TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) BONNIE DRIGGERS RN...................................................................... CHAIR	5.00 .................	X	X		0	0
(2) KATHERINE L KEENE...................................................................... VICE CHAIR	6.00 .................	X	X		0	0
(3) ALAN WYNN...................................................................... SECRETARY/TREASURER	3.72 .................	X	X		0	0
(4) THERESA HASKINS...................................................................... TRUSTEE	5.00 .................	X			0	0
(5) KENNETH SHERMAN JR...................................................................... TRUSTEE	7.00 .................	X			0	0
(6) ROB KELLY MD...................................................................... TRUSTEE	5.00 .................	X			0	0
(7) LANE SHETTERLY...................................................................... TRUSTEE	5.00 .................	X			0	0
(8) ROBERT WELLS...................................................................... PAST-CHAIR	5.00 .................	X			0	0
(9) NANCY REYES-MOLYNEUX MD...................................................................... TRUSTEE	3.50 .................	X			0	0
(10) JOHN COMBES MD...................................................................... TRUSTEE	4.00 .................	X			0	0
(11) JOHN LATTIMER...................................................................... TRUSTEE	5.00 .................	X			0	0
(12) RICARDO LINARES...................................................................... TRUSTEE	3.00 .................	X			0	0
(13) CHERYL NESTER WOLFE...................................................................... PRESIDENT AND CEO	30.00 ................. 10.00		X		1,081,556	59,048
(14) JAMES PARR...................................................................... CHIEF FINANCIAL OFFICER	32.00 ................. 8.00		X		549,324	92,187
(15) RALPH YATES...................................................................... CMO SALEM HEALTH AND SHMG	39.00 ................. 1.00			X	534,014	76,769
(16) LAURIE BARR...................................................................... CHIEF HUMAN RESOURCES OFFICER	30.00 ................. 10.00			X	396,897	78,997
(17) SARAH HORN...................................................................... CHIEF NURSING OFFICER	39.00 ................. 1.00			X	389,773	78,244

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) LEAH MITCHELL........................................................................ CIO	39.00 .......................1.00	X			468,126	75,206
(19) ANDREW FURMAN - TERM 01252019........................................................................ VP MEDICAL AFFAIRS	39.00 .......................1.00	X			416,063	76,745
(20) BAHAA WANLY........................................................................ CHIEF OPERATING OFFICER	39.00 .......................1.00	X			370,073	72,867
(21) CHRISTINE CLARKE........................................................................ GENERAL SURGEON	20.00 .......................0.00	X			347,389	45,599
(22) ZENNIA CENIZA EFF 51218........................................................................ INTERIM VP CLINICAL OPERATIONS	40.00 .......................	X			242,315	39,702
(23) DENISE HOOVER........................................................................ VP SURGICAL SERVICES	39.00 .......................1.00	X			236,188	55,488
(24) SHEA CORUM........................................................................ VP IT OPERATIONS	39.00 .......................1.00	X			221,178	58,283
(25) LEILANI SLAMA........................................................................ VP COMMUNITY ENGAGEMENT	20.00 .......................20.00	X			196,822	55,191
(26) JUAN OYARZUN........................................................................ DIR CARDIOTHORACIC MED	40.00 .......................		X		1,216,638	84,437
(27) NERVIN FANOUS........................................................................ CARDIOTHORACIC SURGEON	40.00 .......................		X		957,819	76,764
(28) NICOLE VANDERHEYDEN MD........................................................................ TRAUMA DIR/ ASSOC CMO SHMG	39.00 .......................1.00		X		769,898	93,002
(29) KATHERINE JONES........................................................................ CARDIOTHORACIC SURGEON	40.00 .......................		X		914,212	57,734
(30) PAUL COELHO........................................................................ MEDICAL DIRECTOR, PAIN MANAGEMENT	40.00 .......................		X		525,682	51,448
(31) LORI JAMES-NIELSEN TERM 31717........................................................................ SEE SCHEDULE J	10.00 .......................30.00			X	120,700	24,905

(A) Name and business address	(B) Description of services	(C) Compensation
OHSU PO BOX 3595 PORTLAND,OR97208	CONTRACT LABOR	4,237,032
EPIC SYSTEMS CORP PO BOX 88314 MILWAUKEE,WI532880314	CONSULTING SERVICES	2,498,458
SALEM PULMONARY ASSOCIATES PC 801 MISSION ST SE SALEM,OR97302	CONTRACT LABOR	1,911,599
RENAL TREATMENT CENTER-WEST PO BOX 781607 PHILADELPHIA,PA191781607	RENAL TREATMENT SERVICES	1,705,118
OREGON ANETHESIOLOGY GROUP 707 SW WASHINGTON ST SUITE 700 PORTLAND,OR972053536	CONTRACT LABOR	1,578,280
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 99

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SALEM HEALTH

Employer identification number

93-0579722

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

SALEM HEALTH

Employer identification number

93-0579722

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization SALEM HEALTH

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization SALEM HEALTH		Employer identification number 93-0579722

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization SALEM HEALTH			Employer identification number 93-0579722
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

SALEM HEALTH

Employer identification number

93-0579722

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(a) Filing organization's totals	(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................	127,723
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................	127,723
d	Other exempt purpose expenditures ...............................................................................	662,417,850
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................	662,545,573
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.	1,000,000
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................	250,000
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................	0
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................	0
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................		Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount	1,000,000	1,000,000	1,000,000	1,000,000	4,000,000

b	Lobbying ceiling amount (150% of line 2a, column(e))					6,000,000

c	Total lobbying expenditures	173,324	97,242	135,334	127,723	533,623

d	Grassroots nontaxable amount	250,000	250,000	250,000	250,000	1,000,000

e	Grassroots ceiling amount (150% of line 2d, column (e))					1,500,000

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-A	SALEM HEALTH CONTRACTED WITH PUBLIC AFFAIRS COUNSEL TO KEEP THE HOSPITAL APPRISED OF BILLS IN THE STATE LEGISLATURE AND TO ENGAGE THE LEGISLATORS ON BEHALF OF THE HOSPITAL WHEN NECESSARY TO PROVIDE INFORMATION TO LEGISLATORS REGARDING THE IMPACT OF LEGISLATION ON THE HOSPITAL. ADDITIONALLY, THE HOSPITAL PAYS MEMBERSHIP DUES TO OAHHS AND AHA. A PORTION OF THE DUES TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING ACTIVITY IN RELATION TO STATE AND NATIONAL HEALTHCARE ISSUES.

Return Reference

Explanation

SCHEDULE C, PART II-A

SALEM HEALTH CONTRACTED WITH PUBLIC AFFAIRS COUNSEL TO KEEP THE HOSPITAL APPRISED OF BILLS IN THE STATE LEGISLATURE AND TO ENGAGE THE LEGISLATORS ON BEHALF OF THE HOSPITAL WHEN NECESSARY TO PROVIDE INFORMATION TO LEGISLATORS REGARDING THE IMPACT OF LEGISLATION ON THE HOSPITAL. ADDITIONALLY, THE HOSPITAL PAYS MEMBERSHIP DUES TO OAHHS AND AHA. A PORTION OF THE DUES TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING ACTIVITY IN RELATION TO STATE AND NATIONAL HEALTHCARE ISSUES.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SALEM HEALTH

Employer identification number

93-0579722

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	2,579,755	3,345,110	2,619,320	2,560,192	2,073,328
b	Contributions ...	458,243	373,134	683,999	318,689	674,913
c	Net investment earnings, gains, and losses	190,571	-201,146	655,272	-66,873	154,704
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	317,906	937,343	613,481	192,688	342,753
f	Administrative expenses ....
g	End of year balance ......	2,910,663	2,579,755	3,345,110	2,619,320	2,560,192

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

100.000 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	11,668,774	23,124,460		34,793,234
b	Buildings ....	13,495,103	609,683,732	273,429,420	349,749,415
c	Leasehold improvements
d	Equipment ....	965,187	279,954,377	201,632,496	79,287,068
e	Other .....		13,190,638		13,190,638
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					477,020,355

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	22,954,921
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	848,870,620
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	14,686,310
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	16,924,515
e	Add lines 2a through 2d .....................			2e	31,610,825
3	Subtract line 2e from line 1..................			3	817,259,795
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	817,259,795

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	748,684,547
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	13,209,741
e	Add lines 2a through 2d....................			2e	13,209,741
3	Subtract line 2e from line 1...................			3	735,474,806
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	-660,916
c	Add lines 4a and 4b.....................			4c	-660,916
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	734,813,890

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	ENDOWMENT FUNDS ARE HELD BY SALEM HEALTH FOUNDATION FOR SALEM HEALTH SUPPORT.
PART X, LINE 2:	UNCERTAIN TAX POSITIONS FROM THE NOTES TO CONSOLIDATED FINANCIAL STATEMENTS ISSUED FOR SALEM HEALTH AND RELATED COMPANIES: THE CORPORATION (SALEM HEALTH HOSPITALS & CLINICS), SALEM HEALTH, SALEM HEALTH WEST VALLEY, SHF, WVHF, SHPS, AND WVIC ARE TAX-EXEMPT ORGANIZATIONS PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AS SUCH, ONLY UNRELATED BUSINESS INCOME IS SUBJECT TO FEDERAL OR STATE INCOME TAXES. THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES IN ACCORDANCE WITH FASB ASC 740-10, INCOME TAXES-IMPLEMENTATION GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES AND DISCLOSURE AMENDMENTS FOR NONPUBLIC ENTITIES. MANAGEMENT HAS NOT RECORDED A PROVISION AS UNRELATED BUSINESS INCOME, IF ANY, IS IMMATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE CORPORATION TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE CORPORATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30,2018 THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE CORPORATION MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO FISCAL YEAR 2011.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	REVENUE NETTED WITH EXPENSES 3,135,121. EXPENSE NETTED WITH REVENUE 13,789,394.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	OTHER RELATED ORGANIZATION REVENUE NOT INCLUDED ON FINANCIAL STATEMENTS
PART XII, LINE 2D - OTHER ADJUSTMENTS:	REVENUE NETTED WITH EXPENSES 3,135,121. EXPENSES NETTED WITH REVENUE 13,789,394. CUMULATIVE EFFECT OF ADOPTION OF FAIR VALUE OPTION -3,714,774.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 337,666. CHANGE IN POSTRETIREMENT BENEFIT OBLIGATION -998,582.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SALEM HEALTH

Employer identification number

93-0579722

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 30000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	30,898	11,029,770		11,029,770	1.560 %
b	Medicaid (from Worksheet 3, column a) . . . . .	162,962	172,945,869	131,419,428	41,526,441	5.890 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	193,860	183,975,639	131,419,428	52,556,211	7.450 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	129,746	2,848,921	69,722	2,779,199	0.390 %
f	Health professions education (from Worksheet 5) . . .	663	2,005,563		2,005,563	0.280 %
g	Subsidized health services (from Worksheet 6) . . . .		29,957,784	17,176,124	12,781,660	1.810 %
h	Research (from Worksheet 7) .		129,847		129,847	0.020 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	27,560	756,724		756,724	0.110 %
j	Total. Other Benefits . .	157,969	35,698,839	17,245,846	18,452,993	2.610 %
k	Total. Add lines 7d and 7j .	351,829	219,674,478	148,665,274	71,009,204	10.060 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	6,040	6,040	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	10,243	10,243	0 %
8	Workforce development	2,217,389	2,217,389	0.310 %
9	Other
10	Total	2,233,672	2,233,672	0.310 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

29,984,352

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

22,480,038

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

107,851,118

Enter Medicare allowable costs of care relating to payments on line 5.....

