SALEM HEALTH WEST VALLEY: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SALEM HEALTH WEST VALLEY (EIN 43-1960221)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-12
- IRS object ID
- 201422249349301122
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-12T10:04:58-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930623286 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AKT LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5665 SW MEADOWS RD SUITE 200 | AddressLine1 |
| City | LAKE OSWEGO | City |
| State | OR | State |
| ZIP Code | 97035 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431960221 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST VALLEY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WEST | NameControl |
| Phone | 5035615200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 SOUTHEAST WASHINGTON STREET | AddressLine1 |
| City | DALLAS | City |
| State | OR | State |
| ZIP Code | 97338 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AARON R CRANE | Name |
| Title | CHIEF FINANCE/STRATEGY OFFICER | Title |
| Phone | 5035615150 | Phone |
| Date Signed | 2014-08-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOYLYN M ANKENEY CPA | Name |
| PTIN | P00366587 | PTIN |
| Phone | 5036204489 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ROBERT BRANNIGAN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 SOUTHEAST WASHINGTON STREET | AddressLine1 |
| City | DALLAS | City |
| State | OR | State |
| ZIP Code | 97338 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 23579241 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.WESTVALLEYHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 176 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 23013 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 14301 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1000 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 118950 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 22597795 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 23457657 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2220 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2634 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 5232 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 22606247 | TotalRevenuePriorYear |
| Total Revenue Current Year | 23579241 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12034009 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12256542 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9253071 | OtherExpensePriorYear |
| Other Expenses Current Year | 10222003 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 21287080 | TotalExpensesPriorYear |
| Total Expenses Current Year | 22478545 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1319167 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1100696 | RevenuesLessExpensesCY |
| Total Assets BOY | 14412585 | TotalAssetsBOY |
| Total Assets EOY | 15412885 | TotalAssetsEOY |
| Total Liabilities BOY | 10229564 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10101407 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4183021 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5311478 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 13532261 | Expense |
| Revenue | 20270106 | Revenue |
| Description | WEST VALLEY HOSPITAL IS A CRITICAL ACCESS HOSPITAL SERVING THE RURAL POLK COUNTY REGION WITH A POPULATION OF 98,000. SERVICES INCLUDE: DIAGNOSTIC IMAGING PROCEDURES 17,060, EMERGENCY DEPARTMENT VISITS 12,388, INPATIENT ADMISSIONS 172, LABORATORY TESTS/DRAWS 90,985, SURGERIES 126. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4567223 | Expense |
| Revenue | 2834219 | Revenue |
| Description | WEST VALLEY HOSPITAL PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. IN FY 2013, THE COST OF SERVICES PROVIDED AS A COMMUNITY BENEFIT TOTALED $1,733,000. THIS FIGURE CONSISTED OF $1,103,066 IN COSTS TO PROVIDE CHARITY CARE TO INDIVIDUALS WHO CANNOT AFFORD TO PAY AND $629,938 IN UNDERPAYMENT BY MEDICAID AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES. WEST VALLEY HOSPITAL DOES NOT PURSUE LEGAL ACTION FOR NON-PAYMENT OF BILLS AGAINST CHARITY CARE PATIENTS WHO HAVE DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 877465 | Expense |
| Grants | 5000 | Grants |
| Revenue | 330319 | Revenue |
| Description | WEST VALLEY HOSPITAL ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN FY 2013, WEST VALLEY HOSPITAL GAVE $114 THOUSAND 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. WEST VALLEY HOSPITAL SUBSIDIZES THE COST OF PROVIDING SERVICES TO THE COMMUNITY AT A FINANCIAL LOSS IN THE AMOUNT OF OVER $400 THOUSAND. WEST VALLEY HOSPITAL PROVIDES CASH AND IN-KIND DONATIONS TO COMMUNITY PROGRAMS, THE LARGEST OF WHICH IS THE CONNECTIONS VAN WHICH PROVIDES TRANSPORTATION SERVICES TO PATIENTS NEEDING MEDICAL SERVICES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 18976949 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 29 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 176 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OR | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SALEM HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5035611200 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 890 OAK STREET SE | AddressLine1 |
| City | SALEM | City |
| State | OR | State |
| ZIP Code | 97301 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| KATHERINE KEENE | ||||||||
| TRUSTEE | 11.30 | X | 0 | 0 | 0 | |||
| GEORGE HAPP | ||||||||
| TRUSTEE | 3.80 | X | 0 | 0 | 0 | |||
| BRUCE CARTER MD | ||||||||
| TRUSTEE | 5.50 | X | 0 | 0 | 0 | |||
| KENNETH SHERMAN JR | ||||||||
| CHAIR | 15.00 | X | 0 | 0 | 0 | X | ||
| DAVID ELMGREN MD | ||||||||
| TRUSTEE | 5.50 | X | 0 | 0 | 0 | |||
| CHUCK HUDKINS | ||||||||
| TRUSTEE | 4.00 | X | 0 | 0 | 0 | |||
| BONNIE DRIGGERS RN | ||||||||
| TRUSTEE | 6.30 | X | 0 | 0 | 0 | |||
| THERESA TAAFFE | ||||||||
