2011-02-11T14:45:54-07:00 2010-06-30 990 2009-07-01 341041385 SALEM COMMUNITY HOSPITAL SALE 3303327214 1995 East State Street Salem OH 44460 Michael Giangardella 3303327214 2011-02-11 2009 2016-02-24 21:20:13Z Michael Giangardella 1995 East State Street Salem OH 44460 100442492 0 X www.salemhosp.com X 1913 OH Salem Community Hospital (SCH) is a 184-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. 18 18 1085 235 2139413 -83845 129057 111399 99672526 96283703 1550693 3263446 651165 505698 102003441 100164246 45244 60185 0 0 48190851 48752431 0 0 0 47390430 45668390 95626525 94481006 6376916 5683240 175944489 189775318 51203316 53973823 124741173 135801495 SCH's mission is to provide high quality care to the sick and injured, on both an inpatient and outpatient basis, and address 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 hospital, while ensuring that sufficient, high-quality primary and specialty physician services are available and accessible to residents of our service area. 0 0 67872380 96283703 The Hospital's mission is to provide high quality care to the sick and injured, on both an inpatient and outpatient basis, and address 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 hospital, while ensuring that sufficient, high-quality primary and specialty physician services are available and accessible to residents of our service area. In addition, the Hospital offers community health improvement and community benefit operations that provide treatment and/or promote health in response to identified community needs. During fiscal year 2010, the Hospital provided comprehensive healthcare services including: 6,078 Admissions; 3,911 Surgeries; 626 Births, and 27,798 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. Subsidized health services provided by the Hospital that are not self-sustaining include obstetric and pediatric services, and the Hospital's costs for supporting these services is $2,273,511. 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 2010, costs incurred by the Hospital for net charity care provided were $2,159,313; with unpaid costs of Medicaid representing $2,063,904; and unreimbursed costs from other government programs representing $2,585,487. 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. 0 0 0 67872380 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 0 0 1 72 0 1 1085 1 1 0 0 0 0 0 18 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OH X Michael Giangardella 3303327214 1995 East State Street Salem OH 44460 Kevin Snyder 1 X 0 0 0 John Dilling 1 X 0 0 0 Catherine Hubbs 1 X 0 0 0 John Haller 1 X 0 0 0 Greg Bestic 1 X 0 0 0 Dave Dickey 1 X 0 0 0 Bill McDevitt 1 X 0 0 0 Derek Hiscox 1 X 0 0 0 Shawna L'Italien 1 X 0 0 0 J C Paumier MD 1 X 0 0 0 Jon Rettig Sr 1 X 0 0 0 Dick Wilk 1 X 0 0 0 Matt Bender 1 X 0 0 0 Dave Mollenkopf 1 X 0 0 0 Dave Gano 1 X 0 0 0 Jeffrey Cohen MD 1 X 0 0 0 LT Simon MD 1 X 0 0 0 Angela Doty MD 1 X 0 0 0 Howard E Rohleder 40 X 292446 0 33196 Anita Hackstedde 40 X 205954 0 9971 Mike Giangardella 40 X 177255 0 25410 Karen Kazel 40 X 159880 0 31790 Barbara Hirst 40 X 133794 0 20333 Keith Meredith 40 X 130347 0 8628 Mark LItalien 40 X 121614 0 31256 Claudia Orsburn 40 X 109662 0 19063 Donald Hughes 40 X 108670 0 0 Kimberly Shea 40 X 112073 0 23834 1551695 0 203481 15 0 1 0 Associates in Anesthesiology Inc PO Box 2190 Youngstown OH 44504 Medical Services 867525 Inpatient Medical Services Inc 822 Kumho Drive Suite 202 Fairlawn OH 44333 Medical Services 817368 Paris Healthcare Linen Service 67 Hoover Avenue PO Box 1043 Dubois PA 15801 Linen Service 420000 Alliance Healthcare Services PO Box 96485 Chicago IL 60693 Healthcare Services 319210 Securitas Security Services PO Box 403412 Atlanta GA 30384 Security Services 311342 17 0 0 0 0 0 111399 0 111399 Patient Service Revenue 622000 94144290 94144290 0 0 Patient Service Revenue 621500 1186491 0 1186491 0 Patient Service Revenue 621610 952922 0 952922 0 0 0 0 0 96283703 3263446 0 0 3263446 0 0 0 0 0 0 0 0 290879 0 278246 0 12633 0 12633 0 0 12633 0 0 0 Dietary Income 900099 419224 419224 0 0 Chart Fees/Medical Records 900099 27435 27435 0 0 Gift Shop 900099 5684 5684 0 0 40722 40722 0 0 493065 100164246 94637355 2139413 3276079 60185 60185 1100029 1100029 36607517 26956404 9651113 2471499 1665692 805807 5707650 3790545 1917105 2865736 2049893 815843 17338 17338 50396 50396 6729710 4076766 2652944 406087 406087 16672399 14870036 1802363 2247417 2247417 4258137 2834796 1423341 165187 35076 130111 281851 281851 8752401 6752161 2000240 702398 632508 69890 Bad Debts 4148318 4148318 0 0 Franchise fee 1236751 0 1236751 0 94481006 67872380 26608626 0 5443440 6325841 8369053 7539180 10078 4895 581305 658216 2444298 2445499 152654891 78254575 78072338 74400316 80073456 96391163 950521 2010208 175944489 189775318 10157708 9095158 34600000 33350000 25856 1826645 6419752 9702020 51203316 53973823 X 124741173 135801495 0 0 0 0 124741173 135801495 175944489 189775318 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1498632 0 1498632 90145895 0 39270453 50875442 1221483 0 870759 350724 59070085 0 38113363 20956722 718796 0 0 718796 74400316 Intercompany Receivable 1811752 Deferred Bond Financing Expenses 198456 2010208 Pledges Payable 80000 Early Retirement 101000 Pension Liability 9291020 Deferred Liability 230000 9702020 SchD_P10_S00_L00 Schedule D, Part X Not Applicable 1 0 1 X 1 X 1 1 0 1 1 3735555 1579538 2156017 0.02282 3687315 1626202 2061113 0.02182 7443427 4866416 2577011 0.02728 0 0 14866297 8072156 6794141 0.07192 75 7376 70477 5910 61567 0.00001 13 313 70412 0 70412 0.00001 2 4455629 2182118 2273511 0.02406 2 12000 0 12000 0.0 7 48026 0 48026 0.00001 99 7689 4656544 2188028 2465516 0.02409 99 7689 19522841 10260184 9259657 0.09601 0 1893432 67700 24909279 31810528 -6901249 X 1 0 Salem Community hospital

