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UVMC NURSING CARE INC: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
UVMC NURSING CARE INC (EIN 31-1224064)
Tax period
2023-01-01 to 2023-12-31
Filed
2024-11-14
IRS object ID
202443199349302029
Schema version
2023v5.1
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2024-11-14T08:53:05-06:00ReturnTs
Tax Period End2023-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2023-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN311224064EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UVMC NURSING CARE INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlUVMCBusinessNameControlTxt
Phone9374499942PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1110 N MAIN ST 200AddressLine1Txt
CityDAYTONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45402ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJ MICHAEL SIMSPersonNm
Person TitleSYSTEM VP & CORP. CONTROLLERPersonTitleTxt
Phone9374499942PhoneNum
Signature2024-11-14SignatureDt
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd
Tax2023TaxYr
Build TS2024-10-15 13:58:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKEVIN HARLANPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13130 N COUNTY ROAD 25AAddressLine1Txt
CityTROYCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45373ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$39,390,161GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PREMIERHEALTH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1987FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionSEE PART III, LINE 1ActivityOrMissionDesc
Voting Members Governing Body3VotingMembersGoverningBodyCnt
Voting Members Independent3VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers5TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$23,183,422PYProgramServiceRevenueAmt
CY Program Service Revenue$24,806,859CYProgramServiceRevenueAmt
PY Investment Income$173,546PYInvestmentIncomeAmt
CY Investment Income-$339,634CYInvestmentIncomeAmt
PY Other Revenue$1,196,083PYOtherRevenueAmt
CY Other Revenue$1,226,918CYOtherRevenueAmt
PY Total Revenue$24,553,051PYTotalRevenueAmt
CY Total Revenue$25,694,143CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$23,885,066PYOtherExpensesAmt
CY Other Expenses$24,884,339CYOtherExpensesAmt
PY Total Expenses$23,885,066PYTotalExpensesAmt
CY Total Expenses$24,884,339CYTotalExpensesAmt
PY Revenues Less Expenses$667,985PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$809,804CYRevenuesLessExpensesAmt
Total Assets BOY$27,421,957TotalAssetsBOYAmt
Total Assets EOY$29,514,195TotalAssetsEOYAmt
Total Liabilities BOY$11,756,507TotalLiabilitiesBOYAmt
Total Liabilities EOY$12,044,921TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,665,450NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$17,469,274NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionWE CARE. WE TEACH. WE INNOVATE. WE SERVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$21,688,748ExpenseAmt
Revenue$23,344,775RevenueAmt
DescTHE PRIMARY EXEMPT PURPOSE OF UVMC NURSING CARE, INC. (UVMCN) IS TO PROVIDE SKILLED NURSING AND REHABILITATIVE SERVICES IN A LONG-TERM HEALTHCARE SETTING TO INDIVIDUALS IN THE COMMUNITY SERVED BY UPPER VALLEY MEDICAL CENTER, A RELATED TAX-EXEMPT HOSPITAL. AS A PART OF THE UVMC HEALTH SYSTEM, UVMCN IS COMMITTED TO PRESERVING LONG-TERM ACCESS TO QUALITY HEALTH CARE SERVICES FOR MIAMI COUNTY AND THE SURROUNDING AREA. THIS ORGANIZATION WAS FORMED IN 1987 TO ASSURE ACCESS TO APPROPRIATE CARE AT AN ACCEPTABLE COST FOR PATIENTS IN A MANAGED CARE ENVIRONMENT. IN JUNE OF 1989, IT WAS GRANTED TAX EXEMPT STATUS.KOESTER PAVILION IS A 150-BED NURSING HOME PROVIDING LONG-TERM CARE FOR SKILLED AND INTERMEDIATE CARE PATIENTS AS WELL AS FREEDOM COURT, A SPECIALIZED ALZHEIMER'S UNIT.SPRINGMEADE HEALTH CENTER IS A 99-BED NURSING HOME OFFERING A RECUPERATIVE, REHABILITATIVE HEALTH CENTER AND CONVALESCENT AND EXTENDED CARE SERVICES INCLUDING FREEDOM COURT, A DEDICATED ALZHEIMER'S UNIT. BOTH NURSING HOMES CARE FOR MEDICAID, MEDICARE, INSURANCE AND PRIVATE PAY PATIENTS.PATIENT DAYS FOR 2023 WERE:KOESTER PAVILION 40,057SPRINGMEADE 34,756 TOTAL 74,813THE MAJORITY OF THE EXPENDITURES FOR UVMC NURSING CARE, INC. RELATES TO THE COSTS OF THE PROFESSIONAL AND NURSING SERVICES NEEDED TO SERVE THOSE ENTRUSTED TO OUR CARE.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,610,817ExpenseAmt
