2014-08-12T10:04:58-05:00 2013-09-30 930623286 AKT LLP 680 HAWTHORNE AVE SE 140 SALEM OR 97301 990 2012-10-01 930579722 SALEM HOSPITAL SALE 5035615535 890 OAK STREET SALEM OR 97301 AARON R CRANE 5035615150 2014-08-07 1 JOYLYN M ANKENEY CPA P00366587 5035857774 2012 2015-11-30 17:44:51Z AARON R CRANE 890 OAK STREET SALEM OR 97301 604079263 0 X WWW.SALEMHOSPITAL.ORG X 1970 OR TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE 14 12 4096 394 3787954 0 1116703 1300559 553452193 588301112 2961948 10056283 2829167 3304977 560360011 602962931 323884 483755 0 0 279517326 286518729 0 0 0 269658835 280707541 549500045 567710025 10859966 35252906 896084291 967313763 391589952 401360778 504494339 565952985 TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES WE SERVE 0 0 122984354 304897918 SALEM HOSPITAL IS ONE OF THE LARGEST OF OREGON'S 59 ACUTE CARE HOSPITALS AND OPERATES THE BUSIEST EMERGENCY DEPARTMENT IN OREGON. THERE ARE 649 PRACTITIONERS, REPRESENTING 46 DIFFERENT SPECIALTIES. MORE THAN 394 VOLUNTEERS PROVIDE NON-MEDICAL SUPPORT FOR THE HOSPITAL. 2013 STATISTICS: BIRTHS - 3,005, DIAGNOSTIC IMAGING PROCEDURES - 156,909, ED VISITS - 93,099, INPATIENT ADMISSIONS - 21,540, LABORATORY PROCEDURES - 1,186,975, SURGERIES - 13,109. THE PRIMARY SERVICE AREA IS THE GREATER WILLAMETTE VALLEY WITH APPROXIMATELY 500,000 RESIDENTS. 350466465 271796104 SALEM HOSPITAL PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. IN FY2013, THE COST OF SERVICES PROVIDED AS A COMMUNITY BENEFIT TOTALED $78.7 MILLION. THIS FIGURE CONSISTED OF $24.8 MILLION IN COSTS TO PROVIDE CHARITY CARE TO INDIVIDUALS WHO CANNOT AFFORD TO PAY; $18.2 MILLION IN UNDERPAYMENT BY MEDICAID AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES; AND $35.7 MILLION IN UNDERPAYMENT BY MEDICARE AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES. SALEM 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. 23313912 536752 11579520 SALEM HOSPITAL ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN FY 2013, SALEM HOSPITAL GAVE $11.7 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 2013, SALEM HOSPITAL PROVIDED MORE THAN $537 THOUSAND IN CASH AND IN-KIND DONATIONS TO COMMUNITY HEALTH PROGRAMS SUCH AS MEDASSIST AND PROJECT ACCESS, PSYCHIATRIC CRISIS CENTER AND THE SALEM FREE CLINIC. 496764731 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 339 0 1 4096 1 1 1 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OR X X SALEM HOSPITAL 5035611200 890 OAK STREET SE SALEM OR 97301 KATHERINE L KEENE 11.30 X 0 0 0 GEORGE HAPP 3.80 X 0 0 0 BRUCE CARTER MD 5.50 X 0 0 0 KENNETH SHERMAN JR 15.00 X X 0 0 0 DAVID ELMGREN MD 5.50 X 0 0 0 CHUCK HUDKINS 4.00 X 0 0 0 BONNIE DRIGGERS RN 6.30 X 0 0 0 THERESA HASKINS 5.50 X 0 0 0 ALAN WYNN 3.60 X X 0 0 0 ALAN COSTIC 12.50 X X 0 0 0 LANE SHETTERLY 6.30 X 0 0 0 ROBERT WELLS 4.00 X 0 0 0 J BART MCMULLAN MD 4.00 X 0 0 0 ROBERT WACHTER MD 2.00 X 0 0 0 NORMAN GRUBER 40.00 X 908997 0 257423 AARON CRANE 40.00 X 462636 0 75121 ROBERT BRANNIGAN 40.00 X 289855 0 55216 LAURIE BARR 40.00 X 226665 0 53986 MARTHA ENRIQUEZ 40.00 X 312821 0 67247 BRIAN DAWSON 40.00 X 207319 0 25161 MARTIN MORRIS 40.00 X 264531 0 57077 CHERYL NESTER WOLFE 40.00 X 453738 0 75298 CORT GARRISON 40.00 X 361877 0 71362 ANNE KOLLER 40.00 X 239711 0 68721 WILLIAM HOLLOWAY MD 40.00 X 538518 0 86488 LEAH MITCHELL 40.00 X 165310 0 31980 AMR HEGAZI MD 40.00 X 501468 0 68320 AHMED EBEID MD 40.00 X 594561 0 84298 ALVIE RICHARDSON MD 40.00 X 461050 0 46849 NICOLE VANDERHEYDEN MD 40.00 X 480400 0 77328 THYE SCHUYLER MD 40.00 X 393181 0 41137 BEVERLY BOW 40.00 X 423562 0 38139 7286200 0 1281151 175 1 1 0 PHOENIX HEALTH SYSTEMS INC 1130 EAST ARAPAHO ROAD SUITE 500 RICHARDSON TX 75081 IT SUPPORT SERVICES 3171555 EPIC SYSTEMS CORP PO BOX 88314 MILWAUKIE WI 53288 CONSULTING SERVICES 2107376 OWENS AND MINOR