| TRUSTEE | 5.50 | X | 0 | 0 | 0 | |||
| ALAN WYNN | ||||||||
| SECRETARY/TREASURER | 3.60 | X | 0 | 0 | 0 | X | ||
| ALAN COSTIC | ||||||||
| VICE-CHAIR | 12.50 | X | 0 | 0 | 0 | X | ||
| LANE SHETTERLY | ||||||||
| TRUSTEE | 6.30 | X | 0 | 0 | 0 | |||
| ROBERT WELLS | ||||||||
| TRUSTEE | 4.00 | X | 0 | 0 | 0 | |||
| J BART MCMULLAN MD | ||||||||
| TRUSTEE | 4.00 | X | 0 | 0 | 0 | |||
| ROBERT WACHTER MD | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| NORMAN GRUBER | ||||||||
| PRESIDENT | 40.00 | 0 | 908997 | 257423 | X | |||
| AARON CRANE | ||||||||
| CHIEF FINANCIAL AND STRATE | 40.00 | 0 | 462636 | 75121 | X | |||
| PAMELA CORTEZ | ||||||||
| DIRECTOR OF CLINICAL OPERA | 40.00 | 180610 | 0 | 39064 | X | |||
| ROBERT BRANNIGAN | ||||||||
| CHIEF ADMIN OFFICER WVH/VP | 40.00 | 0 | 289855 | 55216 | X | |||
| ALISON SMITH MD | ||||||||
| GENERAL SURGEON | 40.00 | 400086 | 0 | 67009 | X | |||
| GREGORY BEAR MD | ||||||||
| DIAGNOSTIC RADIOLOGIST | 40.00 | 438023 | 0 | 58385 | X | |||
| CHARLES ESSEX MD | ||||||||
| PHYSICIAN | 40.00 | 242551 | 0 | 55286 | X | |||
| JOHN HADLEY MD | ||||||||
| PHYSICIAN | 40.00 | 191582 | 0 | 46687 | X | |||
| REBECCA LUCAS MD | ||||||||
| ER PHYSICIAN | 40.00 | 275431 | 0 | 50183 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1728283 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1661488 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 704374 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| EMCARE INC | |||||
| 7032 COLLECTION CTR DR | CHICAGO | IL | 60693 | EMERGENCY ROOM COVERAGE | 272189 |
| CTM MANAGEMENT | |||||
| 476 NW HILLCREST LOOP | MCMINNVILLE | OR | 97128 | CRNA COVERAGE | 232140 |
| SALEM RADIOLOGY CONSULTANTS PC | |||||
| PO BOX 12989 | SALEM | OR | 97309 | RADIOLOGY SERVICES | 123663 |
| DENMED INC | |||||
| 1485 20TH ST SE | SALEM | OR | 97302 | TRANSCRIPTION SERVICES | 109186 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Related Organizations | 113172 | RelatedOrganizations |
| Government Grants | 5778 | GovernmentGrants |
| Total Contributions | 118950 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT REVENUE | 621110 | 14318869 | 14318869 | |
| LABORATORY | 621500 | 6843160 | 6820147 | 23013 |
| PHARMACY | 621300 | 1962178 | 1962178 | |
| OTHER HOSPITAL SERVICES | 900099 | 259314 | 259314 | |
| NUTRITION SERVICES | 900099 | 74136 | 74136 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 23457657 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2634 | TotalRevenueColumn |
| Exclusion | $2,634 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 23579241 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23434644 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 23013 | UnrelatedBusinessRevenue |
| Exclusion | $2,634 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 236299 | Total |
| Management And General | 236299 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9442863 | Total |
| Program Services | 8376314 | ProgramServices |
| Management And General | 1066549 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 543394 | Total |
| Program Services | 470251 | ProgramServices |
| Management And General | 73143 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1386635 | Total |
| Program Services | 1200390 | ProgramServices |
| Management And General | 186245 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 647351 | Total |
| Program Services | 560215 | ProgramServices |
| Management And General | 87136 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13915 | Total |
| Management And General | 13915 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1325650 | Total |
| Program Services | 1297850 | ProgramServices |
| Management And General | 27800 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9505 | Total |
| Management And General | 9505 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1846202 | Total |
| Program Services | 328171 | ProgramServices |
| Management And General | 1518031 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41891 | Total |
| Program Services | 5205 | ProgramServices |
| Management And General | 36686 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 661155 | Total |
| Program Services | 653010 | ProgramServices |
| Management And General | 8145 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45096 | Total |
| Program Services | 17764 | ProgramServices |
| Management And General | 27332 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14397 | Total |
| Program Services | 11055 | ProgramServices |
| Management And General | 3342 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4675 | Total |
| Program Services | 4675 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1103550 | Total |
| Program Services | 1103550 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310483 | Total |
| Program Services | 310483 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 2563722 | 2563722 | |
| PATIENT SUPPLIES | 1829192 | 1818112 | 11080 |
| OTHER PURCHASED SERVICE | 390964 | 229786 | 161178 |
| SPECIAL EVENTS | 20125 | 3681 | 16444 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41481 | Total |
| Program Services | 22715 | ProgramServices |
| Management And General | 18766 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22478545 | Total |
| Program Services | 18976949 | ProgramServices |
| Management And General | 3501596 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 300 | BOY |
| EOY | 299 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 95197 | BOY |
| EOY | 431693 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2593417 | BOY |
| EOY | 2744270 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 287121 | BOY |
| EOY | 331349 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 140770 | BOY |
| EOY | 128636 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 18687929 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6955895 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11008715 | BOY |