120,168,337

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-12,317,219

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	SALEM HEALTH 890 OAK STREET SE SALEM,OR97301 14-1428	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	SALEM HEALTH
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 17

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.SALEMHEALTH.ORG

Other website (list url): WWW.CO.MARION.OR.US AND WWW.CO.POLK.OR.US

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWW.SALEMHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SALEM HEALTH
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 300.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY

The FAP application form was widely available on a website (list url):

HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY

A plain language summary of the FAP was widely available on a website (list url):
HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	SALEM HEALTH
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	SALEM HEALTH
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
SALEM HEALTH	PART V, SECTION B, LINE 3J: A COMPREHENSIVE NEEDS ASSESSMENT WAS CONDUCTED IN THE TAX YEAR 2017 IN COOPERATION WITH THE LOCAL PUBLIC HEALTH DEPARTMENT, COORDINATED CARE ORGANIZATIONS AND LOCAL NON-PROFIT ORGANIZATIONS. THE ASSESSMENT WAS CONDUCTED BY SURVEYING COMMUNITY PARTNERS WORKING IN SOCIAL, HEALTH, COMMUNITY, EDUCATIONAL AND CORRECTIONAL HEALTH SETTINGS AND THE COMMUNITY AT LARGE. PAPER AND ELECTRONIC SURVEYS WERE DISTRIBUTED THROUGHOUT BOTH COUNTIES AND COMMUNITY FORUMS WERE HELD AS WELL TO IDENTIFY HEALTH NEEDS AND PRIORITIES. NATIONAL SURVEILLANCE DATA SUCH AS THE THE BEHAVIOR RISK SURVEILLANCE SURVEY AND OREGON HEALTHY TEENS WAS USED, IN ADDITION TO STATE AND LOCAL DATA FROM BIRTH AND DEATH CERTIFICATES.
SALEM HEALTH	PART V, SECTION B, LINE 5: THE NATIONAL MODEL, MOBILIZATION FOR ACTION THROUGH PLANNING AND PARTNERSHIPS OR MAPP AS THE FRAMEWORK FOR THE COMMUNITY HEALTH ASSESSMENT. THE FOUR ASSESSMENTS OF THE MAPP FRAMEWORK INCLUDE: COMMUNITY THEMES AND STRENGTHS, LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT, COMMUNITY HEALTH STATUS ASSESSMENT AND THE FORCES OF CHANGE ASSESSMENT.THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT WAS CONDUCTED BY SURVEYING COMMUNITY PARTNERS WORKING IN SOCIAL, HEALTH, COMMUNITY, EDUCATIONAL AND CORRECTIONAL HEALTH SETTINGS AND THE COMMUNITY-AT-LARGE. THE SURVEYS USED IN BOTH MARION AND POLK COUNTIES CONSISTED OF THE SAME QUESTIONS AND USED THE 2011 MARION COUNTY SURVEY AS A TEMPLATE. PAPER AND ELECTRONIC SURVEYS WERE ALLOCATED BASED ON POPULATION DISTRIBUTION THROUGHOUT OUR COMMUNITIES. THE COMMUNITY HEALTH STATUS ASSESSMENT WAS CONDUCTED BY COMPILING DATA FROM NATIONAL SURVEILLANCE SYSTEMS LIKE THE BEHAVIOR RISK FACTOR SURVEILLANCE SURVEY AND OREGON HEALTHY TEENS AS WELL AS STATE AND LOCAL DATA FROM BIRTH AND DEATH CERTIFICATES. IN ADDITION, A SERIES OF COMMUNITY CAFES WERE CONDUCTED ACROSS MARION AND POLK COUNTY TO IDENTIFY HEALTH PRIORITIES.SALEM HEALTH HOSTED COMMUNITY CAFES AND REPRESENTATIVES FROM MARION AND POLK COUNTY PUBLIC HEALTH, PRESENTED CHNA FINDINGS TO THE SALEM HEALTH COMMUNITY BENEFIT COMMITTEE OF THE BOARD OF TRUSTEES IN NOVEMBER 2015.
SALEM HEALTH	PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH COOPERATION AND REPRESENTATIVES FROM SANITAM HOSPITAL AND LEGACY HEALTH.
SALEM HEALTH	PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH COMMUNITY ACTION AGENCY, THE EARLY LEARNING HUB, INC, MARION COUNTY HEALTH DEPARTMENT, POLK COUNTY HEALTH DEPARTMENT, OREGON STATE UNIVERSITY COOPERATIVE EXTENSION, UNITED WAY, WVP HEALTH AUTHORITY, AND WILLAMETTE VALLEY COMMUNITY HEALTH.
SALEM HEALTH	PART V, SECTION B, LINE 7D: THE HOSPITAL MADE THE CHNA WIDELY AVAILABLE TO THE COMMUNITY. ALL PARTNERS DESCRIBED IN SECTION B, LINE 6B WERE PROVIDED WITH EXECUTIVE SUMMARY DOCUMENTS FOR DISTRIBUTION TO COMMUNITY MEMBERS FREE OF CHARGE. THE FULL ASSESSMENT IS POSTED TO THE HOSPITAL AND COUNTY WEBSITES.
SALEM HEALTH	PART V, SECTION B, LINE 2: THE HOSPITAL WAS NOT ACQUIRED OR PLACED INTO SERVICE AS A TAX-EXEMPT HOSPITAL IN THE CURRENT TAX YEAR OR THE IMMEDIATELY PRECEDING TAX YEAR 2017.
SALEM HEALTH	PART V, SECTION B, LINE 11: PRIORITY AREAS ADDRESSED IN THE 2017 ASSESSMENT INCLUDE ADOLESCENT MENTAL HEALTH, OBESITY, TOBACCO USE, AND SEXUALLY TRANSMITTED INFECTIONS. SALEM HEALTH HAS CHOSEN TO FOCUS ON THE FIRST THREE AREAS. OREGON'S SUICIDE RATE IN 2017 WAS MORE THAN TWICE AS HIGH AS THE NATIONAL AVERAGE. SUICIDE IS THE SECOND LEADING CAUSE OF DEATH FOR THOSE AGES 15-34 AND THE THIRD LEADING CAUSE FOR THOSE AGES 9-14. ACCORDING TO OREGON HEALTH PLAN (MEDICAID) DATA, 31.5% OF CHILDREN AGES 12-17 IN MARION COUNTY HAVE A MENTAL HEALTH CONDITION AND FEWER THAN HALF ARE RECEIVING TREATMENT. THE NUMBERS ARE EVEN MORE STARK FOR CHILDREN UNDER THE AGE OF 12 - 27% HAVE BEEN IDENTIFIED AS HAVING A MENTAL HEALTH CONDITION AND JUST 4% ARE RECEIVING TREATMENT. THE NUMBER OF PATIENT SEEN IN THE SALEM HOSPITAL EMERGENCY ROOM FOR SUICIDAL IDEATION AND INTENTIONAL SELF HARM HAS INCREASED MORE THAN 200% SINCE 2016. SALEM HEALTH HAS LAUNCHED A COMMUNITY WIDE INITIATIVE TO EXPLORE CONTRIBUTING FACTORS TO THIS INCREASE ALONG WITH SALEM-KEIZER PUBLIC SCHOOLS, THE COUNTY HEALTH DEPARTMENTS AND OTHER MENTAL HEALTH CARE PROVIDERS. THE SCOPE FOR THE 2018-19 YEARS IS COMMUNITY PREVENTION WITH PLANS TO EXPAND THE WORK BEYOND THIS SCOPE IN 2020. SALEM HEALTH OFFERS FREE "QUESTION, PERSUADE, REFER" (QPR) TRAINING TO COMMUNITY MEMBERS AND HAS TRAINED SEVERAL SCHOOL DISTRICT EMPLOYEES AND CONTRACTED EMPLOYEES TO PROVIDE THE TRAINING SEVERAL TIMES A MONTH ALL OVER OUR SERVICE AREA.TOBACCO TOBACCO IS THE AGENT MOST RESPONSIBLE FOR AVOIDABLE ILLNESS AND DEATH IN AMERICA TODAY. ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION, TOBACCO USE BRINGS PREMATURE DEATH TO ALMOST HALF A MILLION AMERICANS EACH YEAR AND IT CONTRIBUTES TO PROFOUND DISABILITY AND PAIN IN MANY OTHERS. THE WORLD HEALTH ORGANIZATION STATES THAT APPROXIMATELY ONE-THIRD OF ALL TOBACCO USERS IN THIS COUNTRY WILL DIE PREMATURELY BECAUSE OF THEIR DEPENDENCE ON TOBACCO. MARION AND POLK COUNTIES CONTINUE TO SEE A SIGNIFICANT INCREASE IN TOBACCO USE AND HAS SINCE 2011: MARION COUNTY HAS 19% OF ITS RESIDENTS USING TOBACCO AND POLK COUNTY REPORTS 16.4%. TOBACCO USE CONTRIBUTES TO MANY DISEASES, BUT ESPECIALLY LUNG CANCER, A DISEASE FROM WHICH MARION AND POLK COUNTY RESIDENTS DIE A HIGHER RATE THAN THOSE IN OTHER PARTS OF OREGON. WITH TOBACCO USE COMES A GREATER EXPOSURE TO SECONDHAND SMOKE FOR NON-SMOKERS, WHICH MAY EXACERBATE A WIDE RANGE OF ADVERSE HEALTH EFFECTS SUCH AS RESPIRATORY INFECTIONS AND ASTHMA. ESPECIALLY CONCERNING IS THE INCREASE OF TOBACCO USE DURING PREGNANCY WHICH, ALTHOUGH IT HAS DECREASED IN RECENT YEARS IS STILL FAR HIGHER AT 10% THAN THE HEALTH PEOPLE 2020 GOAL OF LESS THAN 2%.SALEM HEALTH IS A SMOKE FREE CAMPUS AND HAS WORKED WITH THE CITY OF SALEM TO EXPAND SMOKE FREE ZONES TO NEIGHBORING SIDEWALKS AND CITY PARKS. THE HOSPITAL SCREENS 100% OF ITS PATIENTS FOR TOBACCO USE AND PROVIDES ALL TOBACCO USERS WITH COMMUNITY CESSATION RESOURCE INFORMATION. THE AMERICAN LUNG ASSOCIATION'S FREEDOM FROM SMOKING CURRICULUM IS OFFERED AT NO COST THROUGH THE SALEM HEALTH COMMUNITY HEALTH EDUCATION CENTER AND THE HEALTH EDUCATION AND OUTREACH TEAMS PROVIDE COMMUNITY BASED EDUCATION TO SCHOOLS RELATED TO TOBACCO PREVENTION.OBESITYOBESITY RATES IN MARION AND POLK COUNTIES CONTINUE TO CLIMB AT A RATE HIGHER THAN THE REST OF THE STATE. NEARLY 35% OF ADULTS IN MARION COUNTY ARE CONSIDERED TO BE OBESE AND 18% OF 11TH GRADERS IN MARION COUNTY ARE OBESE, COMPARED WITH 26% AND 15% RESPECTIVELY STATEWIDE. IN POLK COUNTY, 31.5% OF ADULTS ARE OBESE AS ARE 17.5% OF 11TH GRADERS. OBESITY CONTRIBUTES TO NEARLY EVERY CHRONIC MEDICAL CONDITION, INCLUDING HEART DISEASE, DIABETES AND CANCER. SALEM HEALTH CONTINUES TO FOCUS ON OBESITY PREVENTION EFFORTS THROUGH HEALTH OUTREACH AND EDUCATION, SUPPORT OF PARTNERING AGENCIES WITH A SHARED GOAL TO DECREASE OBESITY, MEDICAL PROVIDER BMI SCREENINGS AND COMMUNITY HEALTH EDUCATION CENTER PROGRAMMING FOCUSED ON HEALTH PROMOTION AND PREVENTION OF CHRONIC DISEASE. OBESITY IS ALSO A PRIORITY FOR THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WHICH IS SUPPORTED BY SALEM HEALTH. THE MARION COUNTY PUBLIC HEALTH DEPARTMENT CONVENES COMMUNITY STAKEHOLDERS TO ADDRESS OBESITY USING A LOGIC MODEL AND COLLECTIVE IMPACT FRAMEWORK. PARTNER ADDRESSING OBESITY SUBMIT ANNUAL ACTIVITIES AND REPORT RESULTS. SALEM HEALTH AND OTHER COMMUNITY PARTNERS' COLLECTIVE WORK IMPACT IS PUBLISHED ANNUALLY ON THE MARION COUNTY PUBLIC HEALTH WEBSITE.SEXUALLY TRANSMITTED INFECTIONS MARION COUNTY HAS EXPERIENCED SIGNIFICANT INCREASES IN SEXUALLY TRANSMITTED INFECTIONS IN THE LAST FIVE YEARS, INCLUDING A 7.8% INCREASE IN THE INCIDENCE OF CHLAMYDIA, 186.7% INCREASE IN THE INCIDENCE OF GONORRHEA AND A 490% IN SYPHILIS. MARION COUNTY IS SEEING AN INCREASE IN RATES OF CONGENITAL SYPHILIS. MARION COUNTY IS ACTIVELY WORKING WITH LOCAL PROVIDERS TO ENSURE ACCURATE REPORTING, EDUCATION TO APPROPRIATE AUDIENCES AND EFFICACY OF TREATMENT IN TACKLING THESE DISEASES. SALEM HEALTH'S PROVIDERS ARE PARTICIPATING AND A REPRESENTATIVE MEETS REGULARLY WITH MARION COUNTY PUBLIC HEALTH TO ASSESS THE NEEDS AND PROGRESS MADE.
SALEM HEALTH	PART V, SECTION B, LINE 13B: SALEM HEALTH FINANCIAL MATRIX IS BASED ON INCOME AS A PERCENT OF FEDERAL POVERTY LEVEL.
