Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 451,593 | 2,040,282 | 3,205,010 | 1,752,898 | 1,219,740 | 8,669,523 |
| 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 | 451,593 | 2,040,282 | 3,205,010 | 1,752,898 | 1,219,740 | 8,669,523 |
| 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) .. | 2,596,363 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 6,073,160 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 451,593 | 2,040,282 | 3,205,010 | 1,752,898 | 1,219,740 | 8,669,523 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 402,845 | 1,016,745 | 171,145 | 15,623 | 133,033 | 1,739,391 |
| 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.).. | 13,454 | 24,505 | 21,859 | 35,260 | 33,300 | 128,378 |
| 11 | Total support. Add lines 7 through 10 | 10,537,292 | |||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 on 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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2024 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2024. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | HAMPSHIRE PROPERTIES - 2020 AMOUNT: $ 13,454. 2021 AMOUNT: $ 14,430. 2022 AMOUNT: $ 15,729. 2023 AMOUNT: $ 19,415. 2024 AMOUNT: $ 18,752. SPECIAL EVENTS - 2021 AMOUNT: $ 10,075. 2022 AMOUNT: $ 6,130. 2023 AMOUNT: $ 15,845. 2024 AMOUNT: $ 14,548. |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF SALEM HEALTH FOUNDATION IS SALEM HEALTH HOSPITALS & CLINICS ("SHHC"), A NOT-FOR-PROFIT ENTITY. THE SALEM HEALTH FOUNDATION DIRECTORS ARE ELECTED BY SHHC WHO ALSO APPROVES SIGNIFICANT DECISIONS OF THE SALEM HEALTH FOUNDATION GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BYLAWS OF SALEM HEALTH FOUNDATION STATE THAT THE DIRECTORS OF SALEM HEALTH FOUNDATION SHALL BE ELECTED BY SHHC AT EACH ANNUAL ORGANIZATION MEETING OF THE BOARD OF DIRECTORS OF SHHC, OR IF ANY SUCH ANNUAL MEETING IS NOT HELD, THEN THE DIRECTORS MAY BE ELECTED AT A REGULAR OR SPECIAL MEETING OF THE BOARD OF DIRECTORS OF SHHC. |
| FORM 990, PART VI, SECTION A, LINE 7B | PURSUANT TO THE SALEM HEALTH FOUNDATION BYLAWS, SHHC SHALL HAVE THE SOLE AND EXCLUSIVE RIGHT TO ACT WITH RESPECT TO THE FOLLOWING AFFAIRS OF SALEM HEALTH FOUNDATION: A. APPROVAL OF THE MERGER OR CONSOLIDATION OF SALEM HEALTH FOUNDATION WITH ANY OTHER ORGANIZATION OR ENTITY; PROVIDED, HOWEVER, THAT THE BOARD OF DIRECTORS MAY SUBMIT MERGER AND CONSOLIDATION PROPOSALS TO SHHC FOR ITS APPROVAL; B. ELECTION TO DISSOLVE AND WIND UP THE AFFAIRS OF SALEM HEALTH FOUNDATION; PROVIDED THAT THE BOARD OF DIRECTORS MAY SUBMIT A DISSOLUTION PROPOSAL TO SHHC FOR ITS APPROVAL; C. SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF SALEM HEALTH FOUNDATION; PROVIDED, HOWEVER, THAT THE BOARD OF DIRECTORS MAY SUBMIT PROPOSALS FOR SUCH DISPOSITIONS TO SHHC FOR ITS APPROVAL; |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S ACCOUNTING & FINANCE TEAM WORKS CLOSELY WITH THE OUTSIDE ACCOUNTING FIRM IT ENGAGES TO PREPARE AND REVIEW THE RETURN. THE CONTROLLER AND CFO REVIEW A DRAFT OF THE FORM 990 BEFORE IT IS PRESENTED TO THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES. FINANCE ADMINISTRATION ADDRESSES AND RESPONDS TO QUESTIONS RAISED BY MEMBERS OF THE GOVERNANCE COMMITTEE. AFTER IT IS REVIEWED BY THE GOVERNANCE COMMITTEE, THE FINAL FORM 990 IS FORWARDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | SALEM