2014-04-21T09:13:42-07:00 2013-06-30 990 2012-07-01 341041385 SALEM COMMUNITY HOSPITAL SALE 3303327214 1995 East State Street Salem OH 44460 Michael Giangardella 3303327214 2014-04-21 2012 2015-11-30 17:44:51Z Michael Giangardella 1995 East State Street Salem OH 44460 102861286 0 X www.salemhosp.com X 1913 OH Salem Community Hospital (SCH) is a 110-bed, not-for-profit rural facility, which provides a continuum of medical services to the residents of Columbiana and southern Mahoning counties, including inpatient and outpatient medical and surgical care, obstetrics, and gynecology, pediatrics, orthopedics, intensive care and a 15-bed skilled nursing facility. The Hospital also operates a full-time 24-hour Emergency Department, and treats all patients requiring medical care, irrespective of their financial means. The Hospital provides its services free of charge or on a sliding scale to uninsured/underinsured patients, regardless of race, creed, origin, handicap, age or ability to pay.; in support of its mission- "To Serve. To Care. To Heal.", adopted by the Board of Directors in March 2013. 18 16 1023 195 1990803 0 107383 527923 96568019 94712559 6579676 6547466 649381 749032 103904459 102536980 16655 34790 0 0 46973971 49394827 0 0 0 49293617 49398640 96284243 98828257 7620216 3708723 200584570 234566857 58055743 74532194 142528827 160034663 "To Serve. To Care. To Heal," encompasses the Hospital's mission of providing high quality care on both an inpatient and outpatient basis; and addresses our patients' health care needs at each life stage, within our available resources. SCH seeks to provide a broad range of diagnostic, inpatient, outpatient and emergency services appropriate for a community-based hospital, while ensuring that sufficient, high-quality primary and specialty physician services are available and accessible to residents of our service area. 0 0 69493260 93372036 The Hospital's mission and purpose is achieved by providing quality care to the sick and injured on both and inpatient and outpatient basis, while addressing our patients' healthcare needs at each life stage, within our available resources. SCH seeks to provide a broad range of diagnostic, inpatient, outpatient and emergency services appropriate for a community hospital, while ensuring that sufficient, high-quality primary and specialty physician services are available and accessible to residents of our service area. During fiscal year 2013, the Hospital provided comprehensive healthcare services including: 4,937 Admissions; 3,568 Surgeries; and 27,490 Emergency Department visits. In support of this commitment, the Hospital operates a full-time, 24-hour Emergency Department, and treats all patients requiring emergency medical care, irrespective of their financial means. The Hospital also accepts all patients covered by Medicare, Medicaid and General Assistance. Subsidized health services provided by the Hospital that are not self-sustaining include obstetric and behavioral health services, and the Hospital's costs for supporting these services is $1,346,059. If these programs were closed or not available to the community, the cost to the government or to another tax-exempt organization would increase. The Hospital also accepts all patients covered by Medicare, Medicaid and General Assistance. For fiscal year 2013, costs incurred by the Hospital for net charity care provided were $1,971,965, with unpaid costs of Medicaid representing $1,126,392 , and unreimbursed costs from other governmental programs representing $3,342,465. These community benefits, arising from patient care provided by the Hospital are documented to help to relieve a governmental financial and programmatic burden as evidenced through the Hospital's charitable purpose. Community investment grants provided by the Hospital totaled $6,000 during FY 2013, and included financial support of a medication assistance program to the elderly or disadvantaged. 0 0 0 69493260 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 81 0 1 1023 1 1 1 0 0 0 0 0 0 0 0 0 X 18 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Michael Giangardella 3303327214 1995 East State Street Salem OH 44460 Catherine Hubbs 1 0 X 0 0 0 Derek Hiscox 1 0 X 0 0 0 Matt Bender 1 0 X 0 0 0 Dick Wilk 1 0 X 0 0 0 John Haller 1 0 X 0 0 0 Greg Bestic 1 0 X 0 0 0 Peter Apicella MD 1 X 34703 0 0 Jon Rettig Sr 1 0 X 0 0 0 Dave Mollenkopf 1 1 X 0 0 0 Dave Gano 1 0 X 0 0 0 Jeffrey Cohen MD 1 0 X 0 0 0 John Biastro 1 0 X 0 0 0 Todd Olson 1 0 X 0 0 0 Jon Vollnogle 1 X 2850 0 0 Vicki Hall 1 0 X 0 0 0 Bart Brine MD 1 0 X 0 0 0 John Dawson MD 1 1 X 20000 0 0 Steven Ruwoldt 40 0 X 185272 0 11066 Mike Giangardella 40 0 X 191079 0 19427 Anita Hackstedde 40 1 X 236751 0 19855 Barbara Hirst 40 0 X 164696 0 22580 Keith Meredith 40 0 X 137805 0 14661 Mark LItalien 40 0 X 124219 0 29919 Stephen Ferenchak 40 