SALEM HEALTH	PART V, SECTION B, LINE 13H: CRITERIA CONSIDERED IN DETERMINING ELIGIBILITY INCLUDE, BUT ARE NOT LIMITED TO: 1) THE HOUSEHOLD'S GROSS INCOME. THE DEFINITION OF HOUSEHOLD GROSS INCOME INCLUDES THE COMBINED GROSS MONTHLY INCOME OF ALL PERSONS LEGALLY RESPONSIBLE FOR PATIENT BILL OR BALANCE.2) HOUSEHOLD'S ASSETS OTHER THAN PRIMARY RESIDENCEEQUITY IN A REAL ESTATE (OTHER THAN THE PATIENT/GUARANTOR'S PRIMARY RESIDENCE), SECURITIES OR OTHER ASSETS ARE CONSIDERED AVAILABLE TO PAY THE PATIENTS' MEDICAL EXPENSES AND SHOULD BE INCLUDED IN THE INCOMES CALCULATIONTHE INCOME FROM INCOME-PRODUCING REAL PROPERTY SHOULD BE USED IN CALCULATION RATHER THAN THE EQUITYINDIVIDUAL RETIREMENT ACCOUNTS (IRAS) OR OTHER RETIREMENT FUNDS WILL NOT BE INCLUDED IN HOUSEHOLD ASSETS, HOWEVER DISTRIBUTIONS FROM THOSE FUNDS WILL BE CONSIDERED INCOME.3) FAMILY SIZE (PERSONS LEGALLY RESPONSIBLE FOR THE PATIENT BILL AND THEIR DEPENDENTS4) THE FAMILY'S MONTHLY OUT-OF-POCKET EXPENSES FOR MEDICAL SUPPLIES AND SERVICES5) ELIGIBILITY MAY BE CONTINGENT UPON PATIENT COOPERATION WITH THE APPLICATION PROCESS. HOUSEHOLD INCOMES UP TO 400% OF THE ANNUAL POVERTY LEVEL GUIDELINES (FPG) WILL BE ELIGIBLE FOR FINANCIAL ASSISTANCE AS OUTLINED BELOW AND IN THE FPG FINANCIAL MATRIX:FINANCIAL MATRIX INCOME AS A PERCENTAGE OF FEDERAL POVERTY LEVEL PERCENTAGE OF FPG PERCENTAGE DISCOUNT0-300% 100%301- 400% 65%
SALEM HEALTH	PART V, SECTION B, LINE 15E: SUPPORTING DOCUMENTATION MAY INCLUDE THE FOLLOWING: PATIENT MUST PROVIDE TWO OF THE FOLLOWING DOCUMENTS TO SUPPORT THE INCOME CLAIMS ON THE APPLICATION. THREE MONTHS INCOME VERIFICATION IN THE FORM OF PAY STUBS, BANK DEPOSITS, ETC. SOCIAL SECURITY DETERMINATION LETTERS THE PRIOR YEAR'S TAX RETURNS OR 450T-EZ A "BASIC NEEDS" LETTER THAT INDICATES HOW PERSONS WITH NO INCOME ARE MEETING THEIR DAY TO DAY BASIC LIVING NEEDS. "BASIC NEEDS" LETTER MUST ONLY BE CONSIDERED A SECONDARY SUPPORTING DOCUMENT AFTER THE FINANCIAL COUNSELOR OR CLERK VALIDATES THAT INFORMATION. AS OUTLINED IN SALEM HEALTH'S CONDITIONS OF ADMISSION, A CREDIT BUREAU REPORT OR A CHARITY SCORING VENDOR MAY BE REQUESTED TO VALIDATE INFORMATION PROVIDED ON THE FINANCIAL ASSISTANCE APPLICATION. SALEM HEALTH MAY ACCEPT INFORMATION PROVIDED ON AN OHP APPLICATION, OHP ELIGIBILITY, PROBATE ESTATES DETERMINATION, DOCUMENTATION OF HOMELESS STATUS, OR RELIABLE THIRD PARTY CREDIT INFORMATION AS A SUBSTITUTE FOR THE FINANCIAL FORMS. OHP INFORMATION WILL BE CONSIDERED VALID 30 DAYS PRIOR TO ADMISSION AND 90 DAYS POST DISCHARGE. APPROVED SOURCES OF DOCUMENTATION FOR HOMELESS STATUS INCLUDE CHART NOTES, DISCHARGE PLANS, OR DISCHARGE SUMMARIES ENTERED INTO OUR HEALTH INFORMATION SYSTEM BY CARE PROVIDERS OF THE PATIENT INDICATING THEY ARE HOMELESS DURING THE REGISTRATION PROCESS. FINANCIAL ASSISTANCE GRANTED BASED ON THIRD PARTY INFORMATION RATHER THAN A FINANCIAL ASSISTANCE APPLICATION DOES NOT EXTEND TO FUTURE DATES OF SERVICE AND WOULD NEED TO BE REEVALUATED BASED ON INFORMATION AVAILABLE THAT TIME. APPLICATION PROCESS AND ELIGIBILITY DETERMINATION A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BEFORE, DURING OR AFTER THE PROVISION OF CARE. THE HOSPITAL HAS DEVELOPED AN APPLICATION PROCESS FOR DETERMINING INITIAL INTEREST IN AND QUALIFICATION FOR FINANCIAL ASSISTANCE. REQUESTS FOR FINANCIAL ASSISTANCE WILL BE ACCEPTED FROM THE PATIENT DIRECTLY, OR OTHERS ON THE PATIENT'S BEHALF. THIS COULD INCLUDE BUT IS NOT LIMITED TO, THE PATIENT'S REPRESENTATIVE OR HOSPITAL STAFF. -FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION MAY BE DOWNLOADED FROM OUR WEBSITE: HTTP://WWW.SALEMHEALTH.ORG/ABOUT/CHARITY-CARE-AND-FINANCIAL-POLICY-PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION ARE AVAILABLE IN THE EMERGENCY DEPARTMENT, IN REGISTRATION AREAS AND AT PATIENT FINANCIAL SERVICES, 550 HAWTHORNE SE, SUITE 200, SALEM OREGON 97301. -PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATIONS MAY BE REQUESTED BY MAIL FROM FINANCIAL COUNSELING, SALEM HEALTH, PO BOX 14001, SALEM, OR 97309-9976 OR VIA TELEPHONE BY CALLING 503-562-4357.
SALEM HEALTH	PART V, SECTION B, LINE 16J: INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS MADE PUBLICALLY AVAILABLE FREE OF CHARGE IN THE FOLLOWING MANNER:1) NOTICES ARE POSTED IN KEY AREAS OF THE HOSPITAL, INCLUDING ADMITTING, THE EMERGENCY DEPARTMENT, OUTPATIENT DEPARTMENT REGISTRATION AREAS AND PATIENT FINANCIAL SERVICES2) THE CONDITIONS OF ADMISSION FORM INFORMS THE PATIENT OF THEIR RIGHT TO APPLY FOR FINANCIAL ASSISTANCE.3) WRITTEN INFORMATION IS AVAILABLE IN ENGLISH, SPANISH, RUSSIAN AND VIETNAMESE. THE HOSPITAL WILL PROVIDE THE APPROPRIATE INTERPRETATION SERVICES FOR PATIENTS/GUARANTORS WHO DO NOT SPEAK ENGLISH.4) FRONT LINE STAFF ARE TRAINED TO ANSWER FINANCIAL ASSISTANCE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY THAT CANNOT BE ANSWERED TO FINANCIAL COUNSELORS IN A TIMELY MANNER.5) THIS POLICY IS POSTED ON SALEM HEALTH'S WEBSITE. WRITTEN INFORMATION ABOUT THIS POLICY WILL BE MADE AVAILABLE UPON REQUEST6) ALL PATIENT BILLING STATEMENTS INCLUDE A NOTICE THAT FINANCIAL ASSISTANCE IS AVAILABLE AND CONTRACT INFORMATION IF THEY WANT TO LEARN MORE.
SALEM HEALTH	PART V, SECTION B, LINE 18E: IT IS THE POLICY OF SALEM HEALTH TO PURSUE COLLECTION OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR SERVICES. SALEM HEALTH MAKES REASONABLE EFFORTS TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. COLLECTION PROCEDURES APPLIED CONSISTENTLY AND FAIRLY FOR ALL PATIENTS REGARDLESS OF INSURANCE STATUS. ALL COLLECTIONS PROCEDURES WILL COMPLY WITH APPLICABLE LAWS AND WITH SALEM HEALTH'S MISSION. FOR THOSE PATIENTS UNABLE TO PAY ALL OR A PORTION OF THEIR OPEN BALANCES, THE FINANCIAL ASSISTANCE POLICY WILL BE FOLLOWED.COLLECTION AGENCIES AND/OR LAW FIRMS MAY BE ENLISTED AFTER REASONABLE COLLECTION AND PAYMENT OPTIONS HAVE BEEN EXHAUSTED. AGENCIES MAY HELP RESOLVED ACCOUNTS WHERE PATIENTS ARE UNCOOPERATIVE IN MAKING PAYMENTS, HAVE NOT MADE APPROPRIATE PAYMENTS OR HAVE BEEN UNWILLING TO PROVIDE REASONABLE FINANCIAL AND OTHER DATA TO SUPPORT THEIR REQUEST FOR FINANCIAL ASSISTANCE. COLLECTION AGENCY AND LAW FIRM STAFF WILL UPHOLD THE CONFIDENTIALITY AND INDIVIDUAL DIGNITY OF EACH PATIENT. ALL AGENCIES AND LAW FIRMS WILL COMPLY WITH ALL APPLICABLE LAWS INCLUDING HIPAA REQUIREMENTS FOR HANDLING PROTECTED HEALTH INFORMATION.
SALEM HEALTH	PART V, SECTION B, LINE 19E: SALEM HEALTH WILL NOTIFY INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS AT LEAST 30 DAYS PRIOR TO PURSUING EXTRAORDINARY COLLECTIONS ACTIONS (ECA) TO OBTAIN PAYMENT FOR THE CARE PROVIDED BY THE HOSPITAL. ECAS FOR HOSPITAL SERVICES WILL NOT COMMENCE FOR A PERIOD OF AT LEAST 240 DAYS AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT AND 30 DAYS AFTER THE HOSPITAL OR AUTHORIZED THIRD PARTY PROVIDES WRITTEN NOTICE OF ECAS THE HOSPITAL PLANS TO INITIATE FOR THE APPLICABLE MEDICALLY NECESSARY OR EMERGENCY CARE.
SALEM HEALTH	PART V, SECTION B, LINE 20E: SALEM HEALTH WILL NOTIFY INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS AT LEAST 30 DAYS PRIOR TO PURSUING EXTRAORDINARY COLLECTIONS ACTIONS (ECA) AS TO OBTAIN PAYMENT FOR THE CARE PROVIDED BY THE HOSPITAL BY DOING THE FOLLOWING:1) PROVIDE WRITTEN NOTICE TO THE INDIVIDUAL INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE INDIVIDUALS, INDICATING THAT SALEM HEALTH INTENDS TO INITIATE OR HAVE A THIRD PARTY INITIATE TO OBTAIN PAYMENT FOR THE CARE AND PROVIDE A DEADLINE AFTER WHICH ECAS MAY BE PURSUED AND WHICH IS NO SOONER THAN 30 DAYS AFTER THE DATE OF THIS WRITTEN NOTICE2) PROVIDE THE INDIVIDUAL A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WITH THE WRITTEN NOTICE3) MAKE REASONABLE EFFORTS TO ORALLY NOTIFY INDIVIDUAL ABOUT THE SALEM HEALTH'S FINANCIAL ASSISTANCE POLICY.
SALEM HEALTH	PART V, SECTION B, LINE 21C: NOT APPLICABLE. SALEM HEALTH HAS A POLICY RELATIVE TO EMERGENCY MEDICAL CARE THAT REQUIRED THE HOSPITAL FACILITY TO PROVIDE, WITHOUT DISCRIMINATION, CARE FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.
SALEM HEALTH	PART V, SECTION B, LINE 21D: NOT APPLICABLE. SALEM HEALTH HAS A POLICY RELATIVE TO EMERGENCY MEDICAL CARE THAT REQUIRED THE HOSPITAL FACILITY TO PROVIDE, WITHOUT DISCRIMINATION, CARE FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR ELIGIBILITY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?8
Name and address		Type of Facility (describe)
1	1 - REHABILITATION CENTER 755 MISSION ST SE SALEM,OR97302	REHABILITATION
2	2 - LABORATORY PHLEBOTOMY SITE - HOPE 1600 STATE ST SALEM,OR97301	LABORATORY SERVICES
3	3 - COMPREHENSIVE PAIN CENTER 875 OAK STREET SALEM,OR97302	PAIN MANAGEMENT
4	4 - REGIONAL LABORATORY 3300 STATE ST SALEM,OR97301	LABORATORY SERVICES
5	5 - SALEM HEALTH MEDICAL CLINIC - KEIZER 550 DEITZ AVE NE KEIZER,OR97303	CLINIC
6	6 - SALEM HEALTH MEDICAL CLINIC - S SALEM 2925 RIVER RD S SALEM,OR97302	CLINIC
7	7 - SALEM HEALTH MEDICAL CLINIC - SALEM 966 12TH STREET SE SALEM,OR97301	CLINIC
8	8 - SALEM HEALTH MEDICAL CLINIC - W SALEM 1049 EDGEWATER ST NW SUITE 150 SALEM,OR97304	CLINIC
