2022-05-13T12:15:19-05:00 2021-06-30 135565207 KPMG LLP 1918 EIGHTH AVENUE SUITE 2900 SEATTLE WA 98101 990 2020-07-01 431960221 SALEM HEALTH WEST VALLEY SALE 5038141938 525 SOUTHEAST WASHINGTON ST DALLAS OR 97338 JAMES PARR EVP OF OPERATIONS & CFO 5038141938 2022-05-12 1 JAMES PARR 999009999 SUE ROBISON P00560072 2069134000 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JAMES PARR 525 SOUTHEAST WASHINGTON ST DALLAS OR 97338 44061492 0 X WWW.SALEMHEALTH.ORG X 2002 OR WE STRIVE TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE AND COMMUNITY WE SERVE. 13 13 257 15 29462 15519 45168 55357 37865956 43991498 12484 14637 0 0 37923608 44061492 0 0 0 0 18029445 20140992 0 0 0 13554091 15268320 31583536 35409312 6340072 8652180 40985988 43856584 12287624 5814551 28698364 38042033 TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE. 0 0 13575394 36243656 SALEM HEALTH WEST VALLEY IS A CRITICAL ACCESS HOSPITAL SERVING THE RURAL POLK COUNTY REGION WITH A POPULATION OF 88,916. SERVICES INCLUDE: DIAGNOSTIC IMAGING PROCEDURES 26,788, EMERGENCY DEPARTMENT VISITS 14,229, INPATIENT ADMISSIONS 157, LABORATORY TESTS/DRAWS 291,532, SURGERIES 409. 12966725 6892850 SALEM HEALTH WEST VALLEY PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. IN THE 12 MONTHS ENDED 6/30/21, THE COST OF SERVICES PROVIDED AS A COMMUNITY BENEFIT TOTALED $6M. THIS FIGURE CONSISTED OF $3.3M IN COSTS TO PROVIDE CHARITY CARE TO INDIVIDUALS WHO CANNOT AFFORD TO PAY AND $2.7M IN UNDERPAYMENT BY MEDICAID AS THE AMOUNT PAID UNDER THE PROGRAM WAS LESS THAN THE COST TO PROVIDE THE SERVICES. 1645637 854992 SALEM HEALTH WEST VALLEY ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN THE 12 MONTHS ENDED 6/30/21, SALEM HEALTH WEST VALLEY GAVE $10,814 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. 28187756 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 37 0 257 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X SALEM HEALTH 5038141938 890 OAK STREET SALEM OR 97301 MARK ZOOK TRUSTEE 0.70 4.20 X 0 0 0 LANE SHETTERLY CHAIR 0.80 5.20 X X 0 0 0 KENNETH SHERMAN JR TRUSTEE 0.90 4.70 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 KATHERINE KEENE PAST-CHAIR 0.70 4.30 X 0 0 0 THERESA HASKINS TRUSTEE 0.50 3.00 X 0 0 0 DAVID HARRISON MD TRUSTEE 0.40 2.60 X 0 0 0 BONNIE DRIGGERS RN TRUSTEE 0.70 4.30 X 0 0 0 ALAN WYNN SECRETARY/TREASURER 0.40 2.70 X X 0 0 0 JENN COLUMBUS TRUSTEE 0.40 2.50 X 0 0 0 PHIL JACKSON TRUSTEE 0.40 2.60 X 0 0 0 JOHN COMBES MD CHAIR-ELECT 0.60 3.40 X 0 0 0 CHERYL NESTER WOLFE CEO & PRESIDENT 6.00 34.00 X 0 1421603 37584 JAMES PARR EVP OF OPERATIONS & CFO 3.00 37.00 X 0 810561 88591 JENNIFER BROADUS DIRECTOR, CLINICAL OPS 40.00 0.00 X 186435 0 18370 BRANDON SCHMIDGALL CHIEF ADMIN OFFICER 40.00 0.00 X 322147 0 64640 KIMBERLY WELLS OP SVCS NURSE MGR 40.00 0.00 X 162436 0 23059 JOHN HADLEY MD FAMILY PRACTITIONER 40.00 0.00 X 426627 0 38166 CHARLES ESSEX MD FAMILY PRACTITIONER 39.00 1.00 X 329207 0 36968 ALISON SMITH MD GENERAL SURGEON 27.00 1.00 X 285805 