TY 2019 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Anita Hackstedde...................................................................... President/CEO	35 ................. 5		X				396,878	0	105,124
(2) Dr Lee Simon...................................................................... Director	1 ................. 39	X					0	413,190	22,833
(3) Mike Giangardella...................................................................... VP Finance/Administration	38 ................. 2		X				214,633	0	119,735
(4) Dr Richard Beatty...................................................................... Chief of Staff	5 ................. 35	X					7,500	274,615	12,366
(5) Deborah Pietrzak...................................................................... Asst VP Marketing & Planning	40 ................. 0				X		124,258	0	98,170
(6) Keith Meredith...................................................................... VP Clinical Operations	40 ................. 0			X			164,333	0	57,683
(7) Sue Bryarly...................................................................... Director of Pharmacy	40 ................. 0				X		140,601	0	80,869
(8) Kimberly Meek...................................................................... Pharmacist	40.6 ................. 0				X		123,634	0	59,826
(9) Corey Less...................................................................... Pharmacist	41.4 ................. 0				X		120,788	0	52,816
(10) Barbara Hirst...................................................................... VP Nursing/Human Resources	40 ................. 0					X	135,552	0	11,723
(11) Diane Spalding...................................................................... Pharmacist	40.30 ................. 0				X		125,067	0	5,628
(12) Peter Apicella MD...................................................................... Director	1 ................. 1	X					12,245	0	0
(13) Jon Vollnogle...................................................................... Chair	1 ................. 2	X					0	0	0
(14) Chris Meta...................................................................... Vice-Chair	1 ................. 1	X					0	0	0
(15) Jeffrey Zimmerman...................................................................... Treasurer	1 ................. 1	X					0	0	0
(16) Denise Harlan...................................................................... Secretary	1 ................. 1	X					0	0	0
(17) Dr Michael Sevilla...................................................................... Director	1 ................. 0	X					0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
Northstar Anesthesia 6225N State Hwy 161 Suite 200 Irving,TX75038	Medical Services	1,207,178
University Hospitals 3605 Warrensville Center Road Mail Stop 9230 -- Cube 2344I Shaker Heights,OH441225203	Medical Services	1,018,509
AVI Food Systems 2590 Elm Road NE Warren,OH44483	Food Services/Vending	854,730
Laboratory Corporation of America PO box 12140 Burlington,NC27216	Laboratory services	495,904
Xanitos, 75 Remittance Drive Department 6704 Chicago,IL60675	Housekeeping Services	489,440
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 23

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SALEM COMMUNITY HOSPITAL

Employer identification number

34-1041385

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	19009572
Software Version:	v1.00

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

SALEM COMMUNITY HOSPITAL

Employer identification number

34-1041385

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization SALEM COMMUNITY HOSPITAL

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization SALEM COMMUNITY HOSPITAL		Employer identification number 34-1041385

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization SALEM COMMUNITY HOSPITAL			Employer identification number 34-1041385
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:	19009572
Software Version:	v1.00

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SALEM COMMUNITY HOSPITAL

Employer identification number

34-1041385

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	2,330,744	0		2,330,744
b	Buildings ....	117,379,336	0	54,690,447	62,688,889
c	Leasehold improvements	1,555,485	0	447,464	1,108,021
d	Equipment ....	51,745,990	0	35,553,228	16,192,762
e	Other .....	227,367	0	0	227,367
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					82,547,783

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	32,070,232
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2019

Additional Data

Software ID:	19009572
Software Version:	v1.00

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SALEM COMMUNITY HOSPITAL

Employer identification number

34-1041385

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			1,347,695	2,312,632	0	0 %
b	Medicaid (from Worksheet 3, column a) . . . . .			3,381,887	1,128,676	2,253,205	2.216 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			10,177,787	7,788,472	2,389,315	2.35 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	14,907,369	11,229,780	4,642,520	4.566 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	86	227,675	88,996	400	88,596	0.087 %
f	Health professions education (from Worksheet 5) . . .	261	880	500,414	0	500,414	0.492 %
g	Subsidized health services (from Worksheet 6) . . . .			168,586	162,814	5,772	0 %
h	Research (from Worksheet 7) .			0	0	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	8	1,540	45,939	0	45,939	0.045 %
j	Total. Other Benefits . .	355	230,095	803,935	163,214	640,721	0.624 %
k	Total. Add lines 7d and 7j .	355	230,095	15,711,304	11,392,994	5,283,241	5.190 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	2	200	224	0	224	0 %
2	Economic development	21	1,950	7,710	0	7,710	0.008 %
3	Community support	467	6,440	89,455	0	89,455	0.088 %
4	Environmental improvements	4	185	115,717	8,590	107,127	0.11 %
5	Leadership development and training for community members	0	0	0	0	0	0 %
6	Coalition building	12	860	8,492	0	8,492	0.008 %
7	Community health improvement advocacy	40	2,344	26,326	0	26,326	0.026 %
8	Workforce development	49	2,710	156,724	0	156,724	0.154 %
9	Other	0	0	0	0	0	0 %
10	Total	595	14,689	404,648	8,590	396,058	0.394 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