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	CRITERIA CONSIDERED IN DETERMINING ELIGIBILITY INCLUDE BUT ARE NOT LIMITED TO: 1) THE HOUSEHOLD'S GROSS INCOME. THE DEFINITION OF HOUSEHOLD GROSS INCOME INCLUDES THE COMBINED GROSS MONTHLY INCOME OF ALL PERSONS LEGALLY RESPONSIBLE FOR PATIENT BILL OR BALANCE.2) HOUSEHOLD'S ASSETS OTHER THAN PRIMARY RESIDENCEEQUITY IN A REAL ESTATE (OTHER THAN THE PATIENT/GUARANTOR'S PRIMARY RESIDENCE), SECURITIES OR OTHER ASSETS ARE CONSIDERED AVAILABLE TO PAY THE PATIENTS' MEDICAL EXPENSES AND SHOULD BE INCLUDED IN THE INCOMES CALCULATIONTHE INCOME FROM INCOME-PRODUCING REAL PROPERTY SHOULD BE USED IN CALCULATION RATHER THAN THE EQUITYINDIVIDUAL RETIREMENT ACCOUNTS (IRAS) OR OTHER RETIREMENT FUNDS WILL NOT BE INCLUDED IN HOUSEHOLD ASSETS, HOWEVER DISTRIBUTIONS FROM THOSE FUNDS WILL BE CONSIDERED INCOME.3) FAMILY SIZE (PERSONS LEGALLY RESPONSIBLE FOR THE PATIENT BILL AND THEIR DEPENDENTS)4) THE FAMILY'S MONTHLY OUT-OF-POCKET EXPENSES FOR MEDICAL SUPPLIES AND SERVICES5) ELIGIBILITY MAY BE CONTINGENT UPON PATIENT COOPERATION WITH THE APPLICATION PROCESS. THE DEFINITION OF "HOUSEHOLD GROSS INCOME" INCLUDES THE COMBINED GROSS MONTHLY INCOME OF ALL PERSONS LEGALLY RESPONSIBLE FOR PATIENT BILL OR BALANCE.SUPPORTING DOCUMENTATION MAY INCLUDE THE FOLLOWING: PATIENT MUST PROVIDE TWO OF THE FOLLOWING DOCUMENTS TO SUPPORT THE INCOME CLAIMS ON THE APPLICATION. THREE MONTHS INCOME VERIFICATION IN THE FORM OF PAY STUBS, BANK DEPOSITS, ETC. SOCIAL SECURITY DETERMINATION LETTERS THE PRIOR YEAR'S TAX RETURNS OR 450T-EZ A "BASIC NEEDS" LETTER THAT INDICATES HOW PERSONS WITH NO INCOME ARE MEETING THEIR DAY TO DAY BASIC LIVING NEEDS. "BASIC NEEDS" LETTER MUST ONLY BE CONSIDERED A SECONDARY SUPPORTING DOCUMENT AFTER THE FINANCIAL COUNSELOR OR CLERK VALIDATES THAT INFORMATION. AS OUTLINED IN SALEM HEALTH'S CONDITIONS OF ADMISSION, A CREDIT BUREAU REPORT OR A CHARITY SCORING VENDOR MAY BE REQUESTED TO VALIDATE INFORMATION PROVIDED ON THE FINANCIAL ASSISTANCE APPLICATION. SALEM HEALTH MAY ACCEPT INFORMATION PROVIDED ON AN OHP APPLICATION, OHP ELIGIBILITY, PROBATE ESTATES DETERMINATION, DOCUMENTATION OF HOMELESS STATUS, OR RELIABLE THIRD PARTY CREDIT INFORMATION AS A SUBSTITUTE FOR THE FINANCIAL FORMS. OHP INFORMATION WILL BE CONSIDERED VALID 30 DAYS PRIOR TO ADMISSION AND 90 DAYS POST DISCHARGE. APPROVED SOURCES OF DOCUMENTATION FOR HOMELESS STATUS INCLUDE CHART NOTES, DISCHARGE PLANS, OR DISCHARGE SUMMARIES ENTERED INTO OUR HEALTH INFORMATION SYSTEM BY CARE PROVIDERS OF THE PATIENT INDICATING THEY ARE HOMELESS DURING THE REGISTRATION PROCESS. FINANCIAL ASSISTANCE GRANTED BASED ON THIRD PARTY INFORMATION RATHER THAN A FINANCIAL ASSISTANCE APPLICATION DOES NOT EXTEND TO FUTURE DATES OF SERVICE AND WOULD NEED TO BE REEVALUATED BASED ON INFORMATION AVAILABLE THAT TIME.
PART I, LINE 7:	FINANCIAL ASSISTANCE, MEDICAID AND COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS ACCOUNT FOR A LARGE PORTION OF SALEM HEALTH'S COMMUNITY BENEFIT CONTRIBUTION. ENSURING THAT COMMUNITY MEMBERS HAVE ACCESS TO EMERGENCY, PRIMARY CARE AND OTHER HEALTH SERVICES REGARDLESS OF ABILITY TO PAY ALIGNS WITH THE HOSPITAL MISSION AND COMMITMENT TO SERVE THOSE LIVING IN MARION AND POLK COUNTIES. SALEM HEALTH IS DEEPLY EMBEDDED IN THE COMMUNITY AND HOSPITAL LEADERS WORK HAND IN HAND WITH REPRESENTATIVES FROM GOVERNMENT AGENCIES AND OTHER NON-PROFIT ORGANIZATIONS TO ASSESS AND ADDRESS COMMUNITY NEEDS. THREE AREAS CURRENTLY IDENTIFIED AS PRIORITIES ARE ADOLESCENT MENTAL HEALTH, OBESITY AND TOBACCO. COMMUNITY WIDE TASK FORCES ARE IN PLACE TO ADDRESS THESE HEALTH NEEDS, WHICH ARE DEEMED MOST CRITICAL IN THE TWO COUNTIES SERVED BY SALEM HEALTH. REPRESENTATIVES FROM APPROPRIATE AREAS OF THE HOSPITAL ATTEND TASK FORCE MEETINGS AND LEVERAGE HOSPITAL RESOURCES TO POSITIVELY IMPACT HEALTH OUTCOMES. HOSPITAL LEADERS VOLUNTEER TIME TO SERVE ON COMMUNITY NON-PROFIT BOARDS WHICH MIRROR THE MISSION OF SALEM HEALTH AND ATTEND REGIONAL COLLABORATIVE WORK GROUPS THAT ADDRESS SOCIAL DETERMINANTS OF HEALTH. EXAMPLES INCLUDE BOARD POSITIONS ON SALEM FREE CLINIC, FAMILY BUILDING BLOCKS, MARION POLK FOOD SHARE, THE BOYS AND GIRLS CLUB, UNITED WAY, UNION GOSPEL MISSION, AND LIBERTY HOUSE.THE HOSPITAL PROVIDES COMMUNITY BASES HEALTH IMPROVEMENT SERVICES AS REQUESTED IN MARION AND POLK COUNTIES. IN 2017, THESE INCLUDED HEALTH SCREENINGS, EDUCATION AND OUTREACH. THE COMMUNITY HEALTH EDUCATION CENTER OFFERS A HEALTH RELATED LENDING LIBRARY, DROP-IN NURSING CONSULTATION SERVICES AND GROUP INSTRUCTION. DIABETIC AND NUTRITION COUNSELING IS ALSO OFFERED FOR PATIENTS NEWLY DIAGNOSED AND UNABLE TO PAY FOR THESE SERVICES. THE CENTER PROVIDES SPACE FREE OF CHARGE TO COMMUNITY PARTNERS SEEKING TO IMPROVE HEALTH OUTCOMES. THE ROOMS HOST CLASSES, LECTURES, HEALTH FAIRS AND SUPPORT GROUPS THAT ARE COORDINATED IN PARTNERSHIP WITH COMMUNITY AGENCIES. SALEM HEALTH PROVIDED COMMUNITY PARTNER GRANTS IN 2017. THESE GRANTS SUPPORT THE WORK OF COMMUNITY PARTNERS WHO ARE ADDRESSING THE IDENTIFIED NEEDS FROM THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. LASTLY, THE HOSPITAL PROVIDES TRAINING FOR NURSING STUDENTS AND EMERGING HEALTH CARE PROFESSIONALS. ITS HEALTH CAREER EXPLORATION PROGRAMS FOR HIGH SCHOOL STUDENTS IN DISTRICTS THAT FALL WITHIN THE HOSPITAL CATCHMENT AREA SERVE HUNDREDS OF HIGH SCHOOL STUDENTS ASPIRING TO MEDICAL CAREERS.
PART I, LN 7 COL(F):	THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSE THAT WAS INCLUDED IN FORM 990, PART IX, LINE 25, COLUMN (A), BUT REMOVED FROM THIS FIGURE FOR THE PURPOSES OF CALCULATING THE PERCENTAGE IN SCHEDULE H, PART I, LINE 7, COLUMN (F) WAS $29,984,352.
PART I, LINE 6A	A COMMUNITY BENEFIT REPORT WAS PREPARED DURING THE TAX YEAR AND CAN BE FOUND ON THE SALEM HEALTH WEBSITE AT WWW.SALEMHEALTH.ORG
PART II, COMMUNITY BUILDING ACTIVITIES:	SALEM HEALTH HAS MORE THAN 450 VOLUNTEERS AND A STAFF OF THREE THAT COORDINATE COMMUNITY BUILDING ACTIVITIES. VOLUNTEERS RAISE MONEY FOR COMMUNITY SCHOLARSHIPS, COORDINATE JOB SHADOW OPPORTUNITIES AND ARRANGE FOR BLOOD DRIVES. IN 2017, SALEM HEALTH SPONSORED AN ORGANIZATION WIDE INITIATIVE TO ENCOURAGE EMPLOYEES TO VOLUNTEER IN THE LOCAL COMMUNITY. OVER THE COURSE OF THE YEAR, 83% OF DEPARTMENTS WITHIN THE HOSPITAL HAD AT LEAST ONE EMPLOYEE VOLUNTEER OUTSIDE THE HOSPITAL. GROUP VOLUNTEER OPPORTUNITIES WERE COORDINATED QUARTERLY, SUCH AS PARK BEAUTIFICATION AND SET UP OF LOCAL EVENTS. LEADERS AT ALL LEVELS WITHIN SALEM HEALTH SERVE ON COMMUNITY BOARDS AND TASK FORCES THAT ADDRESS COMMUNITY NEEDS. THE HOSPITAL WORKS WITH THE LOCAL MEDICAL COMMUNITY TO IDENTIFY GAPS IN CARE AND RECRUIT NEEDED PRIMARY CARE PROVIDERS AND SPECIALISTS TO IMPROVE ACCESS TO CARE. PHYSICIAN LEADERSHIP TRAINING AND IS OFFERED TO COMMUNITY PROVIDERS ACROSS THE SERVICE AREA.
PART III, LINE 2:	BAD DEBT EXPENSE IS PRIMARILY ESTIMATED BASED UPON THE HOSPITALS' HISTORICAL COLLECTION EXPERIENCE, THE AGE OF THE PATIENT'S ACCOUNT, THE PATIENT'S ECONOMIC ABILITY TO PAY, AND THE EFFECTIVENESS OF COLLECTION EFFORTS. PATIENT ACCOUNTS RECEIVABLE BALANCES ARE ROUTINELY REVIEWED IN CONJUNCTION WITH HISTORICAL COLLECTION RATES AND OTHER ECONOMIC CONDITIONS THAT MIGHT ULTIMATELY AFFECT THE COLLECTABILITY OF PATIENT ACCOUNTS WHEN CONSIDERING THE ADEQUACY OF THE AMOUNTS RECORDED IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ACTUAL WRITE-OFFS HISTORICALLY HAVE APPROXIMATED MANAGEMENT'S EXPECTATIONS.
PART III, LINE 3:	BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER SALEM HEALTH'S FINANCIAL ASSISTANCE POLICY, IS ESTIMATED BASED ON DATA FROM OUR PATIENT ACCOUNTING SYSTEM. THIS DATA IS THEN COMPARED AND MATCHED TO MEDIAN HOUSEHOLD INCOME CENSUS DATA BY ZIP CODE TO DETERMINE THE ESTIMATED BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE
PART II, LINE 8:	SALEM HEALTH HAS BEEN ACTIVELY RECRUITING PRIMARY CARE PROVIDERS TO MARION AND POLK COUNTIES TO IMPROVE ACCESS TO CARE.
PART II	SALEM HEALTH HAS MORE THAN 450 VOLUNTEERS AND A STAFF OF THREE THAT COORDINATE COMMUNITY BUILDING ACTIVITIES. VOLUNTEERS RAISE MONEY FOR COMMUNITY SCHOLARSHIPS, COORDINATE JOB SHADOW OPPORTUNITIES AND ARRANGE BLOOD DRIVES.LEADERS AT ALL LEVELS WITHIN SALEM HEALTH SERVE ON COMMUNITY BOARDS AND TASK FORCES THAT ADDRESS COMMUNITY NEEDS.THE HOSPITAL HAS BEEN ACTIVELY RECRUITING PRIMARY CARE PROVIDERS TO MARION AND POLK COUNTIES TO IMPROVE ACCESS TO CARE. SALEM HEALTH OFFERS PHYSICIAN LEADERSHIP TRAINING TO COMMUNITY PROVIDERS AND LEADERSHIP DEVELOPMENT COURSES THAT ARE MADE AVAILABLE TO LEADERS ACROSS THE SERVICE AREA.
PART III, LINE 4:	EFFECTIVE OCTOBER 1, 2011, THE HOSPITALS ADOPTED FASB ISSUED ACCOUNTING STANDARDS UPDATE (ASU) NO. 2011-07, HEALTH CARE ENTITIES (TOPIC 954): PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTHCARE ENTITIES. THE ADOPTION OF THIS ASU RESULTED IN A RECLASSIFICATION OF BAD DEBT EXPENSE FROM AN OPERATING EXPENSE TO BE A REDUCTION IN DERIVING NET PATIENT SERVICE REVENUE. THE ALLOWANCES FOR DOUBTFUL ACCOUNTS ARE PRIMARILY ESTIMATED BASED UPON THE HOSPITALS' HISTORICAL COLLECTION EXPERIENCE, THE AGE OF THE PATIENT'S ACCOUNT, THE PATIENT'S ECONOMIC ABILITY TO PAY, AND THE EFFECTIVENESS OF COLLECTION EFFORTS. PATIENT ACCOUNTS RECEIVABLE BALANCES ARE ROUTINELY REVIEWED IN CONJUNCTION WITH HISTORICAL COLLECTION RATES AND OTHER ECONOMIC CONDITIONS THAT MIGHT ULTIMATELY AFFECT THE COLLECTABILITY OF PATIENT ACCOUNTS WHEN CONSIDERING THE ADEQUACY OF THE AMOUNTS RECORDED IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ACTUAL WRITE-OFFS HISTORICALLY HAVE APPROXIMATED MANAGEMENT'S EXPECTATIONS.
PART III, LINE 8:	MEDICARE PAYS A SIGNIFICANTLY REDUCED AMOUNT FOR MEDICAL SERVICES RENDERED TO THEIR ENROLLEES SUCH THAT THE NET REIMBURSEMENT DOES NOT COVER THE EXPENSES INCURRED TO PROVIDE THE SERVICES. SALEM HEALTH CONSIDERS THE DIFFERENCE BETWEEN THE COSTS TO PROVIDE THE SERVICES FOR MEDICARE ENROLLEES AND THE NET REIMBURSEMENT AS A BENEFIT TO THE COMMUNITY. MEDICARE FEE-FOR-SERVICE COSTS ARE DETERMINED FROM SALEM HEALTH'S FILED MEDICARE COST REPORT. THE CALCULATION OF NET BENEFIT IS EQUAL TO TOTAL MEDICARE PAYMENTS LESS MEDICARE COSTS.IN ADDITION TO TRADITIONAL MEDICARE FEE-FOR-SERVICE, SALEM HEALTH PROVIDES SUBSTANTIAL SERVICES TO OTHER MEDICARE POPULATIONS PARTICIPATING IN MEDICARE ADVANTAGE PLANS AT SIGNIFICANTLY REDUCED REIMBURSEMENT. THE NET REVENUES FOR THESE PLANS ARE LESS THAN THE COST TO PROVIDE CARE AND ARE NOT DISCLOSED IN PART III, LINE 8. SALEM HEALTH ALSO CONSIDERS THE DIFFERENCE BETWEEN THE NET COST TO PROVIDE CARE FOR MEDICARE ADVANTAGE ENROLLEES AND THE NET REIMBURSEMENT AS A BENEFIT TO THE COMMUNITY. THESE NET COSTS HAVE BEEN DETERMINED BY APPLYING THE RATIO OF COSTS TO CHARGES AS DETERMINED IN WORKSHEET 2 TO THE FULL BILLED CHARGES. THE CALCULATION OF NET BENEFIT IS EQUAL TO TOTAL MEDICARE ADVANTAGE PAYMENTS OF $154,301,793 LESS MEDICARE ADVANTAGE COSTS OF $182,654,129 FOR A TOTAL ADDITIONAL COMMUNITY BENEFIT IN THE AMOUNT OF $28,352,336.
PART III, LINE 9B:	THE BILLING AND COLLECTIONS ADMINISTRATIVE HOUSE-WIDE POLICY AND PROCEDURE STATES, "IF A PATIENT SUBMITS A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, SALEM HEALTH WILL SUSPEND THE ECAS UNTIL THE PATIENT'S APPLICATION HAS BEEN PROCESSED AND NOTIFY THE PATIENT OF DETERMINATION. IF AN INDIVIDUAL IS FOUND TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, ANY ECAS WILL BE REVERSED.