INC PO BOX 53523 LOS ANGELES CA 90074 CONSULTING SERVICES 2063537 OREGON ANESTHESIOLOGY GROUP 120 NW 14TH STREET SUITE 300 PORTLAND OR 97209 ANESTHESIA COVERAGE 1641095 PEACEHEALTH LABORATORIES PO BOX 77003 SPRINGFIELD OR 97475 LABORATORY SERVICES 1378993 85 1037536 263023 1300559 PATIENT PAYMENTS 621110 571308788 571308788 PHARMACY 446110 6801865 4662350 2139515 OTHER HOSPITAL SERVICES 900099 4625169 4485406 139763 NUTRITION SERVICES 722210 3958528 3958528 REGIONAL LAB 621500 1606762 128444 1478318 588301112 10002837 10002837 714371 1116332 -401961 -401961 -401961 53446 0 53446 53446 53446 PASSTHROUGH INCOME 541900 3706938 3676580 30358 3706938 602962931 588273542 3787954 9600876 428525 428525 55230 55230 5135926 5135926 219319272 205804702 13514570 46203503 43039108 3164395 15860028 14581721 1278307 831516 818416 13100 1441478 96719 1344759 350815 320311 30504 94400 94400 25942587 22891134 3051453 628498 646 627852 31250460 3734922 27515538 7578580 985348 6593232 12324315 10887549 1436766 834970 531209 303761 1098929 919030 179899 12189097 12189084 13 36876589 36876589 3655397 3655397 PATIENT SUPPLIES 88613135 88229781 383354 BAD DEBTS 39488592 39488592 OTHER PURCHASED SERVICE 12466515 10024367 2442148 RECRUITING 2354335 149156 2205179 2687333 1057195 1630138 567710025 496764731 70945294 0 23910 23635 7541116 2630491 72197459 72121978 39096 7630081 9306109 5533209 5957831 4996555 7265839 845797137 410550264 443930557 435246873 326896527 406375733 8257299 11543586 19077578 16802592 896084291 967313763 53608816 61534048 298296387 309879539 1561957 1053233 38122792 28893958 391589952 401360778 X 502373665 563879657 2120674 2073328 504494339 565952985 896084291 967313763 X 35252906 17609805 8595936 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 126332 126332 567615626 567741958 1000000 250000 0 0 1000000 1000000 1500000 126332 126332 250000 250000 375000 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: SALEM HOSPITAL 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. 2120674 160956 379362 587664 2073328 1785208 332125 494527 491186 2120674 1903809 -118601 1785208 2363674 527436 246579 1233880 1903809 3255208 987591 57741 1936866 2363674 0 1 1 9810499 23124460 32934959 5789274 499521650 177184206 328126718 988861 292942887 233366058 60565690 13619506 13619506 435246873 FAIR VALUE INTEREST RATE SWAP AGREEMENT 11805602 ACCRUED POST RETIREMENT HEALTHCARE BENEFITS 6789980 ACCRUED MALPRACTICE INSURANCE 4253502 ESTIMATED LIABILITY TO MEDICARE 5851510 DUE TO SALEM HEALTH 140693 OTHER LONG-TERM LIABILITIES 40999 DUE TO SALEM HOSPITAL FOUNDATION 11672 28893958 642394162 26834574 12596657 39431231 602962931 0 602962931 580935516 13225490 13225490 567710026 0 567710026 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE HELD BY SALEM HOSPITAL FOUNDATION FOR SALEM HOSPITAL SUPPORT. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE NETTED WITH EXPENSES 3,307,434. CHANGE IN POSTRETIREMENT BENEFIT OBLIGATION 1,380,316. CUMULATIVE EFFECT OF ADOPTION OF FAIR VALUE OPTION 7,262,965. EXPENSE NETTED WITH REVENUE 645,942. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET UNREALIZED LOSS ON INVESTMENTS 9,224,768. REVENUE NETTED WITH EXPENSES 3,307,434. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 47,346. EXPENSE NETTED WITH REVENUE 645,942. 1 1 X 1 X 1 X 1 1 1 0 1 1 68096 24775074 24775074 0.04690 71741 90297827 72112888 18184939 0.03440 139837 115072901 72112888 42960013 0.08130 3529195 63023 3466172 0.00660 1779525 1779525 0.00340 16491434 11516497 4974937 0.00940 977006 977006 0.00180 536752 536752 0.00100 23313912 11579520 11734392 0.02220 139837 138386813 83692408 54694405 0.10350 726 726 0.00000 39985 39985 0.00010 846035 846035 0.00160 886746 886746 0.00170 0 17386005 9877710 83120482 97011453 -13890971 X 1 1 1 1 SALEM HOSPITAL