0 X 113925 0 29913 Doreen Sheck 40 0 X 113065 0 24275 Beverly Proverbs 52 0 X 112034 0 0 Howard Rohleder 0 0 X 230849 0 5655 1667248 0 177351 16 1 1 0 Associates in Anesthesiology Inc PO Box 2190 Youngstown OH 44504 Medical Services 1261055 Wilmot Sanz 18310 Montgomery Village Avenue Suite 300 Gaithersburg MD 20879 Architectural services 1008781 Inpatient Medical Services Inc 822 Kumho Drive Suite 202 Fairlawn OH 44333 Medical Services 874974 Laboratory Corporation of America PO box 12140 Burlington NC 27216 Laboratory services 629905 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 Healthcare Services 360025 12 0 0 35855 0 359527 132541 0 527923 Patient Service Revenue 622000 92721756 92721756 0 0 Patient Service Revenue 621500 871920 0 871920 0 Patient Service Revenue 621610 1118883 0 1118883 0 94712559 6546266 0 0 6546266 0 0 0 0 0 0 0 0 411963 0 294698 0 117265 0 117265 0 0 117265 0 1200 0 0 0 1200 1200 0 0 1200 11095 35855 29608 -18513 0 -18513 Dietary Income 900099 548146 548146 0 0 Chart Fees/Medical Records 900099 25302 25302 0 0 Gift Shop Income 900099 15976 15976 0 0 60856 60856 0 0 650280 102536980 93372036 1990803 6646218 X 34790 34790 1113808 1113808 36465154 27249200 9215954 2675721 1856406 819315 6377969 4338122 2039847 2762175 2029743 732432 77707 77707 83703 83703 8273407 5278928 2994479 470982 470982 17511163 14984966 2526197 3001947 3001947 4317427 2954686 1362741 150710 15525 135185 503925 503925 8324825 5505466 2819359 458625 421579 37046 Bad Debts 4823849 4823849 0 0 State Franchise Fee 1400370 0 1400370 0 98828257 69493260 29334997 0 3814525 2943548 7190157 8975895 1632 655430 763142 3754447 3790521 185569344 102290835 66054777 83278509 118933147 134649303 180455 165939 200584570 234566857 10522085 14445674 30850000 52000000 922282 448098 15761376 7638422 58055743 74532194 X 142408827 159914663 120000 120000 0 0 142528827 160034663 200584570 234566857 X 3708723 6879294 0 0 0 6917819 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1908632 0 1908632 91357327 0 48661137 42696190 1483812 0 1174792 309020 71719344 0 52454906 19264438 19100229 0 0 19100229 83278509 0 Deferred Liability 270000 Pension Liability 7368422 7638422 Dinner Party 46950 35855 11095 0 0 0 9770 1325 18513 0 0 46950 35855 11095 0 0 0 9770 1325 18513 29608 -18513 1 1 1 X 1 X 1 1 0 1 1 3416177 1444212 1971965 0.02 3888578 2762186 1126392 0.0114 8961917 5718452 3243465 0.0328 0 0 16266672 9924850 6341822 0.0642 186 38233 194390 18805 175585 0.00177 8 199 1406310 0 1406310 0.01422 3649644 2303585 1346059 0.01362 23 4663 78524 588 77936 0.00079 217 43095 5328868 2322978 3005890 0.03040 217 43095 21595540 12247828 9347712 0.09460 6 27 2190 2190 0.00002 15 815 8150 8150 0.00008 3 754 14892 14892 0.00015 2 450 2952 2952 0.00002 10 247 6273 6273 0.00006 25 9892 9892 0.0001 3 3600 3600 0.00004 4 215 15640 15640 0.00016 68 2508 63589 0 63589 0.00063 0 2165725 206021 21801983 29904510 -8102527 X 1 0 1 1 Salem Community Hospital

1995 East State Street Salem OH 44460

X 15 bed skilled nursing facility Salem Community Hospital 1 1 X X X X X X X X X 13 1 1 1 X X X X X X X X X X X 0 0 1 1 150 1 350 1 X X X X X 1 1 X X 1 X X X 1 X X X X X 1 X 0 0 0 Salem Community Hospital

1995 East State Street Salem OH 44460

15 bed skilled nursing facility SchH_P01_S00_L06a Schedule H, Part I, Line 6a Salem Community Hospital prepares an Annual Report that is distributed to the community in paper format as well as being posted on the Hospital's website at www.salemhosp.com. The Annual Report includes a summary of the Hospital's statement of expenses and uncompensated care, along with highlighting the Hospital's major community benefit initiatives. This community benefit information is provided in an effort to document its tax exempt purpose and demonstrate the benefits provided for the broader community as determined by community need. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Costs are determined by applying the ratio of cost to charges to gross charges and utilizing the format as outlined in the Schedule H worksheets. SchH_P01_S00_L07g Schedule H, Part I, Line 7g Costs for subsidized health services include those attributable to providing women's obstetric services and outpatient behavioral health services. There are no health services attributable to a physician clinic SchH_P02_S00_L00 Schedule H, Part II During the taxable year, the Hospital participated in 68 different community building activities in an effort to provide programs and activities that respond to demonstrated, unmet community needs and meet community benefit objectives by improving access to health services and/or enhancing population health and knowledge. The Hospital participated in the Salem Area Industrial and Development Council and several area Chambers of Commerce activities; provided community support related to youth asset development