PART VI, LINE 2:	AN UPDATED COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED IN 2017. THE NEEDS ASSESSMENT DESCRIBES THE COMMUNITY SERVED BY THE HOSPITAL AND THE DEMOGRAPHICS OF THE COMMUNITY. IT DOES NOT DESCRIBE THE EXISTING HEALTH CARE FACILITIES AND RESOURCES WITHIN THE COMMUNITY THAT ARE AVAILABLE TO RESPOND TO NEEDS. THE MARION AND POLK COUNTY HEALTH CARE SYSTEM CAPACITY AND ACCESS ASSESSMENT CONTAINS HEALTH CARE FACILITY AND RESOURCE INFORMATION. THE CAPACITY AND ACCESS ASSESSMENT IS UPDATED ANNUALLY. THE MOST RECENT CHNA AND HEALTH CARE SYSTEM CAPACITY AND ACCESS ASSESSMENTS ARE PUBLISHED TO THE SALEM HEALTH WEBSITE AT WWW,SALEMHEALTH.ORG. THE NATIONAL MODEL, MOBILIZATION FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) WAS USED AS THE FRAMEWORK FOR CHNA. THE FOUR ASSESSMENTS OF MAPP FRAMEWORK INCLUDE: COMMUNITY THEMES AND STRENGTHS, LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT, COMMUNITY HEALTH STATUS ASSESSMENT AND THE FORCES OF CHANGE ASSESSMENT. THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT WAS CONDUCTED BY SURVEYING COMMUNITY PARTNERS WORKING IN SOCIAL, EDUCATIONAL, COMMUNITY AND CORRECTIONAL HEALTH SETTING AND THE COMMUNITY AT LARGE. THE SURVEYS USED IN BOTH COUNTIES HAS THE SAME QUESTIONS AND WERE BASED ON PAST SURVEYS. PAPER AND ELECTRONIC SURVEYS WERE ALLOCATED BASED ON POPULATION DISTRIBUTION THROUGHOUT THE TWO COUNTIES. THE COMMUNITY HEALTH STATUS ASSESSMENT WAS CONDUCTED BY COMPILING DATA FROM NATIONAL SURVEILLANCE SYSTEMS LIKE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY AND OREGON HEALTHY TEENS, AS WELL AS STATE AND LOCAL DATA FROM BIRTH AND DEATH CERTIFICATES. IN ADDITION, A SERIES OF COMMUNITY FORUMS WERE CONDUCTED ACROSS MARION AND POLK COUNTIES TO IDENTIFY HEALTH PRIORITIES. THE MARION AND POLK COUNTY HEALTH ASSESSMENT UPDATES WERE PUBLISHED IN DECEMBER 2017 AND CAN BE FOUND ON THE SALEM HEALTH WEBSITE AT WWW.SALEMHEALTH.ORG. THE DOCUMENT INFORMED THE DEVELOPMENT OF THE COMMUNITY BENEFIT IMPLEMENTATION STRATEGY FOR THE YEARS 2018-2020, ALSO AVAILABLE ON THE WEBSITE.THE IMPACT OF ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE HOSPITAL FACILITIES' PRIOR CHNAS CAN BE FOUND ON THE COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) ANNUAL REPORT. THE CHIP IS COORDINATED BY MARION COUNTY PUBLIC HEALTH DEPARTMENT AND IS PUBLISHED ON THEIR WEBSITE AT WWW.CO.MARION.OR.US/HLT/CHIP/PAGES/DEFAULT.ASPX
PART VI, LINE 3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCESALEM HEALTH SCREENS UNINSURED PATIENTS FOR ELIGIBILITY THROUGH THE OREGON HEALTH PLAN (OHP/MEDICAID), WORKERS COMPENSATION, THIRD PARTY LIABILITIES, CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA) OR ANY OTHER POTENTIAL FUNDING SOURCE AT THE POINT OF SCHEDULING, PATIENT REGISTRATION, OR WHILE INPATIENT. THE HOSPITAL OR ITS REPRESENTATIVE WILL REVIEW THE PATIENT'S CURRENT RESOURCES AND WORK WITH HIM/HER TO GAIN ELIGIBILITY FOR ANY OF THESE PROGRAMS AS APPROPRIATE. PATIENTS NOT ELIGIBLE FOR OHP OR THE OTHER PROGRAMS LISTED ABOVE WHO HAVE FINANCIAL CONSTRAINTS THAT INHIBIT THEIR ABILITY TO PAY, WILL BE ASSESSED FOR FINANCIAL ASSISTANCE. INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS MADE PUBLICALLY AVAILABLE FREE OF CHARGE IN THE FOLLOWING MANNER:1) NOTICES ARE POSTED IN KEY AREAS OF THE HOSPITAL, INCLUDING ADMITTING, THE EMERGENCY DEPARTMENT, OUTPATIENT DEPARTMENT REGISTRATION AREAS AND PATIENT FINANCIAL SERVICES2) THE CONDITIONS OF ADMISSION FORM INFORMS THE PATIENT OF THEIR RIGHT TO APPLY FOR FINANCIAL ASSISTANCE.3) WRITTEN INFORMATION IS AVAILABLE IN ENGLISH, SPANISH, RUSSIAN AND VIETNAMESE. THE HOSPITAL WILL PROVIDE THE APPROPRIATE INTERPRETATION SERVICES FOR PATIENTS/GUARANTORS WHO DO NOT SPEAK ENGLISH.4) FRONT LINE STAFF ARE TRAINED TO ANSWER FINANCIAL ASSISTANCE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY THAT CANNOT BE ANSWERED TO FINANCIAL COUNSELORS IN A TIMELY MANNER.5) THIS POLICY IS POSTED ON SALEM HEALTH'S WEBSITE. WRITTEN INFORMATION ABOUT THIS POLICY WILL BE MADE AVAILABLE UPON REQUEST6) ALL PATIENT BILLING STATEMENTS INCLUDE A NOTICES THAT FINANCIAL ASSISTANCE IS AVAILABLE AND CONTRACT INFORMATION IF THEY WANT TO LEARN MORE.
PART VI, LINE 4:	SALEM HEALTH SERVES MARION AND POLK COUNTIES. DEMOGRAPHICS IN 2016, THE POPULATION OF POLK COUNTY WAS ESTIMATED TO BE 81,823, WHICH IS AN 8.5% INCREASE FROM 2011. THE LARGEST CITY POPULATION IS LOCATED IN WEST SALEM WITH 28,871 PEOPLE, EVEN THOUGH POLK COUNTY ONLY INCLUDES THE 97304 ZIP CODE OF SALEM. THE NEXT LARGEST CITY IS DALLAS WITH 14,583 PEOPLE. POLK COUNTY HAS A LARGER PROPORTION OF INDIVIDUALS BETWEEN THE AGES OF 0-24 YEARS OLD THAN OREGON AND THE UNITED STATES. THE RACIAL MAKEUP OF THE COUNTY WAS 80% WHITE, 2.6% AMERICAN INDIAN, 2% ASIAN, 0.9% BLACK OR AFRICAN AMERICAN, 0.4% PACIFIC ISLANDER AND 3.5% MADE UP OF 2 OR MORE RACES. THOSE OF HISPANIC OR LATINO ORIGIN MADE UP 13% OF THE POPULATIONS. THE MEDIAN INCOME OF POLK COUNTY IS SLIGHTLY HIGHER THAN THE REST OF OREGON, BUT LOWER THAN THE MEDIAN INCOME FOR THE UNITED STATES. ABOUT 16% OF THE POPULATION LIVE BELOW THE POVERTY LINE, WHICH IS LESS COMPARATIVELY THAN THE REST OF THE STATE. THE UNEMPLOYMENT RATE FOR THOSE 16 AND OLDER IS 6.5%, HIGHER THAN THE REST OF OREGON. POLK COUNTY IS MOSTLY RURAL AND HAS THE SECOND LARGEST AREA DEVOTED TO VITICULTURE IN THE STATE AT 1,322 ACRES. MARION COUNTY IS A MIX OF URBAN AND RURAL WITH A POPULATION OF 336,316. THE RACIAL MAKEUP IS 66% WHITE, 2.6% AMERICAN INDIAN, 2.3% ASIAN, 1.4% BLACK OR AFRICAN AMERICAN, 1% PACIFIC ISLANDER AND 3.3% TWO OR MORE RACES. HISPANIC AND LATINO ORIGIN MAKES UP 26% OF THE POPULATION. MARION COUNTY RESIDENTS HAVE A LOWER MEDIAN HOUSEHOLD INCOME THAN OREGON RESIDENTS AND AMERICANS IN GENERAL. A LARGER PERCENT OF MARION COUNTY RESIDENTS (ESPECIALLY RESIDENTS UNDER 18) LIVE BELOW THE FEDERAL POVERTY LEVEL THAN OREGON RESIDENTS AND AMERICANS IN GENERAL. A SMALLER PERCENT OF MARION COUNTY RESIDENTS HAVE ATTAINED A COLLEGE DEGREE THAN OREGON AND UNITED STATES RESIDENTS. AGRICULTURE AND FOOD PROCESSING ARE IMPORTANT TO THE COUNTY'S ECONOMY AS ARE LUMBER, MANUFACTURING AND EDUCATION. MARION COUNTY IS THE LEADER IN AGRICULTURAL PRODUCTION AMONG ALL OTHER OREGON COUNTIES.
PART VI, LINE 5:	SALEM HEALTH FUNDS A COMMUNITY HEALTH EDUCATION CENTER AND HEALTH EDUCATION OUTREACH PROGRAM. THE CENTER IS STAFFED BY HEALTH EDUCATORS AND REGISTERED NURSES WHO PROVIDE EDUCATION SERVICES TO COMMUNITY MEMBERS ON A DROP-IN BASIS; A MEDICAL PROFESSIONAL AND HEALTH CONSUMER LIBRARY ALLOWS PATRONS TO CHECK OUT HEALTH MATERIALS FREE OF CHARGE. THE LIBRARY SUPPORTS COMMUNITY PROVIDERS, HEALTH PROFESSIONALS AND STUDENTS THAT LIVE, WORK AND LEARN IN MARION AND POLK COUNTIES. FOUR DIFFERENT ONLINE MEDICAL JOURNAL AND RESOURCES SUBSCRIPTION SERVICES ARE PROVIDED TO ENSURE THE MOST UPDATE TO DATE AND ACCURATE INFORMATION AVAILABLE. MORE THAN 1,500 CLASSES AND EVENTS ARE HELD AT THE CENTER AND IN THE COMMUNITY EACH YEAR TO PROMOTE HEALTH AND PREVENT CHRONIC CONDITIONS. THESE RANGE FROM HEALTH SCREENINGS/EARLY DETECTION TO CHRONIC DISEASE MANAGEMENT AND END OF LIFE DECISION SUPPORT, THE OUTREACH PRIORITIES SUPPORT THE CHNA AND STAFF WORK IN COLLABORATION WITH COMMUNITY PARTNERING AGENCIES TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE WITHIN SALEM HEALTH'S SERVICE AREAS.HOSPITAL EXECUTIVES INTENTIONALLY SERVE ON NON-PROFIT BOARDS THROUGHOUT THE COMMUNITY. THESE INCLUDE MARION POLK FOOD SHARE, FAMILY BUILDING BLOCKS, LIBERTY HOUSE, THE BOYS AND GIRLS CLUB, SALEM FREE CLINIC, UNITED WAY, AND THE SALVATION ARMY, AMONG OTHERS. THESE ORGANIZATIONS SERVE VULNERABLE POPULATIONS. OFTEN, COMMUNITY BENEFIT ACTIVITIES, ESPECIALLY CASH AND INKIND DONATIONS SUPPORT THE WORK OF PARTNERING ORGANIZATIONS TO MEET THE IDENTIFIED NEEDS OF THE UNDERSERVED IN OUR COMMUNITY.THE COMMUNITY PARTNER GRANT PROGRAM PROMOTES THE HEALTH AND WELL-BEING OF LOW INCOME INDIVIDUALS AND FAMILIES IN MARION AND POLK COUNTIES THROUGH FUNDING PROJECTS THAT ADDRESS HEALTH RELATED PRIORITIES IN THE CHNA. IN 2017, OVER $300,000 WAS DISTRIBUTED TO COMMUNITY PARTNERS TO ADDRESS EARLY CHILDHOOD HEALTH, SUBSTANCE ABUSE, OBESITY AND MENTAL HEALTH, SPECIFICALLY DEPRESSION.
PART VI, LINE 6:	SALEM HEALTH IS AN OREGON NONPROFIT CORPORATION AND A TAX-EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE. SALEM HEALTH, HOSPITALS AND CLINICS IS THE "PARENT" CORPORATION AND SOLE CORPORATE MEMBER OF SALEM HEALTH, SALEM HEALTH FOUNDATION, SALEM HEALTH WEST VALLEY, WEST VALLEY HOSPITAL FOUNDATION, WILLAMETTE VALLEY INSURANCE CORPORATION, AND SALEM HEALTH PROFESSIONAL SERVICES. ALL ENTITIES WITHIN THE PARENT CORPORATION ARE SEPARATE NONPROFIT CORPORATIONS.SALEM HEALTH IS AN OREGON NONPROFIT CORPORATION AND A TAX-EXEMPT ORGANIZATION. THE CORPORATION ALSO DOES BUSINESS UNDER THE NAME "SALEM HOSPITAL, A PART OF SALEM HEALTH HOSPITALS AND CLINICS." SALEM HEALTH IS ONE OF THE LARGEST ACUTE CARE HOSPITALS IN OREGON. LICENSED FOR 494 BEDS, SALEM HEALTH OFFERS A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES AN AREA OF OVER 500,000 PEOPLE, INCLUDING MARION AND POLK COUNTIES INCLUDING THE RESIDENTS OF THE CITY OF SALEM, THE STATE CAPITAL OF OREGON.SALEM HEALTH, AS PART OF SALEM HEALTH HOSPITALS AND CLINICS IS GOVERNED BY AN ALL-VOLUNTEER COMMUNITY-BASED BOARD OF TRUSTEES (BOARD). THE BOARD HAS THE RESPONSIBILITY FOR THE DEVELOPMENT AND OVERSIGHT OF SALEM HEALTH VALUES, VISION, PURPOSE AND LONG-TERM STRATEGY. THROUGH THESE DOCUMENTS, THE COMMUNITY BENEFIT STEERING COMMITTEE ASSESSES AND REAFFIRMS SALEM HEALTH'S COMMUNITY BENEFIT COMMITMENTS AND CONNECTIONS WITH COMMUNITY NEEDS AND PRIMARY CONSTITUENCIES. THE COMMUNITY BENEFIT PLAN ASSURES MEASUREMENT AND COMPARISON OF SALEM HEALTH'S COMMUNITY ACTIVITIES TO EVOLVING NORMS AND OVERSEES THE CLEAR AND ACCURATE COMMUNICATION OF THESE ACTIVITIES TO KEY CONSTITUENCIES.
PART VI, LINE 7, REPORTS FILED WITH STATES	OR

