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UVMC NURSING CARE INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
UVMC NURSING CARE INC (EIN 31-1224064)
Tax period
2022-01-01 to 2022-12-31
Filed
2023-11-14
IRS object ID
202333189349316053
Schema version
2022v5.0
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)
Return2023-11-14T16:29:05-06:00ReturnTs
Tax Period End2022-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2022-01-01TaxPeriodBeginDt

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 500AddressLine1Txt
CityDAYTONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45402ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJ MICHAEL SIMSPersonNm
Person TitleSYSTEM VP & CORP. CONTROLLERPersonTitleTxt
Phone9374499942PhoneNum
Signature2023-11-14SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJPersonFirstNm
Person LastMICHAEL SIMSPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

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$24,553,051GrossReceiptsAmt
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 Volunteers9TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,126PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$21,970,563PYProgramServiceRevenueAmt
CY Program Service Revenue$23,183,422CYProgramServiceRevenueAmt
PY Investment Income$210,613PYInvestmentIncomeAmt
CY Investment Income$173,546CYInvestmentIncomeAmt
PY Other Revenue$624,962PYOtherRevenueAmt
CY Other Revenue$1,196,083CYOtherRevenueAmt
PY Total Revenue$22,808,264PYTotalRevenueAmt
CY Total Revenue$24,553,051CYTotalRevenueAmt
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$23,168,139PYOtherExpensesAmt
CY Other Expenses$23,885,066CYOtherExpensesAmt
PY Total Expenses$23,168,139PYTotalExpensesAmt
CY Total Expenses$23,885,066CYTotalExpensesAmt
PY Revenues Less Expenses-$359,875PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$667,985CYRevenuesLessExpensesAmt
Total Assets BOY$28,595,230TotalAssetsBOYAmt
Total Assets EOY$27,421,957TotalAssetsEOYAmt
Total Liabilities BOY$12,427,084TotalLiabilitiesBOYAmt
Total Liabilities EOY$11,756,507TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$16,168,146NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$15,665,450NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionWE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST COMPETITIVE HEALTH SERVICES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$20,669,340ExpenseAmt
Revenue$21,768,643RevenueAmt
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 2022 WERE:KOESTER PAVILION 38,560SPRINGMEADE 34,257 TOTAL 72,817THE 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$1,653,249ExpenseAmt
Revenue$1,414,779RevenueAmt
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$22,322,589TotalProgramServiceExpensesAmt
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 Document67IRPDocumentCnt
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 500AddressLine1Txt
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
KEVIN W HARLAN
UPPER VALLEY PRESIDENT0.5039.50Yes (X)$0$547,871$29,797
DIANNE RUHENKAMP
BOARD TREASURER0.5039.50Yes (X)$0$144,447$28,916
ANDREA L FLAUTE
BOARD SECRETARY0.5039.50Yes (X)$0$108,290$13,917
GEOFFREY P WALKER
FORMER OFFICER0.0040.00$0$942,545$48,436Yes (X)
TIMOTHY D SNIDER
FORMER OFFICER0.0040.00$0$328,430$43,395Yes (X)
BENJAMIN A WATSON ESQ
FORMER OFFICER0.0040.00$0$212,206$16,090Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,283,789TotReportableCompRltdOrgAmt
Total Other Compensation$180,551TotalOtherCompensationAmt
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$2,809,404
ADCARE HEALTH SYSTEMS INC
454 SATELLITE BLVD NW 100SUWANEEGA30024MANAGEMENT SERVICES$2,334,722
TREASURER STATE OF OHIO MEDICAID
OHIO DEPARTMENT OF MEDICAID L-3669COLUMBUSOH432603669HEALTHCARE SERVICES$1,223,061
REMEDI SENIOR CARE
PO BOX 75744BALTIMOREMD21275SENIOR CARE$851,910
GORDON FOOD SERVICE
PAYMENT PROCESSING CENTER DEPT CHPALANTINEIL60055FOOD SERVICES$547,765
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K18CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT REVENUE (NURSING HOME624100$21,768,643$21,768,643
RETIREMENT COMMUNITY FEES531390$1,414,779$1,414,779
FieldValueIRS element (for citing)
Total Program Service Revenue$23,183,422TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$173,546TotalRevenueColumnAmt
Exclusion$173,546ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
OTHER FEES900099$1,183,298$1,183,298
BEAUTY SHOP900099$12,013$12,013

