2013-11-07T17:20:08-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET COLUMBUS OH 43215 990 2012-01-01 340714535 SAMARITAN REGIONAL HEALTH SYSTEM SAMA 4192890491 1025 CENTER STREET ASHLAND OH 44805 DANNY L BOGGS 4192890491 2013-10-29 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-02-24 21:20:13Z SEE SCHEDULE O DANNY L BOGGS 1025 CENTER STREET ASHLAND OH 44805 79102501 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 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 2012 WAS VALUED AT $2,460,000. DURING 2012, THE HOSPITAL ALSO PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. SEE PART III FOR ADETAILED LISTING OF THESE PROGRAMS. 15 12 665 190 2564196 -481089 537596 1298898 76395028 73144624 15034 -42545 5151818 4327352 82099476 78728329 2690576 40972 0 0 34360467 35203568 0 0 0 41976569 42033574 79027612 77278114 3071864 1450215 75191324 72908236 29268362 28432281 45922962 44475955 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 68104420 40972 73144624 SEE SCHEDULE O 68104420 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 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 1 0 0 0 0 1 1 1 0 0 1 51 0 1 665 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 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 11.00 X X 387147 0 34979 STEPHEN L STUART PHD 2.00 1.00 X X 0 0 0 HAROLD KEENER PHD 2.00 0.00 X X 0 0 0 ANNE BEER 2.00 1.00 X X 0 0 0 MARY MACDONALD MD 2.00 40.00 X 0 357290 42018 MICHAEL MARTIN MD 2.00 0.00 X 2300 0 0 PAUL R MYERS 2.00 1.00 X 0 0 0 JERRY SEITER 2.00 0.00 X 0 0 0 VICKY STEPHENSON 2.00 0.00 X 0 0 0 MICHAEL D STENCEL MD 2.00 0.00 X 11000 0 0 ROGER KRAMER CPA 2.00 1.00 X 0 0 0 POLLY CHANDLER START 82812 2.00 0.00 X 0 0 0 RALPH KELSAY START 42612 2.00 0.00 X 0 0 0 ROGER HARRAMAN THRU 42612 2.00 0.00 X 0 0 0 TIM COWEN 2.00 1.00 X 0 0 0 SUE HEIMANN 2.00 0.00 X 0 0 0 MARY L GRIEST 40.00 5.00 X 174922 0 23707 CHRISTOPHER HUNT 40.00 0.00 X 156251 0 15642 PHILIP MYERS MD 40.00 1.00 X 165578 0 24508 RONALD MANCHESTER 40.00 0.00 X 148757 0 18361 ALYCE LEGG 40.00 0.00 X 140562 0 19962 KARIN SCHWAN 40.00 0.00 X 131689 0 27265 JEFFREY COOK 40.00 0.00 X 121123 0 23348 1439329 357290 229790 14 0 1 0 CERNER CORPORATION PO BOX 412702 KANSAS CITY MO 64141 IT SERVICES 1304373 SIEMENS MEDICAL SOLUTIONS USA C/O MELLON BANK PO BOX 120001 DEPT DALLAS TX 753120733 IT MANAGEMENT SERVICES 1155247 CARETECH SOLUTIONS PO BOX 764271 DETROIT MI 482674271 IT SERVICES 1088941 HMP OF ASHLAND PO BOX 645037 CINCINNATI OH 452645037 HOSPITALISTS 984154 ASHLAND ANESTHESIA PSC INC C/O COMPREHENSIVE MEDICAL MGMT 601 NEWPORT KY 41070 ANESTHESIA SERVICES 976914 15 1168127 130771 93853 1298898 PATIENT SERVICES 900099 73018832 73018832 RENTS FROM AFFILIATE 900099 125792 125792 73144624 303537 331627 -28090 -28090 -28090 42545 -42545 -42545 -42545 PHARMACY RETAIL 446110 2170668 2170668 OTHER SERVICES- LAB 621500 1176394 651 1175743 ARRA INCENTIVE PAYMENTS 621110 262574 262574 745806 392877 352929 4355442 78728329 73144624 2564196 1720611 X 40972 40972 566888 11000 555888 24515819 19612655 4903164 1516102 1212882 303220 6795550 5436440 1359110 1809209 1447367 361842 55967 55967 92200 92200 10037877 9928124 109753 46264 46264 1340980 1079489 261491 175916 175916 3060961 3060961 222070 177656 44414 432681 432681 6315335 6315335 583227 466582 116645 MEDICAL SUPPLIES 14700937 14700937 PROVISION FOR BAD DEBTS 3507707 3507707 OHIO FRANCHISE FEE 1010000 1010000 EDUCATION PROGRAMS 157992 157992 293460 293460 77278114 68104420 9173694 0 3009771 14268323 17149461 9140377 2322781 1606139 1456549 1503288 2559537 1923211 104445744 62358181 46239008 42087563 112207 59979 2342010 2319356 75191324 72908236 8486076 7575230 17616323 16625246 221321 170485 2944642 4061320 29268362 28432281 X 45802010 44371927 120952 104028 45922962 44475955 75191324 72908236 X 1450215 66783 -2964003 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6292 6292 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MEMBERSHIP DUES IN THE AMOUNT OF $20,126 AND $27,659 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, RESPECTIVELY. $4,826 AND $1,466 OF THE DUES PAYMENTS WERE FOR LOBBYING EXPENSES. 2346208 2346208 17169160 7969807 9199353 2105226 1627783 477443 41021159 29487983 11533176 41803991 23272608 18531383 42087563 COST REPORT SETTLEMENT PAYABLE 3318375 INTEREST RATE SWAP 742945 4061320 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILTIY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM FILES FEDERAL AND STATE TAX RETURNS AND IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE FISCAL YEAR 2009. 1 1 X 1 X 1 X 1 1 0 1 1 2631528 769155 1862373 0.02430 7658765 4208758 3450007 0.04500 10290293 4977913 5312380 0.06930 110479 4140 106339 0.00140 621 621 0.00000 33163 33163 0.00040 144263 4140 140123 0.00180 10434556 4982053 5452503 0.07110 320 320 0.00000 1741 1741 0.00000 12439 12439 0.00020 88 88 0.00000 14588 14588 0.00020 1 3507707 118789 11353434 15052281 -3698847 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 1 200.000000000000 1 X X 1 1 X X X X 1 0 1 X 0 0 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 I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3507707. PART II: SAMARITAN PROVIDES A NUMBER OF FREE TO THE PUBLIC EDUCATIONAL SEMINARS 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 2012 WAS $15,052,281. THE PAYMENTS RELATED TO THESE SERVICES WERE $11,353,434. LEAVING A MEDICARE SHORTFALL OF $3,698,847 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 12H: FAMILY SIZE IS USED TO DETERMINE CHARGES TO PATIENTS SAMARITAN REGIONAL HEALTH SYSTEM PART V, SECTION B, LINE 20D: 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 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. 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 SEVERLY 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 MEDICAL FINANCIAL ASSISTANCE 17 40972 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 X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 DANNY L BOGGS 332046 0 47582 0 7519 0 29100 0 5879 0 422126 0 0 0 MARY MACDONALD MD 0 329261 0 11000 0 17029 0 29100 0 12918 0 399308 0 0 MARY L GRIEST 162856 0 9127 0 2939 0 18895 0 4812 0 198629 0 0 0 CHRISTOPHER HUNT 139140 0 7216 0 9895 0 15642 0 0 0 171893 0 0 0 PHILIP MYERS MD 160778 0 4800 0 0 0 18629 0 5879 0 190086 0 0 0 RONALD MANCHESTER 133321 0 7034 0 8402 0 15177 0 3184 0 167118 0 0 0 ALYCE LEGG 131192 0 7532 0 1838 0 14981 0 4981 0 160524 0 0 0 KARIN SCHWAN 123442 0 7095 0 1152 0 14347 0 12918 0 158954 0 0 0 PART I, LINE 1A AIRFARE OF $538 FOR THE CEO'S SPOUSE IS REPORTED ON FORM W2, BOX 5. THE PRESIDENT/CEO RECEIVES HEALTH/SOCIAL CLUB DUES WHICH ARE NON TAXABLE. THE HOSPITAL IS REIMBURSED FOR ANY PERSONAL USE. A COUNTY OF ASHLAND OHIO 346000122 2008-12-19 9500000 ED & OB BUILDING & STRUCTURE RENOVATION & IMPROVEMENTS; EQUIPMENT 1 0 0 B COUNTY OF ASHLAND OHIO 346000122 2009-01-09 4495023 REFUND PRIOR ISSUE 1 0 0 C COUNTY OF ASHLAND OHIO 346000122 2009-01-27 6004977 BUILDING & STRUCTURE RENOVATION; EQUIPMENT 1 0 0 A 1602959 9665616 119942 1744 9543930 2010 0 0 1 1 B 751923 4495023 4495023 4495023 2006 1 0 1 1 C 1019872 6208273 41424 57 6166792 2011 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 1 FIFTH THIRD BANK 6.900000000000 0 0 0 0 0 B 0 0 1 0 1 1 FIFTH THIRD BANK 6.900000000000 0 0 0 0 0 C 0 0 0 0 1 1 FIFTH THIRD BANK 6.900000000000 0 0 0 0 0 X EQUIPMENT 3 93853 COST OF THE EQUIPMENT 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 SAME DATA WAS USED FOR WAGE DECISIONS IN 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. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACT SERVICES- MEDICAL: PROGRAM SERVICE EXPENSES 6,108,933. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,108,933. CONTRACT SERVICES- NON PATIENT: PROGRAM SERVICE EXPENSES 3,500,543. MANAGEMENT AND GENERAL EXPENSES 108,264. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,608,807. WASTE MANAGEMENT: PROGRAM SERVICE EXPENSES 48,134. MANAGEMENT AND GENERAL EXPENSES 1,489. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,623. COLLECTION FEES: PROGRAM SERVICE EXPENSES 270,514. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 270,514. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: INTERCOMPANY EQUITY TRANSFERS -3,047,807. NET ASSETS RELEASED FROM RESTRICTION 83,804. 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 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 2012 WAS VALUED AT $2,460,000. DURING 2012, THE HOSPITAL ALSO PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. PROGRAM - NET EXPENSE - PERSONS SERVED: COMMUNITY HEALTH IMPROVEMENT SERVICES - $96,065 - 1,411 HEALTH PROFESSIONS EDUCATION - $621 - 16 SUBSIDIZED HEALTH SERVICES - $4,196,400 - UNKNOWN FINANCIAL AND IN-KIND CONTRIBUTIONS - $33,163 - 1,183 COMMUNITY BUILDING ACTIVITIES - $14,588 - UNKNOWN COMMUNITY BENEFIT OPERATIONS - $14,414 - UNKNOWN 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 0 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 1 SAMARITAN PROFESSIONAL CORPORATION A 323410 ACTUAL RENT RECORDED SAMARITAN PROFESSIONAL CORPORATION S 2763949 CASH VALUE SAMARITAN HOSPITAL FOUNDATION C 1168127 ACTUAL CONTRIBUTIONS RECEIVED SAMARITAN HOSPITAL FOUNDATION K 228500 ACTUAL LEASE PAYMENT SAMARITAN PROFESSIONAL CORPORATION L 304873 ACTUAL PAYROLL PAYMENT SAMARITAN PROFESSIONAL CORPORATION O 98873 PAYROLL SAMARITAN HOSPITAL FOUNDATION S 283858 CASH VALUE