| EOY | 11732034 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 287065 | BOY |
| EOY | 44604 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14412585 | BOY |
| EOY | 15412885 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2874814 | BOY |
| EOY | 2562285 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 137673 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7217077 | BOY |
| EOY | 7539122 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10229564 | BOY |
| EOY | 10101407 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4060340 | BOY |
| EOY | 5270570 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 122681 | BOY |
| EOY | 40908 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4183021 | BOY |
| EOY | 5311478 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14412585 | BOY |
| EOY | 15412885 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1100696 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 27761 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 122681 | BeginningOfYearBalance |
| Contributions | 4345 | Contributions |
| Investment Earnings Or Losses | 3956 | InvestmentEarningsOrLosses |
| Other Expenditures | 90074 | OtherExpenditures |
| End Of Year Balance | 40908 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 65975 | BeginningOfYearBalance |
| Contributions | 53985 | Contributions |
| Investment Earnings Or Losses | 5864 | InvestmentEarningsOrLosses |
| Other Expenditures | 3143 | OtherExpenditures |
| End Of Year Balance | 122681 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 62724 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 3251 | InvestmentEarningsOrLosses |
| End Of Year Balance | 65975 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 57619 | BeginningOfYearBalance |
| Contributions | 5977 | Contributions |
| Investment Earnings Or Losses | 3376 | InvestmentEarningsOrLosses |
| Other Expenditures | 4248 | OtherExpenditures |
| End Of Year Balance | 62724 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 91657 | BeginningOfYearBalance |
| Contributions | 4124 | Contributions |
| Investment Earnings Or Losses | -1659 | InvestmentEarningsOrLosses |
| Other Expenditures | 36503 | OtherExpenditures |
| End Of Year Balance | 57619 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 342155 | OtherCostOrOtherBasis |
| Book Value | 342155 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11819519 | OtherCostOrOtherBasis |
| Depreciation | 3854117 | Depreciation |
| Book Value | 7965402 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5324072 | OtherCostOrOtherBasis |
| Depreciation | 3084237 | Depreciation |
| Book Value | 2239835 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1202183 | OtherCostOrOtherBasis |
| Depreciation | 17541 | Depreciation |
| Book Value | 1184642 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11732034 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO MEDICARE/MEDICAID | $559,166 |
| OTHER LONG-TERM ACCRUALS | $4,819 |
| EST. LIABILITY FOR MALPRACTICE INSURANCE | $280,879 |
| EST. POST-RETIREMENT BENEFITS | $320,338 |
| DUE TO SALEM HOSPITAL | $6,373,920 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 7539122 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 23688775 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 109534 | OtherRevenues |
| Revenue Not Rptd F990 | 109534 | RevenueNotRptdF990 |
| Revenue Subtotal | 23579241 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 23579241 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 22560318 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 81773 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 81773 | ExpensesNotRptdF990 |
| Expenses Subtotal | 22478545 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 22478545 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | ENDOWMENT FUNDS ARE HELD BY WEST VALLEY HOSPITAL FOUNDATION FOR WEST VALLEY HOSPITAL SUPPORT. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | REVENUE NETTED WITH EXPENSES CHANGE IN POST RETIREMENT BENEFIT OBLIGATION 109,534. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | REVENUE NETTED WITH EXPENSES CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 81,773. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4759 | PersonsServed |
| Total Community Benefit Expense | 1103066 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1103066 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05540 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7440 | PersonsServed |
| Total Community Benefit Expense | 3464157 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2834219 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 629938 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03160 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 12199 | PersonsServed |
| Total Community Benefit Expense | 4567223 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2834219 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1733004 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08700 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 42242 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1488 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 40754 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 73532 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 73532 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00370 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 731230 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 328831 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 402399 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02020 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 30461 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 30461 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 877465 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 330319 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 547146 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02740 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 12199 | PersonsServed |
