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SALEM COMMUNITY HOSPITAL: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
SALEM COMMUNITY HOSPITAL (EIN 34-1041385)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-02-11
IRS object ID
201120429349301822
Schema version
2009v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-02-11T14:45:54-07:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN341041385EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SALEM COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSALENameControl
Phone3303327214Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11995 East State StreetAddressLine1
CitySalemCity
StateOHState
ZIP Code44460ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMichael GiangardellaName
TitleVP Finance/AdministrationTitle
Phone3303327214Phone
Date Signed2011-02-11DateSigned
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMichael GiangardellaNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11995 East State StreetAddressLine1
CitySalemCity
StateOHState
ZIP Code44460ZIPCode
FieldValueIRS element (for citing)
Gross Receipts100442492GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.salemhosp.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1913YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionSalem 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members18NbrIndependentVotingMembers
Total Nbr Employees1085TotalNbrEmployees
Total Nbr Volunteers235TotalNbrVolunteers
Total Gross UBI2139413TotalGrossUBI
Net Unrelated Business Txbl Income-83845NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year129057ContributionsGrantsPriorYear
Contributions Grants Current Year111399ContributionsGrantsCurrentYear
Program Service Revenue Prior Year99672526ProgramServiceRevenuePriorYear
Program Service Revenue CY96283703ProgramServiceRevenueCY
Investment Income Prior Year1550693InvestmentIncomePriorYear
Investment Income Current Year3263446InvestmentIncomeCurrentYear
Other Revenue Prior Year651165OtherRevenuePriorYear
Other Revenue Current Year505698OtherRevenueCurrentYear
Total Revenue Prior Year102003441TotalRevenuePriorYear
Total Revenue Current Year100164246TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year45244GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY60185GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year48190851SalariesEtcPriorYear
Salaries Etc Current Year48752431SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year47390430OtherExpensePriorYear
Other Expenses Current Year45668390OtherExpensesCurrentYear
Total Expenses Prior Year95626525TotalExpensesPriorYear
Total Expenses Current Year94481006TotalExpensesCurrentYear
Revenues Less Expenses Prior Year6376916RevenuesLessExpensesPriorYear
Revenues Less Expenses CY5683240RevenuesLessExpensesCY
Total Assets BOY175944489TotalAssetsBOY
Total Assets EOY189775318TotalAssetsEOY
Total Liabilities BOY51203316TotalLiabilitiesBOY
Total Liabilities EOY53973823TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY124741173NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY135801495NetAssetsOrFundBalancesEOY
Mission DescriptionSCH'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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense67872380Expense
Revenue96283703Revenue
DescriptionThe 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.Description
Total Of Other Program Service Exp0TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense67872380TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109672NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1085NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed0Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members18NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMichael GiangardellaNamePerson
Telephone Number3303327214TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11995 East State StreetAddressLine1
CitySalemCity
StateOHState
ZIP Code44460ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Kevin Snyder
Chairman1X000
John Dilling
Vice Chairman1X000
Catherine Hubbs
Secretary1X000
John Haller
Treasurer1X000
Greg Bestic
Director1X000
Dave Dickey
Director1X000
Bill McDevitt
Director1X000
Derek Hiscox
Director1X000
Shawna L'Italien
Director1X000
J C Paumier MD
Director1X000
Jon Rettig Sr
Director1X000
Dick Wilk
Director1X000
Matt Bender
Director1X000
Dave Mollenkopf
Director1X000
Dave Gano
Director1X000
Jeffrey Cohen MD
Director1X000
LT Simon MD
Director1X000
Angela Doty MD
Director1X000
Howard E Rohleder
President/CEO40292446033196X
Anita Hackstedde
VP Medical Affairs4020595409971X
Mike Giangardella
VP Finance/Admin.40177255025410X
Karen Kazel
VP Clinical Operations40159880031790X
Barbara Hirst
VP Human Resources40133794020333X
Keith Meredith
Director Pharmacy4013034708628X
Mark LItalien
Director Information Services40121614031256X
Claudia Orsburn
Director of Nursing40109662019063X
Donald Hughes
Pharmacist4010867000X
Kimberly Shea
Pharmacist40112073023834X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1551695TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation203481TotalOtherCompensation
Number Individuals GT100 K15NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensationAddress Line2AddressOfContractor/AddressUS/AddressLine2
Associates in Anesthesiology Inc
PO Box 2190YoungstownOH44504Medical Services867525
Inpatient Medical Services Inc
822 Kumho DriveFairlawnOH44333Medical Services817368Suite 202
