Community Benefit Insight - Tax-exempt hospital

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Legacy Meridian Park Hospital

Legacy Meridian Park Hospital

19300 Sw 65th Avenue
Tualatin, OR 97062

Bed count	150	Medicare provider number	380089	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 930618975

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

6.59%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 3,588,093 1.42 %
Medicaid as % of operating expenses	$ 11,353,050 4.48 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 543,258 0.21 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 482,325 0.19 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 724,622 0.29 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 5,770,265 2.28 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 3,635,267 63.00 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 177037218 including grants of $ 213786) (Revenue $ 273845587)
In support of its mission, LMPH voluntarily provides medically necessary patient care services that are discounted or free of charge to persons who have insufficient resources and/or who are uninsured. During fiscal year 2022, LMPH provided financial assistance on approximately 5,272 patient accounts (of which 668 accounts received discounts totaling 100% of costs) and resulted in LMPH incurring roughly $3,588,090 in uncompensated costs associated with this program. In addition to charity care, LMPH provides services under various states' Medicaid programs for financially needy patients and Medicare beneficiaries programs for which the cost of treating these patients exceeds the government payments received. During fiscal year 2022, LMPH incurred approximately $11,353,050 and $29,860,700 in uncompensated costs attributable to Medicaid and Medicare programs, respectively. LMPH also provides a variety of other community benefit activities such as medical education, donations to other charitable entities, research, and other health improvement services, which totaled roughly $1,750,200 during fiscal year 2022.LMPH is part of Legacy, which collectively provided over $40 million, $292 million, $265 million, and $13 million in uncompensated care attributable to its financial assistance, Medicaid, Medicare, and other government programs, respectively, in fiscal year 2022. In addition, Legacy provided over $26 million in other community benefit activities during fiscal year 2022.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Facility: LEGACY MERIDIAN PARK HOSPITAL - Part V, Section B, Line 5
In 2020, Legacy Meridian Park Medical Center participated with seven other hospital systems, four county health departments and one coordinated care organization in the four-county regional 2019 Healthy Columbia Willamette Collaborative (HCWC) Community Health Needs Assessment (CHNA) which was used as a base for the Legacy Meridian Park Community Health Needs Assessment. The results of Legacys Community Needs Assessment can be found at www.legacyhealth.org.The HCWC CHNA is regional and developed to improve efficiency and effectiveness and also to help meet the requirements of the ACA and Public Health Accreditation. HCWC prioritized community input and lived experiences of priority populations and leaders from community-based organizations across the region. Volunteer participants shared their insights on the vision, strengths, challenges, and needs of their communities in town halls and listening sessions. Four town halls were conductedone in each countyand community-based organizations hosted 18 community listening sessions across the quad-county region, with more than 200 participants. In the 2019 CHNA, HCWC also reviewed population data (health-related behaviors, morbidity, mortality); medical data from local Coordinated Care Organizations (CCO) (most frequent conditions Medicaid-covered individuals sought care for); and hospital data (uninsured patients seen in the emergency department for conditions that could have been managed in primary or ambulatory care settings).Our work included the following community partners: Adelante MujeresAntFarmASACCascade AIDS Project Aging WellCentral City ConcernCommunity Partnership for Affordable HousingCity of Lake OswegoClackamas Behavioral Health DivisionClackamas County Aging Services Advisory CouncilClackamas County Community Action BoardClackamas County Disaster ManagementClackamas County Public Health DivisionClackamas County Social ServicesClackamas WorkforceClark County Community ServicesClark County Public HealthCoalition of Community Health ClinicsEstacada Community CenterFaith Organization in Multnomah CountyFriendly HouseIndividual Facilitators, Arabic CommunityIndividual Facilitator, FarmworkersIraqi Society of OregonLatino NetworkMicronesian Islander CommunityMomentum AllianceNAMI, Clackamas CountyNAYA Family CenterNorthwest Family ServicesOutside InOregon AIDS Education & Training CenterOregon Community Health Workers AssociationOregon Dairy and Nutrition CouncilOregon Food BankOregon Health Equity AllianceOregon Office on Disability and HealthOregon Oral Health CoalitionPacific Islander CoalitionPlanned ParenthoodProject Access NOWProvidence ElderPlaceQuest Center for Integrative HealthSW WA Accountable Community of HealthSociety of St. Vincent de PaulVeterans of Foreign WarsVibrant Future Coalition/NW Family ServicesYMCA of Columbia Willamette

