4A (Expenses $ 421092144 including grants of $ 806029) (Revenue $ 754702780)
SALEM HEALTH IS ONE OF THE LARGEST OF OREGON'S 59 ACUTE HOSPITALS AND OPERATES THE BUSIEST EMERGENCY DEPARTMENT IN OREGON. THERE ARE 588 PRACTIONERS, REPRESENTING 54 DIFFERENT SPECIALTIES. MORE THAN 253 VOLUNTEERS PROVIDE NON-MEDICAL SUPPORT FOR THE HOSPITAL. STATISTICS FOR THE 12 MONTH PERIOD ENDED 06/30/22: BIRTHS - 3,139, DIAGNOSTIC IMAGING PROCEDURES - 212,121, ED VISITS - 101,817, INPATIENT ADMISSIONS - 28,490, LABORATORY PROCEDURES - 1,599,121, SURGERIES - 13,115. THE PRIMARY SERVICE AREA IS MARION AND POLK COUNTIES WITH APPROXIMATELY 348,616 RESIDENTS.

4B (Expenses $ 259422092 including grants of $ 0) (Revenue $ 173992450)
SALEM HEALTH PROVIDES HEALTHCARE TO PEOPLE IN OUR COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY IN THE 12 MONTH PERIOD ENDED 06/30/2022, THE COST OF SERVICES PROVIDED AS A COMMUNITY BENEFIT TOTALED $120.4 MILLION. THIS FIGURE CONSISTED OF $24.8 MILLION IN COSTS TO PROVIDE CHARITY CARE TO INDIVIDUALS WHO CANNOT AFFORD TO PAY AND $60.6 MILLION IN UNDERPAYMENT BY MEDICAID AS THE AMOUNT PAID UNDER THE PROGRAM WAS LESS THAN THE COST TO PROVIDE THE SERVICES; AND $35 MILLION IN UNDERPAYMENT BY MEDICARE AS THE AMOUNT PAID WAS LESS THAN THE COST TO PROVIDE THE SERVICES.

4C (Expenses $ 64778861 including grants of $ 0) (Revenue $ 29798743)
SALEM HEALTH ACTIVELY PARTICIPATES IN COMMUNITY HEALTH IMPROVEMENT SERVICES. IN THE 12 MONTHS ENDED 06/30/2022, SALEM HEALTH GAVE $2,352,585 FOR UNFUNDED OR UNDERFUNDED HEALTH SERVICES, INCLUDING 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 FY2022, SALEM HEALTH PROVIDED MORE THAN $1,589,801 IN CASE AND IN-KIND DONATIONS TO COMMUNITY HEALTH PROGRAMS SUCH AS MEDASSIST AND PROJECT ACCESS, PSYCHIATRIC CRISIS CENTER AND THE SALEM FREE CLINIC.

SALEM HEALTH
PART V, SECTION B, LINE 3J: A COMPREHENSIVE NEEDS ASSESSMENT WAS CONDUCTED IN THE TAX YEAR 2019 AND WAS SUBSTANTIALLY UPDATED IN TAX YEAR 2021. SEE LINE 5 FOR MORE INFORMATION.

SALEM HEALTH
PART V, SECTION B, LINE 5: A COMPREHENSIVE NEEDS ASSESSMENT WAS CONDUCTED IN THE TAX YEAR 2019. UPDATES OCCUR ANNUALLY. PARTNERS INCLUDING MARION COUNTY HEALTH & HUMAN SERVICES, POLK COUNTY HEALTH DEPARTMENT; WILLAMETTE VALLEY COMMUNITY HEALTH (WVCH) AND LATER PACIFICSOURCE COMMUNITY SOLUTIONS, WHICH WAS AWARDED THE CCO CONTRACT FOLLOWING THE DISSOLUTION OF WVCH; LOCAL HEALTH PROFESSIONALS, AND COMMUNITY PARTNERS. THE MAPP (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) CYCLE IS USED TO ASSESS AND IMPROVE THE HEALTH OF THE COMMUNITY. MAPP IS A FLEXIBLE, EVIDENCED BASED FRAMEWORK, CREATED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO). EACH COMMUNITY THAT UTILIZES MAPP CONDUCTS A COMMUNITY HEALTH ASSESSMENT (CHA), WHICH CASTS A WIDE NET COLLECTING DATA IN VARIOUS WAYS TO UNDERSTAND LOCAL HEALTH AND WHY HEALTH CONDITIONS OCCUR.

SALEM HEALTH
PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH COOPERATION AND REPRESENTATIVES FROM KAISER PERMANENTE, SANTIAM HOSPITAL AND LEGACY HEALTH.