Paris Healthcare Linen Service
67 Hoover AvenueDuboisPA15801Linen Service420000PO Box 1043
Alliance Healthcare Services
PO Box 96485ChicagoIL60693Healthcare Services319210
Securitas Security Services
PO Box 403412AtlantaGA30384Security Services311342
FieldValueIRS element (for citing)
Number Of Contractors GT100 K17NumberOfContractorsGT100K
Federated Campaigns0FederatedCampaigns
Membership Dues0MembershipDues
Fundraising Events0FundraisingEvents
Related Organizations0RelatedOrganizations
Government Grants0GovernmentGrants
All Other Contributions111399AllOtherContributions
Noncash Contributions0NoncashContributions
Total Contributions111399TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Patient Service Revenue62200094144290941442900$0
Patient Service Revenue621500118649101186491$0
Patient Service Revenue6216109529220952922$0

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue96283703TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3263446TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$3,263,446ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real290879Real
Personal0Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real278246Real
Personal0Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real12633Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column12633TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$12,633ExclusionAmount

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other0Other
FieldValueIRS element (for citing)
Cntrbtns Rprtd Fundraising Events0CntrbtnsRprtdFundraisingEvents

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Dietary Income9000994192244192240$0
Chart Fees/Medical Records90009927435274350$0
Gift Shop900099568456840$0

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column40722TotalRevenueColumn
Related Or Exempt Function Income40722RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue493065TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column100164246TotalRevenueColumn
Related Or Exempt Function Income94637355RelatedOrExemptFunctionIncome
Unrelated Business Revenue2139413UnrelatedBusinessRevenue
Exclusion$3,276,079ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total60185Total
Program Services60185ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1100029Total
Management And General1100029ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total36607517Total
Program Services26956404ProgramServices
Management And General9651113ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2471499Total
Program Services1665692ProgramServices
Management And General805807ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5707650Total
Program Services3790545ProgramServices
Management And General1917105ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2865736Total
Program Services2049893ProgramServices
Management And General815843ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total17338Total
Management And General17338ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total50396Total
Management And General50396ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6729710Total
Program Services4076766ProgramServices
Management And General2652944ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total406087Total
Management And General406087ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total16672399Total
Program Services14870036ProgramServices
Management And General1802363ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2247417Total
Management And General2247417ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4258137Total
Program Services2834796ProgramServices
Management And General1423341ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total165187Total
Program Services35076ProgramServices
Management And General130111ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total281851Total
Management And General281851ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total8752401Total
Program Services6752161ProgramServices
Management And General2000240ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total702398Total
Program Services632508ProgramServices
Management And General69890ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Bad Debts4148318414831800
Franchise fee1236751012367510

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total94481006Total
Program Services67872380ProgramServices
Management And General26608626ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY5443440BOY
EOY6325841EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8369053BOY
EOY7539180EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY10078BOY
EOY4895EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY581305BOY
EOY658216EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2444298BOY
EOY2445499EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis152654891LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec78254575LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY78072338BOY
EOY74400316EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY80073456BOY
EOY96391163EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY950521BOY
EOY2010208EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY175944489BOY
EOY189775318EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY10157708BOY
EOY9095158EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY34600000BOY
EOY33350000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY25856BOY
