Community Benefit Insight - Tax-exempt hospital

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Legacy Salmon Creek Hospital

Legacy Salmon Creek Hospital

2211 Ne 139th Street
Vancouver, WA 98686

Bed count	220	Medicare provider number	500150	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 331065485

Display data for year:

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

13.24%

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	$ 5,365,535 1.14 %
Medicaid as % of operating expenses	$ 51,847,862 11.02 %
Costs of other means-tested government programs as % of operating expenses	$ 3,196,681 0.68 %
Health professions education as % of operating expenses	$ 928,729 0.20 %
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.	$ 694,714 0.15 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 255,346 0.05 %
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	$ 14,420,791 3.06 %
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	$ 10,382,970 72.00 %

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 $ 333658659 including grants of $ 26260) (Revenue $ 462955717)
LSCH was the State of Washington's first new hospital construction since 1979. The hospital opened in August 2005 with 165 licensed beds, all of which are single occupancy. LSCH provides a full array of hospital services, including surgery, diagnostics, inpatient and outpatient medical services, neonatal intensive care unit, pediatric, obstetrical, and emergency services. LSCH utilizes an electronic information system for medical records and physician order entry. Physicians are able to complete their entire patient records electronically and can remotely access patient records, including diagnostic images.In support of its mission, LSCH 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, LSCH provided financial assistance on approximately 8,364 patient accounts (of which 705 accounts received discounts totaling 100% of costs) and resulted in LSCH incurring roughly $5,365,500 in uncompensated costs associated with this program. In addition to charity care, LSCH provides services under various states' Medicaid programs for financially needy patients Medicare beneficiaries, and other government programs for which the cost of treating these patients exceeds the government payments received. During fiscal year 2022, LSCH incurred approximately $51,847,800, $58,834,600 and $3,196,600 in uncompensated costs attributable to Medicaid, Medicare and other government programs respectively. LSCH 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 $1,878,700 during fiscal year 2022.LSCH 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.

4B (Expenses $ 40611337 including grants of $ 0) (Revenue $ 30512433)
LSCH operates adult, pediatric, and OB/GYN hospitalist programs, as well as four primary care physician practices and thirteen specialty clinics in southwest Washington. From it's opening in 2005, LSCH has used an electronic health information system for medical records and physician order entry.

Facility Information

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

Facility: LEGACY SALMON CREEK HOSPITAL - Part V, Section B, Line 5
In 2020, Legacy Salmon Creek 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 Salmon Creek 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).The following organizations were surveyed or interviewed.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 SALMON CREEK HOSPITAL - Part V, Section B, Line 6a
In addition to Legacy Healths five hospitals which includes Legacy Salmon Creek 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 SALMON CREEK HOSPITAL - Part V, Section B, Line 11
The FY2021 Legacy Salmon Creek CHNA identified health-related needs across the quad county region. Legacy Salmon Creek 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 Salmon Creek 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 Salmon Creek 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 Salmon Creek Medical Center is confident these needs are being addressed by other community organizations. Legacy Salmon Creek 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 Salmon Creek 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 III, Line 2 - Methodology Used To Estimate Bad Debt Expense
LSCH 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, LSCH 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. 72% of Households in the LSCH 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 describes 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 $126,645,623 and $185,480,284 respectively. This results in a total Medicare shortfall of $58,834,661.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 Salmon Creek is experiencing significant challenges in population growth, economic development, education and health care. Recognizing that social and economic determinants impact health, Legacy Salmon Creek 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 3 - Patient Education of Eligibility for Assistance
Legacy Salmon Creek 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 Salmon Creek 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 Salmon Creek 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 Salmon Creek 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 Salmon Creek Financial Assistance Program. Legacy Salmon Creeks website also has information about the availability of financial assistance. Legacy Salmon Creek 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 Salmon Creek requires the use of a collection agency, those agencies are required to provide a telephone number for patients to 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 Salmon Creek 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.

Part VI, Line 4 - Community Information
Legacy Salmon Creek Medical Center is Southwest Washingtons most modern hospital, offering the latest technology in a setting designed for comfort and care for the whole family. Legacy Salmon Creek specialty areas include joint replacement, robotic surgery, pelvic health for women, cancer care, intensive care for newborns, neurosurgery, medical care for children and more. Legacy Salmon Creek is located in Clark County between the cities of Vancouver to the south and Battle Ground and Ridgefield to the north. The primary service area includes Clark County and extends from the Columbia River in the south, to La Center in the north, Vancouver Lake in the west and Camas in the east.The demographic data that informed Legacy Salmon Creeks CHNA/CHIP for FY22 is from 2012-2016. The total population estimate of the primary service area for Legacy Salmon Creek was 450,893. The primary service area was 84.6% White, 8.7% Hispanic/Latino, 4.6% two or more races, 4.3% Asian, 1.9% Black/African American, 0.8% Native Hawaiian/Pacific Islander, and 0.6% American Indian/Alaska Native. The foreign-born population represents 10.4% of the community and languages other than English account for 15%. In Clark County, while Asian Americans median per capita income was $32,306, Hispanics/Latinos had the lowest median per capita income at $15,171 followed by those reporting two or more races at $15,935, Native Hawaiians/Pacific Islanders at $21,686, African Americans/Blacks at $24,854, Native Americans/Alaska Natives at $24,928, and Whites at $31,704. In FY22, Legacy Salmon Creek Hospital provided $5.3 million in charity care; total unreimbursed costs of care for people in need amounted to approximately $119.2 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 in the Portland metropolitan area (Clackamas, Multnomah, Washington counties in Oregon and Clark County in SW Washington) and other community partners in Clark County to assess community needs and describe how the Legacy Salmon Creek Medical Center will address these needs and evaluate the effectiveness of its efforts in its SW Washington service area.The Legacy Salmon Creek Medical Center gives in-kind lab services 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 to the community. 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 Salmon Creek 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.Finally, Legacy Salmon Creeks medical staff is open, with physicians submitting credentialing information that is reviewed according to Legacy Health policies and standards.Legacy Salmon Creek 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 Salmon Creek 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 programs and schools to provide practical training and education.Legacy Health also partners with and supports other health care systems, public health agencies and community-based organizations to improve the health of the community. For example, Legacy collaborated with Kaiser Permanente NW, PeaceHealth and Providence Health & Services to establish the Health Systems Access to Care Fund through the Oregon Community Foundation in the fall of 2018. The goal of this fund is to strengthen the capacity and infrastructure for community clinics that are expanding and/or adapting their current models to respond 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 care, strengthening leadership and improving data collection. Finally, Legacy Community Benefit supports 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	$ 470,510,002
Total amount spent on community benefits as % of operating expenses	$ 62,288,867 13.24 %