0 13843 TIFFANY DUELL PHARMACIST AMBULATORY CARE 40.00 0.00 X 160247 0 26791 BRUCE RODGERS FORMER CHIEF ADMIN OFFICER 0.00 0.00 X 106441 0 0 1979345 2232164 348012 8 1 1 0 SALEM RADIOLOGY CONSULTANTS PO BOX 12989 SALEM OR 97301 CONTRACT LABOR 505660 EMCARE INC 7032 COLLECTION CTR DR CHICAGO IL 60693 CONTRACT LABOR 360298 TODD HIXSON 490 LEFELLE ST S SALEM OR 97302 CONTRACT LABOR 293056 SALEM EMERGENCY PHYSICIANS 890 OAK ST SE BLDG A SALEM OR 97301 CONTRACT LABOR 106250 4 55357 55357 PATIENT SERVICE REVENU 621500 19908189 19908189 REGIONAL LAB 621300 19187733 19168381 19352 PHARMACY 621110 4763673 4753563 10110 NUTRITION SERVICES 722210 118312 118312 OTHER HOSPITAL SERVICE 900099 13591 13591 43991498 14637 14637 44061492 43962036 29462 14637 522639 522639 15309604 13685037 1624567 302874 302874 2921317 2525121 396196 1084558 937468 147090 32866 32866 1648721 1565478 83243 15621 15621 3281813 701784 2580029 33786 33777 9 2044653 904996 1139657 16309 10140 6169 20910 12924 7986 513203 513203 16559 16559 PATIENT SUPPLIES 3027310 3027310 PROVIDER TAX 2022020 2022020 OTHER PURCHASED SERVICE 1422396 1160422 261974 BAD DEBT 1101279 1101279 70874 -29762 100636 35409312 28187756 7221556 0 300 300 2806886 435316 4450029 5682672 514817 548558 145577 110509 7143441 5130562 12900707 2012879 275900 275900 19891772 34790450 40985988 43856584 3519259 3322748 4059378 42465 4708987 2449338 12287624 5814551 X 28650617 37993661 47747 48372 28698364 38042033 40985988 43856584 X 8652180 691489 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 47747 625 48372 48090 -343 47747 45830 2260 48090 43057 2773 45830 40755 2302 43057 1.00000 0 1 1 6959060 5130562 1828498 184381 184381 2012879 DUE FROM PAC-MED 11013702 DUE FROM OAHHS 527368 DUE FROM SALEM HOSPITAL 23064731 LEASED RENTAL SPACE 136277 BENEFICIAL INTEREST IN FOUNDATION 48372 34790450 DUE TO MEDICARE/MEDICAID 1603836 LIAB. FOR MALPRACTICE INSUR. 155368 POST-RETIREMENT BENEFITS 141862 OTHER LONG-TERM ACCRUALS 9751 DUE TO OAHHS 538521 2449338 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 CORPORATION AND 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, 2021 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 2018. 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 8656 3327413 3327413 0.09400 28195 9639312 6892850 2746462 0.07750 36851 12966725 6892850 6073875 0.17150 765 10814 10814 0.00030 1622086 854992 767094 0.02170 12737 12737 0.00040 765 1645637 854992 790645 0.02240 37616 14612362 7747842 6864520 0.19390 0 1647110 304981 5769125 5498709 270416 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 0 0 SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 5: A COMPREHENSIVE NEEDS ASSESSMENT WAS CONDUCTED IN THE TAX YEAR 2019. 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. 