SALEM HEALTH
PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH THE BEHAVIORAL CARE NETWORK, CHEMEKETA COMMUNITY COLLEGE, CHERRIOTS, CITY OF WOODBURN, COMMUNITY ACTION AGENCY, COMMUNITY ADVISORY COUNCIL , EARLY LEARNING HUB, KAISER PERMANENTE, LEGACY HEALTH SILVERTON , MARION COUNTY HEALTH & HUMAN SERVICES, NORTHWEST SENIOR & DISABILITY SERVICES, POLK COUNTY HEALTH DEPARTMENT, SANTIAM HOSPITAL, WESTERN OREGON UNIVERSITY, WILLAMETTE VALLEY COMMUNITY HEALTH AND PACIFICSOURCE COMMUNITY SOLUTIONS.PART V, SECTION B, LINE 7BWWW.CO.POLK.OR.US/PH/COMMUNITY-HEALTH-ASSESSMENT-CHA

SALEM HEALTH
PART V, SECTION B, LINE 7D: THE HOSPITAL MADE THE CHNA AVAILABLE TO THE COMMUNITY. THE FULL ASSESSMENT, AS WELL AS ANNUAL UPDATES, ARE POSTED TO THE HOSPITAL AND COUNTY WEBSITES.

SALEM HEALTH
"PART V, SECTION B, LINE 11: PRIORITY AREAS DETERMINED IN THE 2019 ASSESSMENT AND 2021 UPDATE ARE BEHAVIORAL HEALTH SUPPORT, SUBSTANCE USE AND HOUSING. WHILE COVID WAS NON-EXISTENT AT THE TIME THE CHNA WAS CONDUCTED, ITS IMPACT QUICKLY ECLIPSED OTHER NEEDS AND OVERWHELMED OUR PARTNERS IN PUBLIC HEALTH. DURING THE PRIOR YEAR, SALEM HEALTH RECOGNIZED A NEED WITHIN OUR COMMUNITY TO DISTRIBUTE VACCINATIONS AND ACTED QUICKLY TO STAND UP THE FIRST MASS VACCINATION SITE IN THE STATE OF OREGON. THIS PROVED TO BE AN EFFECTIVE AND EFFICIENT WAY TO VACCINATE OUR COMMUNITY, AS WELL AS REACH OUR VULNERABLE AND MARGINALIZED POPULATIONS. WE EXPANDED OUR FOCUS FROM VACCINES TO ADDRESSING THE DISPARITY OF INCREASED CHRONIC DISEASES, INCLUDING DIABETES, HYPERTENSION AND HIGH BLOOD PRESSURES AMONG OUR BIPOC COMMUNITIES. USING OUR CULTURALLY COMPETENT AND TRUSTED COMMUNITY PARTNERS, SALEM HEALTH OFFERED HEALTH SCREENINGS, EDUCATION CLASSES AND CONNECTIONS TO PRIMARY CARE BY USING BILINGUAL AND BICULTURAL EMPLOYEES. COVID-19 PANDEMIC HIGHLIGHTED HEALTH DISPARITIES IMPACTING LATINOS AND IMMIGRANTS IN OUR COMMUNITY. MARION COUNTY HAS OVER TWICE THE HISPANIC POPULATION (27%) AS THE OREGON STATE AVERAGE (13.3%). THE CHALLENGES AROUND COMMUNICATION OPTIONS IN SPANISH COMBINED WITH A LACK OF A PRIMARY CARE PROVIDER (ESPECIALLY SOMEONE SPEAKING SPANISH) AND OTHER NEEDS EMERGING DURING THE PANDEMIC, CREATED HIGH LEVELS OF TOXIC STRESS WITHIN THE LATINO COMMUNITY. SALEM HEALTH INVESTS IN MANO A MANO, A LATINO LED COMMUNITY NON-PROFIT, BY PROVIDING A COMMUNITY HEALTH WORKER TO BREAK THROUGH BARRIERS IN A CULTURALLY SPECIFIC WAY TO DECREASE TOXIC STRESS THROUGH HAVING A CHW ASSISTS FAMILIES IN ACCESSING EMERGENCY FOOD, UTILIZING HEALTH INSURANCE AND REMOVING OTHER HEALTHCARE BARRIERS, HOUSING, HEALTH EDUCATION AND COMMUNITY GROUPS TO SUPPORT FAMILIES.IN 2021, WE HAD SIGNIFICANT SUCCESS PARTNERING WITH MANO A MANO, PCUN AND OTHER COMMUNITY-BASED ORGANIZATIONS TO DISTRIBUTE COVID VACCINES TO THE LATINA(O) COMMUNITY AT CHURCHES, WORKPLACES, AND OTHER COMMUNITY EVENTS. WE CHOSE TO BUILD ON THAT SUCCESS AND USE OUR LEARNINGS TO ADDRESS CHRONIC DISEASE AND RISK INDICATORS. BLACK, INDIGENOUS AND PEOPLE OF COLOR ARE DISPROPORTIONATELY IMPACTED BY DIABETES. AFRICAN AMERICANS AND HISPANIC/LATINA(O)S ARE OVER 50% MORE LIKELY TO DEVELOP DIABETES. IN CERTAIN ZIP CODES, THE DISPARITIES INCREASE SIGNIFICANTLY. THE 97301-ZIP CODE HAS 35% RESIDENTS WHO IDENTIFY AS HISPANIC/LATINA(O), AND 23% WHO LIVE THERE ARE BELOW THE POVERTY LEVEL, COMPARED WITH 13% IN THE REST OF SALEM. THIS ZIP CODE'S MEDIAN INCOME IS 25% LESS THAN THE WHOLE OF SALEM AND HAS TWICE AS MANY CHILDREN LIVING IN POVERTY. RESIDENTS OF 97301 ALSO EXPERIENCE HIGH BLOOD PRESSURE, DIABETES, AND OBESITY AT HIGHER LEVELS, AND FEWER HAVE HEALTH INSURANCE. ARMED WITH THIS INFORMATION AND THE PARTNERSHIPS ESTABLISHED, SALEM HEALTH BEGAN WEEKLY COMMUNITY SCREENINGS WITH BI-LINGUAL DIABETES EDUCATORS AT EVENTS IN THE 97301 AND 97305 ZIP CODES. MORE THAN 400 PEOPLE WERE SCREENED, 90% IDENTIFYING AS HISPANIC/LATINA(O) AND NEARLY EVERY INDIVIDUAL HAS RISK FACTORS. OUR TEAM PARTNERED WITH MULTIPLE AGENCIES AND ORGANIZATIONS TO PROVIDE WRAP AROUND SERVICES, INCLUDING SIGNING UP FOR HEALTH INSURANCE, CONNECTING WITH A PRIMARY CARE PROVIDER, HEALTH EDUCATION CLASSES, SUPPORT GROUPS, APPOINTMENTS WITH A