| Total Community Benefit Expense | 5444688 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3164538 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2280150 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11440 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 21360 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 21360 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 21360 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 21360 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,290,520 | BadDebtExpenseAmount |
| Amount Attributable To | 372556 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3390826 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3319262 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 71564 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST VALLEY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 525 SOUTHEAST WASHINGTON ST | AddressLine1 |
| City | DALLAS | City |
| State | OR | State |
| ZIP Code | 97338 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST VALLEY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| Other Needs Addressed | X | OtherNeedsAddressed |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONMOUTH MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 512 E MAIN ST 300 | AddressLine1 |
| City | MONMOUTH | City |
| State | OR | State |
| ZIP Code | 97361 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | CLINIC | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: IT IS THE POLICY OF WEST VALLEY HOSPITAL TO PROVIDE FINANCIAL COUNSELING TO PATIENTS REGARDING THEIR FINANCIAL OBLIGATION AT THE EARLIEST OPPORTUNITY POSSIBLE. WEST VALLEY HOSPITAL PROVIDES A VARIETY OF OPTIONS TO ASSIST PATIENTS IN RESOLVING THEIR ACCOUNTS, INCLUDING: OREGON HEALTH PLAN (OHP) SCREENING, CHARITY ASSISTANCE, MEDICAL FINANCING CARDS, LOANS, AND EXTENDED PAYMENT PLANS. DISCOUNTS MAY BE AVAILABLE ON THE NET BALANCE FOR PATIENTS AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL. PATIENTS AT OR BELOW 200% OF THE POVERTY LEVEL ARE ELIGIBLE FOR 100% CHARITY ASSISTANCE.THE HOSPITAL CONSIDERS BOTH INCOME AND/OR ASSETS AVAILABLE TO PAY PATIENT'S MEDICAL EXPENSES.1. THE HOSPITAL WILL MULTIPLY THE FAMILY INCOME BY 30%2. THE HOSPITAL WILL DETERMINE THE PATIENT'S ALLOWABLE MEDICAL EXPENSES3. THE HOSPITAL WILL COMPARE 30% OF THE FAMILY INCOME TO THE TOTAL OF THE PATIENT'S ALLOWABLE MEDICAL EXPENSES. IF THE TOTAL OF THE ALLOWABLE MEDICAL EXPENSES IS GREATER THAN 30% OF THE FAMILY INCOME, THEN THE PATIENT MEETS THE CATASTROPHIC CHARITY CARE QUALIFICATION. THE HOSPITAL WILL LIMIT PATIENT LIABILITY FOR MEDICAL EXPENSES TO 30% OF THE FAMILY'S INCOME. AMOUNTS THAT EXCEED THIS LIMIT WILL BE ELIGIBLE FOR CHARITY CARE.FOR EXAMPLE: FAMILY INCOME OF $70,000 PER YEAR AND MEDICAL EXPENSES OF $45,000. THIRTY-PERCENT OF THE FAMILY'S ANNUAL INCOME IS $21,000; THE FAMILY'S MEDICAL EXPENSES OF $45,000 EXCEED THIS AMOUNT. THE FAMILY SHOULD THEREFORE BE ELIGIBLE FOR A CHARITY WRITE-OFF OF $24,000.ORASSET TESTASSETS CONSIDERED AVAILABLE TO PAY PATIENT'S MEDICAL EXPENSES1. EQUITY IN A REAL ESTATE, OTHER THAN THE PATIENT'S PERSONAL RESIDENCE, SECURITIES OR OTHER ASSETS (E.G.. RENTAL PROPERTY, AGRICULTURAL USE) IS CONSIDERED AVAILABLE TO PAY THE PATIENT'S MEDICAL EXPENSES.2. $201,000 REPRESENTS THE MEDIAN VALUE OF A HOME IN SALEM, OREGON AS OF AUGUST 2010. THE HOSPITAL CONSIDERS THIS AMOUNT TO BE PROTECTED FROM CONSIDERATION AS A FUNDING SOURCE. EQUITY IN A PATIENT'S PERSONAL RESIDENCE OVER AND ABOVE $201,000 WILL BE CONSIDERED AS AVAILABLE TO PAY MEDICAL LIABILITIES.3. THE CATASTROPHIC LIMIT UNDER THIS TEST WILL BE ESTABLISHED AT 100% OF THE EQUITY IN REAL PROPERTY OVER AND ABOVE THE FIRST $201,000 IN A PRIMARY RESIDENCE, AND 100% OF THE EQUITY IN OTHER REAL PROPERTY PRODUCING INCOME.FOR EXAMPLE: $280,000 (MARKET VALUE) - $100,000 (MORTGAGE) = $180,000 (NET VALUE); THEREFORE, $201,000 (PROTECTED SO EQUITY WOULD NOT BE CONSIDERED) | ||
| PART I, LINE 7: NET COMMUNITY BENEFIT EXPENSE IS CALCULATED BY TOTAL COSTS OF CARE PROVIDED LESS THE DIRECT, OFFSETTING NET REVENUES FOR THOSE SERVICES. THE COSTS TO PROVIDE CHARITY CARE AND MEDICAID SERVICES DISCLOSED IN LINE 7, COLUMN (C) LINES (A) AND (B), RESPECTIVELY, ARE DETERMINED BY APPLYING THE COST TO CHARGE RATIO AS DETERMINED IN WORKSHEET 2 TO THE FULL BILLED CHARGES FOR THE SERVICES RENDERED. NET COMMUNITY BENEFIT EXPENSE FOR THE COSTS FOR SUBSIDIZED HEALTH SERVICES DISCLOSED IN PART I, LINE 7(G) USES AN INTERNAL COSTING SYSTEM WHEREBY DIRECT AND INDIRECT EXPENSES ARE ALLOCATED TO DISCRETE OFFSETTING NET REVENUES FOR EACH SERVICE. OVERHEAD COSTS ARE ALLOCATED TO REVENUE GENERATING SERVICES BASED ON UTILIZATION STATISTICS SUCH AS SQUARE FOOTAGE FOR MAINTENANCE COSTS. | ||
| PART I, LINE 7G: MARION AND POLK COUNTY MUA/HPSA DESIGNATION, HEALTH ASSESSMENT DATA SETS AND MARION POLK RESIDENT (2008) SURVEY RESULTS DEMONSTRATE HEALTHCARE ACCESS PROBLEMS, SPECIFICALLY LACK OF PHYSICIANS WILLING TO TAKE MEDICARE AND OREGON HEALTH INSURANCE (MEDICAID). LIKEWISE, ACCESS TO HEALTHCARE WAS ALSO ONE OF THE TOP THREE COMMUNITY HEALTH CONCERNS CITED BY PROVIDERS SURVEY RESPONDENTS. WHILE REGION 3, WHICH INCLUDES MARION, BENTON, LANE, LINN AND POLK COUNTIES, HAS 94 (OR 111) PRIMARY CARE PROVIDERS PER 100,000 POPULATION, ONLY 86 (OR 98) OF THOSE ACCEPT MEDICARE, AND OF THOSE 86, ONLY A PORTION ARE ACTUALLY ACCEPTING NEW PATIENTS. A SIMILAR SITUATION EXISTS FOR OREGON HEALTH PLAN; EVEN WHEN PEOPLE HAVE COVERAGE, THEY MAY NOT HAVE ACCESS TO ESTABLISHING CARE WITH A LOCAL MEDICAL PROVIDER. TO EASE THIS ACCESS BURDEN, WEST VALLEY HOSPITAL HAS SUBSIDIZED PHYSICIAN PRACTICES AND REPORTS THESE SUBSIDIES IN PART 1, LINE 7, COLUMN (F). | ||
