2012-11-06T15:16:40-06:00 2011-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET COLUMBUS OH 43215 990 2011-01-01 340714535 SAMARITAN REGIONAL HEALTH SYSTEM SAMA 4192890491 1025 CENTER STREET ASHLAND OH 44805 DANNY L BOGGS 4192890491 2012-10-30 1 BERNIE OSTROWSKI P00366367 6148493000 2011 2016-02-24 21:20:13Z SEE SCHEDULE O DANNY L BOGGS 1025 CENTER STREET ASHLAND OH 44805 82423761 0 X WWW.SAMARITANHOSPITAL.ORG X 1910 OH SEE SCHEDULE OSAMARITAN REGIONAL HEALTH SYSTEM PROVIDES QUALITY MEDICAL HEALTHCARE SERVICES AND EDUCATION REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES PROVIDED TO MEDICARE AND MEDICAID PATIENTS ARE SOMETIMES PROVIDED BELOW COST. TO THE EXTENTREIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS CHARITY CARE. CHARITY CARE IS ALSO PROVIDED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH THE HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. CHARITY CARE FOR 2011 WAS VALUED AT $2,503,000. DURING 2011, THE HOSPITAL ALSO PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. SEE PART III FOR ADETAILED LISTING OF THESE PROGRAMS. 14 10 666 194 2699397 -296158 785518 537596 74990737 76395028 157335 15034 129600 5151818 76063190 82099476 2751779 2690576 0 0 32378672 34360467 0 0 0 39117420 41976569 74247871 79027612 1815319 3071864 72325431 75191324 28877124 29268362 43448307 45922962 X THE MISSION OF SAMARITAN REGIONAL HEALTH SYSTEM IS TO TAKE THE LEAD IN PROMOTING THE HEALTH AND WELLNESS OF PEOPLE IN THE COMMUNITIES WE SERVE. 0 0 67017035 2690576 76395028 SEE SCHEDULE O 67017035 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 60 0 1 666 1 1 1 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X MARY GRIEST CFO 4192077837 663 EAST MAIN STREET ASHLAND OH 44805 DANNY L BOGGS 35.00 X X 337082 0 34084 TOM MCGEE THRU 42011 2.00 X X 0 0 0 STEPHEN L STUART PHD 2.00 X X 0 0 0 HAROLD KEENER PHD 2.00 X X 0 0 0 ANNE BEER 2.00 X X 0 0 0 MARY MACDONALD MD 2.00 X 0 323194 40742 MATTHEW C BERNHARD MD 2.00 X 46639 0 0 PAUL R MYERS 2.00 X 0 0 0 JERRY SEITER 2.00 X 0 0 0 VICKY STEPHENSON 2.00 X 0 0 0 MICHAEL D STENCEL MD 2.00 X 11000 0 0 ROGER KRAMER CPA 2.00 X 0 0 0 ROGER HARRAMAN 2.00 X 0 0 0 TIM COWEN 2.00 X 0 0 0 SUE HEIMAN 2.00 X 0 0 0 MARY L GRIEST 40.00 X 160751 0 23184 ALYCE LEGG 40.00 X 133582 0 20879 CHRISTOPHER HUNT 40.00 X 138792 0 15474 PHILIP MYERS MD 40.00 X 128396 0 19807 RON MANCHESTER 40.00 X 132521 0 18173 KARIN SCHWAN 40.00 X 123895 0 26624 1212658 323194 198967 12 0 1 0 SIEMENS MEDICAL SOLUTIONS USA C/O MELLON BANK PO BOX 120001 DEPT DALLAS TX 