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 ARE BEHAVIORAL HEALTH SUPPORT, HOUSING, SUBSTANCE USE. WHILE COVID WAS NON-EXISTENT AT THE TIME THE CHNA WAS CONDUCTED, ITS IMPACT QUICKLY ECLIPSED OTHER NEEDS AND OVERWHELMED OUR PARTNERS IN PUBLIC HEALTH. SALEM HEALTH WEST VALLEY RECOGNIZED A NEED WITHIN OUR COMMUNITY TO DISTRIBUTE VACCINATIONS AND ACTED QUICKLY TO STAND UP A MASS VACCINATION SITE, FIRST AT THE POLK COUNTY FAIRGROUNDS, AND THEN AT WESTERN OREGON UNIVERSITY. AS DISPARITIES IN ACCESS FOR OUR COMMUNITIES OF COLOR BECAME APPARENT, WEST VALLEY PARTNERED WITH SALEM HEALTH TO INCLUDE MOBILE VACCINE TEAMS TO REACH UNDERSERVED AND BIPOC COMMUNITIES IN BOTH MARION AND POLK COUNTIES. THE MOBILE VACCINE TEAM BROUGHT OVER 13,000 COVID-19 VACCINATIONS TO PEOPLE AT FARMS, FOOD PROCESSING PLANTS, CHURCHES, PARISHES, AND RURAL AREAS IN MARION AND POLK COUNTIES. WE WENT TO SENIOR LIVING COMMUNITIES, HOMELESS COMMUNITIES AND SCHOOLS. THE OUTREACH WAS PRACTICAL, WIDESPREAD AND SIGNIFICANT.BEHAVIORAL HEALTH: 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 REDUCING SUICIDE ATTEMPTS AND COMPLETIONS. A CDC REPORT IN 2017 RANKED OREGON THE 14TH HIGHEST IN THE COUNTRY FOR DEATHS RELATED TO DRUG OVERDOSES AND 15TH FOR SUICIDE. 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. WE ARE MAKING HEADWAY IN POLK COUNTY WHICH AT 33.8% OF 11TH GRADERS REPORTED SYMPTOMS OF DEPRESSION, WAS A SIGNIFICANT DROP FROM THE PREVIOUS YEAR. MARION COUNTY INCREASED TO 38.3% OF 11TH GRADERS REPORTING SYMPTOMS. 11TH GRADE STUDENTS SERIOUSLY CONSIDERING SUICIDE IN POLK COUNTY WERE 20.4% WITH 7.7% ACTUALLY ATTEMPTING. IN MARION COUNTY 11TH GRADERS SERIOUSLY CONSIDERING SUICIDE IN 2019 WERE 19.9% 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. COVID-19 PANDEMIC HIGHLIGHTED HEALTH DISPARITIES IMPACTING LATINOS AND IMMIGRANTS IN OUR COMMUNITY. AT 27% MARION COUNTY HAS OVER TWICE THE HISPANIC POPULATION AS THE OREGON STATE AVERAGE (13.3%). POLK COUNTY HISPANIC POPULATION IS 14%. THE CHALLENGES AROUND COMMUNICATION OPTIONS IN SPANISH COMBINED WITH A LACK OF A PRIMARY CARE PROVIDER (ESPECIALLY SOMEONE SPEAKING SPANISH) AND OTHER NEEDS EMERGING DURING THE PANDEMIC, CREATED HIGH LEVELS OF TOXIC STRESS WITHIN THE LATINO COMMUNITY. SALEM HEALTH WEST VALLEY PARTNERED WITH CHURCHES, LATINA ORGANIZATIONS AND OTHER TRUSTED PARTNERS TO PROVIDE SERVICES THAT SPECIFICALLY TARGETED AND MET THE NEEDS OF THIS COMMUNITY, ESPECIALLY AROUND COVID VACCINATION EFFORTS.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 MIDVALLEY SUICIDE PREVENTION COALITION.SUBSTANCE ABUSE: SUBSTANCE USE AND ABUSE, INCLUDING ALCOHOL, TOBACCO, AND DRUGS, REMAIN PRIMARY SOURCES OF PREVENTABLE DEATH IN THE COMMUNITY, STATE, AND THE COUNTRY. CO-OCCURRING DIAGNOSES FOR BOTH MENTAL ILLNESS AND SUBSTANCE USE DISORDERS ARE COMMON. 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. THE IMPACT SUBSTANCE ABUSE HAS ON OUR COMMUNITY IS SIGNIFICANT. ABOUT 33% OF MOTOR VEHICLE FATALITIES IN MARION COUNTY INVOLVED ALCOHOL, COMPARED TO 29% IN POLK COUNTY AND 32% IN THE STATE. THE RATE OF DEATHS THAT INVOLVED ALCOHOL HAS BEEN INCREASING IN THE COMMUNITY IN RECENT YEARS. ROUGHLY 14% OF ADULT COMMUNITY MEMBERS BINGE DRINK, COMPARED TO 18% OF ADULTS IN THE STATE. IN MARION COUNTY, 16% OF ADULTS WERE CURRENT CIGARETTE SMOKERS COMPARED TO 15% IN POLK AND 18% IN THE STATE. THE COMMUNITY IS NOT CURRENTLY MEETING THE HEALTHY PEOPLE 2020 GOAL FOR CIGARETTE SMOKING. TOBACCO IS THE AGENT MOST RESPONSIBLE FOR AVOIDABLE ILLNESS AND DEATH IN AMERICA TODAY. ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION, TOBACCO USE BRINGS PREMATURE DEATH TO ALMOST HALF A MILLION AMERICANS EACH YEAR AND IT CONTRIBUTES TO PROFOUND DISABILITY AND PAIN IN MANY OTHERS. THE WORLD HEALTH ORGANIZATION STATES THAT APPROXIMATELY ONE-THIRD OF ALL TOBACCO USERS IN THIS COUNTRY WILL DIE PREMATURELY BECAUSE OF THEIR DEPENDENCE ON TOBACCO. MARION AND POLK COUNTIES CONTINUE TO SEE A SIGNIFICANT INCREASE IN TOBACCO USE AND HAS SINCE 2011: MARION COUNTY HAS 19% OF ITS RESIDENTS USING TOBACCO AND POLK COUNTY REPORTS 16.4%. TOBACCO USE CONTRIBUTES TO MANY DISEASES, ESPECIALLY LUNG CANCER, A DISEASE FROM WHICH MARION AND POLK COUNTY RESIDENTS DIE A HIGHER RATE THAN THOSE IN OTHER PARTS OF OREGON. WITH TOBACCO USE COMES A GREATER EXPOSURE TO SECONDHAND SMOKE FOR NON-SMOKERS, WHICH MAY EXACERBATE A WIDE RANGE OF ADVERSE HEALTH EFFECTS SUCH AS RESPIRATORY INFECTIONS AND ASTHMA. ESPECIALLY CONCERNING IS THE INCREASE OF TOBACCO USE DURING PREGNANCY WHICH, ALTHOUGH IT HAS DECREASED IN RECENT YEARS IS STILL FAR HIGHER AT 10% THAN THE HEALTH PEOPLE 2020 GOAL OF LESS THAN 2%.SALEM HEALTH WEST VALLEY IS A SMOKE FREE CAMPUS. THE HOSPITAL SCREENS 100% OF ITS PATIENTS FOR TOBACCO USE AND PROVIDES ALL TOBACCO USERS WITH COMMUNITY CESSATION RESOURCE INFORMATION AND PROVIDE COMMUNITY BASED EDUCATION TO SCHOOLS RELATED TO TOBACCO PREVENTION. HOUSING: 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.SALEM HEALTH WEST VALLEY SUPPORTS COMMUNITY PARTNERS AND THEIR EFFORTS TO ADDRESS HOUSING AND SOCIAL DETERMINANTS OF HEALTH. 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. COMMUNITY WIDE TASK FORCES ARE IN PLACE TO ADDRESS THESE HEALTH NEEDS, WHICH ARE DEEMED MOST CRITICAL IN THE PRIMARILY TWO COUNTIES SERVED BY SALEM HEALTH WEST VALLEY. 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. 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 LETTERS THE PRIOR YEAR'S TAX RETURNS OR 450T-EZ A "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. SALEM HEALTH WEST VALLEY PART V, SECTION B, LINE 16J: INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS MADE PUBLICALLY 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. 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. PART V, SECTION B, LINE 7B: WWW.CO.POLK.OR.US/PH/COMMUNITY-HEALTH-ASSESSMENT-CHA 4 1 - SALEM HEALTH MEDICAL CLINIC - MONMOUTH 512 MAIN ST E STE 300 MONMOUTH OR 97361 CLINIC 2 - SALEM HEALTH WEST VALLEY MEDICAL CLINIC 555 SE WASHINGTON ST DALLAS OR 97338 CLINIC 3 - CENTRAL SCHOOL - HEALTH CLINIC 1601 MONMOUTH ST STE 100 INDEPENDENCE OR 97351 CLINIC 4 - SALEM HEALTH WEST VALLEY SPECIALTY CLINI 591 SE CLAY ST DALLAS TX 