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$772TotalRevenueColumnAmt
Exclusion$772ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,196,083OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$24,553,051TotalRevenueColumnAmt
Related Or Exempt Func Income$23,183,422RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,369,629ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,054,243TotalAmt
Program Services$956,726ProgramServicesAmt
Management And General$97,517ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$24,915TotalAmt
Program Services$22,610ProgramServicesAmt
Management And General$2,305ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,842,970TotalAmt
Program Services$3,842,970ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$52,237TotalAmt
Program Services$52,237ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$189,063TotalAmt
Program Services$171,575ProgramServicesAmt
Management And General$17,488ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$795,416TotalAmt
Program Services$721,840ProgramServicesAmt
Management And General$73,576ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$6,071TotalAmt
Program Services$5,509ProgramServicesAmt
Management And General$562ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$31TotalAmt
Program Services$31ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$894,970TotalAmt
Program Services$812,185ProgramServicesAmt
Management And General$82,785ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$24,691TotalAmt
Program Services$22,407ProgramServicesAmt
Management And General$2,284ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PURCHASED PERSONNEL$13,820,021$12,541,669$1,278,352
OPERATING SUPPLIES$1,856,560$1,856,560
BED OCCUPANCY TAX$1,220,083$1,220,083
DUES & SUBSCRIPTIONS$21,550$21,550

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$82,245TotalAmt
Program Services$74,637ProgramServicesAmt
Management And General$7,608ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$23,885,066TotalAmt
Program Services$22,322,589ProgramServicesAmt
Management And General$1,562,477ManagementAndGeneralAmt
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$2,751,253BOYAmt
EOY$1,735,029EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,793,244BOYAmt
EOY$4,354,235EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$221,066BOYAmt
EOY$122,923EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$31,192,402LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$22,182,733LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,197,002BOYAmt
EOY$9,009,669EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$12,625,415BOYAmt
EOY$12,226,463EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
EOY-$33,612EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$28,595,230BOYAmt
EOY$27,421,957EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,208,116BOYAmt
EOY$1,833,502EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$2,652,550BOYAmt
EOY$2,794,357EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$183,014BOYAmt
EOY$96,018EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$7,383,404BOYAmt
EOY$7,032,630EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,427,084BOYAmt
EOY$11,756,507EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$16,168,146BOYAmt
EOY$15,665,450EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$16,168,146BOYAmt
EOY$15,665,450EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$28,595,230BOYAmt
EOY$27,421,957EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$667,985ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,170,681NetUnrlzdGainsLossesInvstAmt
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 Minus2 Years$5,974CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,126CurrentTaxYearMinus1YearAmt
Total$8,100TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$21,438,575CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$24,031,490CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$18,993,383CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$21,970,563CurrentTaxYearMinus1YearAmt
Current Tax Year$23,183,422CurrentTaxYearAmt
Total$109,617,433TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$21,438,575CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$24,031,490CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$18,999,357CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$21,972,689CurrentTaxYearMinus1YearAmt
Current Tax Year$23,183,422CurrentTaxYearAmt
Total$109,625,533TotalAmt

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$109,625,533PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$152,192CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$206,957CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$288,793CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$210,613CurrentTaxYearMinus1YearAmt
Current Tax Year-$173,546CurrentTaxYearAmt
Total$685,009TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$152,192CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$206,957CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$288,793CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$210,613CurrentTaxYearMinus1YearAmt
Current Tax Year-$173,546CurrentTaxYearAmt
Total$685,009TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$346,701CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$219,036CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,568,045CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$624,962CurrentTaxYearMinus1YearAmt
Current Tax Year$1,196,083CurrentTaxYearAmt
Total$4,954,827TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$21,937,468CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$24,457,483CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$21,856,195CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$22,808,264CurrentTaxYearMinus1YearAmt
Current Tax Year$24,205,959CurrentTaxYearAmt
Total$115,265,369TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.95110PublicSupportCY509Pct
Public Support PY5090.95510PublicSupportPY509Pct
Investment Income CY0.00590InvestmentIncomeCYPct
Investment Income PY0.00890InvestmentIncomePYPct
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$22,582,287OtherCostOrOtherBasisAmt
Depreciation$15,887,569DepreciationAmt
Book Value$6,694,718BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,870,065OtherCostOrOtherBasisAmt
Depreciation$6,295,164DepreciationAmt
Book Value$1,574,901BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$98,643OtherCostOrOtherBasisAmt
Book Value$98,643BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$9,009,669TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
REFUNDABLE FEES$6,976,393
AFFILIATES PAYABLE$56,237
FieldValueIRS element (for citing)
Total Liability$7,032,630TotalLiabilityAmt
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 2022 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF SAMARITAN BEHAVIORAL HEALTH, INC. 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 INSURING CO. (PHIC), AND PREMIER HEALTH HOLDING COMPANY (PHHC) (WHOLLY OWNED SUBSIDIARIES OF PHP), * PREMIER HEALTH PLAN (PHPLAN) (A WHOLLY OWNED SUBSIDIARY OF PHIC), * MVHE, INC., SAMARITAN FAMILY CARE, INC., PREMIER HEALTH SPECIALISTS, INC. AND PREMIER HEALTH URGENT CARE, INC. (SUBSIDIARIES OF PHHC), * PREMIER HEALTH ACO OF OHIO AND UVMC MANAGEMENT CORPORATION - CLOSED JUNE 2022 (SUBSIDIARIES OF PHP) 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 (2 entries)