Revenue$1,462,084RevenueAmt
DescSPRINGMEADE RESIDENCE, LOCATED ON THE SAME CAMPUS AS THE HEALTH CENTER, OFFERS TWO- AND THREE-BEDROOM RETIREMENT LIVING COACH HOMES. SPRINGMEADE COACH HOMES ARE SITUATED TO OFFER A VIEW OF THE NATURAL BEAUTY AND VISUAL AMENITIES WHICH SURROUND THE AREA. SERVICES ARE DESIGNED TO ENHANCE THE LIVES OF THE RESIDENTS BY PROVIDING:1) ALL PROPERTY TAXES AND INSURANCE ON THE STRUCTURES2) YEAR-ROUND INTERIOR AND EXTERIOR MAINTENANCE AND GROUNDS KEEPING3) SPRINGMEADE SPONSORED SPECIAL EVENTS AND SOCIAL FUNCTIONS4) ELECTRONIC CONTACT SYSTEM THAT PROVIDES NOTIFICATION FOR RAPID RESPONSE TO HEALTH EMERGENCIES.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$23,299,565TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign ActivitiesYes (1)ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document55IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members3GoverningBodyVotingMembersCnt
Independent Voting Member3IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1J MICHAEL SIMSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9374999942PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1110 N MAIN ST SUITE 200AddressLine1Txt
CityDAYTONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45402ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
STEVEN STALEY
BOARD CHAIR0.501.00Yes (X)Yes (X)$0$0$0
LISA SHOCKLEY
BOARD VICE-CHAIR0.501.00Yes (X)$0$0$0
NICOLE ERNST
TRUSTEE0.501.00Yes (X)$0$0$0
BENJAMIN A WATSON ESQ
BOARD SECRETARY (FROM MAY TO SEPT)0.5039.50Yes (X)$0$166,904$14,504
DIANNE RUHENKAMP
BOARD TREASURER0.5039.50Yes (X)$0$147,459$30,539
ELIZABETH D WILFONG
BOARD SECRETARY (FROM OCT)0.5039.50Yes (X)$0$93,483$361
ANDREA L FLAUTE
BOARD SECRETARY (TO FEB)0.5039.50Yes (X)$0$28,257$7,424
GEOFFREY P WALKER
FORMER OFFICER0.0040.00$0$940,274$50,389Yes (X)
KEVIN W HARLAN
FORMER TRUSTEE & OFFICER0.0040.00$0$607,513$42,343Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,983,890TotReportableCompRltdOrgAmt
Total Other Compensation$145,560TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CONCEPT REHAB INC
7150 GRANITE CIRTOLEDOOH43617THERAPY SERVICES$2,662,879
ADCARE HEALTH SYSTEMS INC
454 SATELLITE BLVD NW 100SUWANEEGA30024MANAGEMENT SERVICES$2,214,192
TREASURER STATE OF OHIO MEDICAID
OHIO DEPARTMENT OF MEDICAID L-3669COLUMBUSOH432603669HEALTHCARE SERVICES$1,242,630
REMEDI SENIOR CARE
PO BOX 75744BALTIMOREMD21275SENIOR CARE$722,912
INTELY CARE INC
PO BOX 787317PHILADELPHIAPA191787317SENIOR CARE$657,381
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K17CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT REVENUE (NURSING HOME624100$23,344,775$23,344,775
RETIREMENT COMMUNITY FEES531390$1,462,084$1,462,084
FieldValueIRS element (for citing)
Total Program Service Revenue$24,806,859TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$392,269TotalRevenueColumnAmt
Exclusion$392,269ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$12,964,115SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$13,696,018SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$731,903SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$731,903TotalRevenueColumnAmt
Exclusion-$731,903ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
OTHER FEES900099$1,217,419$1,217,419
BEAUTY SHOP900099$8,640$8,640

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$859TotalRevenueColumnAmt
Exclusion$859ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,226,918OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$25,694,143TotalRevenueColumnAmt
Related Or Exempt Func Income$24,806,859RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$887,284ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,041,093TotalAmt