Facility: LEGACY MERIDIAN PARK HOSPITAL - Part V, Section B, Line 6a
In addition to Legacy Healths five hospitals which includes Legacy Meridian Park Medical Center, the other seven hospital systems in the metro area that participated in the Healthy Columbia Willamette Collaborative Community Health Needs Assessment were: Adventist Health, Kaiser Permanente, Oregon Health & Science University, Peace Health Southwest Medical Center, Providence Health & Services and Tuality Health Care.

Facility: LEGACY MERIDIAN PARK HOSPITAL - Part V, Section B, Line 11
The FY2021 Legacy Meridian Park CHNA identified health-related needs across the quad county region. Legacy Meridian Park grouped the health needs identified in the 2019 Healthy Columbia Willamette Collaborative Community Health Assessment into two broad categories of need: Access to Health Care Chronic ConditionsIn addition to identified health-related needs across the quad county region, Legacy Meridian Park Medical Center heard through community members that discrimination, racism and trauma impact the health and well-being of communities and should be addressed as part of all programming and projects (HCWC CHNA 2019). Legacy Meridian Park Medical Centers Community Health Improvement Plan highlights the health equity strategies for this improvement plan cycle.The priority areas identified in this implementation plan will be addressed through health service delivery, health education and outreach, community partnerships, community investments, and funding for evidence-based health programs and services.No singular hospital facility can address all the issues present in our community. Through our partnerships in the Quad County, Legacy Meridian Park Medical Center is confident these needs are being addressed by other community organizations. Legacy Meridian Park Medical Centers top priority continues to be a focus on the issues which have the greatest impact on the health of the community and where we can affect the most change.Details on the specific initiatives Legacy Meridian Park is undertaking to address these priority issues can be found in the Community Health Improvement Plan (CHIP), which can be found on the organizations website at www.legacyhealth.org.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7 - Explanation of Costing Methodology
Medicare allowable costs were calculated using the costing methodologies in the Medicare Cost Report. The cost report arrives at total allowable hospital cost through a cost finding process that includes direct cost allocations and a step-down allocation of indirect or overhead costs. Inpatient operating costs are composed of general inpatient routine and ICU unit costs derived from cost per diems, as well as inpatient ancillary service costs that utilize cost to charge ratios to arrive at cost. Apportionment of cost applicable to hospital outpatient services is through the application of cost to charge ratios. This excludes other costs incurred to provide services of the hospital to the community that the cost report deems as unallowable costs, such as Physician on-call pay.

Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense
LMPH uses many different approaches to inform and educate patients on the availability of financial assistance as is described later in Part VI of Schedule H. Still, many patients do not respond to requests for information or provide appropriate documentation to benefit from financial assistance. As a result, LMPH must report these amounts as bad debt. A portion of bad debt expense should be considered as charity care, using reasonable methodologies to analyze the information.

Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit
The estimated amount of bad debt expenses attributable to charity care policy was calculated using the FY2021 demographic profile of household income and average household size in the zip code areas around the hospital. 63% of Households in the LMPH service area would qualify for financial assistance with incomes under 400% of the Federal Poverty Guidelines using this methodology.

Part III, Line 4 - Bad Debt Expense
The footnote that explains the Legacy bad debt expense can be found on page 9 of the attached audited financial statements.

Part III, Line 8 - Explanation Of Shortfall As Community Benefit
The entire Medicare shortfall should be considered a community benefit. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in the community served by the hospital. The hospital provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. The Medicare amounts listed in Part III Section B. on lines 5, 6, and 7 do not represent all of the organization's revenues and costs associated with its participation in Medicare programs. The methodology used in reporting in Part III Section B Medicare is inconsistent with the other sections in Schedule H, as the instructions limit Medicare revenues and allowable cost to those from only the Medicare Cost Report. Revenue and costs from Medicare Part C patients, Part B physician services billed by the organization, and clinical laboratory services weren't included. In addition, hospitals incur other costs to provide care that Medicare does not allow in the cost report, such as Physician Call pay to ensure adequate physician coverage for the ED. The total revenues and costs attributable to all Medicare services are $88,031,457 and $117,892,172 respectively. This results in a total Medicare shortfall of $29,860,715.Costing Methodology (Part III, Line 8).Medicare allowable costs were calculated using the costing methodologies in the Medicare Cost Report. The cost report arrives at total allowable hospital cost through a cost finding process that includes direct cost allocations and a step-down allocation of indirect or overhead costs. Inpatient operating costs are composed of general inpatient routine and ICU unit costs derived from cost per diems, as well as inpatient ancillary service costs that utilize cost to charge ratios to arrive at cost. Apportionment of cost applicable to hospital outpatient services is through the application of cost to charge ratios. This excludes other costs incurred to provide services of the hospital to the community that the cost report deems as unallowable costs, such as Physician on-call pay.

