2025-05-15T03:49:56-05:00 2024-06-30 421539623 KMH LLP 1003 BISHOP STREET SUITE 2400 HONOLULU HI 96813 990 2023-07-01 201836190 WILLAMETTE VALLEY INSURANCE CORPORATION C/O MARSH MANAGEMENT SERVICES INC WILL 8085853530 700 BISHOP ST STE 1100 HONOLULU HI 96813 JAMES PARR PRESIDENT 5035615200 2025-05-15 1 0 DEANNA C AWA P00647777 8085262255 2025-04-28 2023 2025-03-06 01:10:19Z JAMES PARR 890 OAK STREET SE BLDG B SALEM OR 97301 3597061 0 X N/A X 2004 HI PROVIDING PROFESSIONAL AND GENERAL LIABILITY INSURANCE TO ITS SOLE MEMBER, SALEM HEALTH HOSPITALS AND CLINICS (FORMERLY SALEM HEALTH), A 501(C)(3) ENTITY, AND OTHER ORGANIZATIONS CONTROLLED DIRECTLY OR INDIRECTLY BY SALEM HEALTH HOSPITALS AND CLINICS AND THAT ARE NON-PROFIT FOUNDATIONS UNDER IRC SEC. 509(A)(1) OR (2). 8 2 0 0 0 0 0 0 0 0 358192 478895 0 0 358192 478895 0 0 0 0 0 0 0 0 0 4205408 2098900 4205408 2098900 -3847216 -1620005 19889818 19413039 8377032 8140866 11512786 11272173 X PROVIDING PROFESSIONAL AND GENERAL LIABILITY INSURANCE TO ITS SOLE MEMBER, SALEM HEALTH HOSPITALS AND CLINICS (FORMERLY SALEM HEALTH), A 501(C)(3) ENTITY, AND OTHER ORGANIZATIONS CONTROLLED DIRECTLY OR INDIRECTLY BY SALEM HEALTH HOSPITALS AND CLINICS AND THAT ARE NON-PROFIT FOUNDATIONS UNDER IRC SEC. 509(A)(1) OR (2). 0 0 1933421 DIRECT PREMIUMS WRITTEN.LOSSES & LOSS ADJUSTMENT EXPENSES INCURRED AND OTHER RELATED COSTS RELATED TO PREMIUMS WRITTEN. 1933421 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 2 1 0 0 0 1 1 0 1 1 1 0 1 1 1 1 0 0 0 0 0 X ANNIE WOO MARSH MANAGEMENT SERVICE 8085853594 700 BISHOP STREET SUITE 1100 HONOLULU HI 96813 X KATHERINE KEENE DIRECTOR 2.00 X 0 0 0 LEAH MITCHELL VICE PRESIDENT/DIRECTOR 2.00 X X 0 857714 109997 JAMES PARR PRESIDENT/DIRECTOR 2.00 X X 0 856362 109318 DR RALPH YATES DIRECTOR 2.00 X 0 692761 37400 CHERYL NESTER WOLFE DIRECTOR 2.00 X 0 1673623 43199 JONATHAN BAUER DIRECTOR 2.00 X 0 595872 84717 DR CHRISTINE CLARKE DIRECTOR 2.00 X 0 658692 62598 MARK ZOOK DIRECTOR 2.00 X 0 0 0 JENNIFER FOWLER TREASURER 2.00 X 0 382995 78918 ELLEN HAMPTON SECRETARY 2.00 X 0 0 0 0 5718019 526147 0 0 1 0 0 491408 491408 3105653 3118166 -12513 -12513 -12513 478895 0 0 478895 439257 376535 62722 5380 5380 35181 35181 34000 34000 27224 27224 LOSSES & LAE EXPENSE 1522886 1522886 INVESTMENT EXPENSES 34321 34321 LICENSE & FEES 651 651 2098900 1933421 165479 0 145968 1394309 19673450 17934323 70400 84407 19889818 19413039 58684 57041 8318348 8083825 8377032 8140866 X 0 0 1600000 1600000 