753120733 IT MANAGEMENT SERVICES 2008257 ASHLAND ANESTHESIA PSC INC C/O COMPREHENSIVE MEDICAL MGMT 601 NEWPORT KY 41070 ANESTHESIA SERVICES 821405 HMP OF ASHLAND PO BOX 645037 CINCINNATI OH 452645037 HOSPITALISTS 716823 CERNER CORPORATION PO BOX 412702 KANSAS CITY MO 64141 NUTRITION SERVICES MANAGEMENT 544055 GREATER OHIO MOBILE LITHOTRIPSY 100 WEST THIRD STREET SUITE 350 COLUMBUS OH 43201 MOBILE LITHOTRIPSY SERVICES 419232 17 89614 447982 537596 PATIENT SERVICES 900099 76347361 76347361 RENTS FROM AFFILIATE 900099 47667 47667 76395028 316245 324285 -8040 -8040 -8040 15034 0 15034 15034 15034 PHARMACY RETAIL 446110 2216556 2216556 ARRA INCENTIVE PAYMENT 900099 1399229 1399229 OTHER SERVICES- LAB 621500 720688 1261 719427 823385 481580 341805 5159858 82099476 76395028 2699397 2467455 2684261 2684261 6315 6315 612740 11000 601740 24425812 19540650 4885162 1523601 1218881 304720 6010503 4808402 1202101 1787811 1430249 357562 91601 91601 83000 83000 9344103 9045092 299011 66887 66887 17587248 14157735 3429513 236870 236870 3291412 3291412 243869 195095 48774 509412 509412 5598212 5598212 651204 520963 130241 PROVISION FOR BAD DEBTS 3394805 3394805 OHIO FRANCHISE FEE 577152 577152 ADULTS & PEDS 141159 141159 EDUCATION PROGRAMS 128744 128744 30891 30891 79027612 67017035 12010577 0 13019443 3009771 7328656 17149461 1570380 2322781 1290280 1456549 1572724 2559537 103577883 57338875 41260048 46239008 124537 112207 6159363 2342010 72325431 75191324 6892636 8486076 18585163 17616323 106233 221321 3293092 2944642 28877124 29268362 X 43304057 45802010 144250 120952 43448307 45922962 72325431 75191324 X 3071864 -597208 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6433 6433 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MEMBERSHIP DUES IN THE AMOUNT OF $19,731 AND $26,761 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, RESPECTIVELY. $4,854 AND $1,579 OF THE DUES PAYMENTS WERE FOR LOBBYING EXPENSES. 2346208 2346208 16978254 7531412 9446842 2105226 1553694 551532 41641553 26901124 14740429 40506642 21352645 19153997 46239008 COST REPORT SETTLEMENT PAYABLE 2134914 INTEREST RATE SWAP 809728 2944642 1 1 X 1 X 1 X 1 1 0 1 1 3278943 894084 2384859 0.03020 7495995 4191621 3304374 0.04180 10774938 5085705 5689233 0.07200 34855 34855 0.00040 500 500 0.00000 5466 5466 0.00010 55444 -469 55913 0.00070 96265 -469 96734 0.00120 10871203 5085236 5785967 0.07320 5000 5000 0.00010 1413 1413 0.00000 4317 4317 0.00010 10730 10730 0.00020 1 1554332 201785 11283914 14042101 -2758187 X 1 1 1 1 SAMARITAN HOSPITAL