Part III, Line 9b - Provisions On Collection Practices For Qualified Patients
Legacy provides care without charge or at amounts less than its established rates to patients who meet certain criteria under its financial assistance policy. Since Legacy does not pursue collection of amounts determined to qualify as charity care, they are excluded from net patient service revenues.

Part VI, Line 2 - Needs Assessment
Legacy Senior leadership, in conjunction with the Community Benefit staff works with local community-based partners to understand the needs of the community. The goal is to develop programs specific to the needs of the community. Involvement is both proactive and responsive - a leadership role in initiating programs as well as being readily available as a collaborative partner when the community asks. The outcome of this work is the development of both long-term and fiscal year plans. These are then aligned to the community health needs identified in the formal CHNA. The region served by the Legacy Meridian Park, along with most of Oregon, is experiencing significant challenges in population growth, economic development, education and health care. Recognizing that social and economic determinants impact health, Legacy Meridian Park has been and will remain committed to addressing these issues to improve the health of all residents in the community and ensure equity among ethnically diverse populations.

Part VI, Line 7 - States Filing of Community Benefit Report
OR

Part VI, Line 3 - Patient Education of Eligibility for Assistance
Legacy Meridian Park employs financial counselors and social workers that assist patients in obtaining coverage for their healthcare needs. This includes assistance with workers compensation, motor vehicle accident policies, COBRA, veterans assistance, Legacys financial assistance program, and public assistance programs, such as Medicaid. In support of its mission, Legacy Meridian Park provides medically necessary patient care services that are discounted or free of charge to persons who have insufficient resources and/or who are uninsured. The criteria for charity care are determined based on eligibility for insurance coverage, household income, catastrophic medical events, or other information supporting a patients inability to pay for services provided. Specifically, Legacy Meridian Park provides an uninsured discount of 35% to self-pay patients with no coverage. Additional discounts, on a sliding scale, are available to patients whose household income is less than 400% of the federal poverty level. For patients whose household income is at or below 300% of the federal poverty level, a full subsidy is available. In addition to the household income criteria, other catastrophic or economic circumstances are considered in determining eligibility for charity care. In addition to financial counselors and social workers, Legacy Meridian Park makes every effort to communicate its Financial Assistance Program to all patients. This includes signage in main admitting areas of the hospital and brochures explaining financial assistance in all patient care areas, translated for patients/individuals with limited English proficiency (LEP). Financial counselors are available to assist patients in understanding and applying for available resources, including the Legacy Meridian Park Financial Assistance Program. Legacy Meridian Parks website also has information about the availability of financial assistance. Legacy Meridian Park offers financial assistance customer service Monday through Friday, as well as the availability of voicemail so patients can leave confidential, detailed messages during non-business hours. Patients are encouraged to sign up for MyHealth, a secure online tool to access their medical record. Using their MyHealth account they can correspond with a financial counselor via email. Finally, all of Legacys billing statements include information regarding the availability of financial assistance. If Legacy Meridian Park requires the use of a collection agency, those agencies are required to provide a telephone number that patients can call to request financial assistance. Annual education is provided to all billing and admitting staff, so they can be kept informed of and speak with knowledge about current financial assistance policies and options. Legacy Meridian Park provides copies of the latest policies in main admitting areas, as well as with the hospital financial counselor, online via the website and through MyHealth. Legacy Meridian Park also partners with Project Access NOW, a community-based organization that aims to improve the health of our community by creating access to care and services for those in need. The Premium Assistance program serves low-income, uninsured or underinsured; participants receive assistance with monthly insurance premiums to help lower additional out-of-pocket expenses and are provided education on how to utilize insurance once covered.