736,347

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

238,509

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

23,454,779

Enter Medicare allowable costs of care relating to payments on line 5.....

26,377,180

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-2,922,401

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)			Other (describe)
1	Salem Community Hospital dba Salem Regional Medical Center 1995 East State Street Salem,OH44460 Salemregional.com	X	15 bed skilled nursing facility (ceased operations fall of 2019)

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Salem Community Hospital
Name of hospital facility or letter of facility reporting group	dba Salem Regional Medical Center

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): http://www.salemregional.com

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): http://www.salemregional.com

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Salem Community Hospital
Name of hospital facility or letter of facility reporting group	dba Salem Regional Medical Center

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 150%
and FPG family income limit for eligibility for discounted care of 350%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

http://www.salemregional.com

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):
http://www.salemregional.com

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	Salem Community Hospital
Name of hospital facility or letter of facility reporting group	dba Salem Regional Medical Center

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Salem Community Hospital
Name of hospital facility or letter of facility reporting group	dba Salem Regional Medical Center

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 5-Salem Community Hospital	To take into account input from persons representing the community served, the CHNA primary data collection process included focus group and stakeholder interviews conducted with a total of 115 adult participants, including those from school districts, juvenile justice, community resource centers, senior services, Hispanic community providers, local government officials, health and human service providers, mental health providers and faith-based organizations. Community leaders and key stakeholders were identified as experts in a particular field related to their background experience or professional position; and/or those who understand the needs of a particular community/geographic region or under-represented group, including the medically underserved and vulnerable populations. In addition, a community survey derived from the Behavioral Risk Factor Surveillance System was completed by 382 adults, so that local primary data could be compared with state and national data.
Schedule H, Part V, Section B, Line 6a-Salem Community Hospital	Along with Salem Regional Medical Center, East Liverpool City Hospital and Akron Children's Hospital also provided financial support for the CHNA process.
Schedule H, Part V, Section B, Line 6b-Salem Community Hospital	A collaborative workgroup conducted the CHNA, composed of the Akron Children's Hospital, Columbiana County Educational Service Center, Columbiana County General Health District, Columbiana County Mental Health and Recovery Services Board, Community Action Agency of Columbiana County, East Liverpool City Health Department, East Liverpool City Hospital, Family and Children First Council, Salem City Health Department, Salem Regional Medical Center and The Ohio State University- Extension. In addition, this workgroup developed a County Health Improvement Plan to address the CHNA's priorities.
Schedule H, Part V, Section B, Line 7d-Salem Community Hospital	The CHNA was posted on Salem Regional Medical Center's website at http://www.salemregional.com/about-us/our-publications:Community Health Needs Assessment, along with being posted on many of the collaborative partners' websites. In addition, two news releases were issued regarding the preliminary CHNA findings and publication of the final report, with information about how the general public could access the CHNA via the internet. A
Schedule H, Part V, Section B, Line 11-Salem Community Hospital	As outlined in the 2019-2022 Implementation Plan, SRMC will focus on the CHNA's top 3 health priorities related to obesity/chronic disease; mental health and addiction/substance abuse and access to health care utilizing a three-year intervention strategy and defined target outcomes for each priority. Note that these priorities align with the priority topics identified in Ohio's 2019 State Health Assessment. To address the significant needs identified in the 2019 CHNA regarding obesity and chronic disease prevention, SRMC is working with existing and/or developing new community partnerships to broaden access to recreational opportunities and promote existing resources for improved physical activity and nutrition to positively impact the rates of physical activity and consumption of healthy foods for residents within SRMC's Service Area. To address the significant needs regarding mental health and substance abuse prevention, SRMC is serving as a community partner in improving access to mental health and substance abuse treatment services through membership on the ADAPT and CASH Coalitions, as well as facilitating the coordination of and access to community-based, post-acute treatment