EOY1826645EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6419752BOY
EOY9702020EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY51203316BOY
EOY53973823EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY124741173BOY
EOY135801495EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY124741173BOY
EOY135801495EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY175944489BOY
EOY189775318EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1498632InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Book Value1498632BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis90145895InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation39270453Depreciation
Book Value50875442BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1221483InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation870759Depreciation
Book Value350724BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis59070085InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation38113363Depreciation
Book Value20956722BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis718796InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value718796BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings74400316TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
Intercompany Receivable1811752
Deferred Bond Financing Expenses198456
FieldValueIRS element (for citing)
Total Book Value Other Assets2010208TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Pledges Payable$80,000
Early Retirement$101,000
Pension Liability$9,291,020
Deferred Liability$230,000
FieldValueIRS element (for citing)
Total Of Amounts9702020TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierSchD_P10_S00_L00Identifier
Return ReferenceSchedule D, Part XReturnReference
ExplanationNot ApplicableExplanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy0WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent350XPcent350
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3735555TotalCommunityBenefitExpense
Direct Offsetting Revenue1579538DirectOffsettingRevenue
Net Community Benefit Expense2156017NetCommunityBenefitExpense
Percent Of Total Expense0.02282PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense3687315TotalCommunityBenefitExpense
Direct Offsetting Revenue1626202DirectOffsettingRevenue
Net Community Benefit Expense2061113NetCommunityBenefitExpense
Percent Of Total Expense0.02182PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense7443427TotalCommunityBenefitExpense
Direct Offsetting Revenue4866416DirectOffsettingRevenue
Net Community Benefit Expense2577011NetCommunityBenefitExpense
Percent Of Total Expense0.02728PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Benefit Expense14866297TotalCommunityBenefitExpense
Direct Offsetting Revenue8072156DirectOffsettingRevenue
Net Community Benefit Expense6794141NetCommunityBenefitExpense
Percent Of Total Expense0.07192PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs75NumberOfActivitiesOrPrograms
Persons Served7376PersonsServed
Total Community Benefit Expense70477TotalCommunityBenefitExpense
Direct Offsetting Revenue5910DirectOffsettingRevenue
Net Community Benefit Expense61567NetCommunityBenefitExpense
Percent Of Total Expense0.00001PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs13NumberOfActivitiesOrPrograms
Persons Served313PersonsServed
Total Community Benefit Expense70412TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense70412NetCommunityBenefitExpense
Percent Of Total Expense0.00001PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Benefit Expense4455629TotalCommunityBenefitExpense
Direct Offsetting Revenue2182118DirectOffsettingRevenue
Net Community Benefit Expense2273511NetCommunityBenefitExpense
Percent Of Total Expense0.02406PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Benefit Expense12000TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense12000NetCommunityBenefitExpense
Percent Of Total Expense0.0PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Total Community Benefit Expense48026TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense48026NetCommunityBenefitExpense
Percent Of Total Expense0.00001PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs99NumberOfActivitiesOrPrograms
Persons Served7689PersonsServed
Total Community Benefit Expense4656544TotalCommunityBenefitExpense
Direct Offsetting Revenue2188028DirectOffsettingRevenue
Net Community Benefit Expense2465516NetCommunityBenefitExpense
Percent Of Total Expense0.02409PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs99NumberOfActivitiesOrPrograms
Persons Served7689PersonsServed
Total Community Benefit Expense19522841TotalCommunityBenefitExpense
Direct Offsetting Revenue10260184DirectOffsettingRevenue
Net Community Benefit Expense9259657NetCommunityBenefitExpense
Percent Of Total Expense0.09601PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,893,432BadDebtExpenseAmount
Amount Attributable To67700AmountAttributableTo
Amount Reimbursed By Medicare24909279AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare31810528CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-6901249MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1Salem Community hospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11995 East State StreetAddressLine1
CitySalemCity
StateOHState
ZIP Code44460ZIPCode
FieldValueIRS element (for citing)
General Medical And SurgicalXGeneralMedicalAndSurgical
Er OtherXErOther
Other15 bed skilled nursing unitOther

