTRY FOR THOSE IN NEED WHO LIVE IN OR NEAR MONMOUTH AND INDEPENDENCE. SHWV ACTIVELY PARTICIPATES WITH COUNTY WIDE SERVICE INTEGRATION TEAMS WHICH FACILITATE A WIDE VARIETY OF DONATIONS FOR IDENTIFIED NEEDS AS WELL AS DURABLE MEDICAL EQUIPMENT FOR THOSE WHO ARE WITHOUT HOMES OR RESOURCES. THE HOSPITAL PROVIDES COMMUNITY BASIC HEALTH IMPROVEMENT SERVICES AS REQUESTED IN MARION AND POLK COUNTIES. IN 2022, THESE INCLUDED HEALTH SCREENINGS, EDUCATION AND OUTREACH. WEST VALLEY PARTICIPATED IN WESTERN OREGON UNIVERSITY'S PRE-MED AND NURSING STUDENT EDUCATION FAIR AS WELL AS THE BUSINESS AND INDUSTRY PARTNERS' EDUCATION FAIR IN POLK COUNTY; PARTICIPATED IN FALLS CITY'S "BACK TO SCHOOL BASH AND PROVIDED FIRST AID SERVICES AT THE POLK COUNTY FAIR.IN TOTAL, WEST VALLEY'S OUTREACH TEAM WAS ABLE TO IMPACT OVER 11,000 UNIQUE INDIVIDUALS. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 13B: SALEM HEALTH WEST VALLEY FINANCIAL MATRIX IS BASED ON INCOME AS A PERCENT OF FEDERAL POVERTY LEVEL. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 13H: CRITERIA CONSIDERED IN DETERMINING ELIGIBILITY INCLUDE, BUT ARE NOT LIMITED TO: 1) THE HOUSEHOLD'S GROSS INCOME. THE DEFINITION OF HOUSEHOLD GROSS INCOME INCLUDES THE COMBINED GROSS MONTHLY INCOME OF ALL PERSONS LEGALLY RESPONSIBLE FOR PATIENT BILL OR BALANCE.2) HOUSEHOLD'S ASSETS OTHER THAN PRIMARY RESIDENCE.1. EQUITY IN A REAL ESTATE (OTHER THAN THE PATIENT/GUARANTOR'S PRIMARY RESIDENCE), SECURITIES OR OTHER ASSETS ARE CONSIDERED AVAILABLE TO PAY THE PATIENT'S MEDICAL EXPENSES AND SHOULD BE INCLUDED IN THE INCOME CALCULATION 2. THE INCOME FROM INCOME-PRODUCING REAL PROPERTY SHOULD BE USED IN THE CALCULATION RATHER THAN THE EQUITY. 3. INDIVIDUAL RETIREMENT ACCOUNTS (IRAS) OR OTHER RETIREMENT FUNDS WILL NOT BE INCLUDED IN HOUSEHOLD ASSETS; HOWEVER DISTRIBUTIONS FROM THOSE FUNDS WILL BE CONSIDERED INCOME.3) FAMILY SIZE (PERSONS LEGALLY RESPONSIBLE FOR THE PATIENT BILL AND THEIR DEPENDENTS).4) THE FAMILY'S MONTHLY OUT-OF-POCKET EXPENSES FOR MEDICAL SUPPLIES AND SERVICES.5) ELIGIBILITY MAY BE CONTINGENT UPON PATIENT COOPERATION WITH THE APPLICATION PROCESS. HOUSEHOLD INCOMES UP TO 400% OF THE ANNUAL POVERTY LEVEL GUIDELINES (FPG) WILL BE ELIGIBLE FOR FINANCIAL ASSISTANCE AS OUTLINED BELOW AND IN THE FPG FINANCIAL MATRIX:FINANCIAL MATRIX INCOME AS A PERCENTAGE OF FEDERAL POVERTY LEVEL PERCENTAGE OF FPG PERCENTAGE DISCOUNT0-300% 100%301- 400% 65% SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 15E: SUPPORTING DOCUMENTATION MAY INCLUDE THE FOLLOWING: PATIENT MUST PROVIDE TWO OF THE FOLLOWING DOCUMENTS TO SUPPORT THE INCOME CLAIMS ON THE APPLICATION. THREE MONTHS INCOME VERIFICATION IN THE FORM OF PAY STUBS, BANK DEPOSITS, ETC.SOCIAL SECURITY DETERMINATION LETTERSTHE PRIOR YEAR'S TAX RETURNS OR 450T-EZA "BASIC NEEDS" LETTER THAT INDICATES HOW PERSONS WITH NO INCOME ARE MEETING THEIR DAY TO DAY BASIC LIVING NEEDS. "BASIC NEEDS" LETTER MUST ONLY BE CONSIDERED A SECONDARY SUPPORTING DOCUMENT AFTER THE FINANCIAL COUNSELOR OR CLERK VALIDATES THAT INFORMATION. AS OUTLINED IN SALEM HEALTH'S CONDITIONS OF ADMISSION, A CREDIT BUREAU REPORT OR A CHARITY SCORING VENDOR MAY BE REQUESTED TO VALIDATE INFORMATION PROVIDED ON THE FINANCIAL ASSISTANCE APPLICATION. SALEM HEALTH WEST VALLEY MAY ACCEPT INFORMATION PROVIDED ON AN OHP APPLICATION, OHP ELIGIBILITY, PROBATE ESTATES DETERMINATION, DOCUMENTATION