Program Services$945,833ProgramServicesAmt
Management And General$95,260ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$63,623TotalAmt
Program Services$57,801ProgramServicesAmt
Management And General$5,822ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,386,689TotalAmt
Program Services$4,386,689ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$57,864TotalAmt
Program Services$57,864ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$221,926TotalAmt
Program Services$201,620ProgramServicesAmt
Management And General$20,306ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$767,487TotalAmt
Program Services$697,262ProgramServicesAmt
Management And General$70,225ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$8,044TotalAmt
Program Services$7,308ProgramServicesAmt
Management And General$736ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$200TotalAmt
Program Services$200ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$914,622TotalAmt
Program Services$830,934ProgramServicesAmt
Management And General$83,688ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$29,388TotalAmt
Program Services$26,699ProgramServicesAmt
Management And General$2,689ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PURCHASED PERSONNEL$14,181,196$12,883,617$1,297,579
OPERATING SUPPLIES$1,825,740$1,825,740
BED OCCUPANCY TAX$1,271,035$1,271,035
DUES & SUBSCRIPTIONS$22,877$22,877

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$92,555TotalAmt
Program Services$84,086ProgramServicesAmt
Management And General$8,469ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$24,884,339TotalAmt
Program Services$23,299,565ProgramServicesAmt
Management And General$1,584,774ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$7,250BOYAmt
EOY$7,250EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,735,029BOYAmt
EOY$3,529,103EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,354,235BOYAmt
EOY$4,361,713EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$122,923BOYAmt
EOY$86,220EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$30,167,618LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$21,526,547LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,009,669BOYAmt
EOY$8,641,071EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$12,226,463BOYAmt
EOY$12,879,505EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY-$33,612BOYAmt
EOY$9,333EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$27,421,957BOYAmt
EOY$29,514,195EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,833,502BOYAmt
EOY$2,250,097EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$2,794,357BOYAmt
EOY$2,871,657EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$96,018BOYAmt
EOY$150,803EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$7,032,630BOYAmt
EOY$6,772,364EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$11,756,507BOYAmt
EOY$12,044,921EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$15,665,450BOYAmt
EOY$17,469,274EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,665,450BOYAmt
EOY$17,469,274EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$27,421,957BOYAmt
EOY$29,514,195EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$809,804ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$994,020NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$5,974CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,126CurrentTaxYearMinus2YearsAmt
Total$8,100TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$24,031,490CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$18,993,383CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$21,970,563CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$23,183,422CurrentTaxYearMinus1YearAmt
Current Tax Year$24,806,859CurrentTaxYearAmt
Total$112,985,717TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$24,031,490CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$18,999,357CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$21,972,689CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$23,183,422CurrentTaxYearMinus1YearAmt