1025 CENTER STREET ASHLAND OH 44805

X X X SAMARITAN REGIONAL HEALTH SYSTEM 1 1 1 200.000000000000 0 1 X X 1 1 X X X X 1 X X X 1 X X X X X X X 1 X 0 1 7 SAMARITAN HEALTH & REHAB CENTER

2163 CLAREMONT AVENUE ASHLAND OH 44805

OUTPATIENT PHYS, OCC, SPEECH REHAB KETTERING SAMARITAN HEALTH CENTER

546 NORTH UNION STREET ASHLAND OH 44842

OUTPATIENT ANCILLARY SVC SAMARITAN PROFESSIONAL PARK

2212 MIFFLIN AVENUE ASHLAND OH 44805

OUTPATIENT ENDOSCOPY SAMARITAN PROFESSIONAL PARK

2212 MIFFLIN AVENUE ASHLAND OH 44805

WOMEN'S HEALTH, OCC MEDICINE SAMARITAN PROFESSIONAL PARK

2212 MIFFLIN AVENUE ASHLAND OH 44805

SLEEP LAB, PHYSICIAN OFFICES SAMARITAN BANEY RD OUTPATIENT FACILITY

1941 BANEY ROAD ASHLAND OH 44805

OUTPATIENT ANCILLARY SVCS SAMARITAN ADMINISTRATIVE BUILDING

663 EAST MAIN STREET ASHLAND OH 44805

ADMINISTRATIVE OFFICES PART I, LINE 3C: SAMARITAN'S POLICY INCLUDES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR CHARITY CARE. IN SOME CIRCUMSTANCES WHEN A PATIENT DOES NOT MEET THE CRITERIA, FURTHER DOCUMENTATION MAY BE REQUESTED (RELATED TO INCOME AND EXPENSES), AND THE CFO MAY GRANT A DISCOUNT AS A SPECIAL CIRCUMSTANCE. PART I, LINE 7: CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO USING THE WORKSHEET 2 METHOD TO CALCULATE THE COST TO CHARGE RATIO. PART I, LINE 7G: NOT APPLICABLE PART II: SAMARITAN PROVIDES A NUMBER OF FREE EDUCATIONAL SEMINARS TO THE PUBLIC RELATED TO VARIOUS HEALTHCARE TOPICS. THROUGH THESE EFFORTS, THE PUBLIC IN OUR SERVICE AREA RELY ON SAMARITAN FOR BOTH INFORMATION AND THEN TREATMENT. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. THE BAD DEBT ESTIMATE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS DETERMINED BY USING THE PERCENTAGE OF ACCOUNTS WRITTEN OFF TO BAD DEBT AND LATER REVERSED FROM BAD DEBT TO WRITE OFF AS A CHARITY ACCOUNT. THIS PERCENTAGE WAS APPLIED TO ALL BAD DEBT WRITE OFFS, THEN THE COST TO CHARGE RATIO APPLIED. PART III, LINE 8: SAMARITAN IS CLASSIFIED AS A MEDICARE DEPENDANT HOSPITAL. IN ORDER TO GAIN THIS CLASSIFICATION, SAMARITAN HAS TO DOCUMENT MEDICARE VOLUME OVER A ROLLING 3 YEAR PERIOD. DURING THAT PERIOD, THE MEDICARE INPATIENT VOLUME MUST BE A MINIMUM OF 60% OF THE TOTAL INPATIENT VOLUME FOR 2 OF THE 3 YEARS. SAMARITAN CONTINUES TO QUALIFY FOR THIS DESIGNATION. BASED ON A COST TO CHARGE RATIO, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2011 WAS $14,042,101. THE PAYMENTS RELATED TO THESE SERVICES WERE $11,283,914. LEAVING A MEDICARE SHORTFALL OF $2,758,187 FOR THE YEAR. PART III, LINE 9B: PATIENTS RECEIVE 3 STATEMENTS FOR SELF PAY BALANCES. FOR BALANCES GREATER THAN $200, ONE ATTEMPT IS MADE TO CALL THE PATIENT TO MAKE PAYMENT ARRANGEMENTS. SAMARITAN REGIONAL HEALTH SYSTEM PART V, SECTION B, LINE 10: THE CURRENT POLICY DOES NOT ALLOW FOR DISCOUNTING FOR CHARITY. SAMARITAN REGIONAL HEALTH SYSTEM PART V, SECTION B, LINE 11H: FAMILY SIZE IS USED TO DETERMINE CHARGES TO PATIENTS SAMARITAN REGIONAL HEALTH SYSTEM PART V, SECTION B, LINE 19D: ALL SELF PAY PATIENTS ARE BILLED GROSS CHARGES UNTIL THEY INDICATE AN INABILITY TO PAY. THEY MAY THEN APPLY FOR FINANCIAL ASSISTANCE AND IF THEY MEET THE CRITERIA IN THE POLICY THEIR BILL IS DISCOUNTED OR