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 930823471 SALEM HEALTH HOSPITALS & CLINICS SALE 5038141938 890 OAK STREET SALEM OR 97301 JAMES PARR EVP OF OPERATIONS & CFO 5038141938 2022-05-13 1 JAMES PARR 999009999 SUE ROBISON P00560072 2069134000 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JAMES PARR 890 OAK STREET SALEM OR 97301 150807987 0 X WWW.SALEMHEALTH.ORG X 1982 OR TO SUPPORT SALEM HEALTH, SALEM HEALTH WEST VALLEY AND RELATED ORGANIZATIONS. 13 13 0 0 0 0 0 0 101543 46777357 703 76428604 0 27602026 102246 150807987 0 0 0 0 0 0 0 0 0 0 24501995 0 24501995 102246 126305992 5205538 1314870796 545456 1095369639 4660082 219501157 TO SUPPORT SALEM HEALTH, SALEM HEALTH WEST VALLEY AND RELATED ORGANIZATIONS. 0 0 24501995 46777357 LEASES LAND AND BUILDINGS TO RELATED FACILITIES 24501995 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 0 0 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 0 0 1 1 OR X SALEM HEALTH 5038141938 890 OAK STREET SALEM OR 97301 JENN COLUMBUS TRUSTEE 0.20 2.80 X 0 0 0 JOHN COMBES MD CHAIR-ELECT 0.20 3.80 X 0 0 0 BONNIE DRIGGERS RN TRUSTEE 0.30 4.70 X 0 0 0 DAVID HARRISON MD TRUSTEE 0.20 2.80 X 0 0 0 THERESA HASKINS TRUSTEE 0.20 3.30 X 0 0 0 PHIL JACKSON TRUSTEE 0.20 2.80 X 0 0 0 KATHERINE KEENE PAST-CHAIR 0.30 4.70 X 0 0 0 ROBERT KELLY MD TRUSTEE 0.20 4.30 X 0 0 0 RICARDO LINARES TRUSTEE 0.20 2.80 X 0 0 0 KENNETH SHERMAN JR TRUSTEE 0.30 5.30 X 0 0 0 LANE SHETTERLY CHAIR 0.30 5.70 X X 0 0 0 ALAN WYNN SECRETARY/TREASURER 0.20 2.90 X X 0 0 0 MARK ZOOK TRUSTEE 0.30 4.70 X 0 0 0 CHERYL NESTER WOLFE CEO & PRESIDENT 2.00 38.00 X 0 1421603 37584 JAMES PARR EVP OF OPERATIONS & CFO 1.00 39.00 X 0 810561 88591 0 2232164 126175 0 0 1 0 0 MISC RENTAL PROPERTY 532000 46675814 46675814 SALEM HEALTH LAND LEAS 532000 101543 101543 46777357 76428604 76428604 CARES FUNDS 900099 27602026 27602026 27602026 150807987 46777357 0 104030630 24501995 24501995 24501995 24501995 0 0 129106 129235 703457136 356244913 917063 347212223 966749338 545456 780000 3613913 0 5205538 1314870796 48313 545456 1095321326 545456 1095369639 X 4660082 219501157 4660082 219501157 5205538 1314870796 X 126305992 89085083 -550000 X 0 1 X 1 0 X X 3 SALEM HEALTH 930579722 3 1 0 0 SALEM HEALTH WEST VALLEY 431960221 3 0 0 0 SALEM HEALTH FOUNDATION 237002687 7 1 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION A, LINE 1: SALEM HEALTH HOSPITALS AND CLINICS IS ORGANIZED AND OPERATED TO CARRY OUT THE PURPOSES OF, AND PERFORM FUNCTIONS FOR SALEM HEALTH AND OTHER RELATED ENTITIES FURTHERING THE MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES SERVED. THESE ENTITIES INCLUDE SALEM HEALTH, SALEM HEALTH WEST VALLEY, SALEM HEALTH PROFESSIONAL SERVICES, SALEM HEALTH FOUNDATION, AND WEST VALLEY HOSPITAL FOUNDATION WHICH ARE ALL 501(C)(3) ENTITIES WHOSE SOLE CORPORATE MEMBER IS SALEM HEALTH HOSPITALS AND CLINICS. 917063 917063 636105544 342288993 293816551 66434529 13955920 52478609 347212223 OTHER INVESTMENTS 966749338 C 966749338 DUE TO SALEM HEALTH 1084307624 DUE TO WVH 11013702 1095321326 X PART X, LINE 2: THE CORPORATION (SALEM HEALTH HOSPITALS & CLINICS), SALEM HEALTH, SALEM HEALTH WEST VALLEY, SALEM HEALTH FOUNDATION, WEST VALLEY HOSPITAL FOUNDATION, SALEM HEALTH PROFESSIONAL SERVICES, AND WILLAMETTE VALLEY INSURANCE COMPANY ARE TAX-EXEMPT ORGANIZATIONS PURSUANT TO INTERNAL REVENUE CODE SECTION 501(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. 0 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 PART I, LINE 4B SOME OF THE ORGANIZATION'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: 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, IS 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 B, LINES 15A AND 15B: ALL COMPENSATION IS PAID BY A RELATED ORGANIZATION. 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: EQUITY TRANSFERS -550,000. MWVP INC 570 LIBRETY ST SE STE 200 SALEM OR 97301 HOLDS LAND OR 0 917063 SHHC SALEM HEALTH FOUNDATION 890 OAK STREET SALEM OR 97301 237002687 SUPPORT SH OR 501(C)(3) LINE 7 N/A 0 SALEM HEALTH 890 OAK STREET SALEM OR 97301 930579722 HOSPITAL OR 501(C)(3) LINE 3 SHHC 1 SALEM HEALTH WEST VALLEY 525 SOUTHEAST WASHINGTON ST DALLAS OR 97338 431960221 HOSPITAL OR 501(C)(3) LINE 3 SHHC 1 WEST VALLEY HOSPITAL FOUNDATION 525 SOUTHEAST WASHINGTON ST 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 1 SALEM HEALTH PROFESSIONAL SERVICES 890 OAK STREET SALEM OR 97301 753175249 BILLING OR 501(C)(3) LINE 12A, I SHHC 1 OREGON COMMUNITY IMAGING LLC 2925 RYAN DR SE SALEM OR 97301 MEDICAL IMAGING OR SHHC RELATED 4400 173 0 1 0.33330 SALEM AMBULATORY SURGERY CENTE 570 LIBERTY ST SE STE 200 SALEM OR 97301 SURGERY CENTER OR N/A N/A 0 0 POPULATION HEALTH ALLIANCE OF 601 SW 2ND AVE STE 1940 PORTLAND OR 97204 DATA MANAGEMENT OR N/A N/A 0 0 WILLAMETTE VALLEY COMMUNITY HE 2995 RYAN DR SE STE 200 SALEM OR 97301 COORDINATED CARE OR N/A N/A 0 0 PREMIER HEALTHCARE ALLIANCE LP 13034 BALLANTYNE CORP PLACE CHARLOTTE OR 28277 FINANCIAL SUPPORT OR N/A N/A 0 0 WILLAMETTE SURGERY CENTER LLC 890 OAK ST SE SALEM OR 97301 SURGERY CENTER OR N/A N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 SALEM HEALTH A 101543 CASH SALEM HEALTH WEST VALLEY A 1138428 CASH SALEM HEALTH A 44903902 CASH SALEM HEALTH S 954333000 FMV