OF HOMELESS STATUS, OR RELIABLE THIRD PARTY CREDIT INFORMATION AS A SUBSTITUTE FOR THE FINANCIAL FORMS. OHP INFORMATION WILL BE CONSIDERED VALID 30 DAYS PRIOR TO ADMISSION AND 90 DAYS POST DISCHARGE. APPROVED SOURCES OF DOCUMENTATION FOR HOMELESS STATUS INCLUDE CHART NOTES, DISCHARGE PLANS, OR DISCHARGE SUMMARIES ENTERED INTO OUR HEALTH INFORMATION SYSTEM BY CARE PROVIDERS OF THE PATIENT INDICATING THEY ARE HOMELESS DURING THE REGISTRATION PROCESS. FINANCIAL ASSISTANCE GRANTED BASED ON THIRD PARTY INFORMATION RATHER THAN A FINANCIAL ASSISTANCE APPLICATION DOES NOT EXTEND TO FUTURE DATES OF SERVICE AND WOULD NEED TO BE REEVALUATED BASED ON INFORMATION AVAILABLE THAT TIME. APPLICATION PROCESS AND ELIGIBILITY DETERMINATIONA REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BEFORE, DURING OR AFTER THE PROVISION OF CARE. THE HOSPITAL HAS DEVELOPED AN APPLICATION PROCESS FOR DETERMINING INITIAL INTEREST IN AND QUALIFICATION FOR FINANCIAL ASSISTANCE. REQUESTS FOR FINANCIAL ASSISTANCE WILL BE ACCEPTED FROM THE PATIENT DIRECTLY, OR OTHERS ON THE PATIENT'S BEHALF. THIS COULD INCLUDE BUT IS NOT LIMITED TO, THE PATIENT'S REPRESENTATIVE OR HOSPITAL STAFF.PART V, SECTION B, LINE 16-FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION MAY BE DOWNLOADED FROM OUR WEBSITE: HTTPS://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY-PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION ARE AVAILABLE IN THE EMERGENCY DEPARTMENT, IN REGISTRATION AREAS AND AT PATIENT FINANCIAL SERVICES, 550 HAWTHORNE SE, SUITE 200, SALEM OREGON 97301. -PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATIONS MAY BE REQUESTED BY MAIL FROM FINANCIAL COUNSELING, SALEM HEALTH, PO BOX 14001, SALEM, OR 97309-9976 OR VIA TELEPHONE BY CALLING 503-562-4357. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 16J: INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS MADE PUBLICLY AVAILABLE FREE OF CHARGE IN THE FOLLOWING MANNER:1. NOTICES ARE POSTED IN KEY AREAS OF THE HOSPITAL, INCLUDING ADMITTING, THE EMERGENCY DEPARTMENT, OUTPATIENT DEPARTMENT REGISTRATION AREAS, AND PATIENT FINANCIAL SERVICES.2. THE CONDITIONS OF ADMISSION FORM INFORMS THE PATIENT OF THEIR RIGHT TO APPLY FOR FINANCIAL ASSISTANCE.3. WRITTEN INFORMATION SHALL BE AVAILABLE IN ENGLISH, SPANISH, RUSSIAN AND VIETNAMESE. THE HOSPITAL WILL PROVIDE THE APPROPRIATE INTERPRETATION SERVICES FOR PATIENTS/GUARANTORS WHO DO NOT SPEAK ENGLISH.4. FRONT-LINE STAFF WILL BE TRAINED TO ANSWER FINANCIAL ASSISTANCE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY THAT CANNOT BE ANSWERED TO FINANCIAL COUNSELOR'S IN A TIMELY MANNER.5. THIS POLICY WILL BE POSTED ON SALEM HEALTH'S WEB SITE. WRITTEN INFORMATION ABOUT THIS POLICY WILL BE MADE AVAILABLE UPON REQUEST.6. ALL PATIENT BILLING STATEMENTS WILL INCLUDE A NOTICE THAT FINANCIAL ASSISTANCE IS AVAILABLE AND CONTACT INFORMATION IF THEY WANT TO LEARN MORE. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 18E: IT IS THE POLICY OF SALEM HEALTH WEST VALLEY TO PURSUE COLLECTION OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR SERVICES. SALEM HEALTH WEST VALLEY MAKES REASONABLE EFFORTS TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. COLLECTION PROCEDURES APPLIED CONSISTENTLY AND FAIRLY FOR ALL PATIENTS REGARDLESS OF INSURANCE STATUS. ALL COLLECTIONS PROCEDURES WILL COMPLY WITH APPLICABLE LAWS AND WITH SALEM HEALTH'S MISSION. FOR THOSE PATIENTS UNABLE TO PAY ALL OR A PORTION OF THEIR OPEN BALANCES, THE FINANCIAL ASSISTANCE POLICY WILL BE FOLLOWED.COLLECTION AGENCIES AND/OR LAW FIRMS MAY BE ENLISTED AFTER REASONABLE COLLECTION AND PAYMENT OPTIONS HAVE BEEN EXHAUSTED. AGENCIES MAY HELP RESOLVED ACCOUNTS WHERE PATIENTS ARE UNCOOPERATIVE IN MAKING PAYMENTS, HAVE NOT MADE APPROPRIATE PAYMENTS OR HAVE BEEN UNWILLING TO PROVIDE REASONABLE FINANCIAL AND OTHER DATA TO SUPPORT THEIR REQUEST FOR FINANCIAL ASSISTANCE. COLLECTION AGENCY AND LAW FIRM STAFF WILL UPHOLD THE CONFIDENTIALITY AND INDIVIDUAL DIGNITY OF EACH PATIENT. ALL AGENCIES AND LAW FIRMS WILL COMPLY WITH ALL APPLICABLE LAWS INCLUDING HIPAA REQUIREMENTS FOR HANDLING PROTECTED HEALTH INFORMATION. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 19E: SALEM HEALTH WEST VALLEY WILL NOTIFY INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS AT LEAST 30 DAYS PRIOR TO PURSUING EXTRAORDINARY COLLECTIONS ACTIONS (ECA) TO OBTAIN PAYMENT FOR THE CARE PROVIDED BY THE HOSPITAL. ECAS FOR HOSPITAL SERVICES WILL NOT COMMENCE FOR A PERIOD OF AT LEAST 240 DAYS AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT AND 30 DAYS AFTER THE HOSPITAL OR AUTHORIZED THIRD PARTY PROVIDES WRITTEN NOTICE OF ECAS THE HOSPITAL PLANS TO INITIATE FOR THE APPLICABLE MEDICALLY NECESSARY OR EMERGENCY CARE. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 20E: SALEM HEALTH WEST VALLEY WILL NOTIFY INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS AT LEAST 30 DAYS PRIOR TO PURSUING EXTRAORDINARY COLLECTIONS ACTIONS (ECA) AS TO OBTAIN PAYMENT FOR THE CARE PROVIDED BY THE HOSPITAL BY DOING THE FOLLOWING:1) PROVIDE WRITTEN NOTICE TO THE INDIVIDUAL INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS, INDICATING THAT SALEM HEALTH WEST VALLEY INTENDS TO INITIATE OR HAVE A THIRD PARTY INITIATE TO OBTAIN PAYMENT FOR THE CARE AND PROVIDE A DEADLINE AFTER WHICH ECAS MAY BE PURSUED AND WHICH IS NO SOONER THAN 30 DAYS AFTER THE DATE OF THIS WRITTEN NOTICE.2) PROVIDE THE INDIVIDUAL A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WITH THE WRITTEN NOTICE.3) MAKE REASONABLE EFFORTS TO ORALLY NOTIFY INDIVIDUAL ABOUT THE SALEM HEALTH'S FINANCIAL ASSISTANCE POLICY. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 21C: NOT APPLICABLE. SALEM HEALTH WEST VALLEY HAS A POLICY RELATIVE TO EMERGENCY MEDICAL CARE THAT REQUIRED THE HOSPITAL FACILITY TO PROVIDE, WITHOUT DISCRIMINATION, CARE FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 21D: NOT APPLICABLE. SALEM HEALTH WEST VALLEY HAS A POLICY RELATIVE TO EMERGENCY MEDICAL CARE THAT REQUIRED THE HOSPITAL FACILITY TO PROVIDE, WITHOUT DISCRIMINATION, CARE FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. 4 1 - SALEM HEALTH MEDICAL CLINIC - MONMOUTH 512 MAIN ST E STE 300 MONMOUTH OR 97361 CLINIC 2 - SALEM HEALTH MEDICAL CLINIC - INDEPENDEN 1430 MONMOUTH ST INDEPENDENCE OR 97351 CLINIC 3 - CENTRAL SCHOOL - HEALTH CLINIC 1601 MONMOUTH ST STE 100 INDEPENDENCE OR 97351 CLINIC 4 - SURGICAL SPECIALTY CLINIC 641 SE MILLER AVE DALLAS OR 97338 CLINIC PART I, LINE 3C: CRITERIA CONSIDERED IN DETERMINING ELIGIBILITY INCLUDE BUT ARE NOT LIMITED TO: 1) THE HOUSEHOLD'S GROSS INCOME. THE DEFINITION OF HOUSEHOLD GROSS INCOME INCLUDES THE COMBINED GROSS MONTHLY INCOME OF ALL PERSONS LEGALLY RESPONSIBLE FOR PATIENT BILL OR BALANCE.2) HOUSEHOLD'S