DIETITIAN AND DIABETES SELF-MANAGEMENT CLASSES OFFERED IN SPANISH AND ON SATURDAYS OR EVENINGS TO ACCOMMODATE WORK AND CHILD CARE SCHEDULES. IN 2020 FAMILY BUILDING BLOCKS, A COMMUNITY NON-PROFIT THAT FOCUSES ON PROVIDING SUPPORT TO HIGH RISK PARENTS OF CHILDREN UNDER 5, INTRODUCED A PEDIATRIC MENTAL HEALTH PRACTITIONER TO THEIR SERVICES. BY 2021, THE DEMAND WAS SO HIGH, THEY ADDED ANOTHER TWO FULL TIME PRACTITIONERS, INCLUDING A BI-LINGUAL THERAPIST. ABOUT HALF OF THE FAMILIES FBB SERVES ARE LATINA(O). WITH HELP FROM A COMMUNITY PARTNER GRANT FROM SALEM HEALTH IN 2021, MORE THAN 90 CHILDREN AND THEIR FAMILIES WERE SEEN FOR SERVICES INCLUDING INDIVIDUAL PSYCHOTHERAPY, FAMILY AND GROUP PSYCHOTHERAPY AND PLAY THERAPY. ANOTHER COMMUNITY PARTNER GRANT WAS GIVEN TO CATHOLIC COMMUNITY SERVICES ""FOSTERING HOPE INITIATIVE"" WHICH PLACES OUTREACH COORDINATORS IN LOW INCOME HOUSING TO CONNECT FAMILIES WITH RESOURCES INCLUDING CLOTHING, FOOD, ACCESS TO HEALTH CARE AND MENTAL HEALTH COUNSELING, AND FINANCIAL ASSISTANCE. THIS GRANT WAS SPECIFIC TO THE NORTH PORTION OF MARION COUNTY, ABOUT 56% LATINA(O) AND IS OFTEN OVERLOOKED DUE TO ITS RURAL NATURE. CCS WAS ABLE TO ENROLL 18 OF 21 FAMILIES REFERRED TO SERVICES, WHICH INCLUDED 32 ADULTS AND 41 CHILDREN.SUBSTANCE USE AND ABUSE, INCLUDING ALCOHOL, TOBACCO, AND DRUGS, REMAIN PRIMARY SOURCES OF PREVENTABLE DEATH IN THE COMMUNITY, STATE, AND THE COUNTRY. CO-OCCURRING DIAGNOSES FOR BOTH MENTAL ILLNESS AND SUBSTANCE USE DISORDERS ARE COMMON. IN 2014, 20.2 MILLION ADULTS IN THE UNITED STATES (8.4%) HAD A SUBSTANCE USE DISORDER AND OF THOSE 7.9 MILLION HAD BOTH A MENTAL DISORDER AND A SUBSTANCE USE DISORDER. THIS SIGNIFICANT OVERLAP BETWEEN SUBSTANCE ABUSE AND MENTAL HEALTH UNDERSCORES THE IMPORTANCE OF CAPTURING WHO IS ENGAGING IN BEHAVIORS INDICATIVE OF THESE DISORDERS IN THE COMMUNITY. THE IMPACT SUBSTANCE ABUSE HAS ON OUR COMMUNITY IS SIGNIFICANT. ABOUT 33% OF MOTOR VEHICLE FATALITIES IN MARION COUNTY INVOLVED ALCOHOL, COMPARED TO 29% IN POLK COUNTY AND 32% IN THE STATE. THE RATE OF DEATHS THAT INVOLVED ALCOHOL HAS BEEN INCREASING IN THE COMMUNITY IN RECENT YEARS. ROUGHLY 14% OF ADULT COMMUNITY MEMBERS BINGE DRINK, COMPARED TO 18% OF ADULTS IN THE STATE. IN MARION, 16% OF ADULTS WERE CURRENT CIGARETTE SMOKERS COMPARED TO 15% IN POLK AND 18% IN THE STATE. THE COMMUNITY IS NOT CURRENTLY MEETING THE HEALTHY PEOPLE 2020 GOAL FOR CIGARETTE SMOKING. 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, 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 OUR COMMUNITY HEALTH EDUCATION CENTER (CHEC) AND THE HEALTH EDUCATION AND OUTREACH TEAMS PROVIDE COMMUNITY BASED EDUCATION TO SCHOOLS RELATED TO TOBACCO PREVENTION. SALEM HEALTH TRAUMA PREVENTION TEAM CONDUCTED CLASSES AND PRESENTATIONS AROUND SUBSTANCE ABUSE INCLUDING MARIJUANA AND VAPING USE AND METHAMPHETAMINE USE.SALEM HEALTH'S CHEC ALSO HOLDS CLASSES ON DUIS, SUBSTANCE ABUSE, METH ADDICTION PREVENTION, AA PROGRAM AND AL-ANON SUPPORT GROUPS, AND MINOR IN POSSESSION CLASSES. NO AND LOW COST HEALTH EDUCATION IS AVAILABLE TO THE GENERAL PUBLIC IN THE FORM OF CLASSES, OUTREACH AND ACCESS TO RESEARCH MATERIALS, ONLINE AND IN PRINT. A PART TIME LIBRARIAN IS ON STAFF TO ASSIST CLINICIANS WITH THE LATEST RESEARCH AND TREATMENT OPTIONS. A STAFF OF HEALTH EDUCATORS PRESENTS TO THE PUBLIC ON VARIOUS COMMUNITY HEALTH TOPICS ON REQUEST AND ATTENDS WELLNESS FAIRS, PROVIDING BIOMETRICS AND HEALTH INFORMATION. THE SALEM CANCER INSTITUTE OFFERS FREE SCREENINGS SEVERAL TIMES A YEAR FOR VARIOUS CANCERS, INCLUDING BREAST, COLON, LUNG, AND SKIN CANCER. STAFF AND CLINICIANS PARTICIPATE IN DOZENS OF HEALTH IMPROVEMENT COMMITTEES, ADDRESSING SOCIAL DETERMINANTS OF HEALTH SUCH AS HOMELESSNESS, FOOD INSECURITY, EDUCATION, AND ACCESS TO CARE. WORKFORCE HAS EMERGED AS A NEED NOT IDENTIFIED IN PREVIOUS ASSESSMENTS, BUT CERTAINLY AN ISSUE THAT IMPACTS THE COMMUNITY AS A WHOLE. SALEM HEALTH PROVIDES TRAINING FOR NURSING STUDENTS, CLINICAL ROTATIONS FOR PHYSICAL AND OCCUPATIONAL THERAPISTS, PHARMACISTS AND DIETITIANS. EMERGING HEALTH CARE PROFESSIONALS IN HIGH SCHOOL ARE GIVEN OPPORTUNITIES TO EXPLORE CAREERS THROUGH JOB SHADOWS."