WRITTEN OFF ENTIRELY. SAMARITAN REGIONAL HEALTH SYSTEM PART V, SECTION B, LINE 21: ALL SELF PAY PATIENTS ARE BILLED GROSS CHARGES UNTIL THEY INDICATE AN INABILITY TO PAY. THEY MAY THEN APPLY FOR FINANCIAL ASSISTANCE AND IF THEY MEET THE CRITERIA IN THE POLICY THEIR BILL IS DISCOUNTED OR WRITTEN OFF ENTIRELY. PART VI, LINE 2: THE ORGANIZATION IS IN THE PROCESS OF DEVELOPING A SURVEY TOOL TO ASSESS COMMUNITY HEALTH NEEDS ALONG WITH FOCUS GROUPS FROM A CROSS SECTION OF COMMUNITY MEMBERS AND KEY STAKEHOLDERS. WE WILL ALSO COLLABORATE WITH OTHER NON-PROFIT AGENCIES WHO CONDUCT SIMILAR STUDIES AND VIEW THEIR FINDINGS AS USEFUL AND PRACTICAL. OUR OCCUPATIONAL MEDICINE PROGRAM SERVES INDUSTRY AND FUNCTIONS AS A "LISTENING POST" TO GATHER INPUT FROM OUR BUSINESS COMMUNITY. PART VI, LINE 3: INFORMATION RELATED TO THE CHARITY PROGRAM AT SAMARITAN IS PROVIDED IN A NUMBER OF WAYS. BROCHURES ARE PROVIDED AT EACH POINT OF ADMISSION ALONG WITH THE PUBLICLY POSTED INFORMATION NOTICES. EACH STATEMENT SENT LISTS THE FEDERAL POVERTY GUIDELINES AND WHAT INFORMATION IS NEEDED TO QUALIFY. AN APPLICATION FOR FREE CARE IS ON THE BACK OF EACH STATEMENT SENT TO PATIENTS. COLLECTION ACTIVITY CEASES ONCE IT IS DETERMINED THAT A PATIENT QUALIFIES UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART VI, LINE 4: SAMARITAN REGIONAL HEALTH SYSTEM DEFINES ASHLAND COUNTY AND THE 10 ZIP CODES THAT COMPRISE IT AS OUR PRIMARY SERVICE AREA (PSA). FURTHER, WE INCLUDE AT LEAST ONE ZIP CODE FROM EACH OF THE 5 CONTIGUOUS COUNTIES WITHIN OUR PSA. OUR PSA IS PRIMARILY RURAL WITH GREATER THAN 50% OF THE POPULATION LIVING IN THE 44805 ZIP CODE AREA. AS A COMMUNITY HOSPITAL WE MEET A BROAD RANGE OF NEEDS FOR A COMMUNITY THAT IS DIVERSE IN AGE AND SOCIO-ECONOMIC MAKE-UP. OUR COMMUNITY INCLUDES A LARGE AMISH POPULATION AND A DEMOGRAPHIC THAT HAS BEEN SEVERELY IMPACTED BY THE ECONOMIC DOWNTURN DUE TO THE DECLINE IN MANUFACTURING BASE OVER THE PAST SEVERAL YEARS. PART VI, LINE 5: SAMARITAN REGIONAL HEALTH SYSTEM IS VIEWED AS THE LEADER IN THE COMMUNITY FOR PROVIDING INFORMATION THAT LEADS TO EARLY TREATMENT AND BETTER OUTCOMES WITH LOWER ASSOCIATED COSTS. SAMARITAN HAS AN EFFECTIVE EDUCATIONAL PROGRAM (FREE OF CHARGE) THAT GATHERS DIRECT INPUT AS TO THE NEEDS AND CONCERNS OF THE COMMUNITY. PART VI, LINE 6: SAMARITAN REGIONAL HEALTH SYSTEM IS A GENERAL ACUTE-CARE FACILITY LOCATED IN ASHLAND, OHIO WHERE IT OPERATES FOUR MEDICAL OFFICE BUILDINGS, AN OUTPATIENT CLINIC, AN OFFSITE REHAB FACILITY, AND AN ADMINISTRATIVE OFFICE BUILDING. SRHS IS THE PARENT ORGANIZATION OF SAMARITAN PROFESSIONAL CORPORATION AND THE SOLE BENEFICIARY OF SAMARITAN HOSPITAL FOUNDATION.SAMARITAN PROFESSIONAL CORPORATION CONTINUED ITS MISSION TO RETAIN QUALITY PHYSICIANS AND EXPAND SERVICES IN THE COMMUNITY. THE STRUCTURE OF THE ORGANIZATION ENABLED THE PHYSICIANS TO CONTINUE THEIR OPERATIONS AND TO ENHANCE SERVICES PROVIDED BY THE LOCAL HEALTHCARE NETWORK.SAMARITAN HOSPITAL FOUNDATION PROVIDES A PROVISION OF FUNDRAISING AND ASSET MANAGEMENT IN SUPPORT OF SAMARITAN REGIONAL HEALTH SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 OH 1 SAMARITAN PROFESSIONAL CORPORATION 1025 CENTER STREET ASHLAND OH 44805 