Current Tax Year$24,806,859CurrentTaxYearAmt
Total$112,993,817TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$112,993,817PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$206,957CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$288,793CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$210,613CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$173,546CurrentTaxYearMinus1YearAmt
Current Tax Year$392,269CurrentTaxYearAmt
Total$1,272,178TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$206,957CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$288,793CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$210,613CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$173,546CurrentTaxYearMinus1YearAmt
Current Tax Year$392,269CurrentTaxYearAmt
Total$1,272,178TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$219,036CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,568,045CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$624,962CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,196,083CurrentTaxYearMinus1YearAmt
Current Tax Year$1,226,918CurrentTaxYearAmt
Total$5,835,044TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$24,457,483CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$21,856,195CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$22,808,264CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$24,553,051CurrentTaxYearMinus1YearAmt
Current Tax Year$26,426,046CurrentTaxYearAmt
Total$120,101,039TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.94080PublicSupportCY509Pct
Public Support PY5090.95110PublicSupportPY509Pct
Investment Income CY0.01060InvestmentIncomeCYPct
Investment Income PY0.00590InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$641,407OtherCostOrOtherBasisAmt
Book Value$641,407BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$22,588,735OtherCostOrOtherBasisAmt
Depreciation$16,236,776DepreciationAmt
Book Value$6,351,959BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,892,680OtherCostOrOtherBasisAmt
Depreciation$5,289,771DepreciationAmt
Book Value$1,602,909BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$44,796OtherCostOrOtherBasisAmt
Book Value$44,796BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$8,641,071TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
REFUNDABLE FEES$6,734,427
AFFILIATES PAYABLE$37,937
FieldValueIRS element (for citing)
Total Liability$6,772,364TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:THE LONG-TERM CARE FACILITIES ARE MANAGED BY AN OUTSIDE COMPANY. THE ESCROW LIABILITY ON FORM 990, PART X, LINE 21 REPRESENTS FUNDS HELD BY EACH NURSING HOME FOR USE BY THE RESIDENTS AND "GOOD FAITH" DEPOSITS ON PURCHASES OF COTTAGES. MEDICAID RESIDENTS ARE ABLE TO KEEP A PORTION OF THEIR BENEFITS AND ARE RESPONSIBLE FOR PERSONAL CARE ITEMS SUCH AS HAIR CARE, TOILETRIES, DINING OUT, ETC. THE NURSING HOME HOLDS THE FUNDS FOR THE RESIDENTS, AND THE RESIDENTS ARE ABLE TO ACCESS THEIR FUNDS WHEN THEY ARE NEEDED. DEPOSITS ON THE PURCHASES OF COTTAGES ARE GENERALLY REFUNDABLE UNDER THE TERMS OF THE RESIDENCY AGREEMENT BETWEEN THE BUYER AND UVMC NURSING CARE, INC. (UVMCN).
PART X, LINE 2:THE FOLLOWING FOOTNOTE IS FROM THE 2023 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF UPPER VALLEY MEDICAL CENTER NURSING CARE (UVMCN). PHP HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE A TAX-EXEMPT NON-PROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS A TAX-EXEMPT ORGANIZATION, ITS INCOME IS EXEMPT FROM FEDERAL INCOME TAX EXCEPT TO THE EXTENT OF ANY UNRELATED BUSINESS ACTIVITIES. PHP CONSOLIDATES CERTAIN SUBSIDIARIES WHICH ARE FOR-PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. THESE ARE: * PREMIER HEALTH HOLDING COMPANY (PHHC) (WHOLLY OWNED SUBSIDIARY OF PHP) * MVHE, INC., (AND ITS WHOLLY OWNED SUBSIDARY EXTENDED CARE), SAMARITAN FAMILY CARE, INC., PREMIER HEALTH SPECIALISTS, INC. AND PREMIER HEALTH URGENT CARE, INC. (WHOLLY OWNED SUBSIDIARIES OF PHHC) MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS.