890 OAK STREET SE SALEM OR 97301

X X X SALEM HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 8 REHABILITATION CENTER

2561 CENTER ST SE SALEM OR 97301

REHABILITATION LABORATORY PHLEBOTOMY SITE - HOPE

1600 STATE ST SALEM OR 97301

LABORATORY SERVICES COMPREHENSIVE PAIN CENTER

280 LIBERTY ST SE SUITE 320 SALEM OR 97301

PAIN MANAGEMENT REGIONAL LABORATORY

3300 STATE ST SALEM OR 97301

LABORATORY SERVICES WHP FAMILY MEDICINE KEIZER

550 DEITZ AVE NE KEIZER OR 97303

CLINIC WHP FAMILY MEDICINE RIVER ROAD S

2925 RIVER RD S SALEM OR 97302

CLINIC WHP FAMILY MEDICINE PARKSIDE

966 12TH STREET SE SALEM OR 97301

CLINIC WHP FAMILY MEDICINE WEST SALEM

1049 EDGEWATER ST NW SUITE 150 SALEM OR 97304

CLINIC PART I, LINE 3C: IT IS THE POLICY OF SALEM HOSPITAL TO PROVIDE FINANCIAL COUNSELING TO PATIENTS REGARDING THEIR FINANCIAL OBLIGATION AT THE EARLIEST OPPORTUNITY POSSIBLE. SALEM 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 EXPENSES1.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, 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 $39,488,592. PART II: IN 2012, SALEM HOSPITAL PROVIDED EXECUTIVE LEADERSHIP TO THE BOARD OF WALTON HOUSE, A RESPITE HOUSING PROVIDER. THE HEALTH EDUCATION DIVISION HOSTED AN ANNUAL UPDATE OF COMMUNITY BENEFIT ACTIVITIES FOR COMMUNITY PARTNERING AGENCIES. ACCESS TO CARE WAS IDENTIFIED AND PRIORITIZED AS A HEALTH NEED IN BOTH THE MARION AND POLK COUNTY COMMUNITY HEALTH REPORTS AND SALEM AND WEST VALLEY HOSPITALS ADDRESS THE NEED AS PART OF THE COMMUNITY BENEFIT IMPLEMENTATION STRATEGIES . MOREOVER, FOCUS GROUPS COORDINATED BY THE SALEM AND WEST VALLEY HOSPITAL BOARD OF TRUSTEES IDENTIFIED ACCESS TO CARE AS A SIGNIFICANT HEALTH CONCERN IN BOTH MARION AND POLK COUNTIES. FOCUS GROUP PARTICIPANTS STATED THAT LANGUAGE BARRIERS, LACK OF DENTAL HEALTH FUNDING, TRANSPORTATION, AND LIMITED ACCESS TO MENTAL HEALTH SERVICES ARE SIGNIFICANT ISSUES IN OUR COMMUNITY. A LIMITED NUMBER OF PROVIDERS WILL TAKE UNINSURED PATIENTS AND THOSE THAT DO, OFTEN CANNOT SEE THESE PATIENTS RIGHT AWAY. ALTHOUGH SOME CLINICS OFFER SAME DAY APPOINTMENTS AND EXTENDED HOURS, THE EMERGENCY DEPARTMENT IS SEEN AS THE SOURCE FOR AFTER-HOURS HEALTH CARE IN OUR COMMUNITY. PARTICIPANT SUGGESTED THAT THE HOSPITALS COULD EASE THE IDENTIFIED BURDENS BY CONTINUING TO RECRUIT MORE PROVIDERS WHO ARE WILLING TO ACCEPT UNINSURED AND UNDER-INSURED PATIENTS. TO EASE THE BURDEN OF ACCESS TO CARE AND TO ENSURE A WELL TRAINED HEALTH PROFESSIONAL WORKFORCE, SALEM HOSPITAL CONTINUES TO MAKE A SIGNIFICANT INVESTMENT IN PHYSICIAN RECRUITMENT AND MEDICAL WORK FORCE DEVELOPMENT. 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 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 8: MEDICARE PAYORS PAY A SIGNIFICANTLY REDUCED AMOUNT FOR MEDICAL SERVICES RENDERED TO THEIR ENROLLEES SUCH THAT THE NET REIMBURSEMENT DOES NOT EVEN COVER THE EXPENSES INCURRED TO PROVIDE THE SERVICE. SALEM HOSPITAL CONSIDERS THE DIFFERENCE BETWEEN THE COSTS TO PROVIDE CARE FOR MEDICARE ENROLLEES AND THE NET REIMBURSEMENT AS A BENEFIT TO THE COMMUNITY. MEDICARE FEE-FOR-SERVICE COSTS ARE DETERMINED FROM SALEM HOSPITALS 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 HOSPITAL 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 HOSPITAL 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 $116,562,734 LESS MEDICARE ADVANTAGE COSTS OF $138,382,111 FOR A TOTAL ADDITIONAL COMMUNITY BENEFIT IN THE AMOUNT OF $21,819,377. 