9912786 9672173 11512786 11272173 19889818 19413039 -1620005 1379392 0 X X 0 1 X 1 0 X X 3 SALEM HEALTH 930579722 3 1 1647038 0 SALEM HEALTH HOSPITALS AND CLINICS 930823471 3 1 0 0 SALEM HEALTH WEST VALLEY 431960221 3 1 0 0 3 1647038 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART I, LINE 12G(V) AMOUNT OF SUPPORT REPRESENTS ACTUAL LOSS AND LOSS ADJUSTMENT EXPENSES PAID IN THE CURRENT YEAR. PART I, LINE 12G(V) EFFECTIVE OCTOBER 1, 2010, SALEM HEALTH WEST VALLEY (FORMERLY WEST VALLEY HOSPITAL) WAS ADDED TO THE INSURANCE POLICY. THEREFORE, $1,647,038 OF LOSS AND LOSS EXPENSES PAID IS PRESENTED AS SALEM HEALTH (FORMERLY SALEM HOSPITAL) AND SALEM HEALTH WEST VALLEY COMBINED. WE WILL SHOW AMOUNT OF SUPPORT AS 100% SALEM HEALTH, ALTHOUGH TOTAL SUPPORT ALSO INCLUDES AMOUNTS FOR SALEM HEALTH WEST VALLEY. PART IV, SECTION A, LINE 1 THE SUPPORTED ORGANIZATIONS LISTED IN WILLAMETTE VALLEY INSURANCE CORPORATION'S GOVERNING DOCUMENTS ARE "SALEM HEALTH HOSPITALS AND CLINICS (FORMERLY SALEM HEALTH) AND OTHER ORGANIZATIONS ('AFFILIATES') THAT ARE CONTROLLED DIRECTLY OR INDIRECTLY BY SALEM HEALTH HOSPITALS AND CLINICS AND THAT ARE NON-PRIVATE FOUNDATIONS UNDER SECTION 509(A)(1) OR (2) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR CORRESPONDING SECTIONS OF ANY FUTURE FEDERAL TAX CODE". WILLAMETTE VALLEY INSURANCE CORPORATION PROVIDES INSURANCE TO SALEM HEALTH HOSPITALS AND CLINICS, SALEM HEALTH (FORMERLY SALEM HOSPITAL), AND SALEM HEALTH WEST VALLEY (FORMERLY WEST VALLEY HOSPITAL). WHILE SALEM HEALTH AND SALEM HEALTH WEST VALLEY AREN'T LISTED BY NAME IN THE GOVERNING DOCUMENTS, BOTH ORGANIZATIONS ARE 501(C)(3) ENTITIES THAT ARE WHOLLY OWNED BY SALEM HEALTH HOSPITALS AND CLINICS AND ARE THEREFORE AMONG SALEM HEALTH HOSPITALS AND CLINIC'S "AFFILIATES" DESCRIBED IN WILLAMETTE VALLEY INSURANCE CORPORATION'S GOVERNING DOCUMENTS. 0 RESERVE FOR LOSSES & LOSS ADJUSTMENT EXPENSES 8024156 PAYABLE TO SALEM HEALTH 59669 8083825 X 1599705 1155131 1155131 444574 34321 34321 478895 2064579 0 2064579 34321 34321 2098900 PART X, LINE 2: THE CORPORATION EVALUATED ITS INCOME TAX POSITIONS IN ACCORDANCE WITH THE FASB ASC 740 STANDARD ON ACCOUNTING FOR UNCERTAIN TAX POSITIONS AND DETERMINED THERE WERE NO UNCERTAIN INCOME TAX POSITIONS AT JUNE 30, 2024 AND 2023. THE CORPORATION CLASSIFIES ALL INTEREST AND PENALTIES RELATED TO TAX CONTINGENCIES AS INCOME TAX EXPENSE. 