Part VI, Line 4 - Community Information
Legacy Meridian Park Medical Center is the South Portland Metropolitan areas full-service medical center, with specialty areas that include stroke, chest pain, minimally invasive and robotic surgery, cancer care and orthopedic and total joint surgery. The facility also includes a birth center and breast health center. Legacy Meridian Park is located in Clackamas County but is in close proximity to Washington County. The primary service area includes Tualatin, Tigard, Wilsonville, Sherwood, West Linn, Canby and Lake Oswego.The demographic data that informed Legacy Meridian Parks CHNA/CHIP for FY22 is from 2012-2016. The population estimate of the primary service area for Legacy Meridian Park was 394,967 for Clackamas County and 564,088 for Washington County. In Clackamas County, the community consists of 89% White, 8.2% Hispanic/Latino, 4.1% Asian, 3.4% two or more races, 0.9% Black/African American, 0.7% American Indian/Alaska Native, and 0.3% Native Hawaiian/Pacific Islander. Foreign-born population represents 8% of the community and languages other than English account for 12.1%. In Washington County, the community consists of 77.6% White, 16.2% Hispanic/Latino, 9.5% Asian, 4.9% two or more races, 1.8% Black/African American, 0.6% American Indian/Alaska Native, and 0.4% Native Hawaiian/Pacific Islander. Foreign-born population represents 17% of the community and languages other than English account for 24.1%. In Clackamas County, while White individuals median per capita income was $36.674, Hispanic/Latino had the lowest median per capita income at $20,162, followed by Native American/Alaska Native at $20,676, two or more races at $20,720, Native Hawaiian/Pacific Islander at $24,676, African American/Black at $27,741, and Asian at $34,355. In Washington County, while Asian individuals median per capita income was $37,972, Hispanic/Latino had the lowest median per capita income at $15,255, followed by two or more races at $17,030, Native Hawaiian/Pacific Islander at $21,765, Native American/Alaska Native at $24,245, African American/Black at $26,730, and White at $35,540. In FY22, Legacy Meridian Park Hospital provided $3.5 million in charity care; total unreimbursed costs of care for people in need amounted to $44.5 million.

Part VI, Line 5 - Promotion of Community Health
The Legacy Health system is involved in several activities and provides a wide variety of services that engage community members and promote community health. For example, the Legacy Health Board is comprised of volunteer community leaders, hospital administrators and representatives of the Lutheran and Episcopal churches who guide Legacys efforts in meeting its mission of providing good health for our people, our patients, our communities and our world. The Community-Based Advisory Committee (CBAC) assists the Community Benefit department with the development and implementation of the Community Health Needs Assessments (CHNAs) and Community Health Implementation Plans (CHIPs) for each Legacy Medical Center. Legacy Community Benefit and the CBAC work closely with the Healthy Columbia and Willamette Collaborative and other partners in the Portland metropolitan area (Clackamas, Multnomah, Washington counties in Oregon and Clark County in SW Washington) to assess community needs and describe how Legacy Meridian Park will address these needs and evaluate the effectiveness of its efforts within its service community.The Legacy Meridian Park Medical Center gives in-kind lab donations to safety net clinics in their service areas. Non-cash donations of clinical and non-clinical services and items, e.g., screenings and support services, internships, information and referral services, and health fairs, also are provided. Legacy Healths supply warehouse is open to local non-profit organizations to obtain surplus equipment and furniture. In addition, free office and conference space and other infrastructure services are made available to local non-profit organizations in the Legacy Meridian Park service area for a variety of uses. In addition, Legacy provides training for interns and residents through its nationally accredited graduate medical education program, Legacy Health supports over 500 employed and visiting medical trainees annually across many disciplines. Health professions training ranged from nursing, occupational and physical therapy, and radiography to public health, lab assistant, emergency medical technician, and many others. Legacy also partners with schools to provide training and education for nursing and other health professionals.Legacy Meridian Parks medical staff is open, with physicians submitting credentialing information that is reviewed according to Legacy Health policies and standards.Legacy Meridian Park collaborates with other health care providers, community-based organizations, business and the public on projects to improve the health of the community. One example of clinically based partnerships includes, among others: CARES NW (Child Abuse Response and Evaluation Services), a collaboration among four health systems Kaiser Permanente, OHSU Doernbecher Childrens Hospital, Providence Childrens Health and Randall Childrens Hospital at Legacy Emanuel; Legacy Emanuel serves as the employer and donates the infrastructure. Additionally, the first collaborative medical initiative of its kind in the Pacific Northwest, Unity Center for Behavioral Health, is a joint effort between Adventist Health, Kaiser Permanente, Oregon Health & Science University and Legacy Health, providing psychiatric emergency services. Legacy has collaborated with more than a dozen community mental health partners in developing this new psychiatric center.

Part VI, Line 6 - Affilated Health Care System
The Legacy Meridian Park Medical Center is a subsidiary of Legacy Health. Legacy Health (Legacy) is an integrated health system headquartered in Portland, Oregon. Legacy operates six acute care hospitals, provides dedicated childrens care at the Randall Childrens Hospital at Legacy Emanuel, Unity Center for Behavioral Health and offers related services (e.g., physician practices, hospice, preferred provider network) in the four-county metro area of Portland, Oregon (Clackamas, Multnomah, Washington counties in Oregon and Clark County in SW Washington) and in Marion County, Oregon, which is approximately 50 miles south of Portland.Legacy Health conducts system-wide projects and activities to improve the health of its service communities. For example, Legacy's policy of providing care regardless of an individuals ability to pay makes it one of the region's largest providers of uncompensated care. As the health needs of communities surrounding our hospitals are frequently changing, Legacy Health continues to identify investments for underserved populations. For example, in FY2022, Legacy contributed over one million dollars ($1,027,420.00) to two health care collaboratives (Project Access NOW and the Health Systems Access to Care Fund (see below)) that ensure access to culturally responsive primary and specialty health services for community members in Legacy service areas.In response to the lack of diversity within health professions and the persistent inequities in education, employment, and income among communities of color, Legacy Health established the Health Occupation Profession and Education program (HOPE, formerly Youth Employment in Summer) to provide work experiences through paid summer internships in the health care professions for underserved students of color. The primary goal of the program is to increase the number of underserved persons of color entering health care careers and to promote greater diversity in health care professions. Each summer between 5-15 students from ethnically diverse communities participate in the program. Students are paid between $15-18 per hour and may work up to 400 hours within available clinical and non-clinical departments across the Legacy Health system. Students meet weekly with a mentor and/or attend workshops to ensure the needs of the student and the department are being met.Students who perform well during the summer internship qualify for college tuition assistance ranging from $3,000 to $10,000 annually. These successful students also may continue in the HOPE program the following summer if they maintain the educational requirements for the program. Some students have remained in the program for seven years. Program alumni graduate with a range of degrees including imaging technology, nursing, and medicine. Most students are the first in their family to go to college. At all sites, Legacy Health trains interns and residents through its nationally accredited graduate medical education program and partners with local nursing and other health professional schools and programs to provide practical training and education.Legacy Health also collaborates with and supports other health care systems, public health agencies and community-based organizations to improve the health of the community. For example, in the fall of 2018, Legacy Health, Kaiser Permanente NW, PeaceHealth and Providence Health & Services came together to create the Health Systems Access to Care Fund through the Oregon Community Foundation. The goal of this fund is to strengthen the capacity and infrastructure for community clinics that are expanding and/or adapting their current models in response to the changing needs of patient populations due to ongoing healthcare reform, Medicaid transformation, and the increasing pressure on the safety net for access to care. Community clinics in Oregon and SW Washington were awarded multiyear grants up to $50,000. In 2022, eleven clinics continued existing work focused on four main areas which included assuring easy access to care, improving quality of care, strengthening leadership and enhancing data collection. Finally, Legacy Community Benefit contributes to organizations and partnerships in the Legacy Medical Centers service communities whose work addresses community-identified needs and aligns with the objectives and strategies of each Medical Centers Community Health Implementation Plan. In FY2022, Community Benefit funded 18 community-based organizations ($668,500.00) that promoted workforce development and educational attainment and addressed behavioral health issues within the communities served by Legacy Health.

Operating expenses	$ 253,473,963
Total amount spent on community benefits as % of operating expenses	$ 16,691,348 6.59 %