resources. SRMC also operates the Behavioral Medicine and Wellness Center as an intensive outpatient and partial hospitalization program designed to meet individual and group needs for mental health services in Columbiana and other surrounding counties. Data related to barriers in accessing clinical care indicated higher ratios of the population to primary care physicians, mental health providers and dental health providers, reflecting health professional shortages in these categories. To reduce barriers to accessing health care, SRMC is actively recruiting providers to underserved areas; exploring alternate delivery of care models, such as telemedicine; and increasing health literacy interventions to reduce hospital readmissions, strengthen medication education and increase patients' knowledge to decrease disparities among vulnerable populations. Primary data gathered from focus group participants and stakeholders identified multi-faceted socio-economic issues related to the poor economy, generational poverty, increased drug abuse and mental health issues, lack of transportation, Appalachian culture/unhealthy lifestyles, obesity, lack of parenting skills and language/health literacy barriers as key drivers of the health status of the community. Other identified needs related to the environment and social determinants of health included not enough money, lack of access to employment/better jobs, safe water/clean air/fracking/agricultural runoff, poor housing conditions and crime/violence. In addition, focus group participants identified the weather, chemical waste and unemployment as environmental determinants that impact community health. Due to their societal magnitude and SRMC's limited resources and capacity to meaningfully impact the environment and economic foundation of the county, SRMC has chosen to allocate significant resources to the priority health needs which yield the greatest opportunities to affect a positive change as outlined in the 2019-2022 Implementation Plan.
Schedule H, Part V, Section B, Line 16j-Salem Community Hospital	The availability of free or discounted care is provided on billing statements to patients and this information is also posted on a sign at the billing office.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?0
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part I, Line 6a	Salem Regional Medical Center (SRMC) prepares an Annual Report that is distributed to the community via a paper and electronic format, as well as being posted on the SRMC website at www.salemregional.com. The Annual Report includes a summary of the Medical Center's statement of expenses and uncompensated care, along with highlighting SRMC's major community benefit initiatives and outcomes. 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.
Schedule H, Part I, Line 7	Costs are determined by applying the ratio of cost to charges to gross charges and utilizing the format as outlined in the Schedule H instructions. Beyond charity care, "Other Benefits" reported include community health improvement services and community benefit operations, with community building activities listed in Part II. The Medical Center seeks opportunities to further its tax exempt purpose by providing a wide variety of benefits for the broader community, including the development of a county-wide needs assessment to identify regional health needs; and the development and adoption of a related Implementation Plan to address the health needs identified. Examples of other community benefit activities include, but are not limited to: grant-writing activities for improved community health; community health education regarding cancer, diabetes, cardiac disease and other chronic diseases; obesity prevention and women's health; and community health fairs and free and reduced-cost clinical screenings for high blood pressure, blood sugar, colorectal cancer and mammography. Many of these educational programs, screenings, health fairs and outreach activities are provided in outlying school districts and communities within the Medical Center's defined geographic service area, in an effort to increase regional access to health services and health resources for people of all ages and socioeconomic means. Due to the Covid-19 pandemic beginning in March 2020, the number of traditional community health improvement programs, outreach activities and community events was severely curtailed. It is estimated that over 230,000 area residents participated in traditional community health improvementprograms and/or events provided and/or sponsored by Salem Regional Medical Center. However, the Hospital aggressively participated in a multitude of Covid-19 related community health improvement activities, including: developed community disaster readiness responses; provided education to increase awareness of Covid-19 risks and available testing and treatment services, which were established at nominal costs; set up a telephone hotline; established emergency food distribution programs; donated personal protective equipment to vulnerable populations; and conducted additional staff training to respond quickly to augment COVID-19 care as necessary.
Schedule H, Part I, Line 7, Column f	Bad debt expense in the amount of $1,962,373 is included in total expenses on Form 990,Part IX ,line 25, but was subtracted for purposes of calculating the percentages in Schedule H, Part 1, line 7.