ASSETS OTHER THAN PRIMARY RESIDENCE. EQUITY IN A REAL ESTATE (OTHER THAN THE PATIENT/GUARANTOR'S PRIMARY RESIDENCE), SECURITIES OR OTHER ASSETS ARE CONSIDERED AVAILABLE TO PAY THE PATIENTS' MEDICAL EXPENSES AND SHOULD BE INCLUDED IN THE INCOMES CALCULATION. THE INCOME FROM INCOME-PRODUCING REAL PROPERTY SHOULD BE USED IN CALCULATION RATHER THAN THE EQUITY. INDIVIDUAL RETIREMENT ACCOUNTS (IRAS) OR OTHER RETIREMENT FUNDS WILL NOT BE INCLUDED IN HOUSEHOLD ASSETS, HOWEVER DISTRIBUTIONS FROM THOSE FUNDS WILL BE CONSIDERED INCOME.3) FAMILY SIZE (PERSONS LEGALLY RESPONSIBLE FOR THE PATIENT BILL AND THEIR DEPENDENTS)4) THE FAMILY'S MONTHLY OUT-OF-POCKET EXPENSES FOR MEDICAL SUPPLIES AND SERVICES5) ELIGIBILITY MAY BE CONTINGENT UPON PATIENT COOPERATION WITH THE APPLICATION PROCESS. THE DEFINITION OF "HOUSEHOLD GROSS INCOME" INCLUDES THE COMBINED GROSS MONTHLY INCOME OF ALL PERSONS LEGALLY RESPONSIBLE FOR PATIENT BILL OR BALANCE.SUPPORTING DOCUMENTATION MAY INCLUDE THE FOLLOWING: PATIENT MUST PROVIDE TWO OF THE FOLLOWING DOCUMENTS TO SUPPORT THE INCOME CLAIMS ON THE APPLICATION. THREE MONTHS INCOME VERIFICATION IN THE FORM OF PAY STUBS, BANK DEPOSITS, ETC.SOCIAL SECURITY DETERMINATION LETTERSTHE PRIOR YEAR'S TAX RETURNS OR 450T-EZA "BASIC NEEDS" LETTER THAT INDICATES HOW PERSONS WITH NO INCOME ARE MEETING THEIR DAY TO DAY BASIC LIVING NEEDS. "BASIC NEEDS" LETTER MUST ONLY BE CONSIDERED A SECONDARY SUPPORTING DOCUMENT AFTER THE FINANCIAL COUNSELOR OR CLERK VALIDATES THAT INFORMATION. AS OUTLINED IN SALEM HEALTH'S CONDITIONS OF ADMISSION, A CREDIT BUREAU REPORT OR A CHARITY SCORING VENDOR MAY BE REQUESTED TO VALIDATE INFORMATION PROVIDED ON THE FINANCIAL ASSISTANCE APPLICATION. SALEM HEALTH WEST VALLEY MAY ACCEPT INFORMATION PROVIDED ON AN OHP APPLICATION, OHP ELIGIBILITY, PROBATE ESTATES DETERMINATION, DOCUMENTATION OF HOMELESS STATUS, OR RELIABLE THIRD PARTY CREDIT INFORMATION AS A SUBSTITUTE FOR THE FINANCIAL FORMS. OHP INFORMATION WILL BE CONSIDERED VALID 30 DAYS PRIOR TO ADMISSION AND 90 DAYS POST DISCHARGE. APPROVED SOURCES OF DOCUMENTATION FOR HOMELESS STATUS INCLUDE CHART NOTES, DISCHARGE PLANS, OR DISCHARGE SUMMARIES ENTERED INTO OUR HEALTH INFORMATION SYSTEM BY CARE PROVIDERS OF THE PATIENT INDICATING THEY ARE HOMELESS DURING THE REGISTRATION PROCESS. FINANCIAL ASSISTANCE GRANTED BASED ON THIRD PARTY INFORMATION RATHER THAN A FINANCIAL ASSISTANCE APPLICATION DOES NOT EXTEND TO FUTURE DATES OF SERVICE AND WOULD NEED TO BE REEVALUATED BASED ON INFORMATION AVAILABLE THAT TIME. PART I, LINE 6A: A COMMUNITY BENEFIT REPORT WAS PUBLISHED AND IS AVAILABLE AT HTTPS://WWW.SALEMHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-BENEFIT-REPORTS. PART I, LINE 7: THE RATIO OF PATIENT CARE COST TO CHARGES WAS USED TO CALCULATE THE TOTAL COMMUNITY BENEFIT EXPENSE ON LINE 7, COLUMN C. THIS RATIO WAS APPLIED TO TOTAL FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS THAT ACCOUNT FOR A LARGE PORTION OF SALEM HEALTH'S COMMUNITY BENEFIT CONTRIBUTION. ENSURING THAT COMMUNITY MEMBERS HAVE ACCESS TO EMERGENCY, PRIMARY CARE AND OTHER HEALTH SERVICES REGARDLESS OF ABILITY TO PAY ALIGNS WITH THE HOSPITAL MISSION AND COMMITMENT TO SERVE THOSE LIVING IN MARION AND POLK COUNTIES.PART II: SALEM HEALTH WEST VALLEY IS DEEPLY EMBEDDED IN THE COMMUNITY AND HOSPITAL LEADERS WORK HAND IN HAND WITH REPRESENTATIVES FROM GOVERNMENT AGENCIES