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 SERVICES.5) 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 LETTERS THE 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, COMMUNITY BUILDING ACTIVITIES: 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:STATE FILING OF A COMMUNITY BENEFIT REPORT OCCURS IN THE STATE OF OREGON. PART VI, LINE 7, REPORTS FILED WITH STATES OR X X X X 1 1 0 0 0 0 0 0 0 CHERYL NESTER WOLFE CEO & PRESIDENT 0 1003683 0 252189 0 165731 0 21375 0 16209 0 1459187 0 0 JAMES PARR EVP OF OPERATIONS & CFO 0 592723 0 170353 0 47485 0 65022 0 23569 0 899152 0 0 JOHN HADLEY MD FAMILY PRACTITIONER 293380 0 42000 0 91247 0 21375 0 16791 0 464793 0 0 0 BRANDON SCHMIDGALL CHIEF ADMIN OFFICER 250986 0 69962 0 1199 0 41739 0 22901 0 386787 0 0 0 CHARLES ESSEX MD FAMILY PRACTITIONER 260195 0 42000 0 27012 0 21375 0 15593 0 366175 0 0 0 ALISON SMITH MD GENERAL SURGEON 102582 0 0 0 183223 0 7789 0 6054 0 299648 0 0 0 JENNIFER BROADUS DIRECTOR, CLINICAL OPS 157209 0 28929 0 297 0 15828 0 2542 0 204805 0 0 0 TIFFANY DUELL PHARMACIST AMBULATORY CARE 159960 0 0 0 287 0 11129 0 15662 0 187038 0 0 0 KIMBERLY WELLS OP SVCS NURSE MGR 136724 0 25262 0 450 0 13833 0 9226 0 185495 0 0 0 BRUCE RODGERS FORMER CHIEF ADMIN OFFICER 0 0 0 0 106441 0 0 0 0 0 106441 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, LINES 4A-B PART I, LINE 4A: DURING CALENDAR YEAR 2020, BRUCE RODGERS RECEIVED $106,441 SEVERANCE PAYMENT 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 - $17,514 (INCLUDED IN DEFERRED COMPENSATION) JAMES PARR - $41,869 (INCLUDED IN DEFERRED COMPENSATION) 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 2020. 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 BENEFICIAL INTEREST 625. CHANGE IN NET BENEFIT COST 140,864. EQUITY TRANSFERS 550,000. SALEM HEALTH 890 OAK STREET SALEM OR 97301 930579722 HOSPITAL OR 501(C)(3) LINE 3 SHHC 0 SALEM HEALTH FOUNDATION 890 OAK STREET SALEM OR 97301 237002687 SUPPORT SH OR 501(C)(3) LINE 7 SHHC 0 SALEM HEALTH HOSPITALS AND CLINICS 890 OAK STREET SALEM OR 97301 930823471 LEASES LAND OR 501(C)(3) LINE 12A, I N/A 0 WEST VALLEY HOSPITAL FOUNDATION 525 SOUTHEAST WASHINGTON STREE DALLAS OR 97338 931298564 SUPPORT SHWV OR 501(C)(3) LINE 12A, I SHHC 0 WILLAMETTE VALLEY INSURANCE COMPANY 745 FORT STREET HONOLULU HI 96813 201836190 INSURANCE HI 501(C)(3) LINE 12A, I SHHC 0 SALEM HEALTH PROFESSIONAL SERVICES 890 OAK STREET SALEM OR 97301 753175249 BILLING OR 501(C)(3) LINE 12A, I SHHC 0 OREGON HEALTHCARE ENTERPRISES INC - 1 4000 KRUSE WAY PLACE BLDG 2 STE 100 LAKE OSWEGO OR 97035 456525337 TAX TRUST PROGRAM OR T 1339 0.00370 0 OREGON HEALTHCARE ENTERPRISES INC - 2 4000 KRUSE WAY PLACE BLDG 2 STE 100 LAKE OSWEGO OR 97035 456822739 TAX TRUST PROGRAM OR T 0 0 0 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 SALEM HEALTH HOSPITALS AND CLINICS K 1138428 CASH WILLAMETTE VALLEY COMMUNITY HEALTH LLC 2995 RYAN DRIVE SALEM OR 97301 455540852 COORDINATED C OR RELATED 0 -934189 736164 0 0 1 0.09090