Schedule H, Part I, Line 7g	Costs for subsidized health services include those attributable to providing Salem Regional Medical Center's outpatient behavioral health services. There are no health services attributable to a physician clinic.
Schedule H, Part II	During the taxable year, SRMC participated in 595 different community building activities in an effort to provide programs and activities that respond to demonstrated, unmet community needs; improve the community's health and safety; and promote the well-being of area residents through the Hospital's resources and expertise. It should be noted that the number of traditional community building activities was significantly reduced from prior years due to curtailed activities beginning in March 2020 related to the pandemic. Prior to the pandemic, SRMC participated in several area activities for the local and regional Chambers of Commerce; assisted in environmental improvements related to community medications' disposal; represented SRMC on diverse community coalitions related to improving community health; assisted with workforce development related to recruiting and retaining physicians and clinical professionals in medically underserved areas; and participated in community workforce boards, partnerships with area universities to address the health care work force shortage and provided many school-based programs on health care careers, including offering teen and college student mentoring opportunities. During the pandemic, SRMC served in a leadership role for the region's disaster readiness and preparedness activities, including coordinating and mobilizing disaster readiness and Covid-19 awareness coalitions and community support. SRMC continues to serve 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, Coordinated Action for School Health, Community Hospice, Kent State University- Salem Campus, Northeast Ohio Medical University and the Salem Community Center. In addition, SRMC makes financial and in-kind contributions to many of these and other not-for-profit organizations through event sponsorships and staff support.
Schedule H, Part III, Section A, Line 4	"Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Organization analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for uncollectible accounts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Organization analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely)." The cost of bad debt was determined by applying the Medical Center's cost to charge ratio to the charges that were written off to bad debt. The Hospital believes this is a community benefit because the patients who may likely qualify for assistance under the Hospital's Financial Assistance Policy do not or are unwilling to provide documentation of the eligibility for charity care and therefore are classified as bad debt. The hospital is very willing to work out payment arrangements and discounted fees; however those patients unwilling to 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 patients classified as bad debt would qualify for charity care. This judgement is based on the economic conditions and specific knowledge of the patients involved.
Schedule H, Part III, Section B, Line 8	The costs were obtained from the Medicare cost report. The Medical Center incurred costs in excess of $26.4 million to care for and treat beneficiaries while receiving reimbursement of $23.5 million, leaving a shortfall of $2.9 million. This is a direct benefit provided by the Medical Center to local beneficiaries who live in the surrounding communities.
Schedule H, Part III, Section C, Line 9b	Per the Medical Center's collection policy, the Medical Center will not pursue collection for non-payment of bills against individuals who demonstrate that they have neither sufficient income nor assets to meet their financial obligations.
Schedule H, Part VI, Line 2	SRMC formally assesses the healthcare needs of the communities that it serves on a minimum of a triennial basis, and does so in collaboration with other community health providers. The most recent comprehensive, county-wide needs assessment was published in May 2019, and was developed by a collaborative of Columbiana County's major health providers, public health entities, and health-focused coalitions including Salem Regional Medical Center; East Liverpool City Hospital and Akron Children's Hospital; the Columbiana County, East Liverpool and Salem City Health Departments; Columbiana County Educational Service Center; Community Action Agency of Columbiana County; the Coordinated Action for School Health (CASH) Coalition; and the Columbiana County Mental Health Services and Recovery Board. The CHNA process began in May 2018, with the development of the project plan and timeline. The above mentioned collaborative convened in June 2018 and continued meeting through May 2019 to evaluate the previous CHNA, collect and analyze primary and secondary data, conduct community asset mapping and identify issues and select priorities to address through the development of the 2019-2022 CHNA. The Hospital Council of Northwest Ohio was retained to facilitate the process and provide data analysis and prioritization support. The geographic area of the needs assessment encompassed Ohio's Columbiana County, most of which is within Salem Regional Medical Center's Service Area; and prioritized the public, primary and specialty health