1995 East State Street Salem OH 44460

X X 15 bed skilled nursing unit Costs are determined by applying the ratio of cost to charges to gross charges. Costs for subsidized health services include those attributable to providing women's(obstetrics) and children's(pediatric) services in the combined total of $2,273,511. There are no subsidized health services attributable to a physician clinic. Excerpt from footnote: "The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers,patients and others. The Hospital provides an allowance for doubtful accounts based upon a review of outstanding receivables,historical collection information and existing economic conditions. As a service to the patient,the Hospital bills third-party payers directly and bills the patient when the patient's liabilty is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account." 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 eligibilty 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 asistance 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 classisified as bad debt ,would qualify for charity care. This judgement is based on the economic conditions of our area and specific knowledge of the patients involved. The costs were obtained from the Hospital's Medicare Cost Report. The Hospital incurred costs in excess of $31.8 million to care for and treat Medicare beneficiaries ,while receiving reimbursment of approx. $24.9 million; leaving a shortfall of $6.9 million. This was a direct health care benefit provided by the Hospital to the local Medicare beneficiaries who live in the surrounding communities. Per the Hospital's Charity Care policy,the Hospital will not pursue collection procedures for non-payment of bills,against individuals who demonstrate that they have neither sufficient income nor assets to meet their financial obligations. SCH formally assesses the healthcare needs of the communities that it serves on a minimum of a three year basis, and does so in collaboration with other community health providers. The most recent comprehensive, county-wide needs assessment was published in January 2009, and included collaboration with organizations such as the Hospital, Community Action Agency, Columbiana County Family and Children First Council, Columbiana County Job and Family Services, Ohio Department of Health, East Liverpool City Hospital and the Family Recovery Counseling Center. Quantitative and qualitative research for the study was performed by the Voinovich School Research Team from Ohio University. Needs identified as priorities from the 2009 county-wide assessment included: transportation, medication assistance and lack of access to primary care and specialty physicians. Interventions occurring as a result included additional transportation services to rural residents enabling increased access to health services; financial support of the county-wide medication assistance program, which yielded increased access to medications through the pharmaceutical companies; and ongoing recruitment and retention of primary care and specialty physicians. In addition, other needs assessments are conducted, such as the school health asset study, through the Search Institute, conducted on an annual basis with area school districts, and the cancer community health initiative, performed in collaboration with Tri-County Cancer Partners, including General Motors, American Cancer Society, and Humility of Mary Health Partners. 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. The Hospital's rural service area includes Columbiana County, excluding Yellow Creek and East Liverpool Townships, and the five lower townships of Mahoning county, which is officially designated as part of the Appalachian region. Columbiana County is also designated as Medically Underserved (MUP), and as a dental and mental health care Health Professional Shortage Area (HPSA).Columbiana and Mahoning 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. Area residents experience higher death rates for chronic diseases, such as heart disease, cerebrovascular disease, 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 brain, breast, colorectal, kidney, leukemia, liver, and lung cancers, and lymphoma. The county rates of death attributable to diabetes mellitus are approximately 25% higher than the state. Only 70.9% of Columbiana County residents aged 18-25 have completed high school or received a GED. As of October 2007, approximately 50.2% of Columbiana County households have incomes at or below the federal poverty level. Over 43% of public school students were eligible for free and reduced price school lunches, with eligibility determined if the household income is 130% of federal poverty level. 14% of the county's total population is uninsured, with 25.5% of this segment being uninsured children. 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. In order to provide services efficiently and cost-effectively, the Hospital also utilizes an active volunteer base, with 215 community members donating over 5,350 hours of volunteer service annually. In addition, the Hospital's Board of Directors is comprised of 17 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. For example, the cost of providing subsidized health services that are not self-sustaining is $2,273,511, and 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 2010, costs incurred by the Hospital for net charity care provided were $2,159,313; with unpaid costs of Medicaid representing $2,063,904; and unreimbursed costs from other government programs representing $2,585,487. 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. Beyond charity care, the Hospital seeks opportunities to further its tax exempt purpose by providing a wide variety of benefits for the broader community as determined by community need, including community education, screenings, social services for vulnerable populations, environmental improvements, workforce development and training, disaster preparedness, and collaborative community health needs assessments. Many of these educational programs, screenings, health fairs and outreach activities are provided in outlying school districts and communities within the Hospital's defined geographic service area, in an effort to increase regional access to health services and health resources for people of all ages. Salem Community Hospital also provides a free, telephone emergency response service for over 220 area residents, enabling elderly and physically disadvantaged individuals to live independently in their homes. In addition, the Hospital continues to serves 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 Ohio Department of Health, Columbiana County Safe Kids Coalition, Coordinated Action for School Health, Hospice of the Valley, Kent State University- Salem Campus, March of Dimes, Northeast Ohio Workforce Development, Northeastern Ohio Universities College of Medicine, Retried Senior Volunteer Program-Medication Assistance, Salem Area Visiting Nurses Association, Salem Community Center, Salem YWCA and Tri-County Community Health Initiative. 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; meeting space; and grant writing services to assist local health agencies. 1 Retired Senior Volunteer Program 966 1/2 North Market Street PO box 355 Lisbon OH 44432 341902451 501(c)(3) 12000 0 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 made to the respective grantee organization. Grantee organizations are also required to submit either itemized invoices for sub-contracted services and/or a detailed outcome report listing the number and types of services provided and the number of clients served. X X X X 0 1 0 0 0 0 0 0 0 Howard E Rohleder 292446 0 0 0 0 0 20447 0 12749 0 325642 0 0 0 Anita Hackstedde 205954 0 0 0 0 0 9371 0 600 0 215925 0 0 0 Mike Giangardella 177255 0 0 0 0 0 13936 0 11474 0 202665 0 0 0 Karen Kazel 159880 0 0 0 0 0 25416 0 6374 0 191670 0 0 0 Barbara Hirst 133794 0 0 0 0 0 13959 0 6374 0 154127 0 0 0 Keith Meredith 130347 0 0 0 0 0 8028 0 600 0 138975 0 0 0 Mark LItalien 121614 0 0 0 0 0 12133 0 19123 0 152870 0 0 0 Claudia Orsburn 109662 0 0 0 0 0 18463 0 600 0 128725 0 0 0 Donald Hughes 108670 0 0 0 0 0 8251 0 19123 0 136044 0 0 0 Kimberly Shea 112073 0 0 0 0 0 4711 0 19123 0 135907 0 0 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 A non-qualified deferred compensation plan exists for the CEO(Howard Rohleder).There were no employer contributions to the plan during the fiscal year. City of Salem Ohio 346002560 794424BY6 2005-09-15 37000000 Hospital Facility Construction 0 1 37000000 0 0 0 241580 170540 27596755 2008 0 1 1 1 0 1 0 0 1 0.0112 0 0.0112 1 0 1 0 0 0 1 Dave Dickey Director 194961 Payment made for electrical contracting services 0 Shawna L'Italien Director 0 The Director is married to the Director of Information Services 0 F990_P05_S00_L03b Form 990, Part V, Line 3b The organization has received an extension to file the Form 990-T until May 15,2011 F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 The final 990 is available for review by the governing body via email prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c On an annual basis, Directors and key employees disclose any potential business 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 meeting room prior to final discussion and for the 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, both of which are composed entirely of independent board members. The Committee evaluates market data through statewide salary surveys as well as targeted regional survey data. Their decision process is documented in their meeting minutes. This process was last completed in June 2009. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 As a private, not-for-profit organization, Salem Community Hospital does not make its governing documents or financial statements generally available to the public, although the Federal Form 990 is available for review upon request. 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 39140 169182 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 SCH Professional Corporation q 1068686 SCH Professional Corporation n 0 Salem Medical Arts & Development Corporation k 10400