2019-05-09T17:02:38-05:00 2018-06-30 930623286 ALDRICH CPAS AND ADVISORS LLP 680 HAWTHORNE AVE SE 140 SALEM OR 97301 990 2017-07-01 930579722 SALEM HEALTH SALE 5038141938 890 OAK STREET SALEM OR 97301 JAMES PARR CFO 5038141938 2019-05-03 1 JOYLYN M ANKENEY CPA P00366587 5035857774 2019-04-27 69.30.50.66 2019-05-03 08:50:08 PD P 8F3AA22F39D27857D024F0A150D4B9C64528F6BF E5FDCD901E0D408F4D4CEC4276ECD8FBEDBFFABE 2017 2019-02-21 02:37:17Z JAMES PARR 890 OAK STREET SALEM OR 97301 818601362 0 X WWW.SALEMHEALTH.ORG X 1970 OR TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE. 12 10 5257 415 2303935 275797 1293735 1056591 749790070 783829055 9717236 31831446 3395065 542703 764196106 817259795 804612 807294 0 0 386294442 412741884 0 0 0 316577436 321264712 703676490 734813890 60519616 82445905 1211931939 1306434818 391556988 385873792 820374951 920561026 TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 123901187 364315400 SALEM HEALTH IS ONE OF THE LARGEST OF OREGON'S 59 ACUTE CARE HOSPITALS AND OPERATES THE BUSIEST EMERGENCY DEPARTMENT IN OREGON. THERE ARE 487 PRACTITIONERS, REPRESENTING 53 DIFFERENT SPECIALTIES. MORE THAN 415 VOLUNTEERS PROVIDE NON-MEDICAL SUPPORT FOR THE HOSPITAL.STATISTICS FOR THE 12 MONTH PERIOD ENDED 6/30/18: BIRTHS - 3,443, DIAGNOSTIC IMAGING PROCEDURES - 190,479, ED VISITS - 107,877, INPATIENT ADMISSIONS - 26,392, LABORATORY PROCEDURES - 1,388,575, SURGERIES - 13,865. THE PRIMARY SERVICE AREA IS MARION AND POLK COUNTIES WITH APPROXIMATELY 500,000 RESIDENTS. 502945547 400652208 SALEM HEALTH PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. IN THE 12 MONTH PERIOD ENDED 6/30/18, THE COST OF SERVICES PROVIDED AS A COMMUNITY BENEFIT TOTALED $102.2 MILLION. THIS FIGURE CONSISTED OF $11.0 MILLION IN COSTS TO PROVIDE CHARITY CARE TO INDIVIDUALS WHO CANNOT AFFORD TO PAY; $41.5 MILLION IN UNDERPAYMENT BY MEDICAID AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES; AND $49.7 MILLION IN UNDERPAYMENT BY MEDICARE AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES. SALEM HEALTH DOES NOT PURSUE LEGAL ACTION FOR NON-PAYMENT OF BILLS AGAINST CHARITY CARE PATIENTS WHO HAVE DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS. 35698839 807294 17245846 SALEM HEALTH ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN THE 12 MONTH PERIOD ENDED 6/30/18, SALEM HEALTH GAVE $12.7 MILLION FOR UNFUNDED OR UNDERFUNDED HEALTH SERVICES, INCLUDING IMPROVING ACCESS TO CARE THROUGH PHYSICIAN RECRUITING, COMMUNITY HEALTH EDUCATION AND PREVENTION PROGRAMS. THE HOSPITAL HAS AN ACTIVE SPEAKERS BUREAU PROVIDING FREE HEALTH LECTURES TO COMMUNITY GROUPS. HEALTH SCREENINGS, SUPPORT GROUPS AND EDUCATION CLASSES ARE OFFERED ON AN ON-GOING BASIS. IN FY 2018, SALEM HEALTH PROVIDED MORE THAN $1 MILLION IN CASH AND IN-KIND DONATIONS TO COMMUNITY HEALTH PROGRAMS SUCH AS MEDASSIST AND PROJECT ACCESS, PSYCHIATRIC CRISIS CENTER AND THE SALEM FREE CLINIC. 662545573 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 337 0 1 5257 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X X SALEM HEALTH 5038141938 890 OAK STREET SE SALEM OR 97301 BONNIE DRIGGERS RN CHAIR 5.00 X X 0 0 0 KATHERINE L KEENE VICE CHAIR 6.00 X X 0 0 0 ALAN WYNN SECRETARY/TREASURER 3.72 X X 0 0 0 THERESA HASKINS TRUSTEE 5.00 X 0 0 0 KENNETH SHERMAN JR TRUSTEE 7.00 X 0 0 0 ROB KELLY MD TRUSTEE 5.00 X 0 0 0 LANE SHETTERLY TRUSTEE 5.00 X 0 0 0 ROBERT WELLS PAST-CHAIR 5.00 X 0 0 0 NANCY REYES-MOLYNEUX MD TRUSTEE 3.50 X 0 0 0 JOHN COMBES MD TRUSTEE 4.00 X 0 0 0 JOHN LATTIMER TRUSTEE 5.00 X 0 0 0 RICARDO LINARES TRUSTEE 3.00 X 0 0 0 CHERYL NESTER WOLFE PRESIDENT AND CEO 30.00 10.00 X 1081556 0 59048 JAMES PARR CHIEF FINANCIAL OFFICER 32.00 8.00 X 549324 0 92187 RALPH YATES CMO SALEM HEALTH AND SHMG 39.00 1.00 X 534014 0 76769 LAURIE BARR CHIEF HUMAN RESOURCES OFFICER 30.00 10.00 X 396897 0 78997 SARAH HORN CHIEF NURSING OFFICER 39.00 1.00 X 389773 0 78244 LEAH MITCHELL CIO 39.00 1.00 X 468126 0 75206 ANDREW FURMAN - TERM 01252019 VP MEDICAL AFFAIRS 39.00 1.00 X 416063 0 76745 BAHAA WANLY CHIEF OPERATING OFFICER 39.00 1.00 X 370073 0 72867 CHRISTINE CLARKE GENERAL SURGEON 20.00 0.00 X 347389 0 45599 ZENNIA CENIZA EFF 51218 INTERIM VP CLINICAL OPERATIONS 40.00 X 242315 0 39702 DENISE HOOVER VP SURGICAL SERVICES 39.00 1.00 X 236188 0 55488 SHEA CORUM VP IT OPERATIONS 39.00 1.00 X 221178 0 58283 LEILANI SLAMA VP COMMUNITY ENGAGEMENT 20.00 20.00 X 196822 0 55191 JUAN OYARZUN DIR CARDIOTHORACIC MED 40.00 X 1216638 0 84437 NERVIN FANOUS CARDIOTHORACIC SURGEON 40.00 X 957819 0 76764 NICOLE VANDERHEYDEN MD TRAUMA DIR/ ASSOC CMO SHMG 39.00 1.00 X 769898 0 93002 KATHERINE JONES CARDIOTHORACIC SURGEON 40.00 X 914212 0 57734 PAUL COELHO MEDICAL DIRECTOR, PAIN MANAGEMENT 40.00 X 525682 0 51448 LORI JAMES-NIELSEN TERM 31717 SEE SCHEDULE J 10.00 30.00 X 120700 0 24905 9954667 0 1252616 690 1 1 0 OHSU PO BOX 3595 PORTLAND OR 97208 CONTRACT LABOR 4237032 EPIC SYSTEMS CORP PO BOX 88314 MILWAUKEE WI 532880314 CONSULTING SERVICES 2498458 SALEM PULMONARY ASSOCIATES PC 801 MISSION ST SE SALEM OR 97302 CONTRACT LABOR 1911599 RENAL TREATMENT CENTER-WEST PO BOX 781607 PHILADELPHIA PA 191781607 RENAL TREATMENT SERVICES 1705118 OREGON ANETHESIOLOGY GROUP 707 SW WASHINGTON ST SUITE 700 PORTLAND OR 972053536 CONTRACT LABOR 1578280 99 657701 398890 1056591 NET PATIENT REVENUE 621110 757937686 757937686 OTHER HOSPITAL SERVICES 900099 17662107 17562479 99628 PHARMACY 446110 6297893 5231738 1066155 REGIONAL LAB 621500 1364187 240750 1123437 VALUE BASED CARE/NUTRITION SERVIC 722210 567182 567182 783829055 32092903 32092903 889342 1034973 -145631 -145631 -145631 45137 306594 -261457 -261457 -261457 PASSTHROUGH INCOME 541900 688334 673619 14715 688334 817259795 782213454 2303935 31685815 567846 567846 239448 239448 5936476 5936476 315470255 288404724 27065531 68686706 62136276 6550430 22648447 20352071 2296376 1121655 900158 221497 1294032 24260 1269772 450550 374808 75742 82500 82500 29642484 25680208 3962276 91934 