Schedule H (Form 990) 2019

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SALEM HEALTH

Employer identification number
93-0579722

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) SALEM HEALTH FOUNDATION PO BOX 14001 SALEM,OR97309	23-7002687	501(C)(3)	6,000	CHARITABLE CONTRIBUTION GOLF TOURNAMENT
(2) SALEM KEIZER EDUCATION FOUNDATION 233 COMMERCIAL STREET NE SALEM,OR97301	93-0831467	501(C)(3)	25,000	AWESOME 3000 SPONSORSHIP/DISEASE PREVENTION
(3) BOYS & GIRLS CLUB 1395 SUMMER ST NE SALEM,OR97301	93-0581470	501(C)(3)	42,000	COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE OF HEALTH
(4) LIBERTY HOUSE 2685 4TH ST NE SALEM,OR97301	93-1236936	501(C)(3)	30,000	CHEFS FOR LIBERTY HOUSE SPONSORSHIP/CHAMPIONS FOR CHILDREN SPONSORSHIP
(5) SALVATION ARMY 1901 FRONT ST SALEM,OR97301	94-1156347	501(C)(3)	25,000	COMMUNITY PARTNER GRANT
(6) UNITED WAY OF MID WILLAMETTE VALLEY 455 BLILER AVE NE SALEM,OR97303	93-0395586	501(C)(3)	5,000	SPONSOR BINATIONAL HEALTH FAIR/PRESIDENT'S LEADERSHIP CIRCLE/IMPROVE SOCIAL DETERMINATE OF HEALTH
(7) SALEM FREE MEDICAL CLINIC 1300 BROADWAY ST NE STE 104 SALEM,OR97301	20-3549992	501(C)(3)	80,000	ACCESS TO CARE (SALEM & DALLAS)
(8) POLK CO FAMILY & COMMUNITY OUTREACH 182 SW ACADEMY STREET 220 DALLAS,OR97338	93-6002310	GOVERNMENT	15,000	COMMUNITY PARTNER GRANT
(9) FAMILY BUILDING BLOCKS 2425 LANCASTER DR NE SALEM,OR97305	93-1233373	501(C)(3)	5,000	COMMUNITY PARTNER GRANT
(10) GILBERT HOUSE 116 MARION ST NE SALEM,OR97301	93-0948548	501(C)(3)	5,000	EXHIBIT SPONSOR - ALL ABOUT ME
(11) MARION COUNTY PO BOX 14500 SALEM,OR97309	93-6002307	GOVERNMENT	25,000	COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH
(12) MARION POLK FOOD SHARE 1660 SALEM INDUSTRIAL DRIVE NE SALEM,OR97301	94-3034161	501(C)(3)	32,471	COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH
(13) MWVCAA 2585 STATE ST SALEM,OR97301	23-7056987	501(C)(3)	12,500	COMMUNITY PARTNER GRANT
(14) CITY OF SALEM HOUSING AUTHORITY 360 CHURCH ST SE SALEM,OR97301	93-0582087	GOVERNMENT	25,000	COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH
(15) COMMUNITY SERVICES CONSORTIUM 250 BROAD ALBIN ST NE ALBANY,OR97321	93-6118438	501(C)(3)	25,000	COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH
(16) ISAAC'S ROOM 299 COTTAGE ST NE SALEM,OR97301	93-1267455	501(C)(3)	20,500	COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH
(17) OPTIONS COUNSELING & FAMILY SERVICES 3500 CHAD DR SUITE 350 EUGENE,OR97408	94-3436426	501(C)(3)	22,209	COMMUNITY PARTNER GRANT/IMPROVE SOCIAL DETERMINATE TO HEALTH
(18) OSBORNE ADVENTURES 4742 LIBERTY RD S SALEM,OR97301	81-4004992	501(C)(3)	8,500	CYCLE SHARE STATION SPONSOR/IMPROVE SOCIAL DETERMINATE TO HEALTH
(19) RONALD MCDONALD HOUSE CHARITY 2620 N COMMERCIAL AVE PORTLAND,OR97227	93-0806912	501(C)(3)	5,000	STRONG TOGETHER WALK SPONSORSHIP/IMPROVE SOCIAL DETERMINATE TO HEALTH
(20) ROTARY TRIATHLON OF SALEM PO BOX 442 SALEM,OR97308	93-7060946	501(C)(3)	5,000	ART FAIR & FESTIVAL SPONSORSHIP/IMPROVE SOCIAL DETERMINATE TO HEALTH
(21) SALEM ART ASSOCIATION 600 MISSION ST S SALEM,OR97302	93-0421613	501(C)(3)	6,250	CLAY BALL SPONSORSHIP/IMPROVE SOCIAL DETERMINATE TO HEALTH
(22) SALEM LEADERSHIP FOUNDATION PO BOX 7384 SALEM,OR97203	93-1215089	501(C)(3)	5,000	OPEN STREETS SPONSORSHIP/IMPROVE SOCIAL DETERMINATE TO HEALTH
(23) SALEM POLICE FOUNDATION PO BOX 2631 SALEM,OR97308	27-1899059	501(C)(3)	8,500	SPONSORSHIP BREAKFAST WITH THE CHIEF/IMPROVE SOCIAL DETERMINATE TO HEALTH
(24) THE INSPIRE FOUNDATION 1110 COMMERCIAL ST NE SALEM,OR97301	46-1482848	501(C)(3)	6,500	GREAT SALEM RACE SPONSORSHIP/DISEASE PREVENTION

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) CASH ASSISTANCE TO PATIENTS IN NEED FOR PRESCRIPTIONS, LIFELINE SUPPORT, REHABILITATION AND OTHER URGENT NEEDS.	149	45,944
(2) SCHOLARSHIPS FOR HEALTH PROFESSIONS EDUCATION	64	193,504
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	GRANTS ARE ONLY MADE TO QUALIFIED EXEMPT ORGANIZATIONS. NO MONITORING IS REQUIRED.