| PART I, L7 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 $2,563,722. | ||
| 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 HEALTH CARE 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. COST OF BAD DEBT EXPENSE DISCLOSED IN LINE 2 IS CALCULATED BY APPLYING THE RATIO OF COST TO CHARGES AS DETERMINED IN WORKSHEET 2 TO THE FULL BILLED CHARGES WRITTEN OFF AGAINST NET PATIENT SERVICES REVENUE ON THE AUDITED FINANCIAL STATEMENT. COST OF BAD DEBT EXPENSE ESTIMATED AS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY ON LINE 3 IS CALCULATED BY SUBTOTALING THE BAD DEBT AMOUNTS BY ZIP CODE. AMOUNTS WRITTEN OFF FOR ZIP CODES WHOSE MEDIAN HOUSEHOLD INCOME FALLS AT OR BELOW 200% OF FEDERAL POVERTY GUIDELINES ARE INCLUDED ON THIS LINE. | ||
| PART III, LINE 9B: IF THERE IS AN INDICATION THAT A PATIENT MAY BE UNABLE TO PAY THEIR BILL, A FINANCIAL QUESTIONNAIRE IS GIVEN OR SENT TO THE PATIENT. UPON RECEIPT OF THE COMPLETED QUESTIONNAIRE, THE PATIENT FINANCIAL COUNSELOR WILL DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE AND NOTIFY THE PATIENT REGARDING THEIR ELIGIBILITY FOR DISCOUNTS UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. ELIGIBILITY IS DETERMINED BASED ON THE QUESTIONNAIRE AND SUPPORTING DOCUMENTATION IN ACCORDANCE TO THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. | ||
| PART V, SECTION B, LINE 3: WEST VALLEY HOSPITAL COLLABORATED WITH THE POLK COUNTY HEALTH DEPARTMENTS IN PUBLICATION OF THE COMMUNITY HEALTH NEEDS REPORT. WEST VALLEY HOSPITAL COMMUNITY BENEFIT ACTIVITIES ARE PROVIDED TO ADDRESS IDENTIFIED HEALTH NEEDS.PARTNERING AGENCIES ARE LISTED IN POLK COUNTY COMMUNITY HEALTH NEEDS REPORT AND CHIP PUBLICATION AND INCLUDE:-THE CONFEDERATED TRIBES OF GRAND RONDE-DEPARTMENT OF HEALTH AND HUMAN SERVICES, STATE OF OREGON-EVANGELICAL BIBLE CHURCH-I LOVE ME DIABETES TASK FORCE-MARION COUNTY CHILD DEVELOPMENT BOARD-MARION AND POLK COUNTY PUBLIC HEALTH SERVICES-MARION-POLK MEDICAL SOCIETY-POLK COUNTY MENTAL HEALTH-OREGON CHILD DEVELOPMENT COALITION-OREGON HEALTH AND SCIENCES UNIVERSITY-OREGON HEALTH AUTHORITY-OREGON STATE UNIVERSITY EXTENSION SERVICE-PERFORMANCE MANAGEMENT PROGRAM-POLK COUNTY HEALTH ADVISORY BOARD-RED CROSS OF THE MID-WILLAMETTE VALLEY-RURAL METRO AMBULANCE-UNITED WAY OF THE MID-WILLAMETTE VALLEY-WESTERN OREGON UNIVERSITY-WESTERN OREGON UNIVERSITYS HEALTH AND WELLNESS CENTER-WILLAMETTE VALLEY HOSPICE-WVP HEALTH AUTHORITY-YMCAIN ADDITION, AS THE HOSPITAL BOARD OF TRUSTEES REVIEWED THE RICH SOURCES OF SECONDARY DATA, THE COLLABORATIVE HEALTH REPORT AND WORK OF THE CHIP, IT BECAME APPARENT THAT LIMITED PRIMARY DATA WAS AVAILABLE. LIKEWISE, THERE WAS LITTLE UNDERSTANDING OF PERCEIVED NEED FROM HEALTH SYSTEM PROVIDERS. IN 2012, THE BOARD ORGANIZED A SERIES OF FIVE FOCUS GROUPS TO HELP FURTHER UNDERSTAND THE NEEDS OF THE COMMUNITY. THE FOCUS GROUP PARTICIPANTS INCLUDED EMERGENCY DEPARTMENT AND URGENT CARE PROVIDERS, SAFETY NET PROVIDERS, PRIMARY CARE PROVIDERS, MENTAL AND BEHAVIORAL HEALTH PROVIDERS AND SENIOR SERVICES AGENCY REPRESENTATIVES. THE GOAL WAS TO GAIN FIRST-HAND KNOWLEDGE OF THE CHALLENGES WITHIN THE CURRENT HEALTH SYSTEM IN PROVIDING SERVICES FOR VULNERABLE POPULATIONS. | WEST VALLEY HOSPITAL | |
| PART V, SECTION B, LINE 4: THE CHNA WAS DONE IN COLLABORATION WITH SALEM HOSPITAL | WEST VALLEY HOSPITAL | |
| PART V, SECTION B, LINE 6I: WEST VALLEY HOSPITAL COMMUNITY BENEFIT ACTIVITY TO ADDRESS AREAS OF NEED IN POLK COUNTYHEALTH NEED: ACCESS TO MEDICAL AND MENTAL HEALTH SERVICES COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:-DEVELOPMENT AND PARTICIPATION IN THE WILLAMETTE VALLEY COORDINATED CARE ORGANIZATION (CCO)-RECRUITMENT OF PRIMARY CARE PROVIDERS TO SERVE POLK COUNTIES-SPONSORSHIP OF THE DALLAS FREE MEDICAL CLINIC-SUPPORT OF PROGRAMS THAT PROVIDE TRANSPORTATION TO MEDICAL SERVICES-DEVELOPMENT OF THE HEALTHCARE WORKFORCEHEALTH NEED: CHRONIC DISEASE PREVENTION AND SELF MANAGEMENT COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:-IMPLEMENT COUNTY-WIDE COMMUNITY HEALTH IMPROVEMENT PLANS WITH PRIMARY FOCUS OF OBESITY PREVENTION-IMPROVE ACCESS TO PRIMARY CARE MEDICAL HOMES FOR RESIDENTS OF POLK COUNTY-FUND SAFETY NET SERVICES IN POLK COUNTY-OFFER CHRONIC DIABETES PREVENTION AND SELF MANAGEMENT PROGRAMS TO UNDERSERVED COMMUNITIES AND INDIVIDUALS-PROVIDE IN-KIND SUPPORT AND MEETING ROOMS FOR COMMUNITY SUPPORT GROUPSHEALTH NEED: CANCER SCREENINGSCOMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:WEST VALLEY HOSPITAL PARTNERS WITH SALEM GASTROENTEROLOGY OF SALEM EACH YEAR IN A MONTH-LONG COLON CANCER AWARENESS CAMPAIGN TO ENCOURAGE MORE PEOPLE TO RECEIVE COLON CANCER SCREENING.-500 STOOL TESTING KITS DISTRIBUTED THROUGHOUT THE COMMUNITY AT VARIOUS LOCATIONS INCLUDING WEST SALEM CLINIC AND DALLAS FREE MEDICAL CLINIC.-PARTNER WITH POLK COUNTY HEALTH DEPARTMENT TO PROVIDE MAMMOGRAMS FOR WOMEN WHO DO NOT QUALIFY FOR OTHER PROGRAMS OR ASSISTANCEHEALTH NEED: EARLY PRENATAL CARE COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:THIS NEED IS DIRECTLY LINKED TO ACCESS TO HEALTH SERVICES AND INCLUDES:-DEVELOPMENT AND PARTICIPATION IN THE WILLAMETTE VALLEY COORDINATED CARE ORGANIZATION-SPONSORSHIP OF DALLAS FREE CLINIC -SUPPORT PROGRAMS THAT PROVIDE TRANSPORTATION TO MEDICAL SERVICES-RECRUITMENT OF PRIMARY CARE PROVIDERS TO SERVE POLK COUNTYHEALTH NEED: POOR MENTAL HEALTH DAYSCOMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:THIS HEALTH NEED IS ALSO LINKED TO ACCESS TO HEALTH SERVICES. MENTAL HEALTH SCREENING, DIAGNOSIS AND TREATMENT IS KEY TO IMPROVING MENTAL HEALTH DAYS. COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:-DEVELOPMENT AND PARTICIPATION IN THE WILLAMETTE VALLEY COORDINATED CARE ORGANIZATION (CCO)-RECRUITMENT OF PRIMARY CARE PROVIDERS TO SERVE POLK COUNTIES-SPONSORSHIP OF THE DALLAS FREE MEDICAL CLINIC-SUPPORT OF PROGRAMS THAT PROVIDE TRANSPORTATION TO MEDICAL SERVICES-DEVELOPMENT OF THE HEALTHCARE WORKFORCEHEALTH NEED: PREVALENCE OF