341856531 501(C)(3) 2684261 RELATED ORGANIZATION SUPPORT 2 2 MEDICAL FINANCIAL ASSISTANCE 5 6315 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SAMARITAN REGIONAL HEALTH SYSTEM MAKES CONTRIBUTIONS IN SUPPORT OF ITS RELATED PARTIES AS WELL AS ORGANIZATIONS WITHIN THE COMMUNITY. WHEN A PATIENT APPLIES FOR FINANCIAL ASSISTANCE, THE FINANCIAL COUNSELOR FOLLOWS THE FINANCIAL ASSISTANCE POLICY. IF THE PATIENT IS OVER INCOME GUIDELINES AND MAY NOT BE ABLE TO RETURN TO WORK DUE TO THE ILLNESS, THE FINANCIAL COUNSELOR WRITES AN EXCEPTION LETTER EXPLAINING THE PATIENT'S CIRCUMSTANCES. THIS LETTER IS ATTACHED TO THE SUPPORTING PAPERWORK AND FORWARDED TO THE CFO FOR APPROVAL. AN E-MAIL IS SENT TO THE FOUNDATION OFFICE EXPLAINING THE PATIENT'S CIRCUMSTANCES WITHOUT GIVING PERSONAL INFORMATION. THE OFFICE MAINTAINS A LOG OF ACCOUNTS WRITTEN OFF USING FOUNDATION FUNDS. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 DANNY L BOGGS 271458 0 53822 0 11802 0 28500 0 5584 0 371166 0 0 0 MARY MACDONALD MD 0 292107 0 13750 0 17337 0 28500 0 12242 0 363936 0 0 MARY L GRIEST 146441 0 11575 0 2735 0 18623 0 4561 0 183935 0 0 0 ALYCE LEGG 121247 0 9844 0 2491 0 15295 0 5584 0 154461 0 0 0 CHRISTOPHER HUNT 119633 0 9433 0 9726 0 15474 0 0 0 154266 0 0 0 RON MANCHESTER 115084 0 9194 0 8243 0 15149 0 3024 0 150694 0 0 0 KARIN SCHWAN 113479 0 9273 0 1143 0 14382 0 12242 0 150519 0 0 0 PART I, LINE 1A THE PRESIDENT/CEO RECEIVES HEALTH/SOCIAL CLUB DUES WHICH ARE NON TAXABLE. THE HOSPITAL IS REIMBURSED FOR ANY PERSONAL USE. COUNTY OF ASHLAND OHIO 346000122 2008-12-19 9500000 ED & OB BUILDING & STRUCTURE RENOVATION & IMPROVEMENTS; EQUIPMENT 1 0 0 COUNTY OF ASHLAND OHIO 346000122 2009-01-09 4495023 REFUND PRIOR ISSUE 1 0 0 COUNTY OF ASHLAND OHIO 346000122 2009-01-27 6004977 BUILDING & STRUCTURE RENOVATION; EQUIPMENT 1 0 0 1131944 9665616 119942 1744 9543930 2010 0 0 1 1 527774 4495023 4495023 4495023 2006 1 0 1 1 723959 6208273 41424 6166792 2011 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 1 FIFTH THIRD BANK 6.900000000000 0 0 0 0 0 0 1 1 FIFTH THIRD BANK 6.900000000000 0 0 0 0 1 0 1 1 FIFTH THIRD BANK 6.900000000000 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE CFO REVIEWS THE 990 PRIOR TO FILING. THE 990 IS REVIEWED AT THE BOARD OF DIRECTORS MEETING WITH SUFFICIENT TIME TO MAKE ANY AND ALL INQUIRIES REGARDING THE INFORMATION CONTAINED THEREIN. A COPY OF THE FORM 990 IS AVAILABLE TO EACH BOARD MEMBER BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A DISCLOSURE OF POTENTIAL CONFLICT OF INTEREST & CONFIDENTIALITY OF INFORMATION AGREEMENT ANNUALLY OR WHEN THEY FIRST JOIN. THE FORMS ARE SENT FROM THE CEO'S OFFICE AND ARE MAINTAINED THERE UPON COMPLETION. SHOULD A CONFLICT OF INTEREST ARISE, A BOARD MEMBER MAY RESIGN FROM THE BOARD DEPENDING ON THE LEVEL OF CONFLICT. IN ADDITION, THE BOARD MEMBER WILL ABSTAIN FROM VOTING AND IF APPROPRIATE WILL BE EXCUSED FROM THE BOARD MEETING DURING THE DISCUSSION REGARDING A POTENTIAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO YEARS, SINCE 2004, AN INDEPENDENT CONSULTANT PERFORMS A MARKET ANALYSIS OF THE SENIOR LEADERSHIP POSITIONS USING THE RESULTS OF AT LEAST THREE INDEPENDENT WAGE