care needs of community members from birth through end-of-life care. The CHNA action plan and report development were presented to and approved by the SRMC Board in May 2019, and distributed to all participating coalition organizations. The SRMC Implementation Plan was approved by the Board in November 2019, and both documents are posted on the SRMC website at: http://www.salemregional.com/about-us/our-publications: Community Health Needs Assessment and SRMC Implementation Plan. The Medical Center will carry forward its implementation strategies by addressing them in its Strategic Plan and annual Organizational Goals. In addition, SRMC is a collaborative partner in other types of needs assessments, such as the school health asset study through the Search Institute, conducted on a bi-annual basis with area school districts; a multi-disciplinary assessment of substance abuse incidence and treatment needs via the county-wide ADAPT coalition; behavioral health needs in collaboration with the Mental Health and Recovery services Board; and minority health access needs in collaboration with faith-based and literacy-based advocacy groups.
Schedule H, Part VI, Line 3	The availability of free or discounted care is provided on billing statements to patients and this information is also posted on a sign at the Hospital's billing office.
Schedule H, Part VI, Line 4	Salem Regional Medical Center's rural service area is officially designated as within one of Ohio's 32 Appalachian counties and includes Columbiana County, excluding Yellow Creek and East Liverpool Townships; and the five lower townships of Mahoning County. Portions of Columbiana County are also designated as Medically Underserved, and as a dental and mental health care Health Professional Shortage Areas. The Robert Wood Johnson 2018 County Health Rankings data also showed that Columbiana County faces a significant barrier to access as indicated by the county's ratio of the population to primary care providers (2,280:1) being higher than Ohio (1,310:1); and the county's ratio of dentists (4,320:1) being considerably higher than Ohio (1,660:1). Columbiana County residents are older than their state and national counterparts, and the Service Area is characterized by a declining social, economic and population base, which impacts the area's health status problems and health service utilization. Generational poverty, lack of transportation and lack of insurance are also barriers to access, with the rate of uninsured Columbiana County adults higher than Ohio. Regional health outcomes and social/economic/environmental rates that were worse than Ohio benchmarks included: higher rates of premature death/years of potential life lost before age 75, higher adult obesity rates combined with lower physical activity rates, higher percentage of people who report their physical health as fair or poor, lower post-secondary education rates, higher teen birth rates, greater number of deaths due to injury and a higher index of air pollution. Health disparities are also more common among vulnerable populations and based on the demographics of Columbiana County's population, the 2019-2022 CHNA identified vulnerable populations as those living in poverty/socioeconomically disadvantaged, the Appalachian culture, children/youth, the elderly and those facing ethnic and literacy barriers.
Schedule H, Part VI, Line 5	Salem Regional Medical Center actively seeks opportunities to further the community's health status by providing a wide variety of benefits for the broader community, including grant-writing activities for improved community health; financial and in-kind contributions for community based feeding programs, physical fitness as an obesity and chronic disease prevention tool, blood drives, social services for vulnerable populations (including assistance with medications, transportation, limited English proficiency, referrals to support systems and provision of personal protective equipment and Covid-19 prevention education during the pandemic); community health education regarding Covid-19 awareness and prevention, cancer, diabetes, arthritis, cardiac and other chronic diseases, and women's health; and community health fairs and free and reduced-cost clinical screenings. Many of these educational programs, screenings, health fairs and outreach activities are provided in outlying school districts and communities within the Medical Center's defined geographic service area, in an effort to increase regional access to health services and health resources for people of all ages and socioeconomic means. Due to the Covid-19 pandemic beginning in March 2020, the number of external outreach activities and community events was significantly curtailed; however the Hospital transitioned to virtual education and awareness campaigns to continue to improve community health and enhance the community's ability to withstand and recover from this public health emergency. It is estimated that over 230,000 area residents participated in community benefit programs and/or events provided and/or sponsored by SRMC. SRMC also utilizes an active volunteer base, with 51 community members donating over 2512 hours of volunteer service annually. In addition, the SRMC Board of Directors is comprised of 16 community volunteers from the SRMC Service Area, who perform fiduciary responsibilities through monthly committee and Board activities.