TEEN MARIJUANA USECOMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:PROVIDE CASH AND IN-KIND SUPPORT TO SERVICE INTEGRATION TEAMS IN POLK COUNTY. THE GOAL OF SERVICE INTEGRATION IS TO PROVIDE COORDINATED COMMUNITY RESOURCES AND INFORMATION TO FAMILIES AND INDIVIDUALS IN POLK COUNTY. THE GOAL IS ACCOMPLISHED BY MEETING WITH AREA PARTNERS ON A REGULAR BASIS TO BUILD RELATIONSHIPS, SHARE SERVICES AND RESOURCES, AND BRAINSTORM WAYS TO OFFER ASSISTANCE AND IDENTIFY GAPS IN SERVICES.HEALTH NEED: SOCIAL DETERMINATES OF HEALTHTHE SOCIAL DETERMINANTS OF HEALTH TOPIC AREA WITHIN HEALTHY PEOPLE 2020 IS DESIGNED TO IDENTIFY WAYS TO CREATE SOCIAL AND PHYSICAL ENVIRONMENTS THAT PROMOTE GOOD HEALTH FOR ALL. ALL AMERICANS DESERVE AN EQUAL OPPORTUNITY TO MAKE CHOICES THAT LEAD TO GOOD HEALTH. BUT TO ENSURE THAT ALL AMERICANS HAVE THAT OPPORTUNITY, ADVANCES ARE NEEDED NOT ONLY IN HEALTH CARE, BUT ALSO IN FIELDS SUCH AS EDUCATION, CHILDCARE, HOUSING, BUSINESS, LAW, MEDIA, COMMUNITY PLANNING, TRANSPORTATION, AND AGRICULTURE. MAKING THESE ADVANCES WOULD INVOLVE WORKING TOGETHER.COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:-PROVIDE LEADERSHIP ON THE 211 ADVISORY BOARD-PROVIDE CASH AND IN-KIND SUPPORT TO SERVICE INTEGRATION TEAMS IN POLK COUNTY | WEST VALLEY HOSPITAL | |
| PART V, SECTION B, LINE 7: NOT ALL IDENTIFIED NEEDS ARE BEING ADDRESSED IN THE HOSPITALS COMMUNITY BENEFIT PLAN. TEEN PREGNANCY AND ADULT BINGE DRINKING IN POLK COUNTY WILL NOT BE ADDRESSED.THE MARION COUNTY CHIP IDENTIFIED TEEN PREGNANCY AS A HEALTH PRIORITY AREA. THE COUNTY HEALTH DEPARTMENT IS TAKING THE LEAD TO ADDRESS THIS HEALTH NEED AND DATA SHOWS SIGNIFICANT IMPROVEMENT IN THIS HEALTH INDICATOR SINCE 2007, WHEN THE RATE WAS 43.0 PREGNANCIES PER 1,000 FEMALES AGED 15 -17. FROM 2010 THROUGH 2011 THE RATE DROPPED FROM 30.6 TO 23.2 PER 1,000. LIKEWISE, POLK COUNTY TEEN PREGNANCIES ARE 16.4 PREGNANCIES PER 1,000 FEMALES AGED 15-17 AND RATES CONTINUE TO SHOW SIGNIFICANT IMPROVEMENT SINCE 2007 WHEN THE RATE WAS REPORTED AT 20.5PREGNANCIES PER 1,000 FEMALES AGED 15-17. SALEM HOSPITAL WILL CONTINUE TO MONITOR IMPROVEMENT AND PARTNER WITH KEY AGENCIES TO SUSTAIN IMPROVEMENT. IN POLK COUNTY 16.5 PERCENT OF ADULT MALES REPORTED BINGE DRINKING AT LEAST ONCE DURING THE 30 DAYS PRIOR TO THE SURVEY. BINGE DRINKING IS DEFINED AS FIVE OR MORE DRINKS ON ONE OCCASION. WHILE COMMUNITY PARTNERING AGENCIES IDENTIFIED BINGE DRINKING AS A HEALTH PRIORITY, THE HEALTHY PEOPLE 2020 NATIONAL HEALTH TARGET IS TO REDUCE THE PROPORTION OF ADULTS AGED 18 YEARS AND OLDER ENGAGING IN BINGE DRINKING DURING THE PAST 30 DAYS TO 24.3 PERCENT. POLK COUNTY DATA SHOWS ADULT MALE BINGE DRINKING WELL BELOW THE NATIONAL TARGET. | WEST VALLEY HOSPITAL | |
| PART V, SECTION B, LINE 20D: THE AMOUNTS CHARGED TO PATIENTS ELIGIBLE UNDER THE FAP ARE DISCOUNTED AT TWO STEPS. THE FIRST STEP IS THAT ALL SELF-PAY PATIENTS RECEIVE A 15% DISCOUNT SO BILLED AMOUNTS ARE 85% OF GROSS CHARGES REGARDLESS OF FAP ELIGIBILITY. PATIENTS ELIGIBLE UNDER THE VERY FIRST TIER OF THE FAP, THOSE RECEIVING THE SMALLEST DISCOUNT, RECEIVE AN ADDITIONAL 20% DISCOUNT OFF THE AMOUNTS BILLED TO SELF-PAY PATIENTS (THE 85% OF GROSS CHARGES AMOUNT). THIS SECOND DISCOUNT MEANS THAT PATIENTS ELIGIBLE UNDER THE FAP ARE LIMITED TO BILLINGS AT A DISCOUNTED RATE OF 68%. THE HOSPITAL CALCULATES AGB USING THE LOOKBACK METHOD PRESCRIBED IN PROPOSED REGULATIONS (REG-130266-11). AS THE PROPOSED REGULATIONS DETAIL, AGB IS CALCULATED UNDER THIS METHOD BY DIVIDING THE SUM OF CLAIMS PAID TO THE HOSPITAL FACILITY BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. THE AGB PERCENTAGES CALCULATED ARE BASED ON ALL CLAIMS THAT HAVE BEEN PAID IN FULL TO THE HOSPITAL FACILITY FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE BY BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS (INCLUDING MEDICARE ADVANTAGE) TOGETHER AS THE PRIMARY PAYER OF THESE CLAIMS. THE AMOUNT CONSIDERED PAID INCLUDES PAYMENTS FROM INSURER, MEDICARE AND AMOUNTS PAID BY THE INDIVIDUALS UNDER CO-INSURANCE, CO-PAYMENTS AND DEDUCTIBLES. THE MOST RECENT CALCULATION WAS BASED ON THE FISCAL YEAR ENDED 9/30/13. THE CALCULATION SHOWED THAT AMOUNTS GENERALLY BILLED ("AGB") WAS DISCOUNTED AT A RATE OF 32% FROM GROSS CHARGES DURING THE PERIOD ANALYZED, IN OTHER WORDS PAYMENTS WERE MADE AT AN AVERAGE RATE OF 68% OF GROSS CHARGES. THE DISCOUNTS UNDER THE FAP WILL BE REVIEWED WITHIN 45 DAYS OF EACH FISCAL YEAR END TO ENSURE THAT EACH YEAR THE POLICY IS UPDATED TO REFLECT CURRENT AGB AMOUNTS. | WEST VALLEY HOSPITAL | |
| PART VI, LINE 2: WEST VALLEY HOSPITAL("WVH"), AS PART OF SALEM HEALTH, THE POLK COUNTIES, PUBLIC HEALTH MANAGER WORKED WITH THE SALEM HOSPITAL COMMUNITY BENEFIT DIRECTOR TO GATHER COMMUNITY PARTNERS FOR REVIEW OF HEALTH INDICATORS AND TO PRIORITIZE NEEDS. A PRIORITIZED DESCRIPTION OF THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE POLK COUNTY COMMUNITY HEALTH REPORT AND THE SALEM HEALTH WEB-BASED, POLK COUNTY INDICATOR TOOLS ARE INCLUDED IN THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE CHIP REPORTS ALSO DESCRIBE THE PROCESS AND CRITERIA USED IN PRIORITIZING HEALTH NEEDS. THE CHIP PLANNING COMMITTEES CHOSE KEY HEALTH INDICATORS THAT MOST ADVERSELY AFFECTED THE COMMUNITY AT LARGE FROM THE HEALTH REPORT AND DASHBOARD FINDINGS.IN POLK COUNTY, THE CHIP PLANNING COMMITTEE CHOSE NINE KEY HEALTH INDICATORS THAT MOST ADVERSELY AFFECTED THE COMMUNITY AT LARGE FROM THE HEALTH REPORT AND DASHBOARD FINDINGS. THE REVIEW RESULTED IN THE FOLLOWING RANKINGS, LISTED IN ORDER OF RECEIVING THE MOST EXPRESSED CONCERN TO LEAST THE EXPRESSED CONCERN: TEENS WHO ARE OBESE; POOR MENTAL HEALTH DAYS; ADULTS WHO ARE OBESE; MOTHERS WHO RECEIVE EARLY PRENATAL CARE; TEEN PREGNANCY RATES; LOW-INCOME PRESCHOOL OBESITY; MALE ADULTS WHO BINGE DRINK; CANCER SCREENINGS AND PREVALENCE; AND TEEN MARIJUANA USE.THE NINE INDICATORS WERE PRESENTED TO REPRESENTATIVES FROM COMMUNITY PARTNERING AGENCIES AT THE POLK COMMUNITY HEALTH ASSESSMENT LAUNCH IN LATE 2011. THE GROUP WAS INSTRUCTED TO SELECT THREE TO FOUR FOCUS AREAS. INDICATORS SELECTED INCLUDED TEENS WHO ARE OBESE, ADULTS WHO ARE OBESE, AND LOW-INCOME PRESCHOOL OBESITY. ALL THREE INDICATORS FOCUSED ON THE ISSUE OF OBESITY. DESPITE THE FACILITATORS ENCOURAGEMENT TO THINK BROADLY, THE COMMUNITY STRONGLY SUPPORTED THE SINGLE ISSUE OF OBESITY, DUE, AMONG OTHER THINGS, TO THE IMPACT ON OTHER HEALTH ISSUES. THE COMMUNITY HEALTH IMPROVEMENT PLAN WORKGROUP AGREED THAT TARGETING THE HIGH RATE OF OBESITY IN POLK COUNTY WOULD HAVE A TREMENDOUS POSITIVE IMPACT DUE TO THE VARIETY OF HEALTH ISSUES DIRECTLY RELATED TO OBESITY INCLUDING: MOBILITY, CHRONIC CONDITIONS, WORKABILITY, SELF-ESTEEM, STRESS, AND PHYSICALITY. ALTHOUGH THE POLK COUNTY CHIP IDENTIFIED NINE HEALTH INDICATORS AND CHOSE TO FOCUS ON THOSE RELATED TO OBESITY, THE HOSPITAL DATA DASHBOARD INCLUDES SOCIAL DETERMINANTS OF HEALTH AS WELL. IN POLK COUNTY, EDUCATIONAL (3RD GRADE READING, AND 8TH GRADE MATH PROFICIENCY), GROCERY STORE DENSITY, AND VIOLENT CRIME RATE NEGATIVELY INFLUENCE HEALTH. THEREFORE, THESE FOUR INDICATORS WERE ALSO IDENTIFIED AS AREAS OF NEED.IN ADDITION, THE HOSPITAL WILL FOCUS RESOURCES AND ALIGN COMMUNITY BENEFIT WORK TO IMPACT SOCIAL DETERMINANTS OF HEALTH IDENTIFIED IN THE CHNA. THE PUBLIC HEALTH DEPARTMENT AND HOSPITAL RECOGNIZE THE IMPORTANCE OF EACH OF THE HEALTH INDICATORS AND ARE COMMITTED TO IMPACT AS MANY HEALTH MEASURES AS POSSIBLE THROUGH DIRECT CONTRIBUTION, COMMUNITY COLLABORATION, AND PARTNERSHIP. | ||
| PART VI, LINE 3: IT IS THE POLICY OF WEST VALLEY HOSPITAL TO PROVIDE FINANCIAL COUNSELING TO PATIENTS REGARDING THEIR FINANCIAL OBLIGATION AT THE EARLIEST OPPORTUNITY POSSIBLE. WEST VALLEY HOSPITAL PROVIDES A VARIETY OF OPTIONS TO ASSIST PATIENTS IN RESOLVING THEIR ACCOUNTS, INCLUDING: OREGON HEALTH PLAN (OHP) SCREENING, CHARITY ASSISTANCE, MEDICAL FINANCING CARDS, LOANS, AND EXTENDED PAYMENT PLANS. DISCOUNTS MAY BE AVAILABLE ON THE NET BALANCE FOR PATIENTS AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL. PATIENTS AT OR BELOW 200% OF THE POVERTY LEVEL ARE ELIGIBLE FOR 100% CHARITY ASSISTANCE.ALL UNINSURED PATIENTS WITH BALANCES OVER $500 ARE SCREENED FOR ELIGIBILITY THROUGH THE OREGON HEALTH PLAN (OHP), CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA) ELIGIBILITY, AND/OR ELIGIBILITY INTO THE FAMILY HEALTH INSURANCE ASSISTANCE PLAN (FHIAP) PROGRAM.WEST VALLEY HOSPITAL OR ITS REPRESENTATIVE WILL REVIEW THE PATIENT'S CURRENT RESOURCES AND WORK WITH HIM/HER TO GAIN ELIGIBILITY FOR ANY OF THESE PROGRAMS AS APPROPRIATE.PATIENTS THAT ARE NOT ELIGIBLE FOR OHP OR THE OTHER PROGRAMS LISTED ABOVE, AND HAVE FINANCIAL CONSTRAINTS THAT INHIBIT THEIR ABILITY TO PAY, WILL BE ASSESSED FOR EITHER CHARITY CARE OR A FINANCIAL DISCOUNT.INFORMATION ON THE HOSPITAL'S CHARITY CARE & FINANCIAL POLICY SHALL BE MADE PUBLICLY AVAILABLE IN THE FOLLOWING MANNER:- NOTICES ARE POSTED IN KEY AREAS OF THE HOSPITAL, INCLUDING ADMITTING, THE EMERGENCY DEPARTMENT, OUTPATIENT DEPARTMENT REGISTRATION AREAS, AND THE BUSINESS OFFICE. - THE CONDITIONS OF ADMISSION FORM INFORMS THE PATIENT OF THEIR RIGHT TO APPLY FOR CHARITY CARE. - WRITTEN INFORMATION SHALL BE AVAILABLE IN ENGLISH AND SPANISH. THE HOSPITAL WILL PROVIDE THE APPROPRIATE INTERPRETATION SERVICES FOR ALL PATIENTS WHO DO NOT SPEAK ENGLISH. - FRONT-LINE STAFF IS TRAINED TO ANSWER CHARITY CARE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY QUESTIONS THAT CANNOT BE ANSWERED TO BUSINESS OFFICE STAFF IN A TIMELY MANNER. - THIS POLICY IS POSTED ON WEST VALLEY HOSPITAL'S WEBSITE. WRITTEN INFORMATION ABOUT THIS POLICY IS MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION. - THE FIRST PATIENT STATEMENT WILL INCLUDE A NOTICE THAT CHARITY CARE AND/OR FINANCIAL ASSISTANCE IS AVAILABLE. | ||
| PART VI, LINE 4: WEST VALLEY HOSPITAL IS A CRITICAL ACCESS HOSPITAL SERVING THE COMMUNITY OF POLK COUNTY, OREGON. WEST VALLEY HOSPITAL, THE ONLY HOSPITAL IN POLK COUNTY, OFFERS SERVICES BEYOND WHAT YOU MIGHT EXPECT FROM A SMALL-TOWN HOSPITAL. IN ADDITION TO MANY OUTPATIENT SURGERIES, THE MRI CAPABILITY TOPS AN IMAGING SERVICE THAT INCLUDES A NEW MAMMOGRAPHY SUITE. THE HOSPITAL PRIDES ITSELF ON PROVIDING LOW WAIT TIME AT ITS ROUND-THE-CLOCK EMERGENCY DEPARTMENT. SEVERAL CARDIOLOGISTS, UROLOGISTS, ORTHOPEDISTS AND GENERAL SURGEONS DO SEE PATIENTS AT WEST VALLEY HOSPITAL FOR PRELIMINARY AND FOLLOW-UP APPOINTMENTS. POLK COUNTY POPULATION ESTIMATE IN 2013 WAS 76,794 WITH PERSONS UNDER THE AGE OF 18 YEARS MAKING UP 23.6% OF THE POPULATION AND THOSE OVER 65 YEARS 15.8% OF THE POPULATION. 12.6% OF POLK COUNTY RESIDENTS ARE HISPANIC OR LATINO, 0.7% BLACK OR AFRICAN AMERICAN, 2,4% AMERICAN INDIAN AND ALASKA NATIVE. 79.9% ARE WHITE, NOT HISPANIC OR LATINO. OVERALL 14.6% OF PERSONS, AND 18.9% OF CHILDREN LIVE BELOW THE FEDERAL POVERTY LEVEL IN POLK COUNTY | ||
| PART VI, LINE 5: WEST VALLEY HOSPITAL, AS A PART OF SALEM HEALTH, IS GOVERNED BY AN ALL-VOLUNTEER COMMUNITY-BASED BOARD OF TRUSTEES (BOARD). WEST VALLEY HOSPITAL LEADERSHIP AND HEALTH SYSTEM EXECUTIVE STAFF SERVE ON COMMUNITY NON-PROFIT ADVISORY BOARDS AND PROFESSIONAL ASSOCIATIONS. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN ITS COMMUNITY AND PROVIDES FREE OFFICE SPACE AND OTHER IN-KIND SUPPORT SERVICES TO NON-PROFIT ORGANIZATIONS. WEST VALLEY HOSPITAL PROVIDES FINANCIAL SUPPORT AND SPONSORSHIP TO NONPROFIT ORGANIZATIONS. BY LEVERAGING HOSPITAL RESOURCES AND WORKING IN COLLABORATIVE PARTNERSHIPS, THE HOSPITAL IS ABLE TO PROVIDE BENEFITS THAT REACH BEYOND HEALTHCARE DELIVERY AND POSITIVELY IMPACT THE SOCIAL DETERMINANTS OF HEALTH. | ||