SURVEYS. THEIR REPORT IS USED TO DEVELOP/REVISE WAGE RANGES FOR ALL LEADERSHIP POSITIONS. THE INFORMATION IS THEN PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR APPROVAL. DECISIONS REGARDING THE CEO'S COMPENSATION ARE DOCUMENTED IN THE BOARD OF DIRECTOR MINUTES WHEN IT IS APPROVED AS WELL AS A NOTIFICATION THAT IS KEPT IN THE CEO'S FILE. IN THE FALL OF 2010 THE SCOPE WAS EXPANDED AND ALL MANAGEMENT POSITIONS WERE REVIEWED. THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OFFICERS WAS LAST UNDERTAKEN DURING 2010. THE LAST FULL REVIEW OF SENIOR LEADERSHIP AND DEPARTMENT DIRECTORS WAS COMPLETED IN NOVEMBER 2010 FOR THE APRIL 2011 WAGE CYCLE. THE NEXT INDEPENDENT CONSULTANT REVIEW OF SENIOR LEADERSHIP COMPENSATION WILL TAKE PLACE IN THE FALL OF 2012. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS FORM 1023, FORM 990, AND FORM 990-T AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -336,698. TEMP NET ASSETS RELEASED FROM RESTRICTION -260,510. TOTAL TO FORM 990, PART XI, LINE 5: -597,208. FORM 990, PAGE 12, PART XII, LINE 2C THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PAGE 1, PART I, LINE C DOING BUSINESS AS: SAMARITAN HOSPITAL PEOPLES HOSPITAL ADDITIONAL HOURS WORKED ON RELATED ENTITIES: FORM 990, PART VII MARY MACDONALD, MD: SAMARITAN PROFESSIONAL CORPORATION- 40 HRS DANNY BOGGS: SAMARITAN PROFESSIONAL CORPORATION- 10 HRS MARY GRIEST: SAMARITAN PROFESSIONAL CORPORATION- 5 HRS FORM 990, PAGE 2, PART III, LINE 4A SAMARITAN REGIONAL HEALTH SYSTEM PROVIDES QUALITY MEDICAL HEALTHCARE SERVICES AND EDUCATION REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES PROVIDED TO MEDICARE AND MEDICAID PATIENTS ARE SOMETIMES PROVIDED BELOW COST. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS CHARITY CARE. CHARITY CARE IS ALSO PROVIDED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH THE HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. CHARITY CARE FOR 2011 WAS VALUED AT $2,503,000. DURING 2011, THE HOSPITAL ALSO PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. THESE INCLUDED: PROGRAM: NET EXPENSE: PERSONS SERVED: COMMUNITY HEALTH IMPROVEMENT SERVICES $134,633 1,346 HEALTH PROFESSIONS EDUCATION $500 UNKNOWN SUBSIDIZED HEALTH SERVICES $3,944,978 UNKNOWN COMMUNITY HEALTH RESEARCH $5,466 372 FINANCIAL AND IN-KIND CONTRIBUTIONS $55,913 49 COMMUNITY BUILDING ACTIVITIES $10,730 242 COMMUNITY BENEFIT OPERATIONS $13,877 UNKNOWN TOTAL ALL $4,166,097 2,009 SAMARITAN PROFESSIONAL CORPORATION 1025 CENTER STREET ASHLAND OH 44805 341856531 PHYSICIAN BASED HEALTH SERVICES OH 501(C)(3) 3 SAMARITAN REGIONAL HEALTH SYSTEM 1 SAMARITAN HOSPITAL FOUNDATION 663 EAST MAIN STREET ASHLAND OH 44805 341783215 FUNDRAISING AND ASSET MANAGEMENT OH 501(C)(3) 11A SAMARITAN REGIONAL HEALTH SYSTEM 1 1 1 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 1 SAMARITAN PROFESSIONAL CORPORATION A 240458 ACTUAL RENT RECORDED SAMARITAN PROFESSIONAL CORPORATION B 2684261 CASH VALUE SAMARITAN PROFESSIONAL CORPORATION K 246940 ACTUAL PAYROLL EXPENSE SAMARITAN HOSPITAL FOUNDATION J 228500 ACTUAL LEASE PAYMENT SAMARITAN PROFESSIONAL CORPORATION N 90881 PAYROLL SAMARITAN HOSPITAL FOUNDATION C 89614 ACTUAL CONTRIBUTIONS RECEIVED