HEALTH HOSPITALS AND CLINICS CONFLICT OF INTEREST POLICY APPLY TO ALL EMPLOYEES OF SALEM HEALTH HOSPITALS AND CLINICS, INCLUDING TRUSTEES, OFFICERS, COMMITTEE MEMBERS. ON AN ANNUAL BASIS, THE CHIEF CORPORATE INTEGRITY OFFICER SHALL PROVIDE EACH DESIGNATED EMPLOYEES, DEFINED FOR PURPOSES OF THIS POLICY AS THE PRESIDENT/CHIEF EXECUTIVE OFFICER, VICE PRESIDENTS, AND DEPARTMENT DIRECTORS, AS WELL AS ANY ADDITIONAL EMPLOYEES DESIGNATED BY THE BOARD WITH A COPY OF THE CONFLICT OF INTEREST POLICY, ALONG WITH A DISCLOSURE QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRE MUST BE RETURNED TO THE CHIEF CORPORATE INTEGRITY OFFICER PRIOR TO THE BEGINNING OF EACH CALENDAR YEAR. WHERE APPROPRIATE, CORPORATE INTEGRITY SHALL PREPARE AND SUBMIT TO THE CEO A CONFIDENTIAL REPORT CONCERNING ANY INTEREST DISCLOSED BY SUCH QUESTIONNAIRE. IF, AT ANY TIME, AN EMPLOYEE COVERED BY THIS POLICY BECOMES INVOLVED IN, OR BECOMES AWARE OF, ANY TRANSACTION, ARRANGEMENT, RELATIONSHIP, OR SITUATION THAT RESULTS IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, OR THE APPEARANCE OF A CONFLICT OF INTEREST, BETWEEN THE INTERESTS OF SALEM HEALTH AND THE INTERESTS OF THAT INDIVIDUAL, OR ANY ENTITY WITH WHICH THE INDIVIDUAL IS CONNECTED OR RELATED, THE INDIVIDUAL SHALL PROMPTLY NOTIFY THE SALEM HEALTH CORPORATE INTEGRITY OFFICE. CORPORATE INTEGRITY, IN COLLABORATION WITH HUMAN RESOURCES WHEN APPROPRIATE, MAY ELECT TO INTERVIEW ANY INDIVIDUAL WHO HAS DISCLOSED, OR IS BELIEVED TO HAVE, A POTENTIAL CONFLICT OF INTEREST. FOLLOWING FULL DISCLOSURE OF THE INTEREST AND ALL MATERIAL FACTS, AND AFTER DISCUSSION WITH THE INTERESTED INDIVIDUAL, CORPORATE INTEGRITY SHALL DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST OR THE APPEARANCE OF A CONFLICT OF INTEREST EXISTS. TO ASSIST IN MAKING THIS DETERMINATION, CORPORATE INTEGRITY MAY, AT THE DIRECTION OF THE EXECUTIVE LEADERSHIP COUNCIL (ELC), CONSULT OR RETAIN A DISINTERESTED INDIVIDUAL OR COMMITTEE TO INVESTIGATE THE MATTER AND EVALUATE REASONABLE ALTERNATIVES, AS APPROPRIATE. UNTIL CORPORATE INTEGRITY HAS COMPLETED ITS REVIEW AND DETERMINED THAT NO ACTUAL OR APPARENT CONFLICT OF INTEREST EXISTS, THE INDIVIDUAL SHALL REFRAIN FROM ACTING ON BEHALF OF SALEM HEALTH WITH RESPECT TO THE TRANSACTION OR SITUATION UNDER REVIEW. ADDITIONALLY, THE INDIVIDUAL SHALL RECUSE HIM OR HERSELF FROM ANY DISCUSSIONS, DECISION MAKING PROCESSES, OR DELIBERATIONS RELATED TO THE MATTER, UNLESS SPECIFICALLY INVITED BY CORPORATE INTEGRITY TO PROVIDE FACTUAL INFORMATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | EXECUTIVE COMPENSATION AT SALEM HEALTH (SH) IS DESIGNED TO ALLOW THE ORGANIZATION TO RECRUIT AND RETAIN QUALIFIED SENIOR LEADERS. ONE OR MORE INDEPENDENT CONSULTANTS ARE RETAINED TO REVIEW EXECUTIVE COMPENSATION. THE SH CEO, IN CONJUNCTION WITH THE INDEPENDENT CONSULTANTS, ENSURES THAT EACH EXECUTIVE'S COMPENSATION IS COMPETITIVE IN THE MARKET FOR SIMILAR POSITIONS AT COMPARABLE ORGANIZATIONS. THE CEO ALSO PROVIDES INFORMATION TO THE BOARD GOVERNANCE COMMITTEE ON THE LEVELS OF EXECUTIVE COMPENSATION. FORM 990, PART VI, LINES 15A AND 15B ALL COMPENSATION IS PAID BY A RELATED ORGANIZATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT PUBLICLY AVAILABLE. |
| FORM 990, PART XI, LINE 9: | ASSETS RELEASED FROM RESTRICTIONS 29,330. |
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