through the Coordinated Action for School Health (CASH) Coalition and was a leading collaborative partner in disaster readiness; assisted in environmental improvements related to community medications disposals; offered leadership development and training related to cultural skills and language skills training for those with limited English proficiency; represented the Hospital on diverse community coalitions related to improving community health; advocated for community health improvements on the local and state levels on behalf of improving access to health care; and assisted with workforce development related to participation in community workforce boards, partnerships with area universities to address the health care work force shortage, and providing many school-based programs on health care careers, including offering teen and college student mentoring opportunities. The Hospital continues to serve as a community resource and partner for regional non-profit organizations, by providing collaborative programming with agencies such as the American Cancer Society, American Diabetes Association, American Heart Association, American Red Cross, Columbiana County Community Action Agency, Columbiana County and Salem City Departments of Health, Coordinated Action for School Health, Hospice of the Valley, Kent State University- Salem Campus, Northeast Ohio Workforce Development, Northeast Ohio Medical University, Retried Senior Volunteer Program-Medication Assistance, Salem Area Visiting Nurses Association, and the Salem Community Center. In addition, the Hospital makes financial and in-kind contributions to many of these not-for-profit organizations through event sponsorships, less the cost of benefits received; and meeting space. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Excerpt from footnote:Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provisions for uncollectible accounts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exits for part of the bill), the Hospital records a significant provision for uncollectible accounts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts." The cost of bad debts was determined by applying the Hospital's cost to charge ratio to the charges that were written off to bad debt. The Hospital believes that this cost is a community benefit because patients ,who would likely qualify for assistance under the Hospital's charity Care policy,do not or are unwilling to provide documentation of their eligibility for charity care and are therefore classified as bad debt. The Hospital is very willing to work out payment arrangements and discounted fees;however those patients who do not respond to repeated offers of assistance are categorized as bad debt expense. Had information been made available to make a determination of their eligibility ,the Hospital believes that many of the patients classified as bad debt would qualify for charity care. This judgement is based on the economic conditions of the area and the specific knowledge of the patients involved. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The costs were obtained from the Hospital's Medicare cost Report. The Hospital incurred costs in excess of $29.9 million to care for and treat Mediciare beneficiaries,while receiving reimbursement of approximately $21.8 million,leaving a shortfall of $8.1 million. This was a direct health care benefit provided by the Hospital to local Medicare beneficiaries who live in the surrounding communities. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Per the Hospital's charity Care policy,the Hospital will not pursue collection for non-payment of bills against individuals who demonstrate that they have neither sufficient income nor assets to meet their financial obligations. SchH_P05_S0B_L03 Schedule H, Part V, Section B, Line 3 To take into account input from persons representing the community served, the CHNA primary data collection process included 2 focus groups that were conducted with a total of 37 adult participants, along with 11 individual interviews conducted with key stakeholders in the community to gather additional insight into the health of a community from diverse community groups and underrepresented populations. In addition, an internet and paper-based Community Needs Survey was conducted with 1,091 completed surveys obtained. SchH_P05_S0B_L04 Schedule H, Part V, Section B, Line 4 Along with Salem Community Hospital, East Liverpool City Hospital also provided financial support for the CHNA process. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 : With financial support from East Liverpool City Hospital and Salem Community Hospital, as well as in-kind support provided by the Community Action Agency of Columbiana County, the Community Health Needs Assessment process not only brought forth the CHNA report, but also included investment in a web-based community health data platform developed by the Healthy Communities Institute. The system is hosted on Salem Community Hospital's website and can be accessed through: http://salemhosp.com. The system includes a comprehensive dashboard of approximately 100 community indicators from over 12 sources, covering over 20 topics in the areas of health, determinants of health, and quality of life. SchH_P05_S0B_L07 Schedule H, Part V, Section B, Line 7 The Columbiana County Needs Assessment identified a high percentage of poverty among children, families, and the general population, as compared to other U.S. counties; along with a high unemployment rate and low proportion of adults with a college degree compared to other U.S. counties. The top environmental needs identified in the Community Survey portion of the CHNA included not enough money, lack of access to employment/better jobs and safe water/clean air. In addition, focus group participants and stakeholders identified multi-faceted and intertwined demographic and socio-economic issues related to income, the poor economy, drug abuse, lack of education, and unemployment as key environmental drivers of the health status of the community. Each of these needs is important and should be addressed by various county-wide organizations and/or community partners of the Hospital. However, due to their societal magnitude and the Hospital's limited resources and capacity to meaningfully impact the economic foundation of the county, the Hospital has chosen to allocate significant internal resources to the priority health needs which yield the greatest opportunities to affect a positive change, as outlined in the Implementation Plan; and will focus on the priorities of chronic disease; physical activity and nutrition; healthy mothers, babies and children; infectious disease; and access to medical care. The Implementation Plan was presented and approved by the Hospital's Board in June 2013. SchH_P05_S0B_L14 Schedule H, Part V, Section B, Line 14 The availability of free or discounted care is provided on billing statements sent to patients. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 The Hospital's uninsured/underinsured polocy provides discounts to patients based on the patient's income( up to 350% of the federal poverty level). The amount of the discount is based on the gross charges ,with the discount level increasing as charges increase. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 SCH formally assesses the healthcare needs of the communities that it serves on a minimum of a triennial basis, and does so in collaboration with other community health providers. The most recent comprehensive, county-wide needs assessment was published in May 2013, and included the formation of a collaborative Columbiana County Health Coalition including Salem Community Hospital; East Liverpool City Hospital; the Columbiana County, East Liverpool and Salem City Health Departments; Community Action Agency of Columbiana County; Columbiana County Job and Family Services, the Coordination Action for School Health (CASH) Coalition; Kent State University; and the Columbiana County Mental Health Services and Recovery Board. The CHNA process began in July 2011, when the Columbiana County Health Coalition convened to outline the approach for following the 6-step Community Health Improvement model outlined by the Association for Community Health Improvement. The coalition initially requested assistance from Kent State University to facilitate the process and to direct the primary and secondary data collection efforts. When the process was not completed by September 2012, the coalition decided to invest in a web-based dashboard system developed by Healthy Communities Institute, which allows data to be easily accessed by its users. In addition, Strategy Solutions, Inc. was retained to facilitate the remainder of the process and provide primary data analysis and prioritization support. The geographic area of the needs assessment encompassed Ohio's Columbiana County, most of which is within Salem Community Hospital's Service Area, and prioritized the public, primary and specialty health care needs of community members from birth through end-of-life care. The CHNA action plan and report development were presented to and approved by the SCH Board in May 2013, and distributed to all participating coalition organizations. The SCH Implementation Plan was then approved by the Board in June 2013, and both documents are posted on the Hospital's website at http://www.salemhosp.com/getpage.php?name=Community_Dashboard&sub=About+Us. The Hospital has carried forward its implementation strategies by including them in its annual Organizational Goals In addition, the Hospital is a collaborative partner in other types of needs assessments, such as the school health