Schedule H (Form 990) 2019

Additional Data

Software ID:	19009572
Software Version:	v1.00

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SALEM COMMUNITY HOSPITAL

Employer identification number

34-1041385

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Anita Hackstedde President/CEO	(i) (ii)	388,878 ------------- 0	0 ------------- 0	8,000 ------------- 0	87,273 ------------- 0	17,851 ------------- 0	502,002 ------------- 0	0 ------------- 0
2Mike Giangardella VP Finance/Administration	(i) (ii)	214,633 ------------- 0	0 ------------- 0	0 ------------- 0	109,421 ------------- 0	10,314 ------------- 0	334,368 ------------- 0	0 ------------- 0
3Keith Meredith VP Clinical Operations	(i) (ii)	164,333 ------------- 0	0 ------------- 0	0 ------------- 0	49,349 ------------- 0	8,334 ------------- 0	222,016 ------------- 0	0 ------------- 0
4Sue Bryarly Director of Pharmacy	(i) (ii)	140,601 ------------- 0	0 ------------- 0	0 ------------- 0	50,968 ------------- 0	29,901 ------------- 0	221,470 ------------- 0	0 ------------- 0
5Diane Spalding Pharmacist	(i) (ii)	125,067 ------------- 0	0 ------------- 0	0 ------------- 0	5,628 ------------- 0	0 ------------- 0	130,695 ------------- 0	0 ------------- 0
6Deborah Pietrzak Asst VP Marketing & Planning	(i) (ii)	124,258 ------------- 0	0 ------------- 0	0 ------------- 0	78,116 ------------- 0	20,054 ------------- 0	222,428 ------------- 0	0 ------------- 0
7Kimberly Meek Pharmacist	(i) (ii)	123,634 ------------- 0	0 ------------- 0	0 ------------- 0	49,512 ------------- 0	10,314 ------------- 0	183,460 ------------- 0	0 ------------- 0
8Corey Less Pharmacist	(i) (ii)	120,788 ------------- 0	0 ------------- 0	0 ------------- 0	22,915 ------------- 0	29,901 ------------- 0	173,604 ------------- 0	0 ------------- 0
9Barbara Hirst VP Nursing/Human Resources	(i) (ii)	135,552 ------------- 0	0 ------------- 0	0 ------------- 0	6,136 ------------- 0	5,587 ------------- 0	147,275 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2019

Additional Data

Software ID:	19009572
Software Version:	v1.00

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SALEM COMMUNITY HOSPITAL

Employer identification number
34-1041385

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	City Of Salem Ohio	34-6002560		04-04-2013	52,000,000	Hospital Facility Construction		X	X			X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	29,600,292
2 Amount of bonds legally defeased ..............	0
3 Total proceeds of issue ..................	52,000,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	193,598
6 Proceeds in refunding escrows ...............	0
7 Issuance costs from proceeds ...............	168,913
8 Credit enhancement from proceeds .............	0
9 Working capital expenditures from proceeds .............	160,493
10 Capital expenditures from proceeds .............	21,883,897
11 Other spent proceeds .............	6,893
12 Other unspent proceeds .............	0
13 Year of substantial completion .............	2014
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........	X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.12 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %
6 Total of lines 4 and 5 .............	1.12 %
7 Does the bond issue meet the private security or payment test? ...	X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........	X
c No rebate due? .........		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation

Schedule K (Form 990) 2019

Additional Data

Software ID:	19009572
Software Version:	v1.00

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SALEM COMMUNITY HOSPITAL

Employer identification number

34-1041385

Return Reference	Explanation
Form 990, Part III, Line 3	SRMC transitioned our skilled care services from our Skilled Nursing Facility unit to Swing beds within our medical/surgical units. The result of this change was to close the Skilled Nursing unit and move patient care to a Swing Bed model effective 8-23-2019. This transition was done to expand our ability to care for patients while improving the management of our patients' chronic conditions and reduce unnecessary readmissions.
Form 990, Part VI, Section B, Line 11b	Form 990, Part VI, Section B, Line 11b - The Form 990 is made available for review to the governing board prior to filing.
Form 990, Part VI, Section B, Line 12c	Form 990, Part VI, Section B, Line 12c - Each member of the Hospital's governing body, along with the Administrative staff, are required to review and disclose conflicts of interest in accordance with the Hospital's Code of Regulations. 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 Employees. In situations when a Director may have a conflict, they may participate in the discussion, but must leave the room prior to final discussion and vote.
Form 990, Part VI, Section B, Line 15	Form 990, Part VI, Section B, Line 15 - The President's compensation is determined by the Board of Directors of Salem Regional Medical Center, based upon the recommendation of the Board's Executive committee, both of which are comprised primarily of independent board members. The committee evaluates market data through formal statewide surveys, as well as targeted regional survey data.
Form 990, Part VI, Section C, Line 19	Form 990, Part VI, Section C, Line 19 - As a private, not-for-profit organization, Salem Regional Medical Center 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
Form 990, Part IX, Line 11g	Form 990, Part IX, Line 11g - Balance in this category represents the following expense: 1) Purchased Services total $9,686,552; 2) Repairs and Maintenance Services total $2,364,136; Professional Health Care Services total $2,104,852.
Form 990, Part XI, Line 9	Form 990, Part XI, Line 9 - Change in defined benefit plan losses, prior service costs or credits and settlements -$3,728,291; transfers to related organization -$5,025,958; change in pledge receivable and medical staff cash -$113,740
Form 990, Part XII, Line 3b	The audit that SRMC will be required to undergo per Single Audit Act and OMB Circular A-133 guidance is related to the CARES Act Relief Funds that the organization received during Fiscal Year 2020 (specifically in April 2020) in direct response to the COVID-19 Pandemic Disaster that was declared March 2020. The due date for the Single Audit related to all funds received in calendar year 2020 is not due until September 2021. Please note that this will be a consolidated Single Audit as the award is considered a single program irrespective of specific entity receipt.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	19009572
Software Version:	v1.00