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. SALEM HOSPITAL PART V, SECTION B, LINE 3: IN BOTH MARION AND POLK COUNTIES, PUBLIC HEALTH DIRECTORS AND MANAGERS WORKED WITH THE SALEM HOSPITAL COMMUNITY BENEFIT DIRECTOR TO GATHER COMMUNITY PARTNERS FOR REVIEW OF HEALTH INDICATORS AND TO PRIORITIZE NEEDS. ALTHOUGH INDIVIDUALS VARIED, GROUPS REPRESENTED INCLUDED THE UNITED WAY OF THE MID-WILMETTE VALLEY, FAITH-BASED ORGANIZATIONS, RED CROSS OF THE MID-WILLAMETTE VALLEY, OSU EXTENSION, WESTERN OREGON UNIVERSITY, MARION-POLK MEDICAL SOCIETY, MARION AND POLK COUNTY MENTAL HEALTH, SCHOOL DISTRICTS WITHIN MARION AND POLK COUNTY, MARION-POLK COUNTY FAMILY YMCA, THE I LOVE ME DIABETES TASK FORCE, SILVERTON HOSPITAL, AND SANTIAM HOSPITAL.IN 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. SALEM HOSPITAL PART V, SECTION B, LINE 4: THE CHNA WAS DONE IN COLLABORATION WITH WEST VALLEY HOSPITAL SALEM HOSPITAL PART V, SECTION B, LINE 6I: SALEM HOSPITAL COMMUNITY BENEFIT ACTIVITY TO ADDRESS AREAS OF NEED IN MARION 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 MARION AND POLK COUNTIES-SPONSORSHIP OF THE SALEM FREE CLINIC AND 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: ASTHMACOMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:THIS NEED IS DIRECTLY LINKED TO ACCESS TO HEALTH SERVICES. ACCESS TO CARE WILL IMPROVE MANAGEMENT OF THIS CONDITION THROUGH MEDICATION PREVENTION STRATEGIES AND BETTER PATIENT EDUCATION TO AVOID CONTACT WITH PREVENTABLE TRIGGERS.HEALTH NEED: CANCER MORTALITYCOMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:SALEM 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.-EDUCATION/AWARENESS TO PROMOTE COLON CANCER SCREENING, INCREASING FIBER IN YOUR DIET, AND EARLY DETECTION.-GO DOWNTOWNS FIRST WEDNESDAY IN MARCH-VOLCANOES CANCER AWARENESS WEEKEND-UNION GOSPEL MISSION-HOMELESS CONNECT FAIR-NATIONAL DRESS IN BLUE DAY IS THE FIRST FRIDAY IN MARCH.-SCREENING: 500 STOOL TESTING KITS DISTRIBUTED THROUGHOUT THE COMMUNITY AT VARIOUS LOCATIONS INCLUDING:WEST SALEM CLINICTHE PHYSICIANS BUILDINGSALEM HOSPITAL PHARMACYWILLAMETTE HEALTH PARTNERSSALEM FREE MEDICAL CLINICSALEM CLINICHEALTH 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-RECRUITMENT OF PRIMARY CARE PROVIDERS TO SERVE MARION COUNTY-SPONSORSHIP OF SALEM FREE CLINIC -SUPPORT PROGRAMS THAT PROVIDE TRANSPORTATION TO MEDICAL SERVICESHEALTH NEED: PNEUMONIA VACCINATION RATE AGE 65+COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:THIS HEALTH NEED IS ALSO LINKED TO ACCESS TO HEALTH SERVICES. IN ADDITION AT SALEM HOSPITAL, ALL PATIENTS OVER THE AGE OF 6 ARE ASSESSED FOR THE NEED FOR PNEUMOCOCCAL POLYSACCHARIDE (AKA PNEUMOVAX 23). . IF NEED IS INDICATED, IMMUNIZATIONS ARE PROVIDED. SALEM HEALTH, PRIMARY CARE CLINICS OFFER PNEUMONIA VACCINE TO PATIENTS AND THE HOSPITALS OUTREACH DEPARTMENT PARTNERS WITH COUNTY, HEALTH DEPARTMENT CLINICS TO REFER PATIENTS. PNEUMOCOCCAL VACCINE IS OFFERED YEAR ROUND TO SENIORS.