asset study, through the Search Institute, conducted on an annual basis with area school districts. During this past fiscal year, Salem Community Hospital also participated in a tri-county health needs assessment and development of an implementation plan for Mahoning, Columbiana and Trumbull Counties, the hospital partners of which included Humility of Mary Health Partners, Akron Children's Hospital and Salem Community Hospital, along with the Mahoning County, Columbiana County, East Liverpool City and Salem City Health Departments. Because the scope of the tri-county needs assessment was so broad, Salem Community Hospital used the preliminary findings from this needs assessment to launch its county-wide needs assessment process, targeted toward the specific needs of Columbiana County residents SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The hospital includes on all billing statements information regarding the availability of free care programs and the required income guidelines. This information is also posted on the Hospital's website,along with the charity care policies. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The hospital's rural service area is officially designated as part of the Appalachian region and includes Columbiana County, excluding Yellow Creek and East Liverpool Townships; and the five lower townships of Mahoning County. Portions of Columbiana County are also designated as Medically Underserved (MUP), and as a dental and mental health care Health Professional Shortage Areas (HPSA). Columbiana County residents are older than their state and national counterparts, and the Service Area is characterized by a declining social and economic base, which impacts the area's health status problems and health service utilization. The age distribution of Columbiana County is more elderly, with 16.7% of Columbiana County residents 65 years and over compared to 14.3% of Ohio residents and 13.3% of U.S residents... In addition, according to the 2010 Census, Columbiana County has a significant older adult population (36.5%), aged 40-65 years, nearing retirement age. Columbiana County has a large percentage of adults who are unable to afford to see a doctor compared to other US counties, and the county is not meeting the Healthy People 2020 goals for health insurance coverage for children and adults. Poverty is also a factor with almost one-half of the county's population at or below 200% of the federal poverty level. Area residents experience higher death rates for chronic diseases, such as heart disease, cerebrovascular disease, diabetes and chronic obstructive pulmonary disease. The overall cancer mortality rate in Columbiana County is significantly higher than surrounding counties and the state of Ohio, especially related to colorectal, kidney, leukemia, liver and lung cancers, and lymphoma; and county rates of death attributable to chronic diseases like diabetes mellitus are higher than the state's average. The county has a high percentage of obesity and sedentary behavior compared to other Ohio counties, and only small percentages of residents engage in health habits related to physical activity and nutrition. The area also has a low educational attainment rate, with 15.5% of adults over age 25 having no high school diploma, and less than 12% of adults having a Bachelor's or Master's degree. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Hospital seeks to provide a broad range of diagnostic, inpatient, outpatient and emergency services appropriate for a community hospital, while ensuring that sufficient, high-quality primary and specialty physician services are available and accessible to residents of our service area. Medical staff privileges are extended to qualified physicians in the Hospital's Service Area, based on documented community need for the medical service and the Hospital's resources to provide the service. During fiscal year 2013, the Hospital provided comprehensive healthcare services including: 4,937 Admissions; 3,568 Surgeries; and 27,490 Emergency Department visits. In support of this commitment, the Hospital operates a full-time, 24-hour Emergency Department, and treats all patients requiring emergency medical care, irrespective of their financial means. The Hospital also accepts all patients covered by Medicare, Medicaid and General Assistance. Subsidized health services provided by the Hospital that are not self-sustaining include obstetric and behavioral health services, and the Hospital's costs for supporting these services is $1,346.059. If these programs were closed or not available to the community, the cost to the government or to another tax-exempt organization would increase. The Hospital also accepts all patients covered by Medicare, Medicaid and General Assistance. For fiscal year 2013, costs incurred by the Hospital for net