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Nonprofiteer
← WILLAMETTE VALLEY INSURANCE CORPORATION

Form 990 for tax year 2022

Filed by WILLAMETTE VALLEY INSURANCE CORPORATION.

Totals

Total revenue
$358,192
Total expenses
$4,205,408
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$0
Investment income
$358,192
Other revenue
$0
Total assets, end of year
$19,889,818
Total liabilities, end of year
$8,377,032
Net assets or fund balances, end of year
$11,512,786
Program services expenses (Part IX)
$4,058,460
Management and general expenses
$146,948
Fundraising expenses
$0
Program service expenses (Part III)
$4,058,460

Program services were 96.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 3 · Investment income

    total $419,738 · excluded $419,738

  • 7a · Gross sales of assets other than inventory

    securities $3,350,698

  • 7b · Less cost or other basis and sales expenses

    securities $3,412,244

  • 7c · Gain or loss

    securities -$61,546

  • 7d · Net gain or loss

    total -$61,546 · excluded -$61,546

Functional expenses

Part IX, the statement of functional expenses.

  • 11a · Fees: management

    total $432,470 · program services $369,748 · management and general $62,722

  • 11b · Fees: legal

    total $13,653 · management and general $13,653

  • 11c · Fees: accounting

    total $34,845 · management and general $34,845

  • 11g · Fees: other

    total $34,652 · program services $34,000 · management and general $652

  • 24a · Other expenses: LOSSES & LAE EXPENSE

    total $3,654,712 · program services $3,654,712

  • 24b · Other expenses: INVESTMENT EXPENSES

    total $35,076 · management and general $35,076

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $311,722 · end of year $145,968

  • 11 · Investments: publicly traded securities

    beginning of year $20,165,353 · end of year $19,673,450

  • 15 · Other assets

    beginning of year $57,641 · end of year $70,400

  • 17 · Accounts payable and accrued expenses

    beginning of year $113,127 · end of year $58,684

  • 25 · Other liabilities

    beginning of year $5,653,545 · end of year $8,318,348

  • 29 · Capital stock, trust principal or current funds

    beginning of year $0 · end of year $0

  • 30 · Paid-in or capital surplus, or land, building or equipment fund

    beginning of year $1,600,000 · end of year $1,600,000

  • 31 · Retained earnings, endowment or other funds

    beginning of year $13,168,044 · end of year $9,912,786

Mission and programs · 2022

Mission

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).

  • DIRECT PREMIUMS WRITTEN.LOSSES & LOSS ADJUSTMENT EXPENSES INCURRED AND OTHER RELATED COSTS RELATED TO PREMIUMS WRITTEN.

    Expenses $4,058,460

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Katherine Keene

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • Leah Mitchell

    VICE PRESIDENT/DIRECTOR

    Total calculated
    $1,076,402
    From this org
    $0
    From related orgs
    $972,629
    Other
    $103,773
    Hours/week
    2

    Schedule J breakdown matched by us

    Base
    $0 + $774,127 related
    Bonus
    $0 + $154,507 related
    Other
    $0 + $43,995 related
    Deferred
    $0 + $80,418 related
    Nontaxable benefits
    $0 + $23,355 related
    Filer's total
    $0 + $1,076,402 related

  • James Parr

    PRESIDENT/DIRECTOR

    Total calculated
    $1,085,378
    From this org
    $0
    From related orgs
    $981,205
    Other
    $104,173
    Hours/week
    2

    Schedule J breakdown matched by us

    Base
    $0 + $773,768 related
    Bonus
    $0 + $154,507 related
    Other
    $0 + $52,930 related
    Deferred
    $0 + $80,418 related
    Nontaxable benefits
    $0 + $23,755 related
    Filer's total
    $0 + $1,085,378 related

  • Dr Ralph Yates

    DIRECTOR

    Total calculated
    $821,593
    From this org
    $0
    From related orgs
    $786,442
    Other
    $35,151
    Hours/week
    2