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp (3 entries)

RegionRegionTxtOfficesOfficesCntEmployeeEmployeeCntType Of Activities ConductedTypeOfActivitiesConductedTxtRegion Total ExpendituresRegionTotalExpendituresAmt
EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM00INVESTMENTS$196,652
NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES00INVESTMENTS$433,404
EAST ASIA AND THE PACIFIC00INVESTMENTS$252,930
FieldValueIRS element (for citing)
Subtotal Offices0SubtotalOfficesCnt
Subtotal Employees0SubtotalEmployeesCnt
Continuation Total Office0ContinuationTotalOfficeCnt
Continuation Total Employee0ContinuationTotalEmployeeCnt
Total Office0TotalOfficeCnt
Total Employee0TotalEmployeeCnt
Subtotal Spent$882,986SubtotalSpentAmt
Continuation Spent$0ContinuationSpentAmt
Total Spent$882,986TotalSpentAmt
Transfer To Foreign Corp0TransferToForeignCorpInd
Interest In Foreign Trust0InterestInForeignTrustInd
Foreign Corp Ownership0ForeignCorpOwnershipInd
Passive Foreign Investmest Co0PassiveForeignInvestmestCoInd
Foreign Partnership0ForeignPartnershipInd
Boycott Countries0BoycottCountriesInd

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
GEOFFREY P WALKER
FORMER OFFICER$0$490,418$0$88,423$0$361,433$0$19,285$0$31,104$0$990,663$0$0
KEVIN W HARLAN
FORMER TRUSTEE & OFFICER$0$500,254$0$77,008$0$30,251$0$30,980$0$11,363$0$649,856$0$0
BENJAMIN A WATSON ESQ
BOARD SECRETARY (FROM MAY TO SEPT)$0$145,490$0$21,105$0$309$0$6,147$0$8,357$0$181,408$0$0
DIANNE RUHENKAMP
BOARD TREASURER$0$130,474$0$15,837$0$1,148$0$10,085$0$20,454$0$177,998$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 4B:FormAndLineReferenceDesc
ExplanationDUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, CERTAIN PERSONS ARE LIMITED IN THE AMOUNT OF BENEFIT THAT CAN BE EARNED UNDER A QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, UVMC NURSING CARE (UVMCN) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. UVMCN SUPPLEMENTS THE AFFECTED EXECUTIVES THROUGH A PENSION RESTORATION PLAN AND A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE BENEFITS UNDER THESE SUPPLEMENTAL NONQUALIFIED PLANS ARE SUBJECT TO MULTI-YEAR VESTING AND A PARTICIPANT CAN FORFEIT BENEFITS EARNED IF VESTING REQUIREMENTS ARE NOT SATISFIED. UNDER THE TERMS OF THE SUPPLEMENTAL PLANS, AND BECAUSE OF TAX RULES PERTAINING TO TAXATION OF THE EARNED BENEFITS UPON VESTING, CERTAIN INDIVIDUALS RECEIVED A PAYOUT OF THE CUMULATIVE VESTED BENEFITS UNDER THEIR SUPPLEMENTAL PLAN DURING 2023. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2023: GEOFFREY WALKER $353,909. THE FOLLOWING SERP AMOUNTS WERE DEFERRED ON THE PARTICIPANTS' BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNTS ARE VESTED: KEVIN HARLAN $19,935. BASED ON THE GUIDANCE PROVIDED IN THE INSTRUCTIONS TO THE FORM 990, ANY PAYMENTS TO THE PARTICIPANTS RELATED TO THESE PLANS THAT WERE MADE WITHIN 2-1/2 MONTHS AFTER THE END OF THE ORGANIZATION'S TAX YEAR ARE NOT TREATED AS DEFERRED COMPENSATION FOR PURPOSES OF SCHEDULE J. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, QUESTION 2A:UVMCN DOES NOT HAVE DIRECT EMPLOYEES. ADCARE HEALTH SYSTEMS, INC. PROVIDES ALL NURSING, ADMINISTRATIVE, AND FINANCIAL SERVICES TO PERFORM THE DAY-TO-DAY OPERATION OF THE NURSING HOMES. ALLOCATED PERSONNEL EXPENSES ARE REPORTED ON PART IX, LINE 24A OF FORM 990.