AND OTHER NON-PROFIT ORGANIZATIONS TO ASSESS AND ADDRESS COMMUNITY NEEDS. THREE AREAS CURRENTLY IDENTIFIED AS PRIORITIES ARE BEHAVIORAL HEALTH SUPPORT, HOUSING, AND SUBSTANCE USE. COMMUNITY WIDE TASK FORCES ARE IN PLACE TO ADDRESS THESE HEALTH NEEDS, WHICH ARE DEEMED MOST CRITICAL IN THE TWO COUNTIES SERVED BY SALEM HEALTH. REPRESENTATIVES FROM APPROPRIATE AREAS OF THE HOSPITAL ATTEND TASK FORCE MEETINGS AND LEVERAGE HOSPITAL RESOURCES TO POSITIVELY IMPACT HEALTH OUTCOMES. HOSPITAL LEADERS VOLUNTEER TIME TO SERVE ON COMMUNITY NON-PROFIT BOARDS WHICH MIRROR THE MISSION OF SALEM HEALTH WEST VALLEY AND ATTEND REGIONAL COLLABORATIVE WORK GROUPS THAT ADDRESS SOCIAL DETERMINANTS OF HEALTH. EXAMPLES INCLUDE BOARD POSITIONS ON SALEM FREE CLINIC, FAMILY BUILDING BLOCKS, MARION POLK FOOD SHARE, THE BOYS AND GIRLS CLUB, UNITED WAY, UNION GOSPEL MISSION, AND LIBERTY HOUSE.THE HOSPITAL PROVIDES COMMUNITY BASES HEALTH IMPROVEMENT SERVICES AS REQUESTED IN MARION AND POLK COUNTIES. IN 2019, THESE INCLUDED HEALTH SCREENINGS, EDUCATION AND OUTREACH. THE COMMUNITY HEALTH EDUCATION CENTER OFFERS A HEALTH RELATED LENDING LIBRARY, DROP-IN NURSING CONSULTATION SERVICES AND GROUP INSTRUCTION. DIABETIC AND NUTRITION COUNSELING IS ALSO OFFERED FOR PATIENTS NEWLY DIAGNOSED AND UNABLE TO PAY FOR THESE SERVICES. THE CENTER PROVIDES SPACE FREE OF CHARGE TO COMMUNITY PARTNERS SEEKING TO IMPROVE HEALTH OUTCOMES. THE ROOMS HOST CLASSES, LECTURES, HEALTH FAIRS AND SUPPORT GROUPS THAT ARE COORDINATED IN PARTNERSHIP WITH COMMUNITY AGENCIES. SALEM HEALTH WEST VALLEY PROVIDED COMMUNITY PARTNER GRANTS IN 2019 TO ENHANCE EXISTING NON-PROFIT ORGANIZATIONS' WORK THAT ADDRESSES NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. ADDITIONAL FINANCIAL GRANTS ARE ISSUED TO NON-PROFITS THAT ADDRESS ACCESS TO HEALTH CARE FOR UN- AND UNDERINSURED POPULATIONS. LASTLY, THE HOSPITAL PROVIDES TRAINING FOR NURSING STUDENTS AND EMERGING HEALTH CARE PROFESSIONALS THROUGH HEALTH CAREER EXPLORATION PROGRAMS FOR HIGH SCHOOL STUDENTS IN DISTRICTS THAT FALL WITHIN THE HOSPITAL CATCHMENT AREA, SERVING HUNDREDS OF HIGH SCHOOL STUDENTS ASPIRING TO MEDICAL CAREERS. PART III, LINE 2: BAD DEBT EXPENSE IS PRIMARILY ESTIMATED BASED UPON THE HOSPITALS' HISTORICAL COLLECTION EXPERIENCE, THE AGE OF THE PATIENT'S ACCOUNT, THE PATIENT'S ECONOMIC ABILITY TO PAY, AND THE EFFECTIVENESS OF COLLECTION EFFORTS. PATIENT ACCOUNTS RECEIVABLE BALANCES ARE ROUTINELY REVIEWED IN CONJUNCTION WITH HISTORICAL COLLECTION RATES AND OTHER ECONOMIC CONDITIONS THAT MIGHT ULTIMATELY AFFECT THE COLLECTABILITY OF PATIENT ACCOUNTS WHEN CONSIDERING THE ADEQUACY OF THE AMOUNTS RECORDED IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ACTUAL WRITE-OFFS HISTORICALLY HAVE APPROXIMATED MANAGEMENT'S EXPECTATIONS. PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER SALEM HEALTH'S FINANCIAL ASSISTANCE POLICY IS ESTIMATED BASED ON DATA FROM OUR PATIENT ACCOUNTING SYSTEM. THIS DATA IS THEN COMPARED AND MATCHED TO MEDIAN HOUSEHOLD INCOME CENSUS DATA BY ZIP CODE TO DETERMINE THE ESTIMATED BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT AN ESTIMATED COLLECTIBLE AMOUNT AND DO NOT BEAR INTEREST. EXPLICIT PRICE CONCESSIONS ARE ESTABLISHED AS A RESULT OF NEGOTIATED REIMBURSEMENT METHODOLOGIES WITH THIRD PARTY PAYORS.THE CORPORATION ALSO RECORDS ESTIMATED IMPLICIT PRICE CONCESSIONS (BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE) RELATED TO UNINSURED ACCOUNTS TO RECORD SELF-PAY REVENUES AT THE ESTIMATED AMOUNTS WE EXPECT TO COLLECT. THE CORPORATION DOES NOT ASSESS CREDIT RISK BEFORE SERVICES ARE RENDERED. PART III, LINE 8: MEDICARE FEE-FOR-SERVICE COSTS ARE DETERMINED FROM SALEM HEALTH WEST VALLEY'S FILED MEDICARE COST REPORT. PART III, LINE 9B: THE BILLING AND COLLECTIONS ADMINISTRATIVE HOUSE-WIDE POLICY AND PROCEDURE STATES, "IF A PATIENT SUBMITS A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, SALEM HEALTH WILL SUSPEND THE ECAS UNTIL THE PATIENT'S APPLICATION HAS BEEN PROCESSED AND NOTIFY THE PATIENT OF DETERMINATION. IF AN INDIVIDUAL IS FOUND TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, ANY ECAS WILL BE REVERSED. PART VI, LINE 2: PLEASE SEE PART V, SECTION B, LINE 11 NARRATIVE PART VI, LINE 3: PLEASE SEE NARRATIVE, PART V, SECTION B, LINES 13-16 PART VI, LINE 4: MARION AND POLK COUNTY ARE LOCATED IN THE WILLAMETTE VALLEY AND ARE THE 5TH AND 13TH MOST POPULOUS COUNTIES IN OREGON RESPECTIVELY. THIS COMMUNITY SPANS ABOUT 1,950 SQUARE MILES, OF WHICH 1,200 ARE IN MARION AND 750 ARE IN POLK. IN MARION, THE FIVE LARGEST CITIES ARE KEIZER, SALEM, SILVERTON, STAYTON, AND WOODBURN, WHICH ARE HOME TO 66% OF THE COUNTY'S TOTAL POPULATION. THE REMAINING 34% LIVE IN ONE OF THE SMALLER 15 CITIES OR ON UNINCORPORATED LAND. IN POLK, THE LARGEST CITIES ARE DALLAS, FALLS CITY, INDEPENDENCE, MONMOUTH, WEST SALEM, AND WILLAMINA, OF WHICH ABOUT 84% OF POLK'S POPULATION RESIDES. THOSE WHO LIVE OUTSIDE OF THE MAJOR POPULATION AREAS IN THE COMMUNITY MAY EXPERIENCE GREATER DIFFICULTY ACCESSING RESOURCES LIKE HEALTH CARE SERVICES AND HEALTHY FOODS. GIVEN THE LIMITED PUBLIC TRANSPORTATION IN THESE RURAL AREAS, ACCESS TO A VEHICLE IS LIKELY REQUIRED TO LIVE A HEALTHY LIFESTYLE. AS OF 2019 THERE WERE ABOUT 433,908 PEOPLE LIVING IN THE COMMUNITY, WHICH IS ABOUT 10% OF THE TOTAL STATE POPULATION OF THOSE, IT IS ESTIMATED THAT 347,818 PEOPLE LIVE IN MARION AND 86,085 LIVE IN POLK. SINCE 2010, THE POPULATION HAS INCREASED BY 8% IN MARION AND 11% IN POLK, WHICH WAS SIMILAR TO THE INCREASE IN THE STATE AS A WHOLE. THERE WERE ALSO A LARGER NUMBER OF PEOPLE LIVING PER SQUARE MILE IN THIS COMMUNITY COMPARED TO THE STATE AND THIS WAS ESPECIALLY TRUE FOR MARION. JUST OVER HALF OF COMMUNITY MEMBERS IDENTIFIED AS FEMALE, WHICH WAS SIMILAR TO THE STATE. THE COMMUNITY HAD A LARGER PROPORTION OF MEMBERS BETWEEN THE AGES OF 0-24 YEARS OLD THAN OREGON. THERE WAS ALSO A SMALLER PROPORTION OF WORKING AGE ADULTS (25-64) IN THE COMMUNITY THAN THE STATE. IN 2016, THE MEDIAN AGE WAS LOWER IN MARION (36.4 YEARS) COMPARED TO POLK (37.7 YEARS) AND THE STATE (39.2 YEARS.) ADDITIONALLY, MORE PEOPLE HAVE BEEN MIGRATING INTO THIS COMMUNITY AS OPPOSED TO LEAVING, WHICH IS EXPECTED TO CONTINUE DURING THE FORECAST PERIOD. BETWEEN 2017 AND 2035, GROWTH WILL OCCUR AT A SLIGHTLY HIGHER PACE AND WILL BEGIN TO SLOW DOWN, TAPERING OFF TOWARDS THE END OF THE FORECAST. IT IS ESTIMATED THAT THIS COMMUNITY WILL EXCEED 500,000 MEMBERS BY 2035 AND POLK WILL BE GROWING AT A FASTER RATE THAN MARION. SHIFTS IN AGE GROUPS WILL BE OCCURRING OVER THE NEXT 50 YEAR FORECAST PERIOD IN THIS COMMUNITY, WITH A GREATER PROPORTION OF MEMBERS FALLING INTO OLDER AGE GROUPS. THIS CHANGE IS IMPORTANT, AS IT HIGHLIGHTS THE NEED TO EXPAND AND PREPARE FOR THE GROWING