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 RESIDENCE.3) EQUITY IN A REAL ESTATE (OTHER THAN THE PATIENT/GUARANTOR'S PRIMARY RESIDENCE), SECURITIES OR OTHER ASSETS ARE CONSIDERED AVAILABLE TO PAY THE PATIENT'S MEDICAL EXPENSES AND SHOULD BE INCLUDED IN THE INCOME CALCULATION 4) THE INCOME FROM INCOME-PRODUCING REAL PROPERTY SHOULD BE USED IN THE CALCULATION RATHER THAN THE EQUITY. 5) INDIVIDUAL RETIREMENT ACCOUNTS (IRAS) OR OTHER RETIREMENT FUNDS WILL NOT BE INCLUDED IN HOUSEHOLD ASSETS; HOWEVER DISTRIBUTIONS FROM THOSE FUNDS WILL BE CONSIDERED INCOME.6) FAMILY SIZE (PERSONS LEGALLY RESPONSIBLE FOR THE PATIENT BILL AND THEIR DEPENDENTS).7) THE FAMILY'S MONTHLY OUT-OF-POCKET EXPENSES FOR MEDICAL SUPPLIES AND SERVICES.8) 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: 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.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-EZA ""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 V, SECTION B, LINE 16-FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION MAY BE DOWNLOADED FROM OUR WEBSITE: HTTPS://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 SERVICES.2. THE CONDITIONS OF ADMISSION FORM INFORMS THE PATIENT OF THEIR RIGHT TO APPLY FOR FINANCIAL ASSISTANCE.3. WRITTEN INFORMATION SHALL BE 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 WILL BE TRAINED TO ANSWER FINANCIAL ASSISTANCE QUESTIONS EFFECTIVELY AND WILL DIRECT ANY THAT CANNOT BE ANSWERED TO FINANCIAL COUNSELOR'S IN A TIMELY MANNER.5. THIS POLICY WILL BE POSTED ON SALEM HEALTH'S WEBSITE. WRITTEN INFORMATION ABOUT THIS POLICY WILL BE MADE AVAILABLE UPON REQUEST.6. ALL PATIENT BILLING STATEMENTS WILL INCLUDE A NOTICE THAT FINANCIAL ASSISTANCE IS AVAILABLE AND CONTACT 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.