Schedule I (Form 990) 2019

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SALEM HEALTH

Employer identification number

93-0579722

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Yes

Any related organization? ......................

Yes

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1CHERYL NESTER WOLFE PRESIDENT AND CEO	(i) (ii)	680,629 ------------- 0	385,687 ------------- 0	15,240 ------------- 0	20,250 ------------- 0	38,798 ------------- 0	1,140,604 ------------- 0	0 ------------- 0
2JAMES PARR CHIEF FINANCIAL OFFICER	(i) (ii)	475,917 ------------- 0	71,607 ------------- 0	1,800 ------------- 0	53,898 ------------- 0	38,289 ------------- 0	641,511 ------------- 0	0 ------------- 0
3RALPH YATES CMO SALEM HEALTH AND SHMG	(i) (ii)	451,585 ------------- 0	67,189 ------------- 0	15,240 ------------- 0	46,684 ------------- 0	30,085 ------------- 0	610,783 ------------- 0	0 ------------- 0
4LAURIE BARR CHIEF HUMAN RESOURCES OFFICER	(i) (ii)	323,000 ------------- 0	72,097 ------------- 0	1,800 ------------- 0	43,054 ------------- 0	35,943 ------------- 0	475,894 ------------- 0	0 ------------- 0
5SARAH HORN CHIEF NURSING OFFICER	(i) (ii)	341,815 ------------- 0	46,878 ------------- 0	1,080 ------------- 0	42,379 ------------- 0	35,865 ------------- 0	468,017 ------------- 0	0 ------------- 0
6LEAH MITCHELL CIO	(i) (ii)	395,127 ------------- 0	71,799 ------------- 0	1,200 ------------- 0	46,459 ------------- 0	28,747 ------------- 0	543,332 ------------- 0	0 ------------- 0
7ANDREW FURMAN - TERM 01252019 VP MEDICAL AFFAIRS	(i) (ii)	359,953 ------------- 0	54,478 ------------- 0	1,632 ------------- 0	40,449 ------------- 0	36,296 ------------- 0	492,808 ------------- 0	0 ------------- 0
8BAHAA WANLY CHIEF OPERATING OFFICER	(i) (ii)	321,460 ------------- 0	47,281 ------------- 0	1,332 ------------- 0	37,830 ------------- 0	35,037 ------------- 0	442,940 ------------- 0	0 ------------- 0
9CHRISTINE CLARKE GENERAL SURGEON	(i) (ii)	346,434 ------------- 0	0 ------------- 0	955 ------------- 0	30,366 ------------- 0	15,233 ------------- 0	392,988 ------------- 0	0 ------------- 0
10ZENNIA CENIZA EFF 51218 INTERIM VP CLINICAL OPERATIONS	(i) (ii)	210,204 ------------- 0	30,876 ------------- 0	1,235 ------------- 0	13,676 ------------- 0	26,026 ------------- 0	282,017 ------------- 0	0 ------------- 0
11DENISE HOOVER VP SURGICAL SERVICES	(i) (ii)	204,919 ------------- 0	30,379 ------------- 0	890 ------------- 0	32,298 ------------- 0	23,190 ------------- 0	291,676 ------------- 0	0 ------------- 0
12SHEA CORUM VP IT OPERATIONS	(i) (ii)	191,931 ------------- 0	28,501 ------------- 0	746 ------------- 0	25,976 ------------- 0	32,307 ------------- 0	279,461 ------------- 0	0 ------------- 0
13LEILANI SLAMA VP COMMUNITY ENGAGEMENT	(i) (ii)	169,250 ------------- 0	25,634 ------------- 0	1,938 ------------- 0	23,472 ------------- 0	31,719 ------------- 0	252,013 ------------- 0	0 ------------- 0
14JUAN OYARZUN DIR CARDIOTHORACIC MED	(i) (ii)	1,186,736 ------------- 0	25,000 ------------- 0	4,902 ------------- 0	44,344 ------------- 0	40,093 ------------- 0	1,301,075 ------------- 0	0 ------------- 0
15NERVIN FANOUS CARDIOTHORACIC SURGEON	(i) (ii)	956,109 ------------- 0	0 ------------- 0	1,710 ------------- 0	42,502 ------------- 0	34,262 ------------- 0	1,034,583 ------------- 0	0 ------------- 0
16NICOLE VANDERHEYDEN MD TRAUMA DIR/ ASSOC CMO SHMG	(i) (ii)	728,212 ------------- 0	34,555 ------------- 0	7,131 ------------- 0	51,491 ------------- 0	41,511 ------------- 0	862,900 ------------- 0	0 ------------- 0
17KATHERINE JONES CARDIOTHORACIC SURGEON	(i) (ii)	913,372 ------------- 0	0 ------------- 0	840 ------------- 0	24,537 ------------- 0	33,197 ------------- 0	971,946 ------------- 0	0 ------------- 0
18PAUL COELHO MEDICAL DIRECTOR, PAIN MANAGEMENT	(i) (ii)	520,780 ------------- 0	0 ------------- 0	4,902 ------------- 0	21,917 ------------- 0	29,531 ------------- 0	577,130 ------------- 0	0 ------------- 0
19LORI JAMES-NIELSEN TERM 31717 SEE SCHEDULE J	(i) (ii)	119,917 ------------- 0	0 ------------- 0	783 ------------- 0	10,300 ------------- 0	14,605 ------------- 0	145,605 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINES 4A-B	SOME OF THE HOSPITAL'S EMPLOYEES RECEIVE DEFERRED COMPENSATION UNDER A 457(F) NONQUALIFIED PLAN. THIS COMPENSATION IS INCLUDED IN COMPENSATION REPORTED IN PART II. THE TOTAL NONQUALIFIED PORTION OF EACH PERSONS DEFERRED COMPENSATION IS: CHERYL NESTER WOLFE $207,151 ($207,151 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $0 INCLUDED IN DEFERRED COMPENSATION) JAMES PARR $33,648 (INCLUDED IN DEFERRED COMPENSATION) RALPH YATES $31,834 (INCLUDED IN DEFERRED COMPENSATION) LAURIE BARR $46,372 ($23,569 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $22,804 INCLUDED IN DEFERRED COMPENSATION) SARAH HORN $22,128 (INCLUDED IN DEFERRED COMPENSATION) LEAH MITCHELL $43,995 ($17,786 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $26,210 INCLUDED IN DEFERRED COMPENSATION) ANDREW FURMAN $25,599 (INCLUDED IN DEFERRED COMPENSATION) BAHAA WANLY $22,981 (INCLUDED IN DEFERRED COMPENSATION) DENISE HOOVER $14,492 (INCLUDED IN DEFERRED COMPENSATION) SHEA CORUM $13,669 (INCLUDED IN DEFERRED COMPENSATION) LEILANI SLAMA $12,459 (INCLUDED IN DEFERRED COMPENSATION) JUAN OYARZUN $29,494 (INCLUDED IN DEFERRED COMPENSATION) NERVIN FANOUS $27,652 (INCLUDED IN DEFERRED COMPENSATION) NICOLE VANDERHEYDEN $65,796 ($34,555 INCLUDED IN BONUS & INCENTIVE COMPENSATION AND $31,241 INCLUDED IN DEFERRED COMPENSATION) CHRISTINE CLARKE $15,516 (INCLUDED IN DEFERRED COMPENSATION) KATHERINE JONES $24,537 (INCLUDED IN DEFERRED COMPENSATION) PAUL COELHO $18,382 (INCLUDED IN DEFERRED COMPENSATION)
PART I, LINE 6	CERTAIN PHYSICIANS RECEIVE INCENTIVE COMPENSATION IN ACCORDANCE WITH THEIR EMPLOYMENT AGREEMENTS WITH SALEM HEALTH. AMOUNTS NOTED ON SCHEDULE J PART II COLUMN (II) REFLECT PAYMENTS EARNED BY THESE PHYSICIAN EMPLOYEES IN SUCH AGREEMENTS. ADDITIONALLY, FOR KEY EMPLOYEES AND MANAGEMENT OF SALEM HEALTH THE BOARD OF TRUSTEES HAS APPROVED AN ANNUAL LEADERSHIP INCENTIVE PROGRAM THAT PROVIDES FOR INCENTIVE PAYMENTS BASED ON OBJECTIVE CRITERIA RELATED TO QUALITY AND SAFETY, ENGAGEMENT, PATIENT SATISFACTION AND FINANCIAL PERFORMANCE. AMOUNTS NOTED ON SCHEDULE J PART II COLUMN (II) REFLECT PAYMENTS EARNED UNDER THE LEADERSHIP INCENTIVE PLAN.
PART I, LINE 7	THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES, IN CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, REVIEWS CEO TOTAL COMPENSATION AND PERFORMANCE ANNUALLY. AS PART OF THE COMMITTEE'S ACTIONS, A NON-FIXED BONUS MAY BE AWARDED TO THE CEO. IN THIS YEAR THE NON-FIXED PAYMENT WAS PAID UNDER THE 457(F) NONQUALIFIED PLAN AND IS INCLUDED IN DEFERRED COMPENSATION REPORTED IN PART II.
ADDITIONAL INFORMATION FOR EXECUTIVE TRANSITIONS	LORI JAMES-NELSEN WAS CHIEF STRATEGY OFFICER UNTIL AUGUST 1, 2016. SUBSEQUENTLY SHE WAS A LOANED EXECUTIVE TO OHSU PARTNERS UNTIL MARCH 17, 2017.

Schedule J (Form 990) 2019

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SALEM HEALTH

Employer identification number
93-0579722

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS	52-1542796	794458CY3	11-13-2008	125,000,000	REFUND SERIES 2004AB AND 2006B. PATIENT TOWER CONSTRUCTION AND OTHER IMP.		X		X		X
B	THE HOSPITAL FACILITY AUTHORITY OF THE CITY OF SALEM OREGON REVENUE BONDS	52-1542796	794458EL9	11-01-2016	215,638,877	REFUND SERIES 2013 AB AND 2008A. PAY COSTS OF ISSUANCE RELATING TO THE BONDS		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	50,000,000		9,395,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	125,021,764		216,071,609
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............			25,890,658
7 Issuance costs from proceeds ...............	633,004		1,649,773
8 Credit enhancement from proceeds .............	1,153,492
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	9,260,268
11 Other spent proceeds .............	113,975,000		188,489,677
12 Other unspent proceeds .............			41,500
13 Year of substantial completion .............	2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.500 %		0.900 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0.100 %		0.200 %
6 Total of lines 4 and 5 .............	0.600 %		1.100 %
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X	X
b Exception to rebate? ........	X		X
c No rebate due? .........	X			X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X
b Name of provider ..........	UBS AG
c Term of hedge .........	2580.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference

Explanation

SUPPLEMENTAL INFORMATION:

COLUMN A: DIFFERENCE BETWEEN PART I(E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS IN THE PROJECT FUND. PART I (F): PROCEEDS WERE USED TO REFUND SERIES 2004AB AND SERIES 2006B BONDS, FINANCE THE CONTRUCTION OF THE PATIENT TOWER AND OTHER IMPROVEMENTS. PART II, LINE 1: BONDS REFUNDING SERIES 2008C: SERIES 2013AB (ISSUED JUNE 27, 2013). PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENTS TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III,LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDSM MAS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. PART IV, LINE 2(B): THE REFUNDING AND NEW MONEY PORTIONS OF THE BONDS HAVE MET THE 6-MONTH EXCEPTION TO REBATE. PART IV, LINE 2(C): PROCEEDS OF THE BONDS MET A SPENDING EXCEPTION TO REBATE AND, THEREFORE, NO PAYMENT WILL EVER BE DUE ON THE BONDS. COLUMN B: DIFFERENCE BETWEEN PART I(E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS ON BOND PROCEEDS. PART I (F): BONDS PROCEEDS WERE EXPENDED TO REFUND THE 2013AB BONDS (ISSUED ON JUNE 27,2013), TO REFUND THE 2008A BONDS (ISSUED ON OCTOBER 8, 2008) TO REFUND THE 2006A BONDS (ISSUED ON NOVEMBER 15, 2006) AND TO PAY COSTS OF ISSUANCE RELATING TO THE BONDS. PART II, LINE 13: SINCE THE PROCEEDS OF THE BONDS WERE USED FOR REFUNDING PURPOSES, THE YEAR OF SUBSTANTIAL COMPLETION IS NOT APPLICABLE. PART III, LINE 7:AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6, IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. PART IV, LINE 2(B): THE PORTION OF BOND PROCEEDS USED FOR CURRENT REFUNDING HAS MET THE 6-MONTH EXCEPTION TO REBATE. PART IV, LINES 2(B): THE PORTION OF BOND PROCEEDS USED FOR CURRENT REFUNDING HAS MET THE 6-MONTH EXCEPTION TO REBATE.