    Schedule J breakdown matched by us

    Base
    $0 + $601,798 related
    Bonus
    $0 + $118,797 related
    Other
    $0 + $65,847 related
    Deferred
    $0 + $19,825 related
    Nontaxable benefits
    $0 + $15,326 related
    Filer's total
    $0 + $821,593 related

  • Cheryl Nester Wolfe

    DIRECTOR

    Total calculated
    $1,616,278
    From this org
    $0
    From related orgs
    $1,574,830
    Other
    $41,448
    Hours/week
    2

    Schedule J breakdown matched by us

    Base
    $0 + $1,003,551 related
    Bonus
    $0 + $264,799 related
    Other
    $0 + $306,480 related
    Deferred
    $0 + $25,925 related
    Nontaxable benefits
    $0 + $15,523 related
    Filer's total
    $0 + $1,616,278 related

  • Jonathan Bauer

    DIRECTOR

    Total calculated
    $768,639
    From this org
    $0
    From related orgs
    $688,029
    Other
    $80,610
    Hours/week
    2

    Schedule J breakdown matched by us

    Base
    $0 + $571,816 related
    Bonus
    $0 + $114,425 related
    Other
    $0 + $1,788 related
    Deferred
    $0 + $57,132 related
    Nontaxable benefits
    $0 + $23,478 related
    Filer's total
    $0 + $768,639 related

  • Dr Christine Clarke

    DIRECTOR

    Total calculated
    $689,129
    From this org
    $0
    From related orgs
    $633,858
    Other
    $55,271
    Hours/week
    2

    Schedule J breakdown matched by us

    Base
    $0 + $518,717 related
    Bonus
    $0 + $111,028 related
    Other
    $0 + $4,113 related
    Deferred
    $0 + $53,569 related
    Nontaxable benefits
    $0 + $1,702 related
    Filer's total
    $0 + $689,129 related

  • Mark Zook

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • Jennifer Fowler

    TREASURER

    Total calculated
    $473,172
    From this org
    $0
    From related orgs
    $400,400
    Other
    $72,772
    Hours/week
    2

    Schedule J breakdown matched by us

    Base
    $0 + $332,074 related
    Bonus
    $0 + $66,880 related
    Other
    $0 + $1,446 related
    Deferred
    $0 + $49,513 related
    Nontaxable benefits
    $0 + $23,259 related
    Filer's total
    $0 + $473,172 related

  • Ellen Hampton

    SECRETARY

    Total calculated
    $0
    Hours/week
    2

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

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 - $54,493 LEAH MITCHELL - $54,493 JENNIFER FOWLER - $23,588 CHRISTINE CLARKE - $33,744 JONATHAN BAUER - $40,357
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: IN CALENDAR YEAR 2022 THE GOVERNANCE COMMITTEE APPROVED THE DESIGN & PAYOUT OF A MULTI-YEAR RETENTION/BONUS PROGRAM FOR STAFF, LEADERS, & PROVIDERS. IN MARCH 2022 SALEM HEALTH PAID OUT THE EMPLOYEE RECOGNITION & RETENTION PLAN. THE PAYOUT WAS BASED ON A STRUCTURED MODEL SCENARIO.
PART I, ITEM 3:
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: COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACT, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY & APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

  • MWVP INC

    HOLDS LAND · OR

    Directly controlled by SALEM HEALTH HOSPITALS AND CLINICS

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • SALEM AMBULATORY SURGERY CENTER LLC

    SURGERY CENTER · OR

  • WILLAMETTE SURGERY CENTER LLC

    SURGERY CENTER · OR

  • WSC BUILDING GROUP LLC

    SURGERY CENTER, REAL ESTATE · OR

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • OREGON HEALTHCARE ENTERPRISES INC TTEE

    T · TAX TRUST PROGRAM · OR

  • PACIFIC MEDICAL CONDOMINIUM UNIT OWNERS ASSOCIATION

    C · OWNERS ASSOCIATION · OR

Provenance

Return type
form_990
Tax year
2022
Filed
13 May 2024
IRS schema version
2022v5.0
Source object
202401359349300215

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