PART V, SECTION B, LINE 11 (CONTINUED):
HOUSING AND HEALTH CARE WORK ARE CRITICAL PARTNERS IN PREVENTING AND ENDING HOMELESSNESS. HEALTHCARE SERVICES ARE MORE EFFECTIVE AND BETTER DELIVERED WHEN A PATIENT IS STABLY HOUSED. THE RATE OF HOMELESSNESS HAS BEEN INCREASING BOTH IN THE COMMUNITY AND THE STATE IN RECENT YEARS, INCLUDING GROWING NUMBERS OF STUDENTS IN K-12 EXPERIENCING HOMELESSNESS. THIS LEADS TO INADEQUATE CARE, DIFFICULT CONNECTING TO SERVICES, AND CONTRIBUTING TO CHRONIC DISEASE. EXPOSURE TO COMMUNICABLE DISEASE INCREASES, AND CHRONIC HEALTH CONDITIONS SUCH AS HIGH BLOOD PRESSURE AND DIABETES BECOME WORSE DUE TO MEDICATION STORAGE ISSUES AND DIFFICULTY MAINTAINING A HEALTHY DIET. BEHAVIORAL HEALTH ISSUES SUCH AS DEPRESSION, ALCOHOLISM, OR OTHER SUBSTANCE USE DISORDERS CAN DEVELOP AND/OR ARE MADE WORSE IN SUCH DIFFICULT SITUATIONS.SALEM HEALTH SUPPORTS COMMUNITY PARTNERS AND THEIR EFFORTS TO ADDRESS HOUSING AND HOMELESSNESS. FOR EXAMPLE, SALEM HEALTH WORKED WITH COMMUNITY PARTNERS TO COVER COST BARRIERS ESTABLISHING THE MARION POLK CONTINUUM OF CARE WITH HUD AND SUPPORTS A COMMUNITY DATABASE ESTABLISHING A SYSTEM FOR ALL PROVIDERS TO LOG ONTO THE SAME SHARED INFORMATION FOR YOUTH HOMELESS SUPPORTS AND COORDINATION. COMMUNITY WIDE TASK FORCES ARE IN PLACE TO ADDRESS HOMELESSNESS, WHICH IS DEEMED A CRITICAL ISSUE 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, LIBERTY HOUSE, AND CATHOLIC COMMUNITY SERVICES.WE ARE ENGAGED IN POLICY MAKING AND LOCAL GOVERNMENTS COMMITTEES. OUR CHIEF NURSING OFFICER SERVES ON THE OREGON STATE BOARD OF NURSING, WHOSE GOALS ARE TO PROTECT THE PUBLIC BY REGULATING NURSING EDUCATION, LICENSURE, AND PRACTICE. WE ALSO HAVE EMPLOYEES WHO SERVE ON THE MARION COUNTY BUDGET COMMITTEE AND THE MARION COUNTY PUBLIC SAFETY COORDINATING COUNCIL.THE HOSPITAL PROVIDES COMMUNITY BASIC HEALTH IMPROVEMENT SERVICES AS REQUESTED IN MARION AND POLK COUNTIES. IN FISCAL YEAR 2022, 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 CHEC 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 FISCAL YEAR 2022 TO ENHANCE EXISTING NON-PROFIT ORGANIZATIONS' WORK THAT ADDRESSES NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. WE INVESTED OVER $300,000 THIS YEAR IN ORGANIZATIONS THAT INCLUDE MID WILLAMETTE VALLEY HOMELESS ALLIANCE; HOME YOUTH SERVICES; LOVE, INC. IN NORTH MARION COUNTY; INTEGRATED SUPPORT FOR LIVING; MARION COUNTY LAW ENFORCEMENT ASSISTED DIVERSION; LIBERTY HOUSE; ST. FRANCIS FAMILY SHELTER; UNITED GOSPEL MISSION; CATHOLIC COMMUNITY SERVICES, HOMELESS YOUTH SERVICES DATABASE, BOYS AND GIRLS CLUB, CENTER 50+, POLK COUNTY SERVICE INTEGRATION TEAMS, NORTH MARION SERVICE INTEGRATION TEAM, WOODBURN SERVICE INTEGRATION TEAM; SALEM POLICE FOUNDATION; MARION POLK FOOD SHARE; MANO A MANO; POLK COUNTY COURT APPOINTED SPECIAL ADVOCATES (CASA); SALEM FREE CLINICS, AND UNITED WAY. ADDITIONALLY, SALEM HEALTH SUPPORTS COMMUNITY PARTNERS AND THEIR EFFORTS TO ADDRESS HOUSING AND SOCIAL DETERMINANTS OF HEALTH. SALEM HEALTH WORKED WITH COMMUNITY PARTNERS TO COVER COST BARRIERS ESTABLISHING THE MARION POLK CONTINUUM OF CARE WITH HUD AND SUPPORTS A COMMUNITY DATABASE ESTABLISHING A SYSTEM FOR ALL PROVIDERS TO LOG ONTO THE SAME SHARED INFORMATION FOR YOUTH HOMELESS SUPPORTS AND COORDINATION. SALEM HEALTH INVESTED IN TAYLORS HOUSE, AN EMERGENCY SHELTER FOR RUNAWAY, TO HIRE A YOUTH NAVIGATOR TO ENSURE ALL NEW RESIDENTS ARE CONNECTED TO STABILIZING RESOURCES AND HEALTH.