| 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 IS THE "PARENT" CORPORATION AND SOLE CORPORATE MEMBER OF THE CORPORATION, SALEM HOSPITAL FOUNDATION, WEST VALLEY HOSPITAL, WEST VALLEY HOSPITAL FOUNDATION, WILLAMETTE VALLEY INSURANCE CORPORATION, AND WILLAMETTE VALLEY PROFESSIONAL SERVICES. ALL ENTITIES WITHIN THE PARENT CORPORATION ARE SEPARATE NONPROFIT CORPORATIONS.WEST VALLEY HOSPITAL IS ALSO AN OREGON NON-PROFIT CORPORATION. WEST VALLEY HOSPITAL, FORMERLY NAMED VALLEY COMMUNITY HOSPITAL, IS LOCATED IN DALLAS, OREGON, AND BECAME A CONTROLLED SUBSIDIARY OF SALEM HEALTH IN 2002. THE CORPORATION ALSO DOES BUSINESS UNDER THE NAME "WEST VALLEY HOSPITAL, A PART OF SALEM HEALTH." IT IS DESIGNATED AS A CRITICAL ACCESS HEALTH CENTER WITH 25 LICENSED BEDS. WEST VALLEY HOSPITAL, AS PART OF SALEM HEALTH, IS GOVERNED BY AN ALL-VOLUNTEER COMMUNITY-BASED BOARD OF TRUSTEES (BOARD). THE BOARD HAS THE RESPONSIBILITY FOR THE DEVELOPMENT AND OVERSIGHT OF SALEM HEALTH VALUES, VISION, PURPOSE AND LONG-TERM STRATEGY. THROUGH THESE DOCUMENTS, THE COMMUNITY BENEFIT STEERING COMMITTEE ASSESSES AND REAFFIRMS WEST VALLEY HOSPITAL'S COMMUNITY BENEFIT COMMITMENTS AND CONNECTIONS WITH COMMUNITY NEEDS AND PRIMARY CONSTITUENCIES. THE COMMUNITY BENEFIT PLAN ASSURES MEASUREMENT AND COMPARISON OF WEST VALLEY HOSPITAL'S COMMUNITY ACTIVITIES TO EVOLVING NORMS AND OVERSEES THE CLEAR AND ACCURATE COMMUNICATION OF THESE ACTIVITIES TO KEY CONSTITUENCIES. | ||
| OR | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NORMAN GRUBER | ||||||||||||||
| PRESIDENT | 0 | 801372 | 0 | 93499 | 0 | 14126 | 0 | 216250 | 0 | 41173 | 0 | 1166420 | 0 | 0 |
| AARON CRANE | ||||||||||||||
| CHIEF FINANCIAL AND STRATE | 0 | 436596 | 0 | 13218 | 0 | 12822 | 0 | 46132 | 0 | 28989 | 0 | 537757 | 0 | 0 |
| PAMELA CORTEZ | ||||||||||||||
| DIRECTOR OF CLINICAL OPERA | 158792 | 0 | 21540 | 0 | 278 | 0 | 15637 | 0 | 23427 | 0 | 219674 | 0 | 0 | 0 |
| ROBERT BRANNIGAN | ||||||||||||||
| CHIEF ADMIN OFFICER WVH/VP | 0 | 245979 | 0 | 36966 | 0 | 6910 | 0 | 30130 | 0 | 25086 | 0 | 345071 | 0 | 0 |
| ALISON SMITH MD | ||||||||||||||
| GENERAL SURGEON | 395649 | 0 | 0 | 0 | 4437 | 0 | 37457 | 0 | 29552 | 0 | 467095 | 0 | 0 | 0 |
| GREGORY BEAR MD | ||||||||||||||
| DIAGNOSTIC RADIOLOGIST | 432617 | 0 | 0 | 0 | 5406 | 0 | 31150 | 0 | 27235 | 0 | 496408 | 0 | 0 | 0 |
| CHARLES ESSEX MD | ||||||||||||||
| PHYSICIAN | 240126 | 0 | 0 | 0 | 2425 | 0 | 24654 | 0 | 30632 | 0 | 297837 | 0 | 0 | 0 |
| JOHN HADLEY MD | ||||||||||||||
| PHYSICIAN | 189077 | 0 | 0 | 0 | 2505 | 0 | 23570 | 0 | 23117 | 0 | 238269 | 0 | 0 | 0 |
| REBECCA LUCAS MD | ||||||||||||||
| ER PHYSICIAN | 274566 | 0 | 0 | 0 | 865 | 0 | 24830 | 0 | 25353 | 0 | 325614 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 4B | SOME OF THE HOSPITAL'S OFFICERS AND 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: NORMAN GRUBER 293,499 ($93,499 INCLUDED IN OTHER REPORTABLE COMPENSATION AND $200,000 INCLUDED IN DEFERRED COMPENSATION) AARON CRANE 29,882 (INCLUDED IN DEFERRED COMPENSATION) ROBERT BRANNIGAN 16,380 (INCLUDED IN DEFERRED COMPENSATION) ALISON SMITH 21,207 (INCLUDED IN DEFERRED COMPENSATION) GREGORY BEAR 17,400 (INCLUDED IN DEFERRED COMPENSATION) CHARLES ESSEX 11,210 (INCLUDED IN DEFERRED COMPENSATION) JOHN HADLEY 11,490 (INCLUDED IN DEFERRED COMPENSATION) REBECCA LUCAS 11,080 (INCLUDED IN DEFERRED COMPENSATION) |
| PART I, LINE 6 | CERTAIN PHYSICIANS RECEIVE INCENTIVE COMPENSATION IN ACCORDANCE WITH THEIR EMPLOYMENT AGREEMENTS WITH SALEM HOSPITAL. AMOUNTS NOTED ON SCHEDULE J PART II COLUMN (II) REFLECT PAYMENTS EARNED BY THESE PHYSICIAN EMPLOYEES IN SUCH AGREEMENTS. |
| PART I, LINE 7 | THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES, IN CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, REVIEWS CEO TOTAL COMPENSATION AND PERFORMANCE ANNUALLY. AS PART OF THE COMMITTEE'S ACTIONS, A NON-FIXED BONUS MAY BE AWARDED TO THE CEO. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE 990. IT IS THEN FORWARDED TO THE ENTIRE BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ON AN ANNUAL BASIS THE SECRETARY OF THE HOSPITAL SHALL SEND TO EACH PERSON WHO IS A TRUSTEE, OFFICER, OR MEMBER OF A COMMITTEE, AND TO THOSE EMPLOYEES OF THE HOSPITAL AS THE BOARD MAY DETERMINE, A COPY OF THE POLICY REGARDING CONFLICTS OF INTEREST, TOGETHER WITH A QUESTIONNAIRE INQUIRING AS TO CONFLICTS, TO BE COMPLETED 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 | COMPENSATION FOR THE CEO IS REVIEWED ON AN ANNUAL BASIS. THE GOVERNANCE COMMITTEE ENGAGES AN OUTSIDE CONSULTANT TO DO A MARKET REVIEW AND COMPARISON. THE CONSULTANT WORKS DIRECTLY WITH THE GOVERNANCE COMMITTEE CHAIR AS WELL AS HUMAN RESOURCES TO COMPLETE THE ASSESSMENT AND MAKE A RECOMMENDATION. THE FINAL RECOMMENDATION IS BROUGHT BEFORE THE BOARD IN EXECUTIVE SESSION FOR FINAL APPROVAL. | |
| 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 (FAS 136) -81,773. CHANGE IN POST RETIREMENT BENEFIT 109,534. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SALEM HOSPITAL | |||||||||||
| 890 OAK STREET SE | SALEM | OR | 97301 | 930579722 | HOSPITAL | OR | 501(C)(3) | 3 | SALEM HEALTH | 0 | |
| SALEM HOSPITAL FOUNDATION | |||||||||||
| 890 OAK STREET SE | SALEM | OR | 97301 | 237002687 | SUPPORTS SALEM HOSPITAL | OR | 501(C)(3) | 11 TYPE 1 | SALEM HEALTH | 0 | |
| SALEM HOSPITAL AUXILIARY | |||||||||||
| 890 OAK STREET SE | SALEM | OR | 97301 | 931081113 | SUPPORTS SALEM HOSPITAL | OR | 501(C)(3) | 9 | 0 | N/A | |
| SALEM HEALTH | |||||||||||
| 890 OAK STREET SE | SALEM | OR | 97301 | 930823471 | LEASES LAND TO SALEM HOSPITAL | OR | 501(C)(3) | 11 TYPE 1 | 0 | N/A | |
| WEST VALLEY HOSPITAL FOUNDATION | |||||||||||
| 525 SOUTHEAST WASHINGTON STREET | DALLAS | OR | 97338 | 931298564 | SUPPORTS WEST VALLEY HOSPITAL | OR | 501(C)(3) | 11 TYPE 1 | SALEM HEALTH | 0 | |
| WILLAMETTE VALLEY INSURANCE COMPANY | |||||||||||
| 745 FORT STREET | HONOLULU | HI | 96813 | 201836190 | CAPTIVE INSURANCE | HI | 501(C)(3) | 11 TYPE 1 | SALEM HEALTH | 0 | |
| WILLAMETTE VALLEY PROFESSIONAL SERVICES | |||||||||||
| 890 OAK STREET SE | SALEM | OR | 97301 | 753175249 | BILLING SERVICE FOR PROFESSIONAL SERVICES | OR | 501(C)(3) | 3 | SALEM HEALTH | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |