2012-04-25T15:21:16-07:00 2011-06-30 990 2010-07-01 341041385 SALEM COMMUNITY HOSPITAL SALE 3303327214 1995 East State Street Salem OH 44460 Michael Giangardella 3303327214 2012-04-26 2010 2016-02-24 21:20:13Z Howard Rohleder 1995 East State Street Salem OH 44460 97855782 0 X www.salemhosp.com X 1913 OH Salem Community Hospital (SCH) is a 184-licensed 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. 19 17 1051 215 2061081 0 111399 118471 96283703 92685567 3263446 4199313 505698 557363 100164246 97560714 60185 19644 0 0 48752431 48318558 0 0 0 45668390 46714552 94481006 95052754 5683240 2507960 189775318 204224659 53973823 42884461 135801495 161340198 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 68296976 92685567 The Hospital's mission is to provide quality care to the sick and injured on both an inpatient and outpatient basis, and address 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 2011, the Hospital provided comprehensive healthcare services including: 5,734 Admissions; 3,784 Surgeries; and 27,180 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 services, and the Hospital's costs for supporting this service was $1,009,000. If this program was 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 2011, costs incurred by the Hospital for net charity care provided were $2,117,000 million, with unpaid costs of Medicaid and other public programs representing $5,148,000 million, and unreimbursed costs from other governmental programs representing $8,658,000 million. These community benefits, arising from patient care provided by the Hospital are documented to substantiate activity that relieves a financial and programmatic burden that would otherwise fall to the Government or another charity. This is done in furtherance of the Hospital's charitable mission. 0 0 0 68296976 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 1 0 0 0 0 0 0 0 1 1 1 0 0 1 73 0 1 1051 1 1 1 0 0 0 0 1 0 0 0 0 0 X 19 17 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 John Dilling 1 X X 0 0 0 Catherine Hubbs 1 X X 0 0 0 Matt Bender 1 X X 0 0 0 Derek Hiscox 1 X 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 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 Dave Mollenkopf 1 X 0 0 0 Dave Gano 1 X 0 0 0 Jeffrey Cohen MD 1 X 0 0 0 Angela Doty MD 6 X 20000 0 0 John Biastro 1 X 0 0 0 Todd Olson 1 X 0 0 0 Howard E Rohleder 40 X 291188 0 48484 Anita Hackstedde 40 X 221930 0 23889 Mike Giangardella 40 X 175769 0 37065 Barbara Hirst 40 X 133239 0 35603 Karen Kazel 40 X 158755 0 61949 Keith Meredith 40 X 129815 0 16161 Mark LItalien 40 X 117656 0 43493 Stephen Ferenchak 40 X 112355 0 29191 Kimberly Meeks 40 X 108322 0 26654 Donald Hughes 40 X 104963 0 35177 1573992 0 357666 12 0 1 0 Inpatient Medical Services Inc 822 Kumho Drive Suite 202 Fairlawn OH 44333 Medical Services 827970 Associates in Anesthesiology Inc PO Box 2190 Youngstown OH 44504 Medical Services 597919 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 390465 The Murphy Contracting Company 285 Andrews Avenue Youngstown OH 44505 Construction Services 323695 17 0 0 16398 0 0 102073 0 118471 Patient Service Revenue 622000 90624486 90624486 0 0 Patient Service Revenue 621500 1121544 0 1121544 0 Patient Service Revenue 621610 939537 0 939537 0 0 0 0 0 92685567 4192813 0 0 4192813 0 0 0 0 0 0 0 0 268354 0 273540 0 -5186 0 -5186 0 0 -5186 0 6500 0 0 0 6500 6500 0 0 6500 11757 16398 21528 -9771 0 -9771 Dietary Income 900099 503931 503931 0 0 Chart Fees/Medical Records 900099 31106 31106 0 0 37283 37283 0 0 572320 97560714 91196806 2061081 4184356 19644 19644 1211458 1211458 36776124 27233595 9542529 2336535 1536012 800523 5164676 3542693 1621983 2829765 2054369 775396 58622 58622 64193 64193 7297290 4430160 2867130 414456 414456 16863942 14891750 1972192 2526038 2526038 4192736 2757607 1435129 101392 18898 82494 315140 315140 8785942 6576218 2209724 698336 628183 70153 Bad Debts 4607847 4607847 0 0 State Franchise Fee 754459 0 754459 0 34159 34159 95052754 68296976 26755778 0 6325841 3512178 7539180 7856791 4895 3263 658216 648671 2445499 3623721 156346123 87176714 74400316 69169409 96391163 119221171 2010208 189455 189775318 204224659 9095158 9085818 33350000 32100000 1826645 1381643 9702020 317000 53973823 42884461 X 135801495 161340198 0 0 0 0 135801495 161340198 189775318 204224659 X 2507960 23030743 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1498632 0 1498632 90727847 0 42345460 48382387 1276681 0 957459 319222 62119885 0 43873795 18246090 723078 0 0 723078 69169409 Pledges Payable 40000 Early Retirement 47000 Deferred Liability 230000 317000 Dinner Party 28155 16398 11757 0 0 600 10397 1400 9131 0 0 28155 16398 11757 0 0 600 10397 1400 9131 21528 -9771 1 1 1 X 1 X 1 1 0 1 1 3568376 1451409 2116967 0.0223 37714720 2076790 1694682 0.0178 8703150 5249897 3453253 0.0363 0 0 49986246 8778096 7264902 0.0764 39 11396 104050 10968 93082 0.0009 15 407 456014 0 456014 0.0048 1 3142043 2132565 1009479 0.0106 32 4466 41370 41370 0.0004 87 16269 3743477 2143533 1599945 0.0167 87 16269 53729723 10921629 8864847 0.0931 1 500 500 8 218 8566 8566 0.0001 4 1975 17581 17581 0.0002 2 200 2509 2509 0.00003 5 160 3653 3653 0.00003 5 3827 3827 0.00003 10 4030 4030 0.00004 7 345 2145 2145 0.00003 42 2898 42811 0 42811 0.00046 0 2121521 111546 23063048 31721056 -8658008 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 1 150 1 350 1 X X X X X 1 1 X X 1 X X X 1 X X X X X 0 X X 0 0 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 Community Benefit section, summarizing the Hospital's community education and outreach activities, as well as its statement of expenses and uncompensated care. 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. Beyond charity care, "Other Benefits" reported include community health improvement services and community benefit operations, with community building activities listed in Part II. The Hospital seeks opportunities to further its tax exempt purpose by providing a wide variety of benefits for the broader community, such as community health improvement services, community benefit operations and community building activities. Examples of these programs include, but are not limited to: participation in community health needs assessments and grant-writing activities for improved community health; health professionals education for nurses, therapists (physical, occupational, speech, and respiratory), medical imaging technologists and dietitians; financial and in-kind contributions for summer feeding programs and community food pantries, blood drives, social services for vulnerable populations (including assistance with medications, transportation, limited English proficiency and referrals to support systems); community health education for breast health, cancer, diabetes, weight management, advance directives and women's health; and community health fairs and free clinical screenings for high blood pressure, cholesterol, blood sugar, bone density and pulmonary lung functions. 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. It is estimated that approximately 16,270 area residents participated in community benefit programs and/or events provided and/or sponsored by the Salem Community Hospital. The 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. SchH_P01_S00_L07g Schedule H, Part I, Line 7g Costs for subsidized health services include those attributable to providing women's obstetrics services in the amount of 1,009,000. There are no subsidized health services attributable to a physician clinic. SchH_P02_S00_L00 Schedule H, Part II During the taxable year, the Hospital participated in 42 different community building activities in an effort to address the root causes of area health problems, such as those related to poverty and the environment. The Hospital assisted an area school district with obtaining funding for a community garden; 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 mentoring opportunities. 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 Salem City Departments 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, Northeast Ohio Medical University, Retried Senior Volunteer Program-Medication Assistance, Salem Area Visiting Nurses Association, and 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; meeting space; and grant writing services to assist local health agencies. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Excerpt from footnote: The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers 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 liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on the 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 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 our area and 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 $31.7 million to care for and treat Medicare beneficiaries,while receiving reimbursement of approximately $23.1 million;leaving a shortfall of $8.6 million. This was a direct health care benefit provided by the Hospital to the 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 procedures 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_L13 Schedule H, Part V, Section B, Line 13 The availability of free or discounted care is provided on billing statements sent to patients. SchH_P05_S0B_L18 Schedule H, Part V, Section B, Line 18 The Hospital provides ,without charge,care for basic medically necessary care. Such care is not limited to emergency situations. SchH_P05_S0B_L19 Schedule H, Part V, Section B, Line 19 The Hospital's uninsured/underinsured policy,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 the 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 bi-annual 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 Ohio University's Voinovich School Research Team. 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. 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 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, 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 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. 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. Poverty is also a factor with approximately one-third of the county's population at or below 200% of the federal poverty level, and 21% of adults being uninsured. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Hospital's mission is to provide quality care to the sick and injured on both and inpatient and outpatient basis, and address 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. 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 2011, the Hospital provided comprehensive healthcare services including: 5,734 Admissions; 3,784 Surgeries; and 27,180 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 services, and the Hospital's costs for supporting this service is $1,009,000. If this program was 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 2011, costs incurred by the Hospital for net charity care provided were $2,117,000 million, with unpaid costs of Medicaid and other public programs representing $5,148,000 million, and unreimbursed costs from other governmental programs representing $8,658,000 million. 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 215 community members donating over 13,073 hours of volunteer service annually. In addition, the Hospital's Board of Directors is comprised of 19 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) 9000 Medical Assistance Program 1 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 Schedule I, Part I, Line 2 - The allocation and utilization of grant funds are monitored through the required tracking and reporting of specfic 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 291188 0 0 0 0 0 36237 0 12247 0 339672 0 0 Anita Hackstedde 221930 0 0 0 0 0 12867 0 11022 0 245819 0 0 Mike Giangardella 175769 0 0 0 0 0 26043 0 11022 0 212834 0 0 Karen Kazel 158755 0 0 0 0 0 55826 0 6123 0 220704 0 0 0 Barbara Hirst 133239 0 0 0 0 0 29480 0 6123 0 168842 0 0 0 Keith Meredith 129815 0 0 0 0 0 10038 0 6123 0 145976 0 0 0 Mark LItalien 117656 0 0 0 0 0 25123 0 18370 0 161149 0 0 0 Stephen Ferenchak 112355 0 0 0 0 0 16438 0 12753 0 141546 0 0 0 Kimberly Meeks 108322 0 0 0 0 0 7524 0 19130 0 134976 0 0 0 Donald Hughes 104963 0 0 0 0 0 16807 0 18370 0 140140 0 0 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 A non-qualified deferred compensation plan exists for the CEO. 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 0 4900000 0 37000000 0 824965 0 241580 168740 1800 27596755 9200000 0 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 39217 Payment made for electrical contracting services 0 F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b 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 potential business or professional relationships they may have with the organization and/or other Directors/Key employess. In situations when a Director has a conflict ,they may participate in the discussion,but leave the 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. 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 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. F990_P11_S00_L05 Form 990, Part XI, Line 5 Investment return- change in unrealized gains on other than trading securities of $15,917,277. Defined benefit pension plan- net gain of $10,106,808. Fund balance transfer to related organization of ($2,993,342). 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 42480 213398 1 0 1 0 0 0 0 0 0 1 0 1 0 0 1 0 0 1 0 SCH Professional Corporation b 2993342 SCH Professional Corporation i 92640 SCH Professional Corporation n 87382 SCH Professional Corporation q 1088950 Salem Medical Arts & Development Corporation k 10400