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Costing Method UsedCosts are determined by applying the ratio of cost to charges to gross charges.CostingMethodUsed
Subsidized Health Services ExplnCosts 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.SubsidizedHealthServicesExpln
Bad Debt FootnoteExcerpt 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.BadDebtFootnote
Shortfall As Community BenefitThe 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.ShortfallAsCommunityBenefit
Debt Collection PolicyPer 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.DebtCollectionPolicy
Needs AssessmentSCH 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.NeedsAssessment
Patient Education AssistanceThe 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.PatientEducationAssistance
Community InformationThe 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.CommunityInformation
Other InformationThe 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.OtherInformation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Retired Senior Volunteer ProgramBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1966 1/2 North Market StreetAddressLine1
Address Line2PO box 355AddressLine2
CityLisbonCity
StateOHState
ZIP Code44432ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient341902451EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant12000AmountOfCashGrant
Amount Of Non Cash Assistance0AmountOfNonCashAssistance
Purpose Of GrantMedication Assistance ProgramPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSchI_P01_S00_L02Identifier
Return ReferenceSchedule I, Part I, Line 2ReturnReference
ExplanationThe 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Howard E Rohleder
29244600000204470127490325642000
Anita Hackstedde
20595400000937106000215925000
Mike Giangardella
17725500000139360114740202665000
Karen Kazel
1598800000025416063740191670000
Barbara Hirst
1337940000013959063740154127000
Keith Meredith
13034700000802806000138975000
Mark LItalien
12161400000121330191230152870000
Claudia Orsburn
109662000001846306000128725000
Donald Hughes
1086700000082510191230136044000
Kimberly Shea
1120730000047110191230135907000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSchJ_P01_S00_L04Identifier
Return ReferenceSchedule J, Part I, Line 4ReturnReference
ExplanationA non-qualified deferred compensation plan exists for the CEO(Howard Rohleder).There were no employer contributions to the plan during the fiscal year.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of Salem OhioBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN346002560IssuerEIN
CUSIP Number794424BY6CUSIPNumber
Date Issued2005-09-15DateIssued
Issue Price37000000IssuePrice
Description Of PurposeHospital Facility ConstructionDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer1OnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds37000000TotalProceeds
Amount In Reserve Fund0AmountInReserveFund
Amount Defeased0AmountDefeased
Amount Unspent0AmountUnspent
Issuance Costs From Proceeds241580IssuanceCostsFromProceeds
Working Capital Expenditures170540WorkingCapitalExpenditures
Capital Expenditures27596755CapitalExpenditures
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements1AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged1BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.0112PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0PercentageOfPrvtBusinessReUBI
Total Private Business Use0.0112TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate1ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Dave Dickey
Director194961Payment made for electrical contracting services0
Shawna L'Italien
Director0The Director is married to the Director of Information Services0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
F990_P05_S00_L03bForm 990, Part V, Line 3bThe organization has received an extension to file the Form 990-T until May 15,2011
F990_P06_S0B_L11Form 990, Part VI, Section B, Line 11The final 990 is available for review by the governing body via email prior to filing.
F990_P06_S0B_L12cForm 990, Part VI, Section B, Line 12cOn 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_L15Form 990, Part VI, Section B, Line 15The 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_L19Form 990, Part VI, Section C, Line 19As 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1SCH Professional CorporationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11995 East State StreetAddressLine1
CitySalemCity
StateOHState
ZIP Code44460ZIPCode
FieldValueIRS element (for citing)
EIN341764515EIN
Primary ActivitiesPhysician OfficesPrimaryActivities
Legal Domicile StateOHLegalDomicileState
Exempt Code Section501(c)(3)ExemptCodeSection
Public Charity Status11PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Salem Medical Arts & Development CorporationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12020 East State StreetAddressLine1
CitySalemCity
StateOHState
ZIP Code44460ZIPCode
FieldValueIRS element (for citing)
EIN341049534EIN
Primary ActivityOffice RentPrimaryActivity
Legal Domicile StateOHLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Share Of Total Income39140ShareOfTotalIncome
Share Of EOY Assets169182ShareOfEOYAssets
Percentage Ownership1PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
SCH Professional Corporation
q1068686
SCH Professional Corporation
n0
Salem Medical Arts & Development Corporation
k10400