HEALTH NEEDS OF AN AGING POPULATION. ABOUT 26% OF COMMUNITY MEMBERS IN MARION IDENTIFIED AS HISPANIC OR LATINA(O), WHICH WAS HIGHER THAN POLK (13%) AND OREGON (12%). MARION HAD A SMALLER PROPORTION OF MEMBERS WHO IDENTIFIED AS WHITE, NON-HISPANIC/LATINA(O) THAN POLK AND THE STATE. MARION ALSO HAD A LARGER PROPORTION OF MEMBERS WHO IDENTIFIED AS NATIVE HAWAIIAN OR PACIFIC ISLANDER THAN POLK AND THE STATE. ABOUT 1 OUT OF 4 HOUSEHOLDS (25%) IN MARION SPOKE A LANGUAGE OTHER THAN OTHER THAN ENGLISH AT HOME THAN POLK (14%) AND THE STATE (15%). COMMUNITY MEMBERS IN MARION HAD LOWER HOUSEHOLD MEDIAN INCOMES AND A HIGHER PERCENTAGE LIVING IN POVERTY, ESPECIALLY CHILDREN, THAN POLK AND THE STATE. ROUGHLY 25% OF CHILDREN WERE LIVING IN POVERTY IN MARION, COMPARED TO 17% IN POLK AND 20% IN OREGON. IN THE COMMUNITY, A HIGHER PROPORTION OF FEMALES WERE LIVING IN POVERTY THAN MALES, AND MEMBERS WHO IDENTIFIED AS A RACE OR ETHNICITY OTHER THAN WHITE, NON-HISPANIC/LATINA(O) HAD HIGHER POVERTY RATES AS WELL. OVERALL, POVERTY RATES HAVE BEEN DECREASING IN THIS COMMUNITY AND THE STATE RECENTLY, LIKELY DUE IN PART TO IMPROVING ECONOMIC CONDITIONS. EDUCATIONAL ACHIEVEMENT HAS BEEN IMPROVING IN RECENT YEARS AS A HIGHER PERCENTAGE OF COMMUNITY MEMBERS HAVE A HIGH SCHOOL DIPLOMA/GED. HOWEVER, EDUCATIONAL ACHIEVEMENT IN MARION WAS LOWER THAN POLK AND THE STATE, ESPECIALLY WITH REGARD TO COLLEGE GRADUATES. IN MARION, 22% OF PEOPLE HAD A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 30% IN POLK AND 31% IN OREGON. EDUCATIONAL ACHIEVEMENT DIFFERED BY SEX, RACE AND ETHNICITY, GEOGRAPHY, AND DISABILITY STATUS. ABOUT 1 OUT OF 5 CHILDREN WERE FOOD INSECURE IN THIS COMMUNITY. IT WAS ALSO DIFFICULT FOR SOME COMMUNITY MEMBERS TO OBTAIN HEALTHY FOODS DUE TO AFFORDABILITY AND LOW ACCESS TO STORES THAT SELL THEM. PART VI, LINE 7, REPORTS FILED WITH STATES OR X X X X 0 1 0 0 0 0 0 0 0 CHERYL NESTER WOLFE PRESIDENT & CEO 0 1004801 0 260357 0 224196 0 21750 0 16013 0 1527117 0 0 JAMES PARR EVP OF OPERATIONS & CFO 0 678541 0 236644 0 53483 0 69633 0 23551 0 1061852 0 0 BRANDON SCHMIDGALL CHIEF ADMIN OFFICER 272513 0 93496 0 1997 0 44111 0 22570 0 434687 0 0 0 MARY S PLACEK FAMILY PRACTITIONER 274123 0 38684 0 840 0 0 0 0 0 313647 0 0 0 JOHN HADLEY MD FAMILY PRACTITIONER 166559 0 52258 0 15685 0 16519 0 9074 0 260095 0 0 0 SEVEN J HILL WVH IMAGING LEAD 214136 0 1000 0 202 0 14077 0 8818 0 238233 0 0 0 MIA H BISHOP WVH OUTPATIENT SVCS NURSE MGR 159638 0 31452 0 134 0 13671 0 14446 0 219341 0 0 0 JENNIFER BROADUS DIRECTOR, CLINICAL OPS 164672 0 31619 0 312 0 16700 0 4111 0 217414 0 0 0 MARGIE L HUGGINS CLINICAL NURSE BSN 182361 0 1744 0 639 0 13935 0 9068 0 207747 0 0 0 PART I, LINE 3 THE BOARD OF TRUSTEES WHO WORK ON CEO COMPENSATION IS THE SAME BOARD FOR SH AND SHWV 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: BRANDON SCHMIDGALL - $19,462 (INCLUDED IN DEFERRED COMPENSATION) JAMES PARR - $47,883 (INCLUDED IN DEFERRED COMPENSATION) FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SALEM HEALTH WEST VALLEY IS SALEM HEALTH HOSPITALS & CLINICS ("SHHC"), A NOT-FOR-PROFIT ENTITY. THE SALEM HEALTH WEST VALLEY TRUSTEES ARE ELECTED BY SHHC WHO ALSO APPROVES SIGNIFICANT DECISIONS OF THE SALEM HEALTH WEST VALLEY GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7A THE BYLAWS OF SALEM HEALTH WEST VALLEY STATE THAT THE TRUSTEES OF SALEM