FORM 990, PART VI, SECTION A, LINE 3ADCARE HEALTH SYSTEMS, INC., UNDER THE DIRECTION OF THE EXECUTIVE MANAGEMENT TEAM OF UVMC, PROVIDES ALL ADMINISTRATIVE, NURSING, AND FINANCIAL SERVICES TO PERFORM THE DAY-TO-DAY OPERATIONS OF THE NURSING HOMES.
FORM 990, PART VI, SECTION A, LINE 6UVMCN HAS ONE CORPORATE MEMBER: PREMIER, AN OHIO NON-PROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7APREMIER HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR UVMCN. PREMIER AS THE OPERATOR OF UVMCN DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR UVMCN, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE SERVICES AND THE CONSOLIDATION OF SUCH SERVICES. UVMCN SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. UVMCN SHALL IMPLEMENT THE CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. UVMCN SHALL IMPLEMENT ANY BUSINESS PLAN APPROVED BY PREMIER. UVMCN MUST HAVE APPROVAL FROM PREMIER TO BORROW IN ANY FISCAL YEAR, GUARANTEE IN ANY YEAR, OR INCUR ANY LIEN OR OTHER ENCUMBRANCE ON ANY PROPERTY IN AN AMOUNT EQUAL TO OR GREATER THAN $1,000,000. UVMCN MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN UVMCN'S ACTIVITIES.
FORM 990, PART VI, SECTION A, LINE 7BSEE EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A.
FORM 990, PART VI, SECTION B, LINE 11BTHIS 990 FILING AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE TAX DEPARTMENT OF PREMIER, WITH WHICH UVMCN IS AFFILIATED. THE RETURN IS REVIEWED BY THE MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. AFTER ALL CHANGES FROM THE ABOVE PERSONS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER. A FINAL VERSION OF THE RETURN IS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT A BOARD OF TRUSTEES MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESSES ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 FILING IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER.
FORM 990, PART VI, SECTION B, LINE 12CPREMIER, WITH WHICH UVMCN IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, MEDICAL DIRECTORS, SUPPLY CHAIN DIVISION MEMBERS, AUTHORIZED SIGNERS, DIRECTORS, EXECUTIVES, MEDICAL EXECUTIVE COMMITTEE MEMBERS, MEDICAL DEPARTMENT AND SECTION CHAIRS, PHYSICIAN PARTNERSHIP COMMITTEE MEMBERS, PHYSICIAN GUIDANCE GROUP MEMBERS, AND ALL EMPLOYED PHYSICIANS TO ANNUALLY REVIEW THE PREMIER COMPREHENSIVE CONFLICT OF INTEREST STATEMENT, AN EXPLANATORY MEMORANDUM, THE ANTITRUST COMPLIANCE POLICY, AND COMPLETE AN INDIVIDUAL QUESTIONNAIRE DISCLOSING ANY POTENTIAL CONFLICTS AS DEFINED IN THE CONFLICT OF INTEREST POLICY. THIS IS ACCOMPLISHED EITHER BY WAY OF AN ELECTRONIC COMMUNICATION SENT OUT DIRECTLY BY THE CORPORATE COMPLIANCE DEPARTMENT OR BY WAY OF A MEMO SENT OUT FROM THE CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER OF PREMIER. IT ALSO INCLUDES AN EXPLANATORY MEMORANDUM