1297 90637 7674667 4414866 3259801 7649545 1282785 6366760 19403492 12301201 7102291 1108429 640102 468327 935194 747819 187375 10556453 10556453 43548559 43548559 5008195 5008195 PATIENT SUPPLIES 103283354 102859725 423629 PROVIDER TAX 40520554 40520554 BAD DEBTS 29984352 29984352 OTHER PURCHASED SERVICE 11088724 9063175 2025549 7820039 2936691 4883348 734813890 662545573 72268317 0 477445 535623 5008688 14572136 86887594 87867240 545456 545456 6386043 6689498 7051916 6274832 952082271 475061916 474377495 477020355 589144876 674691909 18742130 15672505 23310296 22565264 1211931939 1306434818 79929240 83977757 27940 525200 284804178 278251740 231968 164174 26563662 22954921 391556988 385873792 X 817795213 917643621 2579738 2917405 820374951 920561026 1211931939 1306434818 X 82445905 14686310 3053860 X 0 1 X 1 0 X 127723 127723 662417850 662545573 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 173324 97242 135334 127723 533623 250000 250000 250000 250000 1000000 1500000 SCHEDULE C, PART II-A SALEM HEALTH CONTRACTED WITH PUBLIC AFFAIRS COUNSEL TO KEEP THE HOSPITAL APPRISED OF BILLS IN THE STATE LEGISLATURE AND TO ENGAGE THE LEGISLATORS ON BEHALF OF THE HOSPITAL WHEN NECESSARY TO PROVIDE INFORMATION TO LEGISLATORS REGARDING THE IMPACT OF LEGISLATION ON THE HOSPITAL. ADDITIONALLY, THE HOSPITAL PAYS MEMBERSHIP DUES TO OAHHS AND AHA. A PORTION OF THE DUES TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING ACTIVITY IN RELATION TO STATE AND NATIONAL HEALTHCARE ISSUES. 2579755 458243 190571 317906 2910663 3345110 373134 -201146 937343 2579755 2619320 683999 655272 613481 3345110 2560192 318689 -66873 192688 2619320 2073328 674913 154704 342753 2560192 1.00000 0 1 1 11668774 23124460 34793234 13495103 609683732 273429420 349749415 965187 279954377 201632496 79287068 13190638 13190638 477020355 FAIR VALUE INTEREST RATE SWAP AGREEMENT 9158841 ACCRUED POST RETIREMENT HEALTHCARE BENEFITS 5242726 ACCRUED MALPRACTICE INSURANCE 4075826 ESTIMATED LIABILITY TO MEDICARE 1511287 DUE TO SALEM HEALTH HOSPITALS & CLINICS 2860827 OTHER LONG-TERM LIABILITIES 105414 22954921 X 848870620 14686310 16924515 31610825 817259795 0 817259795 748684547 13209741 13209741 735474806 -660916 -660916 734813890 PART V, LINE 4: ENDOWMENT FUNDS ARE HELD BY SALEM HEALTH FOUNDATION FOR SALEM HEALTH SUPPORT. PART X, LINE 2: UNCERTAIN TAX POSITIONS FROM THE NOTES TO CONSOLIDATED FINANCIAL STATEMENTS ISSUED FOR SALEM HEALTH AND RELATED COMPANIES: THE CORPORATION (SALEM HEALTH HOSPITALS & CLINICS), SALEM HEALTH, SALEM HEALTH WEST VALLEY, SHF, WVHF, SHPS, AND WVIC ARE TAX-EXEMPT ORGANIZATIONS PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AS SUCH, ONLY UNRELATED BUSINESS INCOME IS SUBJECT TO FEDERAL OR STATE INCOME TAXES. THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES IN ACCORDANCE WITH FASB ASC 740-10, INCOME TAXES-IMPLEMENTATION GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES AND DISCLOSURE AMENDMENTS FOR NONPUBLIC ENTITIES. MANAGEMENT HAS NOT RECORDED A PROVISION AS UNRELATED BUSINESS INCOME, IF ANY, 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 IRS. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30,2018 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 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE NETTED WITH EXPENSES 3,135,121. EXPENSE NETTED WITH REVENUE 13,789,394. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER RELATED ORGANIZATION REVENUE NOT INCLUDED ON FINANCIAL STATEMENTS PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUE NETTED WITH EXPENSES 3,135,121. EXPENSES NETTED WITH REVENUE 13,789,394. CUMULATIVE EFFECT OF ADOPTION OF FAIR VALUE OPTION -3,714,774. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 337,666. CHANGE IN POSTRETIREMENT BENEFIT OBLIGATION -998,582. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 30898 11029770 11029770 0.01560 162962 172945869 131419428 41526441 0.05890 193860 183975639 131419428 52556211 0.07450 129746 2848921 69722 2779199 0.00390 663 2005563 2005563 0.00280 29957784 17176124 12781660 0.01810 129847 129847 0.00020 27560 756724 756724 0.00110 157969 35698839 17245846 18452993 0.02610 351829 219674478 148665274 71009204 0.10060 6040 6040 0.00000 10243 10243 0.00000 2217389 2217389 0.00310 2233672 2233672 0.00310 0 29984352 22480038 107851118 120168337 -12317219 X 1 1 1 1 SALEM HEALTH 890 OAK STREET SE SALEM OR 97301 14-1428 X X X SALEM HEALTH 1 0 0 1 X X X X X X X X X 17 1 1 1 1 X WWW.SALEMHEALTH.ORG X WWW.CO.MARION.OR.US AND WWW.CO.POLK.OR.US X X 1 15 1 WWW.SALEMHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 300.000000000000 400.000000000000 X 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 1 X 1 X X 1 X 0 0 SALEM HEALTH PART V, SECTION B, LINE 3J: A COMPREHENSIVE NEEDS ASSESSMENT WAS CONDUCTED IN THE TAX YEAR 2017 IN COOPERATION WITH THE LOCAL PUBLIC HEALTH DEPARTMENT, COORDINATED CARE ORGANIZATIONS AND LOCAL NON-PROFIT ORGANIZATIONS. THE ASSESSMENT WAS CONDUCTED BY SURVEYING COMMUNITY PARTNERS WORKING IN SOCIAL, HEALTH, COMMUNITY, EDUCATIONAL AND CORRECTIONAL HEALTH SETTINGS AND THE COMMUNITY AT LARGE. PAPER AND ELECTRONIC SURVEYS WERE DISTRIBUTED THROUGHOUT BOTH COUNTIES AND COMMUNITY FORUMS WERE HELD AS WELL TO IDENTIFY HEALTH NEEDS AND PRIORITIES. NATIONAL SURVEILLANCE DATA SUCH AS THE THE BEHAVIOR RISK SURVEILLANCE SURVEY AND OREGON HEALTHY TEENS WAS USED, IN ADDITION TO STATE AND LOCAL DATA FROM BIRTH AND DEATH CERTIFICATES. SALEM HEALTH PART V, SECTION B, LINE 5: THE NATIONAL MODEL, MOBILIZATION FOR ACTION THROUGH PLANNING AND PARTNERSHIPS OR MAPP AS THE FRAMEWORK FOR THE COMMUNITY HEALTH ASSESSMENT. THE FOUR ASSESSMENTS OF THE MAPP FRAMEWORK INCLUDE: COMMUNITY THEMES AND STRENGTHS, LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT, COMMUNITY HEALTH STATUS ASSESSMENT AND THE FORCES OF CHANGE ASSESSMENT.THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT WAS CONDUCTED BY SURVEYING COMMUNITY PARTNERS WORKING IN SOCIAL, HEALTH, COMMUNITY, EDUCATIONAL AND CORRECTIONAL HEALTH SETTINGS AND THE COMMUNITY-AT-LARGE. THE SURVEYS USED IN BOTH MARION AND POLK COUNTIES CONSISTED OF THE SAME QUESTIONS AND USED THE 2011 MARION COUNTY SURVEY AS A TEMPLATE. PAPER AND ELECTRONIC SURVEYS WERE ALLOCATED BASED ON POPULATION DISTRIBUTION THROUGHOUT OUR COMMUNITIES. THE COMMUNITY HEALTH STATUS ASSESSMENT WAS CONDUCTED BY COMPILING DATA FROM NATIONAL SURVEILLANCE SYSTEMS LIKE THE BEHAVIOR RISK FACTOR SURVEILLANCE SURVEY AND OREGON HEALTHY TEENS AS WELL AS STATE AND LOCAL DATA FROM BIRTH AND DEATH CERTIFICATES. IN ADDITION, A SERIES OF COMMUNITY CAFES WERE CONDUCTED ACROSS MARION AND POLK COUNTY TO IDENTIFY HEALTH PRIORITIES.SALEM HEALTH HOSTED COMMUNITY CAFES AND REPRESENTATIVES FROM MARION AND POLK COUNTY PUBLIC HEALTH, PRESENTED CHNA FINDINGS TO THE SALEM HEALTH COMMUNITY BENEFIT COMMITTEE OF THE BOARD OF TRUSTEES IN NOVEMBER 2015. SALEM HEALTH PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH COOPERATION AND REPRESENTATIVES FROM SANITAM HOSPITAL AND LEGACY HEALTH. SALEM HEALTH PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH COMMUNITY ACTION AGENCY, THE EARLY LEARNING HUB, INC, MARION COUNTY HEALTH DEPARTMENT, POLK COUNTY HEALTH DEPARTMENT, OREGON STATE UNIVERSITY COOPERATIVE EXTENSION, UNITED WAY, WVP HEALTH AUTHORITY, AND WILLAMETTE VALLEY COMMUNITY HEALTH. SALEM HEALTH PART V, SECTION B, LINE 7D: THE HOSPITAL MADE THE CHNA WIDELY AVAILABLE TO THE COMMUNITY. ALL PARTNERS DESCRIBED IN SECTION B, LINE 6B WERE PROVIDED WITH EXECUTIVE SUMMARY DOCUMENTS FOR DISTRIBUTION TO COMMUNITY MEMBERS FREE OF CHARGE. THE FULL ASSESSMENT IS POSTED TO THE HOSPITAL AND COUNTY WEBSITES. SALEM HEALTH PART V, SECTION B, LINE 2: THE HOSPITAL WAS NOT ACQUIRED OR PLACED INTO SERVICE AS A TAX-EXEMPT HOSPITAL IN THE CURRENT TAX YEAR OR THE IMMEDIATELY PRECEDING TAX YEAR 2017. SALEM HEALTH PART V, SECTION B, LINE 11: PRIORITY AREAS ADDRESSED IN THE 2017 ASSESSMENT INCLUDE ADOLESCENT MENTAL HEALTH, OBESITY, TOBACCO USE, AND SEXUALLY TRANSMITTED INFECTIONS. SALEM HEALTH HAS CHOSEN TO FOCUS ON THE FIRST THREE AREAS. OREGON'S SUICIDE RATE IN 2017 WAS MORE THAN TWICE AS HIGH AS THE NATIONAL AVERAGE. SUICIDE IS THE SECOND LEADING CAUSE OF DEATH FOR THOSE AGES 15-34 AND THE THIRD LEADING CAUSE FOR THOSE AGES 9-14. ACCORDING TO OREGON HEALTH PLAN (MEDICAID) DATA, 31.5% OF CHILDREN AGES 12-17 IN MARION COUNTY HAVE A MENTAL HEALTH CONDITION AND FEWER THAN HALF ARE RECEIVING TREATMENT. THE NUMBERS ARE EVEN MORE STARK FOR CHILDREN UNDER THE AGE OF 12 - 27% HAVE BEEN IDENTIFIED AS HAVING A MENTAL HEALTH CONDITION AND JUST 4% ARE RECEIVING TREATMENT. THE NUMBER OF PATIENT SEEN IN THE SALEM HOSPITAL EMERGENCY ROOM FOR SUICIDAL IDEATION AND INTENTIONAL SELF HARM HAS INCREASED MORE THAN 200% SINCE 2016. SALEM HEALTH HAS LAUNCHED A COMMUNITY WIDE INITIATIVE TO EXPLORE CONTRIBUTING FACTORS TO THIS INCREASE ALONG WITH SALEM-KEIZER PUBLIC SCHOOLS, THE COUNTY HEALTH DEPARTMENTS AND OTHER MENTAL HEALTH CARE PROVIDERS. THE SCOPE FOR THE 2018-19 YEARS IS COMMUNITY PREVENTION WITH PLANS TO EXPAND THE WORK BEYOND THIS SCOPE IN 2020. SALEM HEALTH OFFERS FREE "QUESTION, PERSUADE, REFER" (QPR) TRAINING TO COMMUNITY MEMBERS AND HAS TRAINED SEVERAL SCHOOL DISTRICT EMPLOYEES AND CONTRACTED EMPLOYEES TO PROVIDE THE TRAINING SEVERAL TIMES A MONTH ALL OVER OUR SERVICE AREA.TOBACCO 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, BUT 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 IS A SMOKE FREE CAMPUS AND HAS WORKED WITH THE CITY OF SALEM TO EXPAND SMOKE FREE ZONES TO NEIGHBORING SIDEWALKS AND CITY PARKS. THE HOSPITAL SCREENS 100% OF ITS PATIENTS FOR TOBACCO USE AND PROVIDES ALL TOBACCO USERS WITH COMMUNITY CESSATION RESOURCE INFORMATION. THE AMERICAN LUNG ASSOCIATION'S FREEDOM FROM SMOKING CURRICULUM IS OFFERED AT NO COST THROUGH THE SALEM HEALTH COMMUNITY HEALTH EDUCATION CENTER AND THE HEALTH EDUCATION AND OUTREACH TEAMS PROVIDE COMMUNITY BASED EDUCATION TO SCHOOLS RELATED TO TOBACCO PREVENTION.OBESITYOBESITY RATES IN MARION AND POLK COUNTIES CONTINUE TO CLIMB AT A RATE HIGHER THAN THE REST OF THE STATE. NEARLY 35% OF ADULTS IN MARION COUNTY ARE CONSIDERED TO BE OBESE AND 18% OF 11TH GRADERS IN MARION COUNTY ARE OBESE, COMPARED WITH 26% AND 15% RESPECTIVELY STATEWIDE. IN POLK COUNTY, 31.5% OF ADULTS ARE OBESE AS ARE 17.5% OF 11TH GRADERS. OBESITY CONTRIBUTES TO NEARLY EVERY CHRONIC MEDICAL CONDITION, INCLUDING HEART DISEASE, DIABETES AND CANCER. SALEM HEALTH CONTINUES TO FOCUS ON OBESITY PREVENTION EFFORTS THROUGH HEALTH OUTREACH AND EDUCATION, SUPPORT OF PARTNERING AGENCIES WITH A SHARED GOAL TO DECREASE OBESITY, MEDICAL PROVIDER BMI SCREENINGS AND COMMUNITY HEALTH EDUCATION CENTER PROGRAMMING FOCUSED ON HEALTH PROMOTION AND PREVENTION OF CHRONIC DISEASE. OBESITY IS ALSO A PRIORITY FOR THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WHICH IS SUPPORTED BY SALEM HEALTH. THE MARION COUNTY PUBLIC HEALTH DEPARTMENT CONVENES COMMUNITY STAKEHOLDERS TO ADDRESS OBESITY USING A LOGIC MODEL AND COLLECTIVE IMPACT FRAMEWORK. PARTNER ADDRESSING OBESITY SUBMIT ANNUAL ACTIVITIES AND REPORT RESULTS. SALEM HEALTH AND OTHER COMMUNITY PARTNERS' COLLECTIVE WORK IMPACT IS PUBLISHED ANNUALLY ON THE MARION COUNTY PUBLIC HEALTH WEBSITE.SEXUALLY TRANSMITTED INFECTIONS MARION COUNTY HAS EXPERIENCED SIGNIFICANT INCREASES IN SEXUALLY TRANSMITTED INFECTIONS IN THE LAST FIVE YEARS, INCLUDING A 7.8% INCREASE IN THE INCIDENCE OF CHLAMYDIA, 186.7% INCREASE IN THE INCIDENCE OF GONORRHEA AND A 490% IN SYPHILIS. MARION COUNTY IS SEEING AN INCREASE IN RATES OF CONGENITAL SYPHILIS. MARION COUNTY IS ACTIVELY WORKING WITH LOCAL PROVIDERS TO ENSURE ACCURATE REPORTING, EDUCATION TO APPROPRIATE AUDIENCES AND EFFICACY OF TREATMENT IN TACKLING THESE DISEASES. SALEM HEALTH'S PROVIDERS ARE PARTICIPATING AND A REPRESENTATIVE MEETS REGULARLY WITH MARION COUNTY PUBLIC HEALTH TO ASSESS THE NEEDS AND PROGRESS MADE. SALEM HEALTH PART V, SECTION B, LINE 13B: SALEM