RegionRegionTxtOfficesOfficesCntEmployeeEmployeeCntType Of Activities ConductedTypeOfActivitiesConductedTxtRegion Total ExpendituresRegionTotalExpendituresAmt
EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM00INVESTMENTS$490,294
NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES00INVESTMENTS$471,115
FieldValueIRS element (for citing)
Subtotal Offices0SubtotalOfficesCnt
Subtotal Employees0SubtotalEmployeesCnt
Continuation Total Office0ContinuationTotalOfficeCnt
Continuation Total Employee0ContinuationTotalEmployeeCnt
Total Office0TotalOfficeCnt
Total Employee0TotalEmployeeCnt
Subtotal Spent$961,409SubtotalSpentAmt
Continuation Spent$0ContinuationSpentAmt
Total Spent$961,409TotalSpentAmt
Transfer To Foreign Corp0TransferToForeignCorpInd
Interest In Foreign Trust0InterestInForeignTrustInd
Foreign Corp Ownership0ForeignCorpOwnershipInd
Passive Foreign Investmest Co0PassiveForeignInvestmestCoInd
Foreign Partnership0ForeignPartnershipInd
Boycott Countries0BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART III ACCOUNTING METHOD:FormAndLineReferenceDesc

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (1)SeverancePaymentInd
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 (5 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$483,803$0$150,928$0$307,814$0$18,871$0$29,565$0$990,981$0$0
KEVIN W HARLAN
UPPER VALLEY PRESIDENT$0$402,558$0$126,734$0$18,579$0$18,892$0$10,905$0$577,668$0$0
TIMOTHY D SNIDER
FORMER OFFICER$0$0$0$70,757$0$257,673$0$16,007$0$27,388$0$371,825$0$0
BENJAMIN A WATSON ESQ
FORMER OFFICER$0$175,577$0$36,299$0$330$0$6,107$0$9,983$0$228,296$0$0
DIANNE RUHENKAMP
BOARD TREASURER$0$127,842$0$16,000$0$605$0$8,723$0$20,193$0$173,363$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 4A:THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT: TIMOTHY SNIDER RECEIVED $271,152 IN 2022.
PART I, LINE 4B:DUE 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 2022. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2022: GEOFFREY WALKER $300,385. 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 $8,946. 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.

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 3,773,403. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,773,403. MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 54,600. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,600. BANK FEES: PROGRAM SERVICE EXPENSES 14,967. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,967.