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 TO:COMMUNITY BENEFIT ACTIVITIES TO ADDRESS THIS NEED:-PROVIDE LEADERSHIP ON THE 211 ADVISORY BOARD-SERVE AS AN ANCHOR INSTITUTION IN MARION AND POLK COUNTY SALEM 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. SALEM HOSPITAL PART V, SECTION B, LINE 20D: SALEM HOSPITAL USED THE APPROVED PROSPECTIVE AGB CALCULATION METHOD FROM THE PROPOSED REGULATIONS THAT INCLUDES MEDICARE AND COMMERCIAL PAYOR RATES. PART VI, LINE 2: SALEM HOSPITAL COLLABORATED WITH THE MARION COUNTY AND POLK COUNTY HEALTH DEPARTMENTS IN PUBLICATION OF THEIR 2011 AND 2012 COMMUNITY HEALTH REPORTS. IN ADDITION, SALEM HOSPITAL HAS A CONTRACTUAL ARRANGEMENT WITH HEALTHY COMMUNITIES INSTITUTE (CHI) TO PROVIDE COMMUNITY MEMBERS, PARTNERING AGENCIES AND THE COUNTY HEALTH DEPARTMENT STAFF ACCESS TO WEB-BASED HEALTH INDICATOR DATA ON AN ONGOING BASIS. THE CHI WEB-BASED DATA DASHBOARD, MARION AND POLK COUNTY HEALTH ASSESSMENTS; MARION AND POLK COMMUNITY HEALTH IMPLEMENTATION PLANS ARE PUBLISHED ON THE SALEM HOSPITAL WEBSITE. THESE DOCUMENTS SERVE TO INFORM THE SALEM HOSPITAL BENEFIT STRATEGY.A PRIORITIZED DESCRIPTION OF THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH REPORTS AND THE SALEM HOSPITAL WEB-BASED, MARION AND POLK COUNTY INDICATOR TOOLS ARE INCLUDED IN THE COMMUNITY HEALTH IMPROVEMENT PLANS (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 MARION COUNTY 10 INDICATORS WERE CHOSEN FOR CONSIDERATION: ADULTS WHO ARE OBESE, ADULTS ENGAGING IN PHYSICAL ACTIVITY, ADULTS WITH ASTHMA, AGE-ADJUSTED DEATH RATE DUE TO COLORECTAL CANCER, MOTHERS WHO RECEIVED EARLY PRENATAL CARE, PNEUMONIA VACCINATION RATE FOR AGES 65+, TEEN FRUIT AND VEGETABLE CONSUMPTION, TEEN PREGNANCY RATE, TEENS WHO ENGAGE IN REGULAR PHYSICAL ACTIVITY, AND TEENS WHO USE MARIJUANA.COMMUNITY INPUT WAS SOLICITED IN THREE REGIONAL FORUMS ACROSS MARION COUNTY, AS DESCRIBED IN THE MARION COUNTY CHIP REPORT. PRIORITY AREAS BY REGION WERE SELECTED. SALEM HOSPITAL IS WORKING WITH COMMUNITY AGENCIES AND STAKEHOLDERS THAT HAVE CHOSEN TO PLACE PRIORITY ON DECREASING THE RATE OF TEEN PREGNANCY, INCREASING THE RATE OF MOTHERS WHO RECEIVE EARLY PRENATAL CARE AND DECREASING THE PERCENTAGE OF ADULT OBESITY IN MARION COUNTY. 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.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. SALEM HOSPITALS COMMUNITY BENEFIT ACTIVITIES WILL FOCUS PRIMARILY ON IMPROVING HEALTH IN MARION COUNTY, WHILE ASSISTING WEST VALLEY HOSPITAL, ALSO A PART OF SALEM HEALTH, WITH ITS WORK TO IMPACT HEALTH ISSUES IN POLK COUNTY. PART VI, LINE 3: IT IS THE POLICY OF SALEM HOSPITAL TO PROVIDE FINANCIAL COUNSELING TO PATIENTS REGARDING THEIR FINANCIAL OBLIGATION AT THE EARLIEST OPPORTUNITY POSSIBLE. SALEM HOSPITAL PROVIDES A VARIETY OF OPTIONS TO ASSIST PATIENTS IN RESOLVING THEIR ACCOUNTS, INCLUDING: OREGON HEALTH PLAN (OHP) SCREENING, CHARITY ASSISTANCE, 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.SALEM 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 SALEM 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: SALEM HOSPITAL SERVES MARION AND POLK COUNTIESMARION COUNTY POPULATION ESTIMATE IN 2013 WAS REPORTED 232,614 WITH PERSONS UNDER THE AGE OF 18 YEARS MAKING UP 26% OF THE POPULATION AND THOSE OVER 65 YEARS 13.6% OF THE POPULATION. 24.1% OF MARION COUNTY RESIDENTS ARE HISPANIC OR LATINO, 1.4% BLACK OR AFRICAN AMERICAN, 2.5% AMERICAN INDIAN AND ALASKA NATIVE. 67.8% ARE WHITE, NOT HISPANIC OR LATINO. OVERALL EIGHTEEN PERCENT OF PERSONS, AND 27.1% OF CHILDREN LIVE BELOW THE FEDERAL POVERTY LEVEL IN MARION COUNTY.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: SALEM HOSPITAL IS GOVERNED BY AN ALL-VOLUNTEER COMMUNITY-BASED BOARD OF TRUSTEES (BOARD). HOSPITAL LEADERSHIP AND 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. SALEM HOSPITAL PROVIDES FINANCIAL SUPPORT AND SPONSORSHIP TO NONPROFIT ORGANIZATIONS. BY LEVERAGING HOSPITAL RESOURCES AND WORKING IN COLLABORATIVE PARTNERSHIPS, SALEM HOSPITAL IS ABLE TO PROVIDE BENEFITS THAT REACH BEYOND HEALTHCARE DELIVERY AND POSITIVELY IMPACT THE SOCIAL DETERMINANTS OF HEALTH. PART VI, LINE 6: SALEM HOSPITAL 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.SALEM HOSPITAL 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." SALEM HOSPITAL IS ONE OF THE LARGEST ACUTE CARE HOSPITALS IN OREGON. LICENSED FOR 454 BEDS, SALEM HOSPITAL OFFERS A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES AN AREA OF OVER 500,000 PEOPLE, INCLUDING ALL OF MARION AND POLK AND PORTIONS OF LINN AND YAMHILL COUNTIES INCLUDING THE RESIDENTS OF THE CITY OF SALEM, THE STATE CAPITAL OF OREGON.SALEM HOSPITAL IS THE LARGEST PRIVATE EMPLOYER IN SALEM, OREGON, WITH APPROXIMATELY 3,252 FULL AND PART-TIME EMPLOYEES (AS OF SEPTEMBER 30, 2013). THE MEDICAL STAFF IS COMPRISED OF APPROXIMATELY 482 PHYSICIANS REPRESENTING MORE THAN 50 SPECIALTIES AND SUBSPECIALTIES, AND MORE THAN 300 VOLUNTEERS PROVIDE NON-MEDICAL SUPPORT FOR SALEM HOSPITAL.SALEM 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 SALEM HOSPITAL'S COMMUNITY BENEFIT COMMITMENTS AND CONNECTIONS WITH COMMUNITY NEEDS AND PRIMARY CONSTITUENCIES. THE COMMUNITY BENEFIT PLAN ASSURES MEASUREMENT AND COMPARISON OF SALEM HOSPITAL'S COMMUNITY ACTIVITIES TO EVOLVING NORMS AND OVERSEES THE CLEAR AND ACCURATE COMMUNICATION OF THESE ACTIVITIES TO KEY CONSTITUENCIES. REPORTS FILED WITH STATES PART VI, LINE 7 OR 1 MARION COUNTY TREASURER 3180 CENTER STREET NE SALEM OR 97301 936002307 MARION COUNTY 53086 ACCESS TO PRENATAL CARE MEDICAL FOUNDATION OF MARION & POLK COUNTIES 2995 RYAN DRIVE STE 100 SALEM OR 97301 931261633 501 (C ) (3) 15000 IMPROVE ACCESS TO HEALTHCARE AMERICAN CANCER SOCIETY 2120 1ST AV N SEATTLE WA 98121 841316555 501 (C ) (3) 7500 RELAY FOR LIFE SPONSERSHIP/IMPROVE SOCIAL DETERMINATE OF HEALTH BOYS & GIRLS CLUB 1395 SUMMER ST NE SALEM OR 97307 930581470 501 (C ) (3) 5000 IMPROVE SOCIAL DETERMINATE OF HEALTH FESTIVAL OF LIGHTS 4742 LIBERTY RD S 211 SALEM OR 97302 931323330 501 (C ) (3) 5000 DISEASE PREVENTION MARCH OF DIMES PO BOX 28256 PORTLAND OR 97228 131846366 501 (C ) (3) 7500 IMPROVE SOCIAL DETERMINATE OF HEALTH SALEM FREE MEDICAL CLINIC 1300 BROADWAY ST NE STE 104 SALEM OR 97301 203549992 501 (C ) (3) 55000 ACCESS TO CARE (SALEM & DALLAS) SALEM HOSPITAL FOUNDATION PO BOX 14001 SALEM OR 97309 237002687 501 (C ) (3) 5000 CHARITABLE CONTRIBUTION GOLF TOURNAMENT UNITED WAY 455 BLILER AVE NE SALEM OR 97303 930395586 501 (C ) (3) 5000 IMPROVE SOCIAL DETERMINATE OF HEALTH PSYCHIATRIC CRISIS CENTER PO BOX 14500 SALEM OR 97309 936002307 MARION COUNTY 141702 ALLOCATION OF COSTS FREE RENT INCLUDING UTILITIES ACCESS TO MEDICAL SERVICES MEDASSIST AND PROJECT ACCESS 2995 RYAN DRIVE STE 100 SALEM OR 97301 931261633 501 (C ) (3) 25298 ALLOCATION OF COSTS FREE RENT INCLUDING UTILITIES ACCESS TO MEDICAL SERVICES CITY OF SALEM 555 LIBERTY ST SE SALEM OR 97301 936002249 MUNICIPALITY 5000 IMPROVE SOCIAL DETERMINATE OF HEALTH THE FOUNDATION FOR MEDICAL EXCELLENCE 1 SW COLUMBIA ST 860 PORTLAND OR 97258 930632522 501 (C ) (3) 25000 ACCESS TO CARE LIBERTY HOUSE 2685 4TH ST NE SALEM OR 97301 931236936 501 (C ) (3) 5000 DISEASE PREVENTION SALEM KEIZER EDUC FOUNDATION 233 COMMERICAL STREET NE SALEM OR 97301 930831467 501 (C ) (3) 5000 DISEASE PREVENTION LINDA L VLADYKA BREAST WELLNESS FOUNDATION 4742 LIBERTY RD S PMB 270 SALEM OR 97302 931328274 501 (C ) (3) 5000 IMPROVE SOCIAL DETERMINATE OF HEALTH SALEM MULTICULTURAL INST PO BOX 4611 SALEM OR 97302 911780361 501 (C ) (3) 5000 IMPROVE SOCIAL DETERMINATE OF HEALTH CASH ASSISTANCE TO PATIENTS IN NEED FOR PRESCRIPTIONS, LIFELINE SUPPORT, REHABILITATION AND OTHER URGENT NEEDS. 202 55230 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS ARE ONLY MADE TO QUALIFIED EXEMPT ORGANIZATIONS. NO MONITORING IS REQUIRED. X X X X X 0 1 0 0 0 1 0 1 0 NORMAN GRUBER 801372 0 93499 0 14126 0 216250 0 41173 0 1166420 0 0 0 AARON CRANE 436596 0 13218 0 12822 0 46132 0 28989 0 537757 0 0 0 ROBERT BRANNIGAN 245979 0 36966 0 6910 0 30130 0 25086 0 345071 0 0 0 LAURIE BARR 218870 0 6820 0 975 0 30430 0 23556 0 280651 0 0 0 MARTHA ENRIQUEZ 296180 0 9300 0 7341 0 34774 0 32473 0 380068 0 0 0 BRIAN DAWSON 198720 0 6687 0 1912 0 3494 0 21667 0 232480 0 0 0 MARTIN MORRIS 250442 0 7224 0 6865 0 35089 0 21988 0 321608 0 0 0 CHERYL NESTER WOLFE 432895 0 13603 0 7240 0 47003 0 28295 0 529036 0 0 0 CORT GARRISON 348463 0 10856 0 2558 0 38292 0 33070 0 433239 0 0 0 ANNE KOLLER 228092 0 7184 0 4435 0 44203 0 24518 0 308432 0 0 0 WILLIAM HOLLOWAY MD 518219 0 15516 0 4783 0 51286 0 35202 0 625006 0 0 0 LEAH MITCHELL 159307 0 5481 0 522 0 20032 0 11948 0 197290 0 0 0 AMR HEGAZI MD 453992 0 46000 0 1476 0 32152 0 36168 0 569788 0 0 0 AHMED EBEID MD 543028 0 50000 0 1533 0 46751 0 37547 0 678859 0 0 0 ALVIE RICHARDSON MD 424205 0 35929 0 916 0 13750 0 33099 0 507899 0 0 0 NICOLE VANDERHEYDEN MD 469039 0 7998 0 3363 0 42040 0 35288 0 557728 0 0 0 THYE SCHUYLER MD 322060 0 69000 0 2121 0 14616 0 26521 0 434318 0 0 0 BEVERLY BOW 341420 0 64145 0 17997 0 19422 0 18717 0 461701 0 0 0 PART I, LINE 4B SOME OF THE HOSPITAL'S EMPLOYEES RECEIVE DEFERRED COMPENSATION UNDER A 457(F) NONQUALIFIED PLAN. THIS COMPENSATION IS INCLUDED IN COMPENSATION REPORTED IN PART II. THE TOTAL NONQUALIFIED PORTION OF EACH PERSONS DEFERRED COMPENSATION IS: NORMAN GRUBER 293,498 ($93,498 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $200,000 INCLUDED IN DEFERRED COMPENSATION) AARON CRANE 29,882 (INCLUDED IN DEFERRED COMPENSATION) ROBERT BRANNIGAN 16,380 (INCLUDED IN DEFERRED COMPENSATION) LAURIE BARR 15,506 (INCLUDED IN DEFERRED COMPENSATION) MARTHA ENRIQUEZ 21,024 (INCLUDED IN DEFERRED COMPENSATION) MARTIN MORRIS 16,338 (INCLUDED IN DEFERRED COMPENSATION) CHERYL NESTER WOLFE 30,753 (INCLUDED IN DEFERRED COMPENSATION) CORT GARRISON 24,542 (INCLUDED IN DEFERRED COMPENSATION) ANNE KOLLER 32,027 (INCLUDED IN DEFERRED COMPENSATION WILLIAM HOLLOWAY 35,036 (INCLUDED IN DEFERRED COMPENSATION) AMR HEGAZI 18,401 (INCLUDED IN DEFERRED COMPENSATION) AHMED EBEID 33,001 (INCLUDED IN DEFERRED COMPENSATION) NICOLE VANDERHEYDEN 25,790 (INCLUDED IN DEFERRED COMPENSATION) THYE SCHUYLER 12,161 (INCLUDED IN DEFERRED COMPENSATION) LEAH MITCHELL 9,313 (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. A THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS 521542796 794458CL1 2006-11-15 123122698 QUALIFIED HOSPITAL BOND 0 0 0 B 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 C THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS 521542796 794458CX5 2008-10-08 60487711 REFUND SERIES 2004A; CONSTRUCTION AND RENOVATION OF VARIOUS BUILDINGS. 