HEALTH WEST VALLEY SHALL BE ELECTED BY SHHC AT EACH ANNUAL ORGANIZATION MEETING OF THE BOARD OF DIRECTORS OF SHHC, OR IF ANY SUCH ANNUAL MEETING IS NOT HELD, THEN THE TRUSTEES MAY BE ELECTED AT A REGULAR OR SPECIAL MEETING OF THE BOARD OF DIRECTORS OF SHHC. FORM 990, PART VI, SECTION A, LINE 7B PURSUANT TO THE SALEM HEALTH WEST VALLEY BYLAWS, SHHC SHALL HAVE THE SOLE AND EXCLUSIVE RIGHT TO ACT WITH RESPECT TO THE FOLLOWING AFFAIRS OF SALEM HEALTH WEST VALLEY: A. APPROVAL OF THE MERGER OR CONSOLIDATION OF SALEM HEALTH WEST VALLEY WITH ANY OTHER ORGANIZATION OR ENTITY; PROVIDED, HOWEVER, THAT THE BOARD OF TRUSTEES MAY SUBMIT MERGER AND CONSOLIDATION PROPOSALS TO SHHC FOR ITS APPROVAL; B. ELECTION TO DISSOLVE AND WIND UP THE AFFAIRS OF SALEM HEALTH WEST VALLEY; PROVIDED THAT THE BOARD OF TRUSTEES MAY SUBMIT A DISSOLUTION PROPOSAL TO SHHC FOR ITS APPROVAL; C. SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF SALEM HEALTH WEST VALLEY; PROVIDED, HOWEVER, THAT THE BOARD OF TRUSTEES MAY SUBMIT PROPOSALS FOR SUCH DISPOSITIONS TO SHHC FOR ITS APPROVAL; D. APPROVAL OF ANNUAL OPERATING CASH AND CAPITAL BUDGETS; E. APPROVAL OF LONG-TERM COMMITMENTS; F. APPROVAL OF LONG-RANGE PLANS; G. APPROVAL OF SPECIAL PROJECTS INVOLVING CAPITAL OR OPERATING EXPENDITURES IN EXCESS OF $1,000,000; AND H. MATERIAL ADDITIONS OR DELETIONS OF SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S ACCOUNTING & FINANCE TEAM WORKS CLOSELY WITH THE OUTSIDE ACCOUNTING FIRM IT ENGAGES TO PREPARE AND REVIEW THE RETURN. THE CONTROLLER AND CFO REVIEW A DRAFT OF THE FORM 990 BEFORE IT IS PRESENTED TO THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES. FINANCE ADMINISTRATION ADDRESSES AND RESPONDS TO QUESTIONS RAISED BY MEMBERS OF THE GOVERNANCE COMMITTEE. AFTER IT IS REVIEWED BY THE GOVERNANCE COMMITTEE, THE FINAL FORM 990 IS FORWARDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. 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 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 HEALTH (SH) IS DESIGNED TO ALLOW THE ORGANIZATION TO RECRUIT AND RETAIN QUALIFIED SENIOR LEADERS. THE GOVERNANCE COMMITTEE OF THE SH BOARD OF TRUSTEES, NONE OF WHOM IS A SH EMPLOYEE, ENGAGES ONE OR MORE INDEPENDENT CONSULTANTS TO PROVIDE MARKET DATA ON CEO COMPENSATION, INCLUDING BENEFITS, FOR THE CEOS AT COMPARABLE ORGANIZATIONS. THIS INFORMATION IS USED BY THE GOVERNANCE COMMITTEE AND BOARD OF TRUSTEES IN ITS DISCUSSIONS AND DECISIONS ON CEO COMPENSATION. COMPENSATION FOR THE CEO IS REVIEWED ON AN ANNUAL BASIS. THE MOST RECENT REVIEW TOOK PLACE IN SEPTEMBER 2021. THE COMPENSATION DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN THE GOVERNANCE COMMITTEE AND BOARD MINUTES FOR THIS MEETING. ONE OR MORE INDEPENDENT CONSULTANTS ARE ALSO RETAINED TO REVIEW EXECUTIVE COMPENSATION SEPARATE FROM THE CEO. THE CEO, IN CONJUNCTION WITH THE INDEPENDENT CONSULTANTS, ENSURES THAT EACH EXECUTIVE'S COMPENSATION IS COMPETITIVE IN THE MARKET FOR SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS. THE CEO ALSO PROVIDES INFORMATION TO THE BOARD GOVERNANCE COMMITTEE ON THE LEVELS OF EXECUTIVE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE ON THE HOSPITAL WEBSITE. FORM 990, PART XI, LINE 9: CHANGE IN NET BENEFIT COST 18,280. CHANGE IN BENEFICIAL INTEREST -1,231. OTHER CHANGE IN NET ASSETS 476,439. 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