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 500DAYTONOH45402311446699PARENTOH501(C)(3)12BN/A0
MEDAMERICA HEALTH SYSTEMS CO
110 N MAIN ST 500DAYTONOH45402311040228SUPPORT ORGOH501(C)(3)12BN/A0
MIAMI VALLEY HOSPITAL
110 N MAIN ST 500DAYTONOH45402310537504HOSPITALOH501(C)(3)30PREMIER HEALTH
MIAMI VALLEY HOSPITAL FOUNDATION
110 N MAIN ST 500DAYTONOH45402311040231FOUNDATIONOH501(C)(3)70PREMIER HEALTH
FIDELITY HEALTH CARE INC
110 N MAIN ST 500DAYTONOH45402311075381HOME HEALTHOH501(C)(3)100PREMIER HEALTH
PREMIER COMMUNITY HEALTH
110 N MAIN ST 500DAYTONOH45402311122883HEALTH EDUCATIONOH501(C)(3)100FIDELITY HEALTH CARE
GOOD SAMARITAN FOUNDATION - DAYTON
110 N MAIN ST 500DAYTONOH45402237296923FOUNDATIONOH501(C)(3)70PREMIER HEALTH
SAMARITAN BEHAVIORAL HEALTH INC
110 N MAIN ST 500DAYTONOH45402020633634BEHAVIORAL HEALTHOH501(C)(3)70PREMIER HEALTH
ATRIUM HEALTH SYSTEM
110 N MAIN ST 500DAYTONOH45402310537492SUPPORT ORGOH501(C)(3)12BN/A0
ATRIUM MEDICAL CENTER
110 N MAIN ST 500DAYTONOH45402311079309HOSPITALOH501(C)(3)30PREMIER HEALTH
UVMC
110 N MAIN ST 500DAYTONOH45402341850683SUPPORT ORGOH501(C)(3)12BN/A0
UPPER VALLEY MEDICAL CENTER
110 N MAIN ST 500DAYTONOH45402310537095HOSPITALOH501(C)(3)30PREMIER HEALTH
UPPER VALLEY PROFESSIONAL CORP
110 N MAIN ST 500DAYTONOH45402311400963HEALTH CAREOH501(C)(3)100PREMIER HEALTH HOLDING CO
UVPC SPECIALISTS INC
110 N MAIN ST 500DAYTONOH45402203687536HEALTH CAREOH501(C)(3)100PREMIER HEALTH HOLDING CO
COMPUNET CLINICAL LABORATORIES LLC
110 MAIN STREET SUITE 500DAYTONOH45402311258010LABOH501(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 STREET SUITE 500DAYTONOH45402454700417REAL ESTATEOHMVHE INCEXCLUDED00
SWEITZER MOB LLC
110 N MAIN STREET SUITE 500DAYTONOH45402474554657REAL 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 NORTH MAIN STREET SUITE 500DAYTONOH45402311185270PHYSICIAN SVCSOHPREMIER HEALTH HOLDING COC0
PREMIER HEALTH SPECIALISTS
110 NORTH MAIN STREET SUITE 500DAYTONOH45402061744704PHYSICIAN SVCSOHPREMIER HEALTH HOLDING COC0
SAMARITAN FAMILY CARE
110 NORTH MAIN STREET SUITE 500DAYTONOH45402311299450PHYSICIAN SVCSOHPREMIER HEALTH HOLDING COC0
AFTER HOURS FAMILY CARE
110 NORTH MAIN STREET SUITE 500DAYTONOH45402311269483HEALTH CAREOHUPPER VALLEY PROFESSIONAL CORPC0
UVMC MANAGEMENT CORP
110 NORTH MAIN STREET SUITE 500DAYTONOH45402311360489MANAGEMENT COMPANYOHPREMIER HEALTHC0
PREMIER HEALTH URGENT CARE INC
110 NORTH MAIN STREET SUITE 500DAYTONOH45402822079409URGENT CAREOHPREMIER HEALTH HOLDING COC0
PREMIER HEALTH INT'L INSURANCE
980548485INSURANCEPREMIER HEALTHC0BUTTERFIELD BANK BLDG 6TH FLOOR 6HAMILTONBDHM12BD
PREMIER HEALTH PLAN INC
110 NORTH MAIN STREET SUITE 500DAYTONOH45402463024049HEALTH INSURANCEOHPREMIER HEALTH INSURING COC0
GOOD SAMARITAN HOSPITAL
110 NORTH MAIN STREET SUITE 500DAYTONOH45402310536981HOSPITALOHPREMIER HEALTHC0
PREMIER HEALTH ACO OF OHIO
110 NORTH MAIN STREET SUITE 500DAYTONOH45402474049773MEDICARE ACOOHPREMIER HEALTHC0
PREMIER HEALTH HOLDING CO
110 NORTH MAIN STREET SUITE 500DAYTONOH45402812419110HOLDING COOHPREMIER HEALTHC0
PREMIER HEALTH INSURING CO
110 NORTH MAIN STREET SUITE 500DAYTONOH45402464766841HEALTH 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