charity care provided were $1,971,965, with unpaid costs of Medicaid representing $1,126,392 MG, and unreimbursed costs from other governmental programs representing 3,342,465. These community benefits, arising from patient care provided by the Hospital are documented to help to relieve a governmental financial and programmatic burden as evidenced through the Hospital's charitable purpose. In order to provide services efficiently and cost-effectively, the Hospital also utilizes an active volunteer base, with 180 community members donating over 16,730 hours of volunteer service annually. In addition, the Hospital's Board of Directors is comprised of 15 community volunteers from the Hospital's Service Area, who perform fiduciary responsibilities through monthly committee and Board activities. The Hospital actively seeks opportunities to further its tax exempt purpose through community health improvement and community benefit operations that provide treatment and/or promote health in response to identified community needs. 1 Retired Senior Volunteer Program 966 1/2 North Market Street PO Box 355 Lisbon OH 44432 341902451 501(c)(3) 6000 Medication Assistance Program 1 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 The allocation and utilization of grant funds are monitored through the required tracking and reporting of specific outcomes by each grantee,along with site visits to the respective grantee organization. Grantee organizations are also required to submit either itemized invoices for subcontracted services and/or a detailed outcome report listing the number and types of services provided and the number of clients served. X X 0 1 0 0 0 0 0 0 0 Steven Ruwoldt 185272 0 0 0 0 0 0 0 11066 0 196338 0 Anita Hackstedde 236751 0 0 0 0 0 9226 0 10629 0 256606 0 Mike Giangardella 191079 0 0 0 0 0 8207 0 11220 0 210506 0 Barbara Hirst 164696 0 0 0 0 0 16674 0 5906 0 187276 0 Keith Meredith 137805 0 0 0 0 0 8755 0 5906 0 152466 0 Mark LItalien 124219 0 0 0 0 0 10718 0 19201 0 154138 0 Howard Rohleder 230849 0 0 0 0 0 -251 0 5906 0 236504 0 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The President's compensation is determined by the Board of Directors.,based upon the recommendation of the Board's Executive Committee. The Committee evaluates market data through statewide salary surveys as well as targeted regional survey data. Their decision is documented in their minutes. This process was last completed during the fiscal year ending June 30,2012. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 A non-qualified compensation plan exists for a former CEO. There were no employer contributions to the plan during the fiscal year. A City Of Salem Ohio 346002560 2013-04-04 52000000 Hospital Facility Construction 0 1 0 A 29600292 0 52000000 0 112550 0 168913 0 16460628 3727 5661344 0 1 0 1 A 0 1 0 0 0.0112 0 0.0112 1 0 1 A 0 1 0 0 1 0 0 0 1 A 1 F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The final 990 is available for review by the governing body ,prior to review. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c On an annual basis,Directors and key employees disclose potential busienss or professional relationships they may have with the organization and/or other Directors/key employees. In situations when a Director has a conflict ,they may participate in the discussion ,but leave the room prior to final discussion and vote. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The President's compensation is determined by the Board of directors, based upon the recommendation of the Board's Executive Committee. The Committee evaluates market data through statewide salary surveys ,as well as targeted regional survey data. Their decision is documented in their minutes. The process was last completed during the fiscal year ended June 30,2012. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 As a private not-for-profit organization,Salem Community Hospital does not mahke its governing documents or financial statements generally available to the public,although the Federal Form 990 is available for review upon request. F990_P09_S00_L11g Form 990, Part IX, Line 11g Professional Fees and Purchased Services F990_P11_S00_L09 Form 990, Part XI, Line 9 Change in defined benefit plan net gains of $8,538,029 and fund balance transfer to related organization of $1,620,210 SCH Professional Corporation 1995 East State Street Salem OH 44460 341764515 Physician Offices OH 501(c)(3) 11 N/A Salem Medical Arts & Development Corporation 2020 East State Street Salem OH 44460 341049534 Office Rent OH N/A C 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 SCH Professional Corporation n 93829 % of time spent SCH Professional Corporation b 1541956 actual expenditures SCH Professional Corporation i 100635 Actual expenditures Salem Medical Arts & Development Corporation k 10400 Actual expenditures