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SALEM COMMUNITY HOSPITAL

Employer identification number

34-1041385

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)SCH Professional Corporation 1995 East State Street Salem,OH44460 34-1764515	Physician Offices	OH	501(c)(3)	11	Salem Community Hospital		No
(2)The Charitable Foundation of Salem Community Hospital 1995 East State Street Salem,OH44460 46-2902698	Support Salem Community Hospital	OH	501(c)(3)	11	Salem Communiy Hospital		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) Salem Medical Arts & Development Corporation 2020 East State Street Salem,OH44460 34-1049534	Office Rent	OH	N/A	C			100 %		No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) SCH Professional Corporation	j	215,884	Cost per square foot
(2) SCH Professional Corporation	b	5,025,958	Actual capital contribution
(3) SCH Professional Corporation	o	278,967	Net of actual salaries and benefits paid
(4) The Charitable Foundation of Salem Community Hospital	q	110,000	Reimburse actual salary, benefit and accounts payable cost paid.

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:	19009572
Software Version:	v1.00

1	Briefly describe the organization’s mission or most significant activities: Salem Regional Medical Center (SRMC) is an 87-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, orthopedics and intensive care. 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.; in support of its mission- "To Serve. To Care. To Heal."
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	905
6	Total number of volunteers (estimate if necessary) .............	6	51
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,004,246
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-25,896

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	115,703	5,674,993
9	Program service revenue (Part VIII, line 2g) .........	111,463,788	106,300,282
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,305,358	3,645,409
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	521,303	291,462
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	118,406,152	115,912,146
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	4,900	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	48,968,883	44,006,025
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	56,960,719	59,623,121
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	105,934,502	103,629,146
19	Revenue less expenses. Subtract line 18 from line 12.......	12,471,650	12,283,000
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	240,445,095	254,361,671
21	Total liabilities (Part X, line 26).............	73,550,080	85,461,550
22	Net assets or fund balances. Subtract line 21 from line 20.....	166,895,015	168,900,121

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 89,950,346 including grants of $ ) (Revenue $ 105,467,078 )
	SRMC's mission and purpose is achieved by providing quality care to the sick and injured on both an inpatient and outpatient basis, while addressing our patients' healthcare needs at each life stage, within our available resources. The Medical Center 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 2020, SRMC provided comprehensive healthcare services including: 3,176 Admissions; 3,117 Surgeries; and 20,329 Emergency Department visits. In support of this commitment, SRMC operates a full-time, 24-hour Emergency Department, and treats all patients requiring emergency medical care, irrespective of their financial means. The Medical Center also accepts all patients covered by Medicare, Medicaid and General Assistance. For fiscal year 2020, costs incurred by SRMC for unpaid costs of the Medicaid program were $2,253,205 and unreimbursed costs from other governmental programs were $5,311,716. These community benefits, arising from patient care provided by SRMC are documented to help to relieve a governmental financial and programmatic burden as evidenced through the Medical Center's charitable purpose.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e	Total program service expenses89,950,346

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Vicki Hall........................................................................ Director	1 .......................1	X	0	0	0
(19) William Young EdD........................................................................ Director	1 .......................1	X	0	0	0
(20) Ruth Ann Rinto........................................................................ Director	1 .......................1	X	0	0	0
(21) Lynn Scullion O D........................................................................ Director	1 .......................1	X	0	0	0
(22) Terry Criss........................................................................ Director	1 .......................0	X	0	0	0
(23) Nelson Witmer........................................................................ Director	1 .......................0	X	0	0	0
(24) Vito Abruzzino........................................................................ Director	1 .......................0	X	0	0	0
(25) Scott Tuel........................................................................ Director	1 .......................0	X	0	0	0
(26) Bruce Rhodes Jr........................................................................ Director	1 .......................0	X	0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,565,489	687,805	626,773