Schedule K (Form 990) 2019

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1	Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	5,257
6	Total number of volunteers (estimate if necessary) .............	6	415
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	2,303,935
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	275,797

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,293,735	1,056,591
9	Program service revenue (Part VIII, line 2g) .........	749,790,070	783,829,055
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	9,717,236	31,831,446
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,395,065	542,703
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	764,196,106	817,259,795
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	804,612	807,294
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	386,294,442	412,741,884
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	316,577,436	321,264,712
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	703,676,490	734,813,890
19	Revenue less expenses. Subtract line 18 from line 12.......	60,519,616	82,445,905
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,211,931,939	1,306,434,818
21	Total liabilities (Part X, line 26).............	391,556,988	385,873,792
22	Net assets or fund balances. Subtract line 21 from line 20.....	820,374,951	920,561,026

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 123,901,187 including grants of $ ) (Revenue $ 364,315,400 )
	SALEM HEALTH IS ONE OF THE LARGEST OF OREGON'S 59 ACUTE CARE HOSPITALS AND OPERATES THE BUSIEST EMERGENCY DEPARTMENT IN OREGON. THERE ARE 487 PRACTITIONERS, REPRESENTING 53 DIFFERENT SPECIALTIES. MORE THAN 415 VOLUNTEERS PROVIDE NON-MEDICAL SUPPORT FOR THE HOSPITAL.STATISTICS FOR THE 12 MONTH PERIOD ENDED 6/30/18: BIRTHS - 3,443, DIAGNOSTIC IMAGING PROCEDURES - 190,479, ED VISITS - 107,877, INPATIENT ADMISSIONS - 26,392, LABORATORY PROCEDURES - 1,388,575, SURGERIES - 13,865. THE PRIMARY SERVICE AREA IS MARION AND POLK COUNTIES WITH APPROXIMATELY 500,000 RESIDENTS.

4b	(Code: ) (Expenses $ 502,945,547 including grants of $ ) (Revenue $ 400,652,208 )
	SALEM HEALTH PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. IN THE 12 MONTH PERIOD ENDED 6/30/18, THE COST OF SERVICES PROVIDED AS A COMMUNITY BENEFIT TOTALED $102.2 MILLION. THIS FIGURE CONSISTED OF $11.0 MILLION IN COSTS TO PROVIDE CHARITY CARE TO INDIVIDUALS WHO CANNOT AFFORD TO PAY; $41.5 MILLION IN UNDERPAYMENT BY MEDICAID AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES; AND $49.7 MILLION IN UNDERPAYMENT BY MEDICARE AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES. SALEM HEALTH DOES NOT PURSUE LEGAL ACTION FOR NON-PAYMENT OF BILLS AGAINST CHARITY CARE PATIENTS WHO HAVE DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS.

4c	(Code: ) (Expenses $ 35,698,839 including grants of $ 807,294 ) (Revenue $ 17,245,846 )
	SALEM HEALTH ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN THE 12 MONTH PERIOD ENDED 6/30/18, SALEM HEALTH GAVE $12.7 MILLION FOR UNFUNDED OR UNDERFUNDED HEALTH SERVICES, INCLUDING IMPROVING ACCESS TO CARE THROUGH PHYSICIAN RECRUITING, COMMUNITY HEALTH EDUCATION AND PREVENTION PROGRAMS. THE HOSPITAL HAS AN ACTIVE SPEAKERS BUREAU PROVIDING FREE HEALTH LECTURES TO COMMUNITY GROUPS. HEALTH SCREENINGS, SUPPORT GROUPS AND EDUCATION CLASSES ARE OFFERED ON AN ON-GOING BASIS. IN FY 2018, SALEM HEALTH PROVIDED MORE THAN $1 MILLION IN CASH AND IN-KIND DONATIONS TO COMMUNITY HEALTH PROGRAMS SUCH AS MEDASSIST AND PROJECT ACCESS, PSYCHIATRIC CRISIS CENTER AND THE SALEM FREE CLINIC.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses662,545,573

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	9,954,667	0	1,252,616

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	657,701
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	398,890

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		1,056,591

		Business Code
2a	NET PATIENT REVENUE	621110	757,937,686	757,937,686
b	OTHER HOSPITAL SERVICES	900099	17,662,107	17,562,479	99,628
c	PHARMACY	446110	6,297,893	5,231,738	1,066,155
d	REGIONAL LAB	621500	1,364,187	240,750	1,123,437
e	VALUE BASED CARE/NUTRITION SERVIC	722210	567,182	567,182
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		783,829,055

3 Investment income (including dividends, interest, and othersimilar amounts) ......			32,092,903			32,092,903
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		889,342	6a
b	Less: rental expenses		1,034,973	6b
c	Rental income or (loss)		-145,631	6c
d	Net rental income or (loss).......			-145,631			-145,631
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	45,137		7a
b	Less: cost or other basis and sales expenses	306,594		7b
c	Gain or (loss)	-261,457		7c
d	Net gain or (loss).........			-261,457			-261,457
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	PASSTHROUGH INCOME		541900	688,334	673,619	14,715
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			688,334
12	Total revenue. See instructions.....			817,259,795	782,213,454	2,303,935	31,685,815

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	567,846	567,846
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	239,448	239,448
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	5,936,476		5,936,476
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	315,470,255	288,404,724	27,065,531
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	68,686,706	62,136,276	6,550,430
10	Payroll taxes ...........	22,648,447	20,352,071	2,296,376
11	Fees for services (non-employees):
a	Management ......	1,121,655	900,158	221,497
b	Legal .........	1,294,032	24,260	1,269,772
c	Accounting ...........	450,550	374,808	75,742
d	Lobbying ...........	82,500		82,500
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	29,642,484	25,680,208	3,962,276
12	Advertising and promotion ....	91,934	1,297	90,637
13	Office expenses .......	7,674,667	4,414,866	3,259,801
14	Information technology ......	7,649,545	1,282,785	6,366,760
15	Royalties ..
16	Occupancy ...........	19,403,492	12,301,201	7,102,291
17	Travel ............	1,108,429	640,102	468,327
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	935,194	747,819	187,375
20	Interest ...........	10,556,453	10,556,453
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	43,548,559	43,548,559
23	Insurance ...	5,008,195	5,008,195
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PATIENT SUPPLIES	103,283,354	102,859,725	423,629
b	PROVIDER TAX	40,520,554	40,520,554
c	BAD DEBTS	29,984,352	29,984,352
d	OTHER PURCHASED SERVICE	11,088,724	9,063,175	2,025,549
e	All other expenses	7,820,039	2,936,691	4,883,348
25	Total functional expenses. Add lines 1 through 24e	734,813,890	662,545,573	72,268,317	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			477,445	1	535,623
2	Savings and temporary cash investments .........			5,008,688	2	14,572,136
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			86,887,594	4	87,867,240
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			545,456	7	545,456
8	Inventories for sale or use ............			6,386,043	8	6,689,498
9	Prepaid expenses and deferred charges ......			7,051,916	9	6,274,832
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	952,082,271
b	Less: accumulated depreciation	10b	475,061,916	474,377,495	10c	477,020,355
11	Investments—publicly traded securities .			589,144,876	11	674,691,909
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			18,742,130	13	15,672,505
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			23,310,296	15	22,565,264
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,211,931,939	16	1,306,434,818

17	Accounts payable and accrued expenses .....	79,929,240	17	83,977,757
18	Grants payable ...		18
19	Deferred revenue .........	27,940	19	525,200
20	Tax-exempt bond liabilities .........	284,804,178	20	278,251,740
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	231,968	23	164,174
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	26,563,662	25	22,954,921
26	Total liabilities. Add lines 17 through 25..	391,556,988	26	385,873,792

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	820,374,951	32	920,561,026
33	Total liabilities and net assets/fund balances ........	1,211,931,939	33	1,306,434,818

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE 990. IT IS THEN FORWARDED TO THE ENTIRE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12C	ON AN ANNUAL BASIS THE SECRETARY OF THE HOSPITAL SHALL SEND TO EACH PERSON WHO IS A TRUSTEE, OFFICER, OR MEMBER OF A COMMITTEE, AND TO THOSE EMPLOYEES OF THE HOSPITAL AS THE BOARD MAY DETERMINE, A COPY OF THE POLICY REGARDING CONFLICTS OF INTEREST, TOGETHER WITH A QUESTIONNAIRE INQUIRING AS TO CONFLICTS, TO BE COMPLETED AND RETURNED TO THE SECRETARY BY THE TRUSTEE, OFFICER, COMMITTEE MEMBER OR EMPLOYEE PRIOR TO THE BEGINNING OF EACH CALENDAR YEAR.
FORM 990, PART VI, SECTION B, LINE 15	EXECUTIVE COMPENSATION AT SALEM HEALTH IS DESIGNED TO ALLOW THE ORGANIZATION TO RECRUIT AND RETAIN QUALIFIED SENIOR LEADERS. THE GOVERNANCE COMMITTEE OF THE SALEM HEALTH BOARD OF TRUSTEES, NONE OF WHOM IS A SALEM HEALTH EMPLOYEE, ENGAGES ONE OR MORE INDEPENDENT CONSULTANTS TO PROVIDE A MARKET DATA ON EXECUTIVE COMPENSATION, INCLUDING BENEFITS, FOR THE CEO AND OTHER EXECUTIVES IN SIMILAR ROLES AT COMPARABLE ORGANIZATIONS. THIS INFORMATION IS USED BY THE GOVERNANCE COMMITTEE IN ITS DISCUSSIONS AND DECISIONS ON CEO COMPENSATION. THE CEO, IN CONJUNCTION WITH OTHER SALARY SURVEY OR PUBLIC INFORMATION AND THE INDEPENDENT CONSULTANT, ENSURES THAT EACH EXECUTIVE'S COMPENSATION IS COMPETITIVE IN THE MARKET FOR SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS.
FORM 990, PART VI, SECTION C, LINE 19	THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE ON THE HOSPITAL WEBSITE.
FORM 990, PART XI, LINE 9:	CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 3,714,776. CHANGE IN NET BENEFIT COST -998,582. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 337,666.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(f) Direct controlling entity
(1) MWVP INC 570 LIBERTY ST SE STE 200 SALEM,OR97301 12-3456789	HOLDS LAND	OR	SALEM HEALTH HOSPITALS AND CLINICS

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)SALEM HEALTH FOUNDATION 890 OAK STREET SE SALEM,OR97301 23-7002687	SUPPORTS SALEM HEALTH	OR	501(C)(3)	7	SALEM HEALTH HOSPITALS AND CLINICS		No
(2)SALEM HEALTH HOSPITALS & CLINICS 890 OAK STREET SE SALEM,OR97301 93-0823471	LEASES LAND TO SALEM HEALTH	OR	501(C)(3)	11 TYPE 1	N/A		No
(3)SALEM HEALTH WEST VALLEY 525 SOUTHEAST WASHINGTON STREET DALLAS,OR97338 43-1960221	HOSPITAL	OR	501(C)(3)	3	SALEM HEALTH HOSPITALS AND CLINICS		No
(4)WEST VALLEY HOSPITAL FOUNDATION 525 SOUTHEAST WASHINGTON STREET DALLAS,OR97338 93-1298564	SUPPORTS SALEM HEALTH WEST VALLEY	OR	501(C)(3)	11 TYPE 1	SALEM HEALTH HOSPITALS AND CLINICS		No
(5)WILLAMETTE VALLEY INSURANCE COMPANY 745 FORT STREET HONOLULU,HI96813 20-1836190	CAPTIVE INSURANCE	HI	501(C)(3)	11 TYPE 1	SALEM HEALTH HOSPITALS AND CLINICS		No
(6)SALEM HEALTH PROFESSIONAL SERVICES 890 OAK STREET SE SALEM,OR97301 75-3175249	BILLING SERVICE FOR PROFESSIONAL FEES	OR	501(C)(3)	3	SALEM HEALTH HOSPITALS AND CLINICS		No

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) SALEM AMBULATORY SURGERY CENTER LLC 570 LIBERTY ST SE SUITE 200 SALEM,OR97301 82-4752936	OWN, OPERATE, & MANAGE OUTPATIENT SURGERY CENTER	OR	N/A	RELATED				No			No	51.000 %
(2) POPULATION HEALTH ALLIANCE OF OREGON LLC 601 SW 2ND AVE STE 1940 PORTLAND,OR97204 47-1546023	POPULATION HEALTH DATA MANAGEMENT	OR	N/A	RELATED	-1,798,910	-588,908		No			No	12.890 %
(3) WILLAMETTE VALLEY COMMUNITY HEALTH LLC 2995 RYAN DRIVE SE STE 200 SALEM,OR97301 45-5540852	COORDINATED CARE ORGANIZATION	OR	N/A	RELATED	-553,660	-586,669		No			No	9.090 %
(4) PREMIER HEALTHCARE ALLIANCE LP 13034 BALLANTYNE CORPORATE PLACE CHARLOTTE,NC28277 33-0387407	ENABLE HOSPITALS TO IMPROVE CLINICAL & FINANCIAL PERFORMANCE	NC	N/A	RELATED	730,578	901,579		No	14,715	Yes		0.080 %

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No