OF SPECIFIC ACTIVITIES THAT MIGHT GIVE CAUSE TO A CONFLICT AND AN INDIVIDUAL QUESTIONNAIRE TO DISCLOSE ALL SUCH ACTIVITIES. THIS QUESTIONNAIRE MUST BE COMPLETED AND SIGNED BY THE INDIVIDUAL. THIS CORRESPONDENCE INCLUDES A COPY OF THE ANTITRUST COMPLIANCE POLICY THAT MUST BE SIGNED BY THE INDIVIDUAL. ALL OF THESE DOCUMENTS ARE SENT TO THE CORPORATE COMPLIANCE DEPARTMENT. THE CORPORATE COMPLIANCE DEPARTMENT ENSURES ALL FORMS ARE RETURNED AND RETAINS THE DOCUMENTS FOR FIVE YEARS. IN ADDITION, AT EACH MEETING OF THE BOARD OR ANY BOARD COMMITTEE, FOLLOWING APPROVAL OF THE PREVIOUS MEETING'S MINUTES, THE BOARD OR COMMITTEE CHAIR SHALL REQUEST ANY BOARD MEMBER WHO PERCEIVES A POTENTIAL CONFLICT OF INTEREST ON ANY OF THE MEETING'S AGENDA ITEMS TO DISCLOSE THE POTENTIAL CONFLICT. ADDITIONALLY, AT ANY BOARD OR BOARD COMMITTEE MEETING WHERE THE SUBJECT OF CONFLICT OF INTEREST IS DISCUSSED, THE MINUTES SHALL CONTAIN THE NAME OF THE PARTY DISCUSSING A POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE POTENTIAL CONFLICT OF INTEREST AND WHETHER A CONFLICT OF INTEREST WAS FOUND TO EXIST. IF A CONFLICT OF INTEREST IS DETERMINED BY THE BOARD TO EXIST, THE MEMBER WILL BE EXCUSED FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON THE PARTICULAR AGENDA ITEM. THE CHIEF COMPLIANCE AND ENTERPRISE RISK OFFICER REPORTS THE RESULTS OF THE PREMIER CONFLICT OF INTEREST QUESTIONNAIRES NO LESS THAN ANNUALLY TO THE BOARD OF TRUSTEES BY WAY OF THE COMPLIANCE AND AUDIT COMMITTEE. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE MEETING. PERIODICALLY, THE INTERNAL AUDIT DEPARTMENT WILL REVIEW A SAMPLE OF COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND REPORT THE RESULTS TO THE COMPLIANCE AND AUDIT COMMITTEE. THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE INDIVIDUALLY SUMMARIZED IN A DOCUMENT AND SENT ELECTRONICALLY TO THE FINANCE DEPARTMENT FOR ANY NECESSARY DISCLOSURES REQUIRED ON THE 990 FILING.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC WHEN REQUIRED BY LAW OR FOR ACCREDITATION PURPOSES. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11GCONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,322,006. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,322,006. MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 52,688. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 52,688. BANK FEES: PROGRAM SERVICE EXPENSES 11,995. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,995.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
PREMIER HEALTH
110 N MAIN ST 200DAYTONOH45402311446699PARENTOH501(C)(3)12BN/A0
MEDAMERICA HEALTH SYSTEMS CO
110 N MAIN ST 200DAYTONOH45402311040228SUPPORT ORGOH501(C)(3)12BN/A0
MIAMI VALLEY HOSPITAL
110 N MAIN ST 200DAYTONOH45402310537504HOSPITALOH501(C)(3)30PREMIER HEALTH
MIAMI VALLEY HOSPITAL FOUNDATION
110 N MAIN ST 200DAYTONOH45402311040231FOUNDATIONOH501(C)(3)70PREMIER HEALTH
FIDELITY HEALTH CARE INC
110 N MAIN ST 200DAYTONOH45402311075381HOME HEALTHOH501(C)(3)100PREMIER HEALTH
PREMIER COMMUNITY HEALTH
110 N MAIN ST 200DAYTONOH45402311122883HEALTH EDUCATIONOH501(C)(3)100FIDELITY HEALTH CARE
GOOD SAMARITAN FOUNDATION - DAYTON
110 N MAIN ST 200DAYTONOH45402237296923FOUNDATIONOH501(C)(3)70PREMIER HEALTH
SAMARITAN BEHAVIORAL HEALTH INC
110 N MAIN ST 200DAYTONOH45402020633634BEHAVIORAL HEALTHOH501(C)(3)70PREMIER HEALTH
ATRIUM HEALTH SYSTEM
110 N MAIN ST 200DAYTONOH45402310537492SUPPORT ORGOH501(C)(3)12BN/A0
ATRIUM MEDICAL CENTER
110 N MAIN ST 200DAYTONOH45402311079309HOSPITALOH501(C)(3)30PREMIER HEALTH
UVMC
110 N MAIN ST 200DAYTONOH45402341850683SUPPORT ORGOH501(C)(3)12BN/A0
UPPER VALLEY MEDICAL CENTER
110 N MAIN ST 200DAYTONOH45402310537095HOSPITALOH501(C)(3)30PREMIER HEALTH
UPPER VALLEY PROFESSIONAL CORP
110 N MAIN ST 200DAYTONOH45402311400963HEALTH CAREOH501(C)(3)100PREMIER HEALTH HOLDING CO
UVPC SPECIALISTS INC
110 N MAIN ST 200DAYTONOH45402203687536HEALTH CAREOH501(C)(3)100PREMIER HEALTH HOLDING CO
COMPUNET CLINICAL LABORATORIES LLC
110 N MAIN ST 200DAYTONOH45402311258010LABOH501(C)(3)12B0PREMIER HEALTH

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerInd
SWEITZER STREET LLC
110 N MAIN ST 200DAYTONOH45402454700417REAL ESTATEOHMVHE INCEXCLUDED00
SWEITZER MOB LLC
110 N MAIN ST 200DAYTONOH45402474554657REAL ESTATEOHMVHE INCEXCLUDED00

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
MVHE INC
110 N MAIN ST 200DAYTONOH45402311185270PHYSICIAN SVCSOHPREMIER HEALTH HOLDING COC0
PREMIER HEALTH SPECIALISTS
110 N MAIN ST 200DAYTONOH45402061744704PHYSICIAN SVCSOHPREMIER HEALTH HOLDING COC0
SAMARITAN FAMILY CARE
110 N MAIN ST 200DAYTONOH45402311299450PHYSICIAN SVCSOHPREMIER HEALTH HOLDING COC0
AFTER HOURS FAMILY CARE
110 N MAIN ST 200DAYTONOH45402311269483HEALTH CAREOHUPPER VALLEY PROFESSIONAL CORPC0
UVMC MANAGEMENT CORP
110 N MAIN ST 200DAYTONOH45402311360489MANAGEMENT COMPANYOHPREMIER HEALTHC0
PREMIER HEALTH URGENT CARE INC
110 N MAIN ST 200DAYTONOH45402822079409URGENT CAREOHPREMIER HEALTH HOLDING COC0
PREMIER HEALTH INT'L INSURANCE
980548485INSURANCEPREMIER HEALTHC0BUTTERFIELD BANK BLDG 6TH FLOOR 6HAMILTONBDHM12BD
PREMIER HEALTH PLAN INC
110 N MAIN ST 200DAYTONOH45402463024049HEALTH INSURANCEOHPREMIER HEALTH INSURING COC0
GOOD SAMARITAN HOSPITAL
110 N MAIN ST 200DAYTONOH45402310536981HOSPITALOHPREMIER HEALTHC0
PREMIER HEALTH ACO OF OHIO
110 N MAIN ST 200DAYTONOH45402474049773MEDICARE ACOOHPREMIER HEALTHC0
PREMIER HEALTH HOLDING CO
110 N MAIN ST 200DAYTONOH45402812419110HOLDING COOHPREMIER HEALTHC0
PREMIER HEALTH INSURING CO
110 N MAIN ST 200DAYTONOH45402464766841HEALTH INSURANCEOHPREMIER HEALTHC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd