2011-11-14T16:58:37-06:00 2010-12-31 PLANTE & MORAN PLLC 65 EAST STATE STREET COLUMBUS OH 43215 990 2010-01-01 340714535 SAMARITAN REGIONAL HEALTH SYSTEM SAMA 4192890491 1025 CENTER STREET ASHLAND OH 44805 DANNY L BOGGS 4192890491 2011-11-14 1 BERNIE OSTROWSKI 6148493000 2010 2016-02-24 21:20:13Z SEE SCHEDULE O DANNY L BOGGS 1025 CENTER STREET ASHLAND OH 44805 76498623 0 X WWW.SAMARITANHOSPITAL.ORG X 1910 OH 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 2010 WAS VALUED AT $4,634,000. DURING 2010, THE HOSPITAL ALSO PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. SEE PART III FOR A DETAILED LISTING OF THESE PROGRAMS. 15 11 656 206 2641160 -243248 108218 785518 75367706 74990737 301782 157335 269713 129600 76047419 76063190 8971 2751779 0 0 32642039 32378672 0 0 0 39121157 39117420 71772167 74247871 4275252 1815319 70826342 72325431 28649636 28877124 42176706 43448307 X THE MISSION OF SAMARITAN REGIONAL HEALTH SYSTEM IS TO TAKE THE LEAD IN PROMOTING THE HEALTH AND WELLNESS OF PEOPLE IN THE COMMUNITIES WE SERVE. 0 0 63122352 2662309 71567852 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 2010 WAS VALUED AT $4,634,000.DURING 2010, THE HOSPITAL ALSO PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. THESE INCLUDED: PROGRAM: NET EXPENSE: PERSONS SERVED: COMMUNITY HEALTH IMPROVEMENT SERVICES $62,746 1,170 HEALTH PROFESSIONS EDUCATION $12,626 96SUBSIDIZED HEALTH SERVICES $4,918,938 UNKNOWN FINANCIAL AND IN-KIND CONTRIBUTIONS $56,395 438 COMMUNITY BUILDING ACTIVITIES $9,646 286 COMMUNITY BENEFIT OPERATIONS $14,547 UNKNOWN TOTAL ALL $5,074,898 1,990 63122352 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 72 0 1 656 1 1 1 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 OH X MARY GRIEST CFO 4192077837 663 EAST MAIN STREET ASHLAND OH 44805 DANNY L BOGGS 35.00 X X 297068 0 33971 TOM MCGEE 2.00 X X 0 0 0 STEPHEN L STUART PHD 2.00 X X 0 0 0 HAROLD KEENER PHD 2.00 X X 0 0 0 MARY MACDONALD MD 2.00 X 0 308972 40482 MEHRDAD M TAVALLAEE MD 2.00 X 0 217437 33994 PAUL R MYERS 2.00 X 0 0 0 JERRY SEITER 2.00 X 0 0 0 VICKY STEPHENSON 2.00 X 0 0 0 MICHAEL D STENCEL MD 2.00 X 11000 0 0 ROGER KRAMER CPA 2.00 X 0 0 0 ROGER HARRAMAN 2.00 X 0 0 0 ANNE BEER 2.00 X 0 0 0 TIM COWEN 2.00 X 0 0 0 SUE HEIMAN 2.00 X 0 0 0 MARY L GRIEST 40.00 X 141374 0 20740 ALYCE LEGG 40.00 X 121224 0 19275 CHRISTOPHER HUNT 40.00 X 117217 0 13011 JEFFREY J COOK 40.00 X 112049 0 21385 RON MANCHESTER 40.00 X 121154 0 16684 KARIN SCHWAN 40.00 X 106474 0 24285 1027560 526409 223827 8 0 1 0 SIEMENS MEDICAL SOLUTIONS USA C/O MELLON BANK PO BOX 120001 DEPT DALLAS TX 753120733 IT MANAGEMENT SERVICES 2436840 CERNER CORPORATION PO BOX 412702 KANSAS CITY MO 64141 EHR CONVERSION 2400502 HMP OF ASHLAND 4535 DRESSLER ROAD CANTON OH 44718 HOSPITALISTS 871303 MORRISON MANAGEMENT PO BOX 102289 ATLANTA GA 303682289 NUTRITION SERVICES MANAGEMENT 729324 SAMARITAN EMERGENCY PHYSICIANS LLP PO BOX 793 TRAVERSE CITY MI 496850793 ER PHYSICIANS 677627 15 166180 619338 785518 PATIENT SERVICES 900099 71567852 71567852 PHARMACY RETAIL 446110 2231720 2231720 OTHER SERVICES-LAB 621500 474597 2210 472387 AIMS REVENUE 900099 396553 396553 CAFETERIA/VENDING 900099 309338 309338 10677 10677 74990737 153586 153586 554353 427196 127157 127157 127157 11986 8237 3749 3749 3749 2443 2443 2443 76063190 71567852 2641160 1068660 2735756 2735756 16023 16023 504152 11000 493152 23249859 18599887 4649972 1410588 1128470 282118 5522088 4417670 1104418 1691985 1353588 338397 116455 116455 81100 81100 8033807 7776725 257082 49025 49025 18176663 14632214 3544449 47135 47135 3206175 3206175 234032 187226 46806 518878 518878 4618917 4618917 812726 650181 162545 PROVISION FOR BAD DEBTS 2326309 2326309 RECRUITMENT 713611 713611 EDUCATION PROGRAMS 98987 98987 ADULTS & PEDS 83600 83600 74247871 63122352 11125519 0 24803822 13019443 6109713 7328656 870024 1570380 1269992 1290280 1513769 1572724 93261830 52001782 35850850 41260048 200167 124537 208005 6159363 70826342 72325431 6281155 6892636 19532289 18585163 201157 106233 2635035 3293092 28649636 28877124 X 42117004 43304057 59702 144250 42176706 43448307 70826342 72325431 X 1815319 -543718 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6087 6087 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: MEMBERSHIP DUES IN THE AMOUNT OF $19,536 AND $26,329 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, RESPECTIVELY. $4,771 AND $1,316 OF THE DUES PAYMENTS WERE FOR LOBBYING EXPENSES. 2346208 2346208 14731723 7124107 7607616 2081730 1474802 606928 32692562 23808921 8883641 41409607 19593952 21815655 41260048 BOND ISSUE COSTS 114664 RESTRICTED CASH 6044699 6159363 COST REPORT SETTLEMENT PAYABLE 2820062 INTEREST RATE SWAP 473030 3293092 76063190 74247871 1815319 -543718 -543718 1271601 1 1 X 1 X 1 X 1 1 0 1 1 3244532 820391 2424141 0.03370 6466010 1275554 5190456 0.07220 9710542 2095945 7614597 0.10590 37896 37896 0.00050 13310 684 12626 0.00020 89470 33075 56395 0.00080 140676 33759 106917 0.00150 9851218 2129704 7721514 0.10740 1 990 990 0.00000 4 7084 7084 0.00010 1 1572 1572 0.00000 6 9646 9646 0.00010 1 1168488 13987892 16034822 -2046930 X 1 1 1 1 SAMARITAN HOSPITAL

1025 CENTER STREET ASHLAND OH 44805

X X X NA 1 7 SAMARITAN HEALTH & REHAB CENTER

2163 CLAREMONT AVENUE ASHLAND OH 44805

OUTPATIENT PHYS, OCC, SPEECH REHAB KETTERING SAMARITAN HEALTH HEALTH CENTER

546 NORTH UNION STREET LOUDONVILLE OH 44842

OUTPATIENT ANCILLARY SVCS 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 OFFICIES 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 $ 2326309. PART II: SAMARITAN PROVIDES A NUMBER OF FREE EDUCATIONAL SEMINARS TO THE PUBLIC RELATED TO VARIOUS HEALTHCARE TOPICS. THROUGH THESE EFFORTS, THE PUBLIC IN OUR SERVICE AREA RELY ON SAMARITAN FOR BOTH INFORMATION AND THEN TREATMENT. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. THE METHODOLOGY FOR DETERMINING THE COST OF THE SERVICES PROVIDED IN THE BAD DEBT CATEGORY, WAS THE COST TO CHARGE RATIO APPLIED TO THE GROSS EXPENSE RELATED TO BAD DEBT. THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO COULD QUALIFY FOR FINANCIAL ASSISTANCE WAS INDETERMINABLE. PART III, LINE 8: SAMARITAN IS CLASSIFIED AS A MEDICARE DEPENDENT 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 2010 WAS $16,034,822. THE PAYMENTS RELATED TO THESE SERVICES WERE $13,987,892, LEAVING A MEDICARE SHORTFALL