0 0 0 D THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS 521542796 NONEAVAIL 2013-06-27 69965000 CURRENT REFUNDING; FINANCE VARIOUS IMPROVEMENTS TO HEALTH CARE FACILITIES. 0 0 0 A 4605000 128355347 1105000 127250347 2009 0 0 1 1 B 50000000 125021764 633004 1153492 9260268 113975000 2009 1 0 1 1 C 12750000 60600453 5971000 837965 6160859 47630629 2009 1 0 1 1 D 69965007 290837 791913 50003336 18878921 2013 1 0 0 1 A 0 1 1 1 1 1 0.02800 0.00200 0.03000 0 0 1 B 0 1 1 1 1 1 0.01000 0.00100 0.01100 0 0 1 C 0 1 1 1 1 1 0.01000 0.00100 0.01100 0 0 1 D 0 1 1 1 1 1 0.00800 0.00000 0.00800 0 0 1 A 0 0 1 0 0 0 1 WELLS FARGO BANK NA 2.000000000000 1 0 1 B 0 0 1 0 1 1 UBS AG 25.800000000000 0 0 0 0 1 C 0 0 1 1 0 0 0 0 1 D 0 1 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 SUPPLEMENTAL INFORMATION: BOND A: DIFFERENCE BETWEEN PART I(E) AND PART II QUESTION 3 IS DUE TO INTEREST EARNED FROM THE PROJECT FUND. 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. BOND B: DIFFERENCE BETWEEN PART I(E) AND PART II QUESTION 3 IS DUE TO INTEREST EARNED FROM THE PROJECT FUND. PART I (F): BONDS REFUNDED BY SERIES 2008B: SERIES 2004AB (ISSUED NOVEMBER 23, 2004) AND SERIES 2006B (ISSUED NOVEMBER 15, 2006). 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. BOND C: DIFFERENCE BETWEEN PART I(E) AND PART II QUESTION 3 IS DUE TO INTEREST EARNED ON INVESTED BOND PROCEEDS. PART I (F): BONDS REFUNDED BY SERIES 2008A: SERIES 2004A (ISSUED NOVEMBER 23, 2004). 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 THE BOND ISSUE THAT CURRENTLY REFUNDED THE SERIES 2004A BONDS MET THE 6-MONTH EXPENDITURE EXCEPTION. PART IV, LINE 2C: THE REBATE COMPUTATION WAS PERFORMED ON OCTOBER 18, 2013. BOND D: DIFFERENCE BETWEEN PART I(E) AND PART II QUESTION 3 IS DUE TO INTEREST EARNED FROM THE PROJECT FUND. PART I (F): BONDS REFUNDED BY SERIES 2013AB: SERIES 2008C (ISSUED NOVEMBER 13, 2008). 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 CURRENT REFUNDING PORTION OF THE BOND ISSUE WILL MEET THE 6-MONTH EXPENDITURE EXCEPTION. THYE SCHUYLAR MD HIGHLY COMPENSATED EMPLOYEE PHYSICIAN RECRUITMENT/RELOCATION X 60000 38175 0 1 1 AARON CRANE TO FUND MASTER'S DEGREE EDUCATION X 37000 921 0 1 1 39096 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 A 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 HOSPITAL IS DESIGNED TO ALLOW THE ORGANIZATION TO RECRUIT AND RETAIN QUALIFIED SENIOR LEADERS. THE GOVERNANCE COMMITTEE OF THE SALEM HOSPITAL BOARD OF TRUSTEES, NONE OF WHOM IS A SALEM HOSPITAL 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 7,262,965. CHANGE IN NET BENEFIT COST 1,380,317. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION -47,346. MWVP INC 570 LIBERTY ST SE STE 200 SALEM OR 97301 123456789 HOLDS LAND OR SALEM HEALTH SALEM HOSPITAL FOUNDATION 890 OAK STREET SE SALEM OR 97301 237002687 SUPPORTS SALEM HOSPITAL OR 501(C)(3) 7 SALEM HEALTH 0 SALEM HOSPITAL AUXILIARY 890 OAK STREET SE SALEM OR 97301 931081113 SUPPORTS SALEM HOSPITAL OR 501(C)(3) 9 N/A 0 SALEM HEALTH 890 OAK STREET SE SALEM OR 97301 930823471 LEASES LAND TO SALEM HOSPITAL OR 501(C)(3) 11 TYPE 1 N/A 0 WEST VALLEY HOSPITAL 525 SOUTHEAST WASHINGTON STREET DALLAS OR 97338 431960221 HOSPITAL OR 501(C)(3) 3 SALEM HEALTH 0 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 FEES OR 501(C)(3) 3 SALEM HEALTH 0 OREGON COMMUNITY IMAGING LLC 2925 RYAN DR SE SALEM OR 97301 202683062 MEDICAL IMAGING COOPERATIVE OR N/A 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 1