0 1 0 0 0 0 0 1 0 CHERYL NESTER WOLFE DIRECTOR 0 1053743 0 275391 0 344489 0 28050 0 15149 0 1716822 0 320387 LEAH MITCHELL VICE PRESIDENT/DIRECTOR 0 813013 0 0 0 44701 0 84724 0 25273 0 967711 0 40622 JAMES PARR PRESIDENT/DIRECTOR 0 804313 0 0 0 52049 0 84724 0 24594 0 965680 0 49349 DR RALPH YATES DIRECTOR 0 625964 0 0 0 66797 0 21450 0 15950 0 730161 0 43574 DR CHRISTINE CLARKE DIRECTOR 0 606106 0 0 0 52586 0 62519 0 79 0 721290 0 0 JONATHAN BAUER DIRECTOR 0 594072 0 0 0 1800 0 60121 0 24596 0 680589 0 0 JENNIFER FOWLER TREASURER 0 371169 0 0 0 11826 0 54445 0 24473 0 461913 0 10308 PART I, LINE 4B SOME OF THE HOSPITAL'S EMPLOYEES RECEIVE DEFERRED COMPENSATION UNDER A 457(F) NONQUALIFIED PLAN. THIS COMPENSATION IS INCLUDED IN COMPENSATION REPORTED IN PART II. THE TOTAL NONQUALIFIED PORTION OF EACH PERSONS DEFERRED COMPENSATION IS: JAMES PARR - $56,674 LEAH MITCHELL - $56,674 JENNIFER FOWLER - $26,395 CHRISTINE CLARKE - $41,069 JONATHAN BAUER - $41,971 PART I, LINE 7 EXPLANATION: THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR, AND OTHER OFFICERS OR KEY EMPLOYEES ARE NOT COMPENSATED BY WILLAMETTE VALLEY INSURANCE CORPORATION, BUT BY SALEM HEALTH (EIN: 93-0579722). AS SUCH, NONE OF THE FOLLOWING APPLY. HOWEVER, SALEM HEALTH USES THE FOLLOWING: THE SALEM HEALTH HOSPITALS AND CLINICS BOARD OF TRUSTEES ESTABLISHES ANNUAL PERFORMANCE GOALS FOR THE CEO AT THE BEGINNING OF EACH FISCAL YEAR. AT THE END OF THE FISCAL YEAR, THE BOARD INDEPENDENTLY EVALUATES THE CEO'S PERFORMANCE AGAINST THESE GOALS AND, AT ITS SOLE DISCRETION, DETERMINES AND AWARDS AN APPROPRIATE BONUS BASED ON THE EXTENT TO WHICH THE GOALS WERE MET. FORM 990, PART V, LINES 1C, 2B, 3B, 5C, 6B, 7B, 7G, 7H, 8, 9A, 9B, 12A, 13A EXPLANATION: THESE QUESTIONS DO NOT APPLY TO WILLAMETTE VALLEY INSURANCE CORPORATION IN THE CURRENT YEAR. AS SUCH, THEY HAVE BEEN MARKED "NO". FORM 990, PART VI, SECTION A, LINE 2 EXPLANATION: CHERYL NESTER WOLFE, RALPH YATES, JAMES PARR, JENNIFER FOWLER & LEAH MITCHELL - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION: SOLE MEMBER SALEM HEALTH HOSPITALS AND CLINICS (FORMERLY SALEM HEALTH) FORM 990, PART VI, SECTION A, LINE 7A EXPLANATION: MEMBER ELECTS BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B EXPLANATION: FORM 990 IS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EXPLANATION: CONFLICT OF INTEREST STATEMENTS ARE PROVIDED BY EACH BOARD MEMBER ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 EXPLANATION: THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR, & OTHER OFFICERS ARE NOT COMPENSATED BY WILLAMETTE VALLEY INSURANCE CORPORATION, BUT BY SALEM HEALTH (FORMERLY SALEM HOSPITAL) (EIN: 93-0579722). AS SUCH, ITEMS 15A AND 15B ARE MARKED "NO". FORM 990, PART VI, SECTION C, LINE 19 EXPLANATION: DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION A, LINE 9 EXPLANATION: ALL DIRECTORS AND OFFICERS CAN BE CONTACTED AT SALEM HEALTH, 890 OAK STREET, SALEM, OR 97301. FORM 990, PART VII, SECTION A, (B): EXPLANATION: AVERAGE HOURS PER WEEK LISTED IS FOR WILLAMETTE VALLEY INSURANCE CORPORATION ONLY. FOR AVERAGE HOURS PER WEEK FOR RELATED ORGANIZATIONS, PLEASE REFER TO THE TAX RETURNS OF RELATED ORGANIZATIONS LISTED IN SCHEDULE R. FORM 990, PART XII, LINE 2C EXPLANATION: THE BOARD OF DIRECTORS IS RESPONSIBLE FOR OVERSIGHT OF AUDIT OF FINANCIAL STATEMENTS AND SELECTION OF INDEPENDENT ACCOUNTANT. SALEM HEALTH 890 OAK STREET SE SALEM OR 97301 930579722 HOSPITAL OR 501(C)(3) 3 N/A 0 SALEM HEALTH FOUNDATION 890 OAK STREET SE SALEM OR 97301 237002687 SUPPORTS SALEM HEALTH OR 501(C)(3) 7 SALEM HEALTH HOSPITALS AND CLINICS 0 SALEM HEALTH HOSPITALS AND CLINICS 890 OAK STREET SE SALEM OR 97301 930823471 LEASES LAND OR 501(C)(3) 12 TYPE 1 N/A 0 SALEM HEALTH PROFESSIONAL SERVICES 890 OAK STREET SE SALEM OR 97301 753175249 BILLING OR 501(C)(3) 12 TYPE 1 SALEM HEALTH HOSPITALS AND CLINICS 0 SALEM HEALTH WEST VALLEY 525 SOUTHEAST WASHINGTON STREET DALLAS OR 97339 431960221 HOSPITAL OR 501(C)(3) 3 SALEM HEALTH HOSPITALS AND CLINICS 0 WEST VALLEY HOSPITAL FOUNDATION 525 SOUTHEAST WASHINGTON STREET DALLAS OR 97339 931298564 SUPPORTS SALEM HEALTH WEST VALLEY OR 501(C)(3) 12 TYPE 1 SALEM HEALTH HOSPITALS AND CLINICS 0 SALEM AMBULATORY SURGERY CENTER LLC 570 LIBERTY ST SE SUITE 200 SALEM OR 97301 824752936 SURGERY CENTER OR N/A 0 0 WILLAMETTE SURGERY CENTER LLC 890 OAK STREET SE SALEM OR 97301 260018738 SURGERY CENTER OR N/A 0 0 WSC BUILDING GROUP LLC 1445 STATE STREET SALEM OR 97301 871401703 SURGERY CENTER, REAL ESTATE OR N/A 0 0 OREGON COMMUNITY IMAGING LLC 2925 RYAN DR SE SALEM OR 97301 262683062 MEDICAL IMAGING OR N/A 0 0 WILLAMETTE VALLEY COMMUNITY LLC 2925 RYAN DR SE SALEM OR 97301 455540852 COORDINATED CARE OR N/A 0 0 OREGON HEALTHCARE ENTERPRISES INC TTEE 4000 KRUSEWAY PLACE BLDG 2 STE 100 LAKE OSWEGO OR 97035 456525337 TAX TRUST PROGRAM OR N/A T 0 PACIFIC MEDICAL CONDOMINIUM UNIT OWNERS ASSOCIATION 890 OAK STREET SE SALEM OR 97301 454353791 OWNERS ASSOCIATION OR N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 SALEM HEALTH M 376535 FMV