OF $2,046,930 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. PART VI, LINE 2: THE ORGANIZATION IS IN THE PROCESS OF DEVELOPING A SURVEY TOOL TO ASSESS COMMUNITY HEALTH NEEDS ALONG WITH FOCUS GROUPS FROM A CROSS SECTION OF COMMUNITY MEMBERS AND KEY STAKEHOLDERS. WE WILL ALSO COLLABORATE WITH OTHER NON-PROFIT AGENCIES WHO CONDUCT SIMILAR STUDIES AND VIEW THEIR FINDINGS AS USEFUL AND PRACTICAL. OUR OCCUPATIONAL MEDICINE PROGRAM SERVES INDUSTRY AND FUNCTIONS AS A "LISTENING POST" TO GATHER INPUT FROM OUR BUSINESS COMMUNITY. PART VI, LINE 3: INFORMATION RELATED TO THE CHARITY PROGRAM AT SAMARITAN IS PROVIDED IN A NUMBER OF WAYS. BROCHURES ARE PROVIDED AT EACH POINT OF ADMISSION ALONG WITH THE PUBLICLY POSTED INFORMATION NOTICES. EACH STATEMENT SENT LISTS THE FEDERAL POVERTY GUIDELINES AND WHAT INFORMATION IS NEEDED TO QUALIFY. AN APPLICATION FOR FREE CARE IS ON THE BACK OF EACH STATEMENT SENT TO PATIENTS. COLLECTION ACTIVITY CEASES ONCE IT IS DETERMINED THAT A PATIENT QUALIFIES UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART VI, LINE 4: SAMARITAN REGIONAL HEALTH SYSTEM DEFINES ASHLAND COUNTY AND THE 10 ZIP CODES THAT COMPRISE IT AS OUR PRIMARY SERVICE AREA (PSA). FURTHER, WE INCLUDE AT LEAST ONE ZIP CODE FROM EACH OF THE 5 CONTIGUOUS COUNTIES WITHIN OUR PSA. OUR PSA IS PRIMARILY RURAL WITH GREATER THAN 50% OF THE POPULATION LIVING IN THE 44805 ZIP CODE AREA. AS A COMMUNITY HOSPITAL WE MEET A BROAD RANGE OF NEEDS FOR A COMMUNITY THAT IS DIVERSE IN AGE AND SOCIO-ECONOMIC MAKE-UP. OUR COMMUNITY INCLUDES A LARGE AMISH POPULATION AND A DEMOGRAPHIC THAT HAS BEEN SEVERELY IMPACTED BY THE ECONOMIC DOWNTURN DUE TO THE DECLINE IN MANUFACTURING BASE OVER THE PAST SEVERAL YEARS. PART VI, LINE 6: 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 7: SAMARITAN REGIONAL HEALTH SYSTEM IS A GENERAL ACUTE-CARE FACILITY LOCATED IN ASHLAND, OHIO WHERE IT OPERATES FOUR MEDICAL OFFICE BUILDINGS, AN OUTPATIENT CLINIC, AN OFFSITE REHAB FACILITY, AND AN ADMINISTRATIVE OFFICE BUILDING. SRHS IS THE PARENT ORGANIZATION OF SAMARITAN PROFESSIONAL CORPORATION AND THE SOLE BENEFICIARY OF SAMARITAN HOSPITAL FOUNDATION.SAMARITAN PROFESSIONAL CORPORATION CONTINUED ITS MISSION TO RETAIN QUALITY PHYSICIANS AND EXPAND SERVICES IN THE COMMUNITY. THE STRUCTURE OF THE ORGANIZATION ENABLED THE PHYSICIANS TO CONTINUE THEIR OPERATIONS AND TO ENHANCE SERVICES PROVIDED BY THE LOCAL HEALTHCARE NETWORK.SAMARITAN HOSPITAL FOUNDATION PROVIDES A PROVISION OF FUNDRAISING AND ASSET MANAGEMENT IN SUPPORT OF SAMARITAN REGIONAL HEALTH SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 OH 1 SAMARITAN PROFESSIONAL CORPORATION 1025 CENTER STREET ASHLAND OH 44805 341856531 501(C)(3) 2646286 0 RELATED ORGANIZATION SUPPORT UNITED WAY OF ASHLAND COUNTY 132 W MAIN ST LOWER LEVEL ASHLAND OH 44805 346004364 501(C)(3) 17180 BENEFIT TO ASHLAND COMMUNITY ASHLAND AREA CHAMBER OF COMMERCE 211 CLAREMONT AVE ASHLAND OH 44805 340678472 501(C)(6) 5900 ECONOMIC DEVELOPMENT MARION TECHNICAL COLLEGE 1467 MOUNT VERNON AVE MARION OH 43302 N/A 9927 BOOK VALUE LAB EQUIPMENT USE TO EDUCATE STUDENTS 2 2 MEDICAL FINANCIAL ASSISTANCE 24 16023 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. OTHER INFORMATION: PART IV: WHEN A PATIENT APPLIES FOR FINANCIAL ASSISTANCE, THE FINANCIAL COUNSELOR FOLLOWS THE FINANCIAL ASSISTANCE POLICY. IF THE PATIENT IS OVER INCOME GUIDELINES AND MAY NOT BE ABLE TO RETURN TO WORK DUE TO THE ILLNESS, THE FINANCIAL COUNSELOR WRITES AN EXCEPTION LETTER EXPLAINING THE PATIENT'S CIRCUMSTANCES. THIS LETTER IS ATTACHED TO THE SUPPORTING PAPERWORK AND FORWARDED TO THE CFO FOR APPROVAL. AN E-MAIL IS SENT TO THE FOUNDATION OFFICE EXPLAINING THE PATIENT'S CIRCUMSTANCES WITHOUT GIVING PERSONAL INFORMATION. THE OFFICE MAINTAINS A LOG OF ACCOUNTS WRITTEN OFF USING FOUNDATION FUNDS. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 DANNY L BOGGS 266108 0 0 0 30960 0 28500 0 5471 0 331039 0 0 0 MARY MACDONALD MD 0 293254 0 15000 0 718 0 28500 0 11982 0 349454 0 0 MEHRDAD M TAVALLAEE MD 0 214657 0 2600 0 180 0 25511 0 8483 0 251431 0 0 MARY L GRIEST 138702 0 0 0 2672 0 16276 0 4464 0 162114 0 0 0 PART I, LINE 1A THE PRESIDENT/CEO RECEIVES HEALTH/SOCIAL CLUB DUES WHICH ARE NON TAXABLE. THE HOSPITAL IS REIMBURSED FOR ANY PERSONAL USE. COUNTY OF ASHLAND OHIO 346000122 2008-12-19 9500000 ED & OB BUILDING & STRUCTURE RENOVATION & IMPROVEMENTS; EQUIPMENT 1 0 0 COUNTY OF ASHLAND OHIO 346000122 2009-01-09 4495023 REFUND PRIOR ISSUE 1 0 0 COUNTY OF ASHLAND OHIO 346000122 2009-01-27 6004977 BUILDING & STRUCTURE RENOVATION; EQUIPMENT 1 0 0 669936 9663385 119942 9543443 2010 0 0 1 1 311198 4495023 4495023 4495023 2006 1 0 1 1 433703 6200185 41424 2366288 3792473 2011 0 0 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 1 FIFTH THIRD BANK 6.900000000000 0 0 0 0 0 0 1 1 FIFTH THIRD BANK 6.900000000000 0 0 0 0 1 0 1 1 FIFTH THIRD BANK 6.900000000000 0 0 0 0 0 SCHEDULE K, PART II, LINE 3, BOND ISSUE A INCLUDES INVESTMENT EARNINGS OF $163,385 SCHEDULE K, PART II, LINE 3, BOND ISSUE C INCLUDES INVESTMENT EARNINGS OF $195,208 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. NORMALLY, A COPY OF THE FORM 990 IS PROVIDED 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. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -543,718. FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION'S 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 THE FOLLOWING OFFICERS ARE COMPENSATED BY SAMARITAN PROFESSIONAL CORP: THE FOLLOWING TRUSTEES DEVOTED TIME TO SAMARITAN PROFESSIONAL CORPORATION: MARY MACDONALD, MD 40 HRS MEHRDAD M TAVALLAEE, MD 40 HRS SAMARITAN PROFESSIONAL CORPORATION 1025 CENTER STREET ASHLAND OH 44805 341856531 PHYSICIAN BASED HEALTH SERVICES OH 501(C)(3) 3 SAMARITAN REGIONAL HEALTH SYSTEM 1 SAMARITAN HOSPITAL FOUNDATION 663 EAST MAIN STREET ASHLAND OH 44805 341783215 FUNDRAISING AND ASSET MANAGEMENT OH 501(C)(3) 11A SAMARITAN REGIONAL HEALTH SYSTEM 1 1 1 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 1 SAMARITAN PROFESSIONAL CORPORATION A 259191 ACTUAL RENT RECORDED SAMARITAN PROFESSIONAL CORPORATION B 2646624 CASH VALUE SAMARITAN PROFESSIONAL CORPORATION K 261012 ACTUAL PAYROLL EXPENSE SAMARITAN HOSPITAL FOUNDATION J 228500 ACTUAL LEASE PAYMENT SAMARITAN PROFESSIONAL CORPORATION N 71407 PAYROLL SAMARITAN HOSPITAL FOUNDATION C 166180 ACTUAL CONTRIBUTIONS RECEIVED