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	5,564,556

f	All other contributions, gifts, grants, and similar amounts not included above		1f	110,437

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		5,674,993

		Business Code
2a	Patient Service Revenue	622000	104,104,540	104,104,540	0	0
b	Outside Lab Revenue	621500	77,566	0	77,566	0
c	Durable Medical Equipment Revenue	621610	1,898,504	971,824	926,680	0
d	Affiliated Exempt Organization Rent	531190	219,672	219,672	0	0
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		106,300,282

3 Investment income (including dividends, interest, and othersimilar amounts) ......			3,636,918			3,636,918
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents	0	165,774	6a
b	Less: rental expenses	0	45,354	6b
c	Rental income or (loss)	0	120,420	6c
d	Net rental income or (loss).......			120,420			120,420
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	11,500		7a
b	Less: cost or other basis and sales expenses	3,009		7b
c	Gain or (loss)	8,491	0	7c
d	Net gain or (loss).........			8,491			8,491
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Gift Shop Revenue		900099	85,883	85,883	0	0
b	Medical Records Fees		900099	9,534	9,534	0	0
c	Canteen Revenue		900099	6,802	6,802	0	0
d	All other revenue ....			68,823	68,823	0	0
e	Total. Add lines 11a–11d ......			171,042
12	Total revenue. See instructions.....			115,912,146	105,467,078	1,004,246	3,765,829

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0	0
4	Benefits paid to or for members .......	0	0
5	Compensation of current officers, directors, trustees, and key employees ...........	896,919	0	896,919	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0	0	0	0
7	Other salaries and wages........	31,366,434	28,512,537	2,853,897	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,186,055	3,140,806	1,045,249	0
9	Other employee benefits .......	5,209,788	4,653,480	556,308	0
10	Payroll taxes ...........	2,346,829	2,099,178	247,651	0
11	Fees for services (non-employees):
a	Management ......	198,714	0	198,714	0
b	Legal .........	207,978	0	207,978	0
c	Accounting ...........	87,000	0	87,000	0
d	Lobbying ...........	0	0	0	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	0	0	0	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	14,152,901	12,187,129	1,965,772	0
12	Advertising and promotion ....	197,767	0	197,767	0
13	Office expenses .......	1,612,301	1,110,873	501,428	0
14	Information technology ......	2,630,778	1,817,025	813,753	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	2,087,626	1,834,226	253,400	0
17	Travel ............	72,246	50,675	21,571	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	0	0	0	0
20	Interest ...........	1,097,069	1,097,069	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	9,819,619	8,501,382	1,318,237	0
23	Insurance ...	243,654	0	243,654	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Bad Debt	1,962,373	1,962,373	0	0
b	State Assessment	2,139,724	0	2,139,724	0
c	Drugs & Pharmaceuticals	11,559,076	11,559,076	0	0
d	Medical Supplies	11,389,433	11,389,433	0	0
e	All other expenses	164,862	35,084	129,778	0
25	Total functional expenses. Add lines 1 through 24e	103,629,146	89,950,346	13,678,800	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			9,249,133	1	9,941,841
2	Savings and temporary cash investments .........				2	13,836,164
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			11,553,809	4	9,077,186
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			1,312,230	8	1,546,090
9	Prepaid expenses and deferred charges ......			3,069,947	9	2,830,428
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	173,238,922
b	Less: accumulated depreciation	10b	90,691,139	89,695,755	10c	82,547,783
11	Investments—publicly traded securities .			125,564,221	11	134,582,179
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........				15
16	Total assets. Add lines 1 through 15 (must equal line 33)...			240,445,095	16	254,361,671

17	Accounts payable and accrued expenses .....	11,445,278	17	10,906,388
18	Grants payable ...		18
19	Deferred revenue .........		19	140,000
20	Tax-exempt bond liabilities .........	43,897,538	20	42,207,534
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	216,885	23	137,396
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	17,990,379	25	32,070,232
26	Total liabilities. Add lines 17 through 25..	73,550,080	26	85,461,550

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	166,895,015	27	168,900,121
28	Net assets with donor restrictions ...........	0	28	0
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	166,895,015	32	168,900,121
33	Total liabilities and net assets/fund balances ........	240,445,095	33	254,361,671