HEALTH FINANCIAL MATRIX IS BASED ON INCOME AS A PERCENT OF FEDERAL POVERTY LEVEL. SALEM HEALTH 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 RESIDENCEEQUITY 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 CALCULATIONTHE INCOME FROM INCOME-PRODUCING REAL PROPERTY SHOULD BE USED IN CALCULATION RATHER THAN THE EQUITYINDIVIDUAL 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 DEPENDENTS4) THE FAMILY'S MONTHLY OUT-OF-POCKET EXPENSES FOR MEDICAL SUPPLIES AND SERVICES5) 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 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 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 DETERMINATION A 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. -FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION MAY BE DOWNLOADED FROM OUR WEBSITE: HTTP://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 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 SERVICES2) THE CONDITIONS OF ADMISSION FORM INFORMS THE PATIENT OF THEIR RIGHT TO APPLY FOR FINANCIAL ASSISTANCE.3) WRITTEN INFORMATION IS 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 ARE TRAINED TO ANSWER FINANCIAL ASSISTANCE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY THAT CANNOT BE ANSWERED TO FINANCIAL COUNSELORS IN A TIMELY MANNER.5) THIS POLICY IS POSTED ON SALEM HEALTH'S WEBSITE. WRITTEN INFORMATION ABOUT THIS POLICY WILL BE MADE AVAILABLE UPON REQUEST6) ALL PATIENT BILLING STATEMENTS INCLUDE A NOTICE THAT FINANCIAL ASSISTANCE IS AVAILABLE AND CONTRACT INFORMATION IF THEY WANT TO LEARN MORE. SALEM HEALTH PART V, SECTION B, LINE 18E: IT IS THE POLICY OF SALEM HEALTH TO PURSUE COLLECTION OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR SERVICES. SALEM HEALTH 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 PART V, SECTION B, LINE 19E: SALEM HEALTH 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 PART V, SECTION B, LINE 20E: SALEM HEALTH 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 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 NOTICE2) PROVIDE THE INDIVIDUAL A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WITH THE WRITTEN NOTICE3) MAKE REASONABLE EFFORTS TO ORALLY NOTIFY INDIVIDUAL ABOUT THE SALEM HEALTH'S FINANCIAL ASSISTANCE POLICY. SALEM HEALTH PART V, SECTION B, LINE 21C: NOT APPLICABLE. SALEM HEALTH 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 PART V, SECTION B, LINE 21D: NOT APPLICABLE. SALEM HEALTH 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. 8 1 - REHABILITATION CENTER 755 MISSION ST SE SALEM OR 97302 REHABILITATION 2 - LABORATORY PHLEBOTOMY SITE - HOPE 1600 STATE ST SALEM OR 97301 LABORATORY SERVICES 3 - COMPREHENSIVE PAIN CENTER 875 OAK STREET SALEM OR 97302 PAIN MANAGEMENT 4 - REGIONAL LABORATORY 3300 STATE ST SALEM OR 97301 LABORATORY SERVICES 5 - SALEM HEALTH MEDICAL CLINIC - KEIZER 550 DEITZ AVE NE KEIZER OR 97303 CLINIC 6 - SALEM HEALTH MEDICAL CLINIC - S SALEM 2925 RIVER RD S SALEM OR 97302 CLINIC 7 - SALEM HEALTH MEDICAL CLINIC - SALEM 966 12TH STREET SE SALEM OR 97301 CLINIC 8 - SALEM HEALTH MEDICAL CLINIC - W SALEM 1049 EDGEWATER ST NW SUITE 150 SALEM OR 97304 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 RESIDENCEEQUITY 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 CALCULATIONTHE INCOME FROM INCOME-PRODUCING REAL PROPERTY SHOULD BE USED IN CALCULATION RATHER THAN THE EQUITYINDIVIDUAL 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 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 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 7: FINANCIAL ASSISTANCE, MEDICAID AND COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS 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. SALEM HEALTH 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 ADOLESCENT MENTAL HEALTH, OBESITY AND TOBACCO. 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 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 2017, 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 PROVIDED COMMUNITY PARTNER GRANTS IN 2017. THESE GRANTS SUPPORT THE WORK OF COMMUNITY PARTNERS WHO ARE ADDRESSING THE IDENTIFIED NEEDS FROM THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. LASTLY, THE HOSPITAL PROVIDES TRAINING FOR NURSING STUDENTS AND EMERGING HEALTH CARE PROFESSIONALS. ITS HEALTH CAREER EXPLORATION PROGRAMS FOR HIGH SCHOOL STUDENTS IN DISTRICTS THAT FALL WITHIN THE HOSPITAL CATCHMENT AREA SERVE HUNDREDS OF HIGH SCHOOL STUDENTS ASPIRING TO MEDICAL CAREERS. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSE THAT WAS INCLUDED IN FORM 990, PART IX, LINE 25, COLUMN (A), BUT REMOVED FROM THIS FIGURE FOR THE PURPOSES OF CALCULATING THE PERCENTAGE IN SCHEDULE H, PART I, LINE 7, COLUMN (F) WAS $29,984,352. PART I, LINE 6A A COMMUNITY BENEFIT REPORT WAS PREPARED DURING THE TAX YEAR AND CAN BE FOUND ON THE SALEM HEALTH WEBSITE AT WWW.SALEMHEALTH.ORG PART II, COMMUNITY BUILDING ACTIVITIES: SALEM HEALTH HAS MORE THAN 450 VOLUNTEERS AND A STAFF OF THREE THAT COORDINATE COMMUNITY BUILDING ACTIVITIES. VOLUNTEERS RAISE MONEY FOR COMMUNITY SCHOLARSHIPS, COORDINATE JOB SHADOW OPPORTUNITIES AND ARRANGE FOR BLOOD DRIVES. IN 2017, SALEM HEALTH SPONSORED AN ORGANIZATION WIDE INITIATIVE TO ENCOURAGE EMPLOYEES TO VOLUNTEER IN THE LOCAL COMMUNITY. OVER THE COURSE OF THE YEAR, 83% OF DEPARTMENTS WITHIN THE HOSPITAL HAD AT LEAST ONE EMPLOYEE VOLUNTEER OUTSIDE THE HOSPITAL. GROUP VOLUNTEER OPPORTUNITIES WERE COORDINATED QUARTERLY, SUCH AS PARK BEAUTIFICATION AND SET UP OF LOCAL EVENTS. LEADERS AT ALL LEVELS WITHIN SALEM HEALTH SERVE ON COMMUNITY BOARDS AND TASK FORCES THAT ADDRESS COMMUNITY NEEDS. THE HOSPITAL WORKS WITH THE LOCAL MEDICAL COMMUNITY TO IDENTIFY GAPS IN CARE AND RECRUIT NEEDED PRIMARY CARE PROVIDERS AND SPECIALISTS TO IMPROVE ACCESS TO CARE. PHYSICIAN LEADERSHIP TRAINING AND IS OFFERED TO COMMUNITY PROVIDERS ACROSS THE SERVICE AREA. 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 II, LINE 8: SALEM HEALTH HAS BEEN ACTIVELY RECRUITING PRIMARY CARE PROVIDERS TO MARION AND POLK COUNTIES TO IMPROVE ACCESS TO CARE. PART II SALEM HEALTH HAS MORE THAN 450 VOLUNTEERS AND A STAFF OF THREE THAT COORDINATE COMMUNITY BUILDING ACTIVITIES. VOLUNTEERS RAISE MONEY FOR COMMUNITY SCHOLARSHIPS, COORDINATE JOB SHADOW OPPORTUNITIES AND ARRANGE BLOOD DRIVES.LEADERS AT ALL LEVELS WITHIN SALEM HEALTH SERVE ON COMMUNITY BOARDS AND TASK FORCES THAT ADDRESS COMMUNITY NEEDS.THE HOSPITAL HAS BEEN ACTIVELY RECRUITING PRIMARY CARE PROVIDERS TO MARION AND POLK COUNTIES TO IMPROVE ACCESS TO CARE. SALEM HEALTH OFFERS PHYSICIAN LEADERSHIP TRAINING TO COMMUNITY PROVIDERS AND LEADERSHIP DEVELOPMENT COURSES THAT ARE MADE AVAILABLE TO LEADERS ACROSS THE SERVICE AREA. PART III, LINE 4: EFFECTIVE OCTOBER 1, 2011, THE HOSPITALS ADOPTED FASB ISSUED ACCOUNTING STANDARDS UPDATE (ASU) NO. 2011-07, HEALTH CARE ENTITIES (TOPIC 954): PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTHCARE ENTITIES. THE ADOPTION OF THIS ASU RESULTED IN A RECLASSIFICATION OF BAD DEBT EXPENSE FROM AN OPERATING EXPENSE TO BE A REDUCTION IN DERIVING NET PATIENT SERVICE REVENUE. THE ALLOWANCES FOR DOUBTFUL ACCOUNTS ARE 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 8: MEDICARE PAYS A SIGNIFICANTLY REDUCED AMOUNT FOR MEDICAL SERVICES RENDERED TO THEIR ENROLLEES SUCH THAT THE NET REIMBURSEMENT DOES NOT COVER THE EXPENSES INCURRED TO PROVIDE THE SERVICES. SALEM HEALTH CONSIDERS THE DIFFERENCE BETWEEN THE COSTS TO PROVIDE THE SERVICES FOR MEDICARE ENROLLEES AND THE NET REIMBURSEMENT AS A BENEFIT TO THE COMMUNITY. MEDICARE FEE-FOR-SERVICE COSTS ARE DETERMINED FROM SALEM HEALTH'S FILED MEDICARE COST REPORT. THE CALCULATION OF NET BENEFIT IS EQUAL TO TOTAL MEDICARE PAYMENTS LESS MEDICARE COSTS.IN ADDITION TO TRADITIONAL MEDICARE FEE-FOR-SERVICE, SALEM HEALTH PROVIDES SUBSTANTIAL SERVICES TO OTHER MEDICARE POPULATIONS PARTICIPATING IN MEDICARE ADVANTAGE PLANS AT SIGNIFICANTLY REDUCED REIMBURSEMENT. THE NET REVENUES FOR THESE PLANS ARE LESS THAN THE COST TO PROVIDE CARE AND ARE NOT DISCLOSED IN PART III, LINE 8. SALEM HEALTH ALSO CONSIDERS THE DIFFERENCE BETWEEN THE NET COST TO PROVIDE CARE FOR MEDICARE ADVANTAGE ENROLLEES AND THE NET REIMBURSEMENT AS A BENEFIT TO THE COMMUNITY. THESE NET COSTS HAVE BEEN DETERMINED BY APPLYING THE RATIO OF COSTS TO CHARGES AS DETERMINED IN WORKSHEET 2 TO THE FULL BILLED CHARGES. THE CALCULATION OF NET BENEFIT IS EQUAL TO TOTAL MEDICARE ADVANTAGE PAYMENTS OF $154,301,793 LESS MEDICARE ADVANTAGE COSTS OF $182,654,129 FOR A TOTAL ADDITIONAL COMMUNITY BENEFIT IN THE AMOUNT OF $28,352,336. 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: AN UPDATED COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED IN 2017. THE NEEDS ASSESSMENT DESCRIBES THE COMMUNITY SERVED BY THE HOSPITAL AND THE DEMOGRAPHICS OF THE COMMUNITY. IT DOES NOT DESCRIBE THE EXISTING HEALTH CARE FACILITIES AND RESOURCES WITHIN THE COMMUNITY THAT ARE AVAILABLE TO RESPOND TO NEEDS. THE MARION AND POLK COUNTY HEALTH CARE SYSTEM CAPACITY AND ACCESS ASSESSMENT CONTAINS HEALTH CARE FACILITY AND RESOURCE INFORMATION. THE CAPACITY AND ACCESS ASSESSMENT IS UPDATED ANNUALLY. THE MOST RECENT CHNA AND HEALTH CARE SYSTEM CAPACITY AND ACCESS ASSESSMENTS ARE PUBLISHED TO THE SALEM HEALTH WEBSITE AT WWW,SALEMHEALTH.ORG. THE NATIONAL MODEL, MOBILIZATION FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) WAS USED AS THE FRAMEWORK FOR CHNA. THE FOUR ASSESSMENTS OF MAPP FRAMEWORK INCLUDE: COMMUNITY THEMES AND STRENGTHS, LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT, COMMUNITY HEALTH STATUS ASSESSMENT AND THE FORCES OF CHANGE ASSESSMENT. THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT WAS CONDUCTED BY SURVEYING COMMUNITY PARTNERS WORKING IN SOCIAL, EDUCATIONAL, COMMUNITY AND CORRECTIONAL HEALTH SETTING AND THE COMMUNITY AT LARGE. THE SURVEYS USED IN BOTH COUNTIES HAS THE SAME QUESTIONS AND WERE BASED ON PAST SURVEYS. PAPER AND ELECTRONIC SURVEYS WERE ALLOCATED BASED ON POPULATION DISTRIBUTION THROUGHOUT THE TWO COUNTIES. THE COMMUNITY HEALTH STATUS ASSESSMENT WAS CONDUCTED BY COMPILING DATA FROM NATIONAL SURVEILLANCE SYSTEMS LIKE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY AND OREGON HEALTHY TEENS, AS WELL AS STATE AND LOCAL DATA FROM BIRTH AND DEATH CERTIFICATES. IN ADDITION, A SERIES OF COMMUNITY FORUMS WERE CONDUCTED ACROSS MARION AND POLK COUNTIES TO IDENTIFY HEALTH PRIORITIES. THE MARION AND POLK COUNTY HEALTH ASSESSMENT UPDATES WERE PUBLISHED IN DECEMBER 2017 AND CAN BE FOUND ON THE SALEM HEALTH WEBSITE AT WWW.SALEMHEALTH.ORG. THE DOCUMENT INFORMED THE DEVELOPMENT OF THE COMMUNITY BENEFIT IMPLEMENTATION STRATEGY FOR THE YEARS 2018-2020, ALSO AVAILABLE ON THE WEBSITE.THE IMPACT OF ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE HOSPITAL FACILITIES' PRIOR CHNAS CAN BE FOUND ON THE COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) ANNUAL REPORT. THE CHIP IS COORDINATED BY MARION COUNTY PUBLIC HEALTH DEPARTMENT AND IS PUBLISHED ON THEIR WEBSITE AT WWW.CO.MARION.OR.US/HLT/CHIP/PAGES/DEFAULT.ASPX PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCESALEM HEALTH SCREENS UNINSURED PATIENTS FOR ELIGIBILITY THROUGH THE OREGON HEALTH PLAN (OHP/MEDICAID), WORKERS COMPENSATION, THIRD PARTY LIABILITIES, CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA) OR ANY OTHER POTENTIAL FUNDING SOURCE AT THE POINT OF SCHEDULING, PATIENT REGISTRATION, OR WHILE INPATIENT. THE HOSPITAL OR ITS REPRESENTATIVE WILL REVIEW THE PATIENT'S CURRENT RESOURCES AND WORK WITH HIM/HER TO GAIN ELIGIBILITY FOR ANY OF THESE PROGRAMS AS APPROPRIATE. PATIENTS NOT ELIGIBLE FOR OHP OR THE OTHER PROGRAMS LISTED ABOVE WHO HAVE FINANCIAL CONSTRAINTS THAT INHIBIT THEIR ABILITY TO PAY, WILL BE ASSESSED FOR FINANCIAL ASSISTANCE. 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 SERVICES2) THE CONDITIONS OF ADMISSION FORM INFORMS THE PATIENT OF THEIR RIGHT TO APPLY FOR FINANCIAL ASSISTANCE.3) WRITTEN INFORMATION IS 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 ARE TRAINED TO ANSWER FINANCIAL ASSISTANCE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY THAT CANNOT BE ANSWERED TO FINANCIAL COUNSELORS IN A TIMELY MANNER.5) THIS POLICY IS POSTED ON SALEM HEALTH'S WEBSITE. WRITTEN INFORMATION ABOUT THIS POLICY WILL BE MADE AVAILABLE UPON REQUEST6) ALL PATIENT BILLING STATEMENTS INCLUDE A NOTICES THAT FINANCIAL ASSISTANCE IS AVAILABLE AND CONTRACT INFORMATION IF THEY WANT TO LEARN MORE. PART VI, LINE 4: SALEM HEALTH SERVES MARION AND POLK COUNTIES. DEMOGRAPHICS IN 2016, THE POPULATION OF POLK COUNTY WAS ESTIMATED TO BE 81,823, WHICH IS AN 8.5% INCREASE FROM 2011. THE LARGEST CITY POPULATION IS LOCATED IN WEST SALEM WITH 28,871 PEOPLE, EVEN THOUGH POLK COUNTY ONLY INCLUDES THE 97304 ZIP CODE OF SALEM. THE NEXT LARGEST CITY IS DALLAS WITH 14,583 PEOPLE. POLK COUNTY HAS A LARGER PROPORTION OF INDIVIDUALS BETWEEN THE AGES OF 0-24 YEARS OLD THAN OREGON AND THE UNITED STATES. THE RACIAL MAKEUP OF THE COUNTY WAS 80% WHITE, 2.6% AMERICAN INDIAN, 2% ASIAN, 0.9% BLACK OR AFRICAN AMERICAN, 0.4% PACIFIC ISLANDER AND 3.5% MADE UP OF 2 OR MORE RACES. THOSE OF HISPANIC OR LATINO ORIGIN MADE UP 13% OF THE POPULATIONS. THE MEDIAN INCOME OF POLK COUNTY IS SLIGHTLY HIGHER THAN THE REST OF OREGON, BUT LOWER THAN THE MEDIAN INCOME FOR THE UNITED STATES. ABOUT 16% OF THE POPULATION LIVE BELOW THE POVERTY LINE, WHICH IS LESS COMPARATIVELY THAN THE REST OF THE STATE. THE UNEMPLOYMENT RATE FOR THOSE 16 AND OLDER IS 6.5%, HIGHER THAN THE REST OF OREGON. POLK COUNTY IS MOSTLY RURAL AND HAS THE SECOND LARGEST AREA DEVOTED TO VITICULTURE IN THE STATE AT 1,322 ACRES. MARION COUNTY IS A MIX OF URBAN AND RURAL WITH A POPULATION OF 336,316. THE RACIAL MAKEUP IS 66% WHITE, 2.6% AMERICAN INDIAN, 2.3% ASIAN, 1.4% BLACK OR AFRICAN AMERICAN, 1% PACIFIC ISLANDER AND 3.3% TWO OR MORE RACES. HISPANIC AND LATINO ORIGIN MAKES UP 26% OF THE POPULATION. MARION COUNTY RESIDENTS HAVE A LOWER MEDIAN HOUSEHOLD INCOME THAN OREGON RESIDENTS AND AMERICANS IN GENERAL. A LARGER PERCENT OF MARION COUNTY RESIDENTS (ESPECIALLY RESIDENTS UNDER 18) LIVE BELOW THE FEDERAL POVERTY LEVEL THAN OREGON RESIDENTS AND AMERICANS IN GENERAL. A SMALLER PERCENT OF MARION COUNTY RESIDENTS HAVE ATTAINED A COLLEGE DEGREE THAN OREGON AND UNITED STATES RESIDENTS. AGRICULTURE AND FOOD PROCESSING ARE IMPORTANT TO THE COUNTY'S ECONOMY AS ARE LUMBER, MANUFACTURING AND EDUCATION. MARION COUNTY IS THE LEADER IN AGRICULTURAL PRODUCTION AMONG ALL OTHER OREGON COUNTIES. PART VI, LINE 5: SALEM HEALTH FUNDS A COMMUNITY HEALTH EDUCATION CENTER AND HEALTH EDUCATION OUTREACH PROGRAM. THE CENTER IS STAFFED BY HEALTH EDUCATORS AND REGISTERED NURSES WHO PROVIDE EDUCATION SERVICES TO COMMUNITY MEMBERS ON A DROP-IN BASIS; A MEDICAL PROFESSIONAL AND HEALTH CONSUMER LIBRARY ALLOWS PATRONS TO CHECK OUT HEALTH MATERIALS FREE OF CHARGE. THE LIBRARY SUPPORTS COMMUNITY PROVIDERS, HEALTH PROFESSIONALS AND STUDENTS THAT LIVE, WORK AND LEARN IN MARION AND POLK COUNTIES. FOUR DIFFERENT ONLINE MEDICAL JOURNAL AND RESOURCES SUBSCRIPTION SERVICES ARE PROVIDED TO ENSURE THE MOST UPDATE TO DATE AND ACCURATE INFORMATION AVAILABLE. MORE THAN 1,500 CLASSES AND EVENTS ARE HELD AT THE CENTER AND IN THE COMMUNITY EACH YEAR TO PROMOTE HEALTH AND PREVENT CHRONIC CONDITIONS. THESE RANGE FROM HEALTH SCREENINGS/EARLY DETECTION TO CHRONIC DISEASE MANAGEMENT AND END OF LIFE DECISION SUPPORT, THE OUTREACH PRIORITIES SUPPORT THE CHNA AND STAFF WORK IN COLLABORATION WITH COMMUNITY PARTNERING AGENCIES TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE WITHIN SALEM HEALTH'S SERVICE AREAS.HOSPITAL EXECUTIVES INTENTIONALLY SERVE ON NON-PROFIT BOARDS THROUGHOUT THE COMMUNITY. THESE INCLUDE MARION POLK FOOD SHARE, FAMILY BUILDING BLOCKS, LIBERTY HOUSE, THE BOYS AND GIRLS CLUB, SALEM FREE CLINIC, UNITED WAY, AND THE SALVATION ARMY, AMONG OTHERS. THESE ORGANIZATIONS SERVE VULNERABLE POPULATIONS. OFTEN, COMMUNITY BENEFIT ACTIVITIES, ESPECIALLY CASH AND INKIND DONATIONS SUPPORT THE WORK OF PARTNERING ORGANIZATIONS TO MEET THE IDENTIFIED NEEDS OF THE UNDERSERVED IN OUR COMMUNITY.THE COMMUNITY PARTNER GRANT PROGRAM PROMOTES THE HEALTH AND WELL-BEING OF LOW INCOME INDIVIDUALS AND FAMILIES IN MARION AND POLK COUNTIES THROUGH FUNDING PROJECTS THAT ADDRESS HEALTH RELATED PRIORITIES IN THE CHNA. IN 2017, OVER $300,000 WAS DISTRIBUTED TO COMMUNITY PARTNERS TO ADDRESS EARLY CHILDHOOD HEALTH, SUBSTANCE ABUSE, OBESITY AND MENTAL HEALTH, SPECIFICALLY DEPRESSION. PART VI, LINE 6: SALEM HEALTH IS AN OREGON NONPROFIT CORPORATION AND A TAX-EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE. SALEM HEALTH, HOSPITALS AND CLINICS IS THE "PARENT" CORPORATION AND SOLE CORPORATE MEMBER OF SALEM HEALTH, SALEM HEALTH FOUNDATION, SALEM HEALTH WEST VALLEY, WEST VALLEY HOSPITAL FOUNDATION, WILLAMETTE VALLEY INSURANCE CORPORATION, AND SALEM HEALTH PROFESSIONAL SERVICES. ALL ENTITIES WITHIN THE PARENT CORPORATION ARE SEPARATE NONPROFIT CORPORATIONS.SALEM HEALTH IS AN OREGON NONPROFIT CORPORATION AND A TAX-EXEMPT ORGANIZATION. THE CORPORATION ALSO DOES BUSINESS UNDER THE NAME "SALEM HOSPITAL, A PART OF SALEM HEALTH HOSPITALS AND CLINICS." SALEM HEALTH IS ONE OF THE LARGEST ACUTE CARE HOSPITALS IN OREGON. LICENSED FOR 494 BEDS, SALEM HEALTH OFFERS A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES AN AREA OF OVER 500,000 PEOPLE, INCLUDING MARION AND POLK COUNTIES INCLUDING THE RESIDENTS OF THE CITY OF SALEM, THE STATE CAPITAL OF OREGON.SALEM HEALTH, AS PART OF SALEM HEALTH HOSPITALS AND CLINICS IS GOVERNED BY AN ALL-VOLUNTEER COMMUNITY-BASED BOARD OF TRUSTEES (BOARD). THE BOARD HAS THE RESPONSIBILITY FOR THE DEVELOPMENT AND OVERSIGHT OF SALEM HEALTH VALUES, VISION, PURPOSE AND LONG-TERM STRATEGY. THROUGH THESE DOCUMENTS, THE COMMUNITY BENEFIT STEERING COMMITTEE ASSESSES AND REAFFIRMS SALEM HEALTH'S COMMUNITY BENEFIT COMMITMENTS AND CONNECTIONS WITH COMMUNITY NEEDS AND PRIMARY CONSTITUENCIES. THE COMMUNITY BENEFIT PLAN ASSURES MEASUREMENT AND COMPARISON OF SALEM HEALTH'S COMMUNITY ACTIVITIES TO EVOLVING NORMS AND OVERSEES THE CLEAR AND ACCURATE COMMUNICATION OF THESE ACTIVITIES TO KEY CONSTITUENCIES. PART VI, LINE 7, REPORTS FILED WITH STATES OR 1 SALEM HEALTH FOUNDATION PO BOX 14001 SALEM OR 97309 237002687 501(C)(3) 6000 CHARITABLE CONTRIBUTION GOLF TOURNAMENT SALEM KEIZER EDUCATION FOUNDATION 233 COMMERCIAL STREET NE SALEM OR 97301 930831467 501(C)(3) 25000 AWESOME 3000 SPONSORSHIP/DISEASE PREVENTION BOYS & GIRLS CLUB 1395 SUMMER ST NE SALEM OR 97301 930581470 501(C)(3) 42000 COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE OF HEALTH LIBERTY HOUSE 2685 4TH ST NE SALEM OR 97301 931236936 501(C)(3) 30000 CHEFS FOR LIBERTY HOUSE SPONSORSHIP/CHAMPIONS FOR CHILDREN SPONSORSHIP SALVATION ARMY 1901 FRONT ST SALEM OR 97301 941156347 501(C)(3) 25000 COMMUNITY PARTNER GRANT UNITED WAY OF MID WILLAMETTE VALLEY 455 BLILER AVE NE SALEM OR 97303 930395586 501(C)(3) 5000 SPONSOR BINATIONAL HEALTH FAIR/PRESIDENT'S LEADERSHIP CIRCLE/IMPROVE SOCIAL DETERMINATE OF HEALTH SALEM FREE MEDICAL CLINIC 1300 BROADWAY ST NE STE 104 SALEM OR 97301 203549992 501(C)(3) 80000 ACCESS TO CARE (SALEM & DALLAS) POLK CO FAMILY & COMMUNITY OUTREACH 182 SW ACADEMY STREET 220 DALLAS OR 97338 936002310 GOVERNMENT 15000 COMMUNITY PARTNER GRANT FAMILY BUILDING BLOCKS 2425 LANCASTER DR NE SALEM OR 97305 931233373 501(C)(3) 5000 COMMUNITY PARTNER GRANT GILBERT HOUSE 116 MARION ST NE SALEM OR 97301 930948548 501(C)(3) 5000 EXHIBIT SPONSOR - ALL ABOUT ME MARION COUNTY PO BOX 14500 SALEM OR 97309 936002307 GOVERNMENT 25000 COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH MARION POLK FOOD SHARE 1660 SALEM INDUSTRIAL DRIVE NE SALEM OR 97301 943034161 501(C)(3) 32471 COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH MWVCAA 2585 STATE ST SALEM OR 97301 237056987 501(C)(3) 12500 COMMUNITY PARTNER GRANT CITY OF SALEM HOUSING AUTHORITY 360 CHURCH ST SE SALEM OR 97301 930582087 GOVERNMENT 25000 COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH COMMUNITY SERVICES CONSORTIUM 250 BROAD ALBIN ST NE ALBANY OR 97321 936118438 501(C)(3) 25000 COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH ISAAC'S ROOM 299 COTTAGE ST NE SALEM OR 97301 931267455 501(C)(3) 20500 COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH OPTIONS COUNSELING & FAMILY SERVICES 3500 CHAD DR SUITE 350 EUGENE OR 97408 943436426 501(C)(3) 22209 COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH OSBORNE ADVENTURES 4742 LIBERTY RD S SALEM OR 97301 814004992 501(C)(3) 8500 CYCLE SHARE STATION SPONSOR/IMPROVE SOCIAL DETERMINATE TO HEALTH RONALD MCDONALD HOUSE CHARITY 2620 N COMMERCIAL AVE PORTLAND OR 97227 930806912 501(C)(3) 5000 STRONG TOGETHER WALK SPONSORSHIP/IMPROVE SOCIAL DETERMINATE TO HEALTH ROTARY TRIATHLON OF SALEM PO BOX 442 SALEM OR 97308 937060946 501(C)(3) 5000 ART FAIR & FESTIVAL SPONSORSHIP/IMPROVE SOCIAL DETERMINATE TO HEALTH SALEM ART ASSOCIATION 600 MISSION ST S SALEM OR 97302 930421613 501(C)(3) 6250 CLAY BALL SPONSORSHIP/IMPROVE SOCIAL DETERMINATE TO HEALTH SALEM LEADERSHIP FOUNDATION PO BOX 7384 SALEM OR 97203 931215089 501(C)(3) 5000 OPEN STREETS SPONSORSHIP/IMPROVE SOCIAL DETERMINATE TO HEALTH SALEM POLICE FOUNDATION PO BOX 2631 SALEM OR 97308 271899059 501(C)(3) 8500 SPONSORSHIP BREAKFAST WITH THE CHIEF/IMPROVE SOCIAL DETERMINATE TO HEALTH THE INSPIRE FOUNDATION 1110 COMMERCIAL ST NE SALEM OR 97301 461482848 501(C)(3) 6500 GREAT SALEM RACE SPONSORSHIP/DISEASE PREVENTION 21 4 CASH ASSISTANCE TO PATIENTS IN NEED FOR PRESCRIPTIONS, LIFELINE SUPPORT, REHABILITATION AND OTHER URGENT NEEDS. 149 45944 SCHOLARSHIPS FOR HEALTH PROFESSIONS EDUCATION 64 193504 PART I, LINE 2: GRANTS ARE ONLY MADE TO QUALIFIED EXEMPT ORGANIZATIONS. NO MONITORING IS REQUIRED. X X X X X 1 1 0 0 0 1 1 1 0 CHERYL NESTER WOLFE PRESIDENT AND CEO 680629 0 385687 0 15240 0 20250 0 38798 0 1140604 0 0 0 JAMES PARR CHIEF FINANCIAL OFFICER 475917 0 71607 0 1800 0 53898 0 38289 0 641511 0 0 0 RALPH YATES CMO SALEM HEALTH AND SHMG 451585 0 67189 0 15240 0 46684 0 30085 0 610783 0 0 0 LAURIE BARR CHIEF HUMAN RESOURCES OFFICER 323000 0 72097 0 1800 0 43054 0 35943 0 475894 0 0 0 SARAH HORN CHIEF NURSING OFFICER 341815 0 46878 0 1080 0 42379 0 35865 0 468017 0 0 0 LEAH MITCHELL CIO 395127 0 71799 0 1200 0 46459 0 28747 0 543332 0 0 0 ANDREW FURMAN - TERM 01252019 VP MEDICAL AFFAIRS 359953 0 54478 0 1632 0 40449 0 36296 0 492808 0 0 0 BAHAA WANLY CHIEF OPERATING OFFICER 321460 0 47281 0 1332 0 37830 0 35037 0 442940 0 0 0 CHRISTINE CLARKE GENERAL SURGEON 346434 0 0 0 955 0 30366 0 15233 0 392988 0 0 0 ZENNIA CENIZA EFF 51218 INTERIM VP CLINICAL OPERATIONS 210204 0 30876 0 1235 0 13676 0 26026 0 282017 0 0 0 DENISE HOOVER VP SURGICAL SERVICES 204919 0 30379 0 890 0 32298 0 23190 0 291676 0 0 0 SHEA CORUM VP IT OPERATIONS 191931 0 28501 0 746 0 25976 0 32307 0 279461 0 0 0 LEILANI SLAMA VP COMMUNITY ENGAGEMENT 169250 0 25634 0 1938 0 23472 0 31719 0 252013 0 0 0 JUAN OYARZUN DIR CARDIOTHORACIC MED 1186736 0 25000 0 4902 0 44344 0 40093 0 1301075 0 0 0 NERVIN FANOUS CARDIOTHORACIC SURGEON 956109 0 0 0 1710 0 42502 0 34262 0 1034583 0 0 0 NICOLE VANDERHEYDEN MD TRAUMA DIR/ ASSOC CMO SHMG 728212 0 34555 0 7131 0 51491 0 41511 0 862900 0 0 0 KATHERINE JONES CARDIOTHORACIC SURGEON 913372 0 0 0 840 0 24537 0 33197 0 971946 0 0 0 PAUL COELHO MEDICAL DIRECTOR, PAIN MANAGEMENT 520780 0 0 0 4902 0 21917 0 29531 0 577130 0 0 0 LORI JAMES-NIELSEN TERM 31717 SEE SCHEDULE J 119917 0 0 0 783 0 10300 0 14605 0 145605 0 0 0 PART I, LINES 4A-B 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: CHERYL NESTER WOLFE $207,151 ($207,151 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $0 INCLUDED IN DEFERRED COMPENSATION) JAMES PARR $33,648 (INCLUDED IN DEFERRED COMPENSATION) RALPH YATES $31,834 (INCLUDED IN DEFERRED COMPENSATION) LAURIE BARR $46,372 ($23,569 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $22,804 INCLUDED IN DEFERRED COMPENSATION) SARAH HORN $22,128 (INCLUDED IN DEFERRED COMPENSATION) LEAH MITCHELL $43,995 ($17,786 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $26,210 INCLUDED IN DEFERRED COMPENSATION) ANDREW FURMAN $25,599 (INCLUDED IN DEFERRED COMPENSATION) BAHAA WANLY $22,981 (INCLUDED IN DEFERRED COMPENSATION) DENISE HOOVER $14,492 (INCLUDED IN DEFERRED COMPENSATION) SHEA CORUM $13,669 (INCLUDED IN DEFERRED COMPENSATION) LEILANI SLAMA $12,459 (INCLUDED IN DEFERRED COMPENSATION) JUAN OYARZUN $29,494 (INCLUDED IN DEFERRED COMPENSATION) NERVIN FANOUS $27,652 (INCLUDED IN DEFERRED COMPENSATION) NICOLE VANDERHEYDEN $65,796 ($34,555 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $31,241 INCLUDED IN DEFERRED COMPENSATION) CHRISTINE CLARKE $15,516 (INCLUDED IN DEFERRED COMPENSATION) KATHERINE JONES $24,537 (INCLUDED IN DEFERRED COMPENSATION) PAUL COELHO $18,382 (INCLUDED IN DEFERRED COMPENSATION) PART I, LINE 6 CERTAIN PHYSICIANS RECEIVE INCENTIVE COMPENSATION IN ACCORDANCE WITH THEIR EMPLOYMENT AGREEMENTS WITH SALEM HEALTH. AMOUNTS NOTED ON SCHEDULE J PART II COLUMN (II) REFLECT PAYMENTS EARNED BY THESE PHYSICIAN EMPLOYEES IN SUCH AGREEMENTS. ADDITIONALLY, FOR KEY EMPLOYEES AND MANAGEMENT OF SALEM HEALTH THE BOARD OF TRUSTEES HAS APPROVED AN ANNUAL LEADERSHIP INCENTIVE PROGRAM THAT PROVIDES FOR INCENTIVE PAYMENTS BASED ON OBJECTIVE CRITERIA RELATED TO QUALITY AND SAFETY, ENGAGEMENT, PATIENT SATISFACTION AND FINANCIAL PERFORMANCE. AMOUNTS NOTED ON SCHEDULE J PART II COLUMN (II) REFLECT PAYMENTS EARNED UNDER THE LEADERSHIP INCENTIVE PLAN. PART I, LINE 7 THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES, IN CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, REVIEWS CEO TOTAL COMPENSATION AND PERFORMANCE ANNUALLY. AS PART OF THE COMMITTEE'S ACTIONS, A NON-FIXED BONUS MAY BE AWARDED TO THE CEO. IN THIS YEAR THE NON-FIXED PAYMENT WAS PAID UNDER THE 457(F) NONQUALIFIED PLAN AND IS INCLUDED IN DEFERRED COMPENSATION REPORTED IN PART II. ADDITIONAL INFORMATION FOR EXECUTIVE TRANSITIONS LORI JAMES-NELSEN WAS CHIEF STRATEGY OFFICER UNTIL AUGUST 1, 2016. SUBSEQUENTLY SHE WAS A LOANED EXECUTIVE TO OHSU PARTNERS UNTIL MARCH 17, 2017. A THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS 521542796 794458CY3 2008-11-13 125000000 REFUND SERIES 2004AB AND 2006B. PATIENT TOWER CONSTRUCTION AND OTHER IMP. 0 0 0 B THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS 521542796 794458EL9 2016-11-01 215638877 REFUND SERIES 2013 AB AND 2008A. PAY COSTS OF ISSUANCE RELATING TO THE BONDS 0 0 0 A 50000000 125021764 633004 1153492 9260268 113975000 2009 1 0 1 1 B 9395000 216071609 25890658 1649773 188489677 41500 1 1 1 1 A 0 1 1 1 1 1 0.00500 0.00100 0.00600 0 0 1 B 0 1 1 1 1 1 0.00900 0.00200 0.01100 0 0 1 A 0 0 1 1 1 1 UBS AG 25.800000000000 0 0 0 0 1 B 0 1 1 0 0 0 0 0 1 A 1 B 1 SUPPLEMENTAL INFORMATION: COLUMN A: DIFFERENCE BETWEEN PART I(E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS IN THE PROJECT FUND. PART I (F): PROCEEDS WERE USED TO REFUND SERIES 2004AB AND SERIES 2006B BONDS, FINANCE THE CONTRUCTION OF THE PATIENT TOWER AND OTHER IMPROVEMENTS. PART II, LINE 1: BONDS REFUNDING SERIES 2008C: SERIES 2013AB (ISSUED JUNE 27, 2013). PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENTS TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III,LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDSM MAS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. PART IV, LINE 2(B): THE REFUNDING AND NEW MONEY PORTIONS OF THE BONDS HAVE MET THE 6-MONTH EXCEPTION TO REBATE. PART IV, LINE 2(C): PROCEEDS OF THE BONDS MET A SPENDING EXCEPTION TO REBATE AND, THEREFORE, NO PAYMENT WILL EVER BE DUE ON THE BONDS. COLUMN B: DIFFERENCE BETWEEN PART I(E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS ON BOND PROCEEDS. PART I (F): BONDS PROCEEDS WERE EXPENDED TO REFUND THE 2013AB BONDS (ISSUED ON JUNE 27,2013), TO REFUND THE 2008A BONDS (ISSUED ON OCTOBER 8, 2008) TO REFUND THE 2006A BONDS (ISSUED ON NOVEMBER 15, 2006) AND TO PAY COSTS OF ISSUANCE RELATING TO THE BONDS. PART II, LINE 13: SINCE THE PROCEEDS OF THE BONDS WERE USED FOR REFUNDING PURPOSES, THE YEAR OF SUBSTANTIAL COMPLETION IS NOT APPLICABLE. PART III, LINE 7:AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. PART IV, LINE 2(B): THE PORTION OF BOND PROCEEDS USED FOR CURRENT REFUNDING HAS MET THE 6-MONTH EXCEPTION TO REBATE. PART IV, LINES 2(B): THE PORTION OF BOND PROCEEDS USED FOR CURRENT REFUNDING HAS MET THE 6-MONTH EXCEPTION TO REBATE. FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE 990. IT IS THEN FORWARDED TO THE ENTIRE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS THE SECRETARY OF THE HOSPITAL SHALL SEND TO EACH PERSON WHO IS A TRUSTEE, OFFICER, OR MEMBER OF A COMMITTEE, AND TO THOSE EMPLOYEES OF THE HOSPITAL AS THE BOARD MAY DETERMINE, A COPY OF THE POLICY REGARDING CONFLICTS OF INTEREST, TOGETHER WITH A QUESTIONNAIRE INQUIRING AS TO CONFLICTS, TO BE COMPLETED 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 IS DESIGNED TO ALLOW THE ORGANIZATION TO RECRUIT AND RETAIN QUALIFIED SENIOR LEADERS. THE GOVERNANCE COMMITTEE OF THE SALEM HEALTH BOARD OF TRUSTEES, NONE OF WHOM IS A SALEM HEALTH EMPLOYEE, ENGAGES ONE OR MORE INDEPENDENT CONSULTANTS TO PROVIDE A MARKET DATA ON EXECUTIVE COMPENSATION, INCLUDING BENEFITS, FOR THE CEO AND OTHER EXECUTIVES IN SIMILAR ROLES AT COMPARABLE ORGANIZATIONS. THIS INFORMATION IS USED BY THE GOVERNANCE COMMITTEE IN ITS DISCUSSIONS AND DECISIONS ON CEO COMPENSATION. THE CEO, IN CONJUNCTION WITH OTHER SALARY SURVEY OR PUBLIC INFORMATION AND THE INDEPENDENT CONSULTANT, ENSURES THAT EACH EXECUTIVE'S COMPENSATION IS COMPETITIVE IN THE MARKET FOR SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE ON THE HOSPITAL WEBSITE. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 3,714,776. CHANGE IN NET BENEFIT COST -998,582. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 337,666. 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