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 RESIDENCE3) EQUITY 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 CALCULATION.THE 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.* FAMILY SIZE (PERSONS LEGALLY RESPONSIBLE FOR THE PATIENT BILL AND THEIR DEPENDENTS)* THE FAMILY'S MONTHLY OUT-OF-POCKET EXPENSES FOR MEDICAL SUPPLIES AND SERVICES* 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 6A:
A COMMUNITY BENEFIT REPORT WAS PUBLISHED AND IS AVAILABLE AT HTTPS://WWW.SALEMHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-BENEFIT-REPORTS.

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 III, LINE 4:
PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT AN ESTIMATED COLLECTIBLE AMOUNT AND DO NOT BEAR INTEREST. EXPLICIT PRICE CONCESSIONS ARE ESTABLISHED AS A RESULT OF NEGOTIATED REIMBURSEMENT METHODOLOGIES WITH THIRD PARTY PAYORS.THE CORPORATION ALSO RECORDS ESTIMATED IMPLICIT PRICE CONCESSIONS (BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE) RELATED TO UNINSURED ACCOUNTS TO RECORD SELF-PAY REVENUES AT THE ESTIMATED AMOUNTS WE EXPECT TO COLLECT. THE CORPORATION DOES NOT ASSESS CREDIT RISK BEFORE SERVICES ARE RENDERED.

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 $228,653,843 LESS MEDICARE ADVANTAGE COSTS OF $308,658,311 FOR A TOTAL ADDITIONAL COMMUNITY BENEFIT IN THE AMOUNT OF $80,004,469.

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 3:
PLEASE SEE ABOVE NARRATIVE, PART V, SECTION B, LINES 13-16

PART VI, LINE 7, REPORTS FILED WITH STATES
OR

PART I, LINE 7:
THE RATIO OF PATIENT CARE COST TO CHARGES WAS USED TO CALCULATE THE TOTAL COMMUNITY BENEFIT EXPENSE ON LINE 7, COLUMN C. THIS RATIO WAS APPLIED TO TOTAL FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS THAT 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.PART II: 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 BEHAVIORAL HEALTH SUPPORT, HOUSING, AND SUBSTANCE USE. 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, LIBERTY HOUSE, AND CATHOLIC COMMUNITY SERVICES.THE HOSPITAL PROVIDES COMMUNITY BASED HEALTH IMPROVEMENT SERVICES AS REQUESTED IN MARION AND POLK COUNTIES INCLUDING 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 FISCAL YEAR 2022 TO ENHANCE EXISTING NON-PROFIT ORGANIZATIONS' WORK THAT ADDRESSES NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. WE INVESTED OVER $400,000 THIS YEAR IN ORGANIZATIONS THAT INCLUDE LOVE, INC. IN NORTH MARION COUNTY; INTEGRATED SUPPORT FOR LIVING; LIBERTY HOUSE; ST. FRANCIS FAMILY SHELTER; UNITED GOSPEL MISSION; CATHOLIC COMMUNITY SERVICES; BOYS AND GIRLS CLUB; MARION POLK FOOD SHARE; MANO A MANO; SALEM FREE CLINICS; FAMILY BUILDING BLOCKS; HABITAT FOR HUMANITY; UNITED WAY, ETC. ADDITIONALLY, SALEM HEALTH SUPPORTS COMMUNITY PARTNERS AND THEIR EFFORTS TO ADDRESS HOUSING AND SOCIAL DETERMINANTS OF HEALTH. SALEM HEALTH WORKED WITH COMMUNITY PARTNERS TO COVER COST BARRIERS ESTABLISHING THE MARION POLK CONTINUUM OF CARE WITH HUD AND SUPPORTS A COMMUNITY DATABASE ESTABLISHING A SYSTEM FOR ALL PROVIDERS TO LOG ONTO THE SAME SHARED INFORMATION FOR YOUTH HOMELESS SUPPORTS AND COORDINATION. SALEM HEALTH INVESTED IN TAYLORS HOUSE, AN EMERGENCY SHELTER FOR RUNAWAY, TO HIRE A YOUTH NAVIGATOR TO ENSURE ALL NEW RESIDENTS ARE CONNECTED TO STABILIZING RESOURCES AND HEALTH. SALEM HEALTH PROVIDES TRAINING FOR NURSING STUDENTS AND EMERGING HEALTH CARE PROFESSIONALS THROUGH HEALTH CAREER EXPLORATION.

PART VI, LINE 5:
IN ADDITION TO THE WORK DESCRIBED IN THE ABOVE NARRATIVE, SALEM HEALTH HAS A COMMUNITY HEALTH EDUCATION CENTER THAT OFFERS NO AND LOW COST HEALTH EDUCATION TO THE GENERAL PUBLIC IN THE FORM OF CLASSES, OUTREACH AND ACCESS TO RESEARCH MATERIALS, ONLINE AND IN PRINT. A FULL TIME LIBRARIAN IS ON STAFF TO ASSIST CLINICIANS WITH THE LATEST RESEARCH AND TREATMENT OPTIONS. A STAFF OF HEALTH EDUCATORS PRESENTS TO THE PUBLIC ON VARIOUS COMMUNITY HEALTH TOPICS ON REQUEST AND ATTENDS WELLNESS FAIRS, PROVIDING BIOMETRICS AND HEALTH INFORMATION. THE SALEM CANCER INSTITUTE OFFERS FREE SCREENINGS SEVERAL TIMES A YEAR FOR VARIOUS CANCERS, INCLUDING BREAST, COLON, LUNG AND SKIN CANCER. STAFF AND CLINICIANS PARTICIPATE IN DOZENS OF HEALTH IMPROVEMENT COMMITTEES, ADDRESSING SOCIAL DETERMINANTS OF HEALTH SUCH AS HOMELESSNESS, FOOD INSECURITY, EDUCATION AND ACCESS TO CARE. FURTHER INFORMATION REGARDING HEALTH PROMOTION CAN BE FOUND IN PART V, SECTION B, LINE 11 NARRATIVE.

PART VI, LINE 4:
MARION AND POLK COUNTY ARE LOCATED IN THE WILLAMETTE VALLEY AND ARE THE 5TH AND 13TH MOST POPULOUS COUNTIES IN OREGON RESPECTIVELY. THIS COMMUNITY SPANS ABOUT 1,950 SQUARE MILES, OF WHICH 1,200 ARE IN MARION AND 750 ARE IN POLK. IN MARION, THE FIVE LARGEST CITIES ARE KEIZER, SALEM, SILVERTON, STAYTON, AND WOODBURN, WHICH ARE HOME TO 66% OF THE COUNTY'S TOTAL POPULATION. THE REMAINING 34% LIVE IN ONE OF THE SMALLER 15 CITIES OR ON UNINCORPORATED LAND. IN POLK, THE LARGEST CITIES ARE DALLAS, FALLS CITY, INDEPENDENCE, MONMOUTH, WEST SALEM, AND WILLAMINA, OF WHICH ABOUT 84% OF POLK'S POPULATION RESIDES. THOSE WHO LIVE OUTSIDE OF THE MAJOR POPULATION AREAS IN THE COMMUNITY MAY EXPERIENCE GREATER DIFFICULTY ACCESSING RESOURCES LIKE HEALTH CARE SERVICES AND HEALTHY FOODS. GIVEN THE LIMITED PUBLIC TRANSPORTATION IN THESE RURAL AREAS, ACCESS TO A VEHICLE IS LIKELY REQUIRED TO LIVE A HEALTHY LIFESTYLE. AS OF 2020 THERE WERE ABOUT 433,353 PEOPLE LIVING IN THE COMMUNITY OR MARION AND POLK COUNTIES, WHICH IS ABOUT 10% OF THE TOTAL STATE POPULATION. OF THOSE, IT IS ESTIMATED THAT 344,920 PEOPLE LIVE IN MARION AND 87,433 LIVE IN POLK. SINCE 2010, THE POPULATION HAS INCREASED BY 8% IN MARION AND 11% IN POLK, WHICH WAS SIMILAR TO THE INCREASE IN THE STATE AS A WHOLE. THERE WERE ALSO A LARGER NUMBER OF PEOPLE LIVING PER SQUARE MILE IN THIS COMMUNITY COMPARED TO THE STATE AND THIS WAS ESPECIALLY TRUE FOR MARION. JUST OVER HALF OF COMMUNITY MEMBERS IDENTIFIED AS FEMALE, WHICH WAS SIMILAR TO THE STATE. THE COMMUNITY HAD A LARGER PROPORTION OF MEMBERS BETWEEN THE AGES OF 0-24 YEARS OLD THAN OREGON. THERE WAS ALSO A SMALLER PROPORTION OF WORKING AGE ADULTS (25-64) IN THE COMMUNITY THAN THE STATE. IN 2016, THE MEDIAN AGE WAS LOWER IN MARION (36.4 YEARS) COMPARED TO POLK (37.7 YEARS) AND THE STATE (39.2 YEARS.) ADDITIONALLY, MORE PEOPLE HAVE BEEN MIGRATING INTO THIS COMMUNITY AS OPPOSED TO LEAVING, WHICH IS EXPECTED TO CONTINUE DURING THE FORECAST PERIOD. IT IS ESTIMATED THAT THIS COMMUNITY WILL EXCEED 500,000 MEMBERS BY 2035 AND POLK WILL BE GROWING AT A FASTER RATE THAN MARION. SHIFTS IN AGE GROUPS WILL BE OCCURRING OVER THE NEXT 50 YEAR FORECAST PERIOD IN THIS COMMUNITY, WITH A GREATER PROPORTION OF MEMBERS FALLING INTO OLDER AGE GROUPS. THIS CHANGE IS IMPORTANT, AS IT HIGHLIGHTS THE NEED TO EXPAND AND PREPARE FOR THE GROWING HEALTH NEEDS OF AN AGING POPULATION. ABOUT 27% OF COMMUNITY MEMBERS IN MARION IDENTIFIED AS HISPANIC OR LATINA(O), WHICH WAS HIGHER THAN POLK (14%) AND OREGON (12%). MARION HAD A SMALLER PROPORTION OF MEMBERS WHO IDENTIFIED AS WHITE, NON-HISPANIC/LATINA(O) THAN POLK AND THE STATE. MARION ALSO HAD A LARGER PROPORTION OF MEMBERS WHO IDENTIFIED AS NATIVE HAWAIIAN OR PACIFIC ISLANDER THAN POLK AND THE STATE. ABOUT 1 OUT OF 4 HOUSEHOLDS (25%) IN MARION SPOKE A LANGUAGE OTHER THAN OTHER THAN ENGLISH AT HOME THAN POLK (14%) AND THE STATE (15%). COMMUNITY MEMBERS IN MARION HAD LOWER HOUSEHOLD MEDIAN INCOMES AND A HIGHER PERCENTAGE LIVING IN POVERTY, ESPECIALLY CHILDREN, THAN POLK AND THE STATE. 14.2% OF PEOPLE IN MARION COUNTY AND 12.5% IN POLK COUNTY ARE LIVING BELOW THE FEDERAL POVERTY LINE. ROUGHLY 25% OF CHILDREN WERE LIVING IN POVERTY IN MARION COUNTY, COMPARED TO 17% IN POLK COUNTY AND 20% IN OREGON OVERALL. IN THE COMMUNITY, A HIGHER PROPORTION OF FEMALES WERE LIVING IN POVERTY THAN MALES, AND MEMBERS WHO IDENTIFIED AS A RACE OR ETHNICITY OTHER THAN WHITE, NON-HISPANIC/LATINA(O) HAD HIGHER POVERTY RATES AS WELL.EDUCATIONAL ACHIEVEMENT HAS BEEN IMPROVING IN RECENT YEARS AS A HIGHER PERCENTAGE OF COMMUNITY MEMBERS HAVE A HIGH SCHOOL DIPLOMA/GED. 85% OF ADULTS OVER 25 IN MARION COUNTY AND 91% OF ADULTS IN POLK COUNTY HAVE A HIGH SCHOOL DIPLOMA OR GED. HOWEVER, THE PERCENTAGES DROP SIGNIFICANTLY FOR LATINO POPULATIONS WHICH WERE 53% IN MARION COUNTY AND 61% IN POLK COUNTY. EDUCATIONAL ACHIEVEMENT IN MARION COUNTY WAS LOWER THAN POLK AND THE STATE, ESPECIALLY WITH REGARD TO COLLEGE GRADUATES. IN MARION COUNTY 23% OF PEOPLE HAD A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 31% IN POLK. EDUCATIONAL ACHIEVEMENT DIFFERED BY SEX, RACE AND ETHNICITY, GEOGRAPHY, AND DISABILITY STATUS. ABOUT 1 OUT OF 5 CHILDREN WERE FOOD INSECURE IN THIS COMMUNITY. IT WAS ALSO DIFFICULT FOR SOME COMMUNITY MEMBERS TO OBTAIN HEALTHY FOODS DUE TO AFFORDABILITY AND LOW ACCESS TO STORES THAT SELL THEM.