PREMIER HEALTH PARTNERS: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PREMIER HEALTH PARTNERS (EIN 31-1446699)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202213199349326591
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule F
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T18:11:51-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 346565596 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 221 E 4TH ST 2900 | AddressLine1Txt |
| City | CINCINNATI | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311446699 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PREMIER HEALTH PARTNERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PREM | BusinessNameControlTxt |
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | J MICHAEL SIMS | PersonNm |
| Person Title | VP & CONTROLLER | PersonTitleTxt |
| Phone | 9374999942 | PhoneNum |
| Signature | 2022-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | J | PersonFirstNm |
| Person Last | MICHAEL SIMS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JULIE L SPARKS | PreparerPersonNm |
| PTIN | P01268401 | PTIN |
| Phone | 5136121400 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PREMIER HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL C RIORDAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,820,090 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PREMIERHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH QUALITY, COST-COMPETITIVE HEALTH SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 21 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 17 | VotingMembersIndependentCnt |
| Total Employee | 15 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $36,121 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $834,002 | PYContributionsGrantsAmt |
| CY Contributions Grants | $127,650 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,717,029 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,590,021 | CYProgramServiceRevenueAmt |
| PY Investment Income | $25,000 | PYInvestmentIncomeAmt |
| CY Investment Income | -$24,219 | CYInvestmentIncomeAmt |
| PY Other Revenue | $225,899 | PYOtherRevenueAmt |
| CY Other Revenue | $102,419 | CYOtherRevenueAmt |
| PY Total Revenue | $5,801,930 | PYTotalRevenueAmt |
| CY Total Revenue | $1,795,871 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $158 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $116,425,048 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $120,480,198 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $108,458,964 | PYOtherExpensesAmt |
| CY Other Expenses | $125,944,357 | CYOtherExpensesAmt |
| PY Total Expenses | $224,884,512 | PYTotalExpensesAmt |
| CY Total Expenses | $246,424,713 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$219,082,582 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$244,628,842 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $62,759,053 | TotalAssetsBOYAmt |
| Total Assets EOY | $58,265,641 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $34,095,759 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $33,782,872 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $28,663,294 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,482,769 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE 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 Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $212,357,938 | ExpenseAmt |
| Grant | $158 | GrantAmt |
| Revenue | $1,590,021 | RevenueAmt |
| Desc | THE PRIMARY EXEMPT PURPOSE OF PREMIER HEALTH (PREMIER) IS TO ESTABLISH, MAINTAIN, SUPPORT, AND STIMULATE THE DEVELOPMENT OF A HEALTHCARE SYSTEM INCLUDING WITHOUT LIMITATION, HOSPITALS, CLINICS, AND OTHER FACILITIES THAT PROVIDE INPATIENT OR OUTPATIENT CARE OR AMBULATORY SERVICES, ACCOMMODATIONS, DIAGNOSTICS, AND TREATMENTS TO PERSONS SUFFERING FROM ILLNESS.CONTINUED IN SCHEDULE O. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,251,300 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | PREMIER HEALTH GROUP (PHG) IS A NON-EQUITY MODEL PHYSICIAN HOSPITAL ORGANIZATION CREATED TO CLINICALLY INTEGRATE PHYSICIANS AND HOSPITALS IN THE COMMON INTEREST OF ACHIEVING THE TRIPLE AIM: IMPROVED CONSUMER EXPERIENCE WITH THE HEALTHCARE SYSTEM AND LOWERING TOTAL COST OF CARE, WHILE MAINTAINING OR IMPROVING QUALITY OUTCOMES. PHG SERVES AS THE PROVIDER NETWORK FOR AND PROVIDES CONTINUOUS QUALITY IMPROVEMENT FUNCTIONS FOR PREMIER HEALTH PLAN, PREMIER HEALTH INSURING CORPORATION AND PREMIER HEALTH ACO OF OHIO, ALL AFFILIATES OF PREMIER HEALTH. THROUGH OUR PHYSICIAN-LED ORGANIZATION, WE DEPLOY VARIOUS POPULATION HEALTH MODELS TO OUR PROVIDERS TO HELP THEM BETTER COORDINATE CARE FOR THEIR PATIENTS IN OUR EFFORTS TO SERVE PREMIER HEALTH'S MISSION OF BUILDING HEALTHIER COMMUNITIES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $214,609,238 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 790 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 15 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | Yes (1) | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 21 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 17 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | J MICHAEL SIMS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (40 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| MARY H BOOSALIS | ||||||||||
| PRESIDENT & CEO | 38.00 | 2.00 | Yes (X) | Yes (X) | $3,030,456 | $0 | $40,515 | |||
| DARIN J PANGALANGAN MD | ||||||||||
| TRUSTEE & SYS VP-CLINICAL SERVICE LINES | 0.50 | 39.50 | Yes (X) | $300 | $566,896 | $3,215 | ||||
| SUBODH K WADHWA MD | ||||||||||
| TRUSTEE & PHYSICIAN: SPECIALTY | 0.50 | 39.50 | Yes (X) | $0 | $269,671 | $14,735 | ||||
| ANITA J MOORE | ||||||||||
| BOARD CHAIR | 0.50 | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| STEVE BEINLICH | ||||||||||
| TRUSTEE | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| KATHLEEN A CARLSON | ||||||||||
| TRUSTEE | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| MARVA COSBY | ||||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| GAIL P FOREST | ||||||||||
| TRUSTEE | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| MARTIN K FUJIMURA MD | ||||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOSEPH M GERAGHTY | ||||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| LARRY L HOLLINGSHEAD | ||||||||||
| TRUSTEE | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| DANIEL L HOOD MD | ||||||||||
| TRUSTEE | 0.50 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN W JACK LOHBECK | ||||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| MITCH MELFI | ||||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| DOUGLAS L MEYER | ||||||||||
| TRUSTEE | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| ROWAN R NICKOL MD | ||||||||||
| TRUSTEE | 0.50 | 1.50 | Yes (X) | $0 | $0 | $0 | ||||
| EDGAR M PURVIS JR | ||||||||||
| TRUSTEE | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| COLLEEN RYAN | ||||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| STEVEN STALEY | ||||||||||
| TRUSTEE | 0.50 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| JILL WILSON | ||||||||||
| TRUSTEE | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| SUSIE WISE | ||||||||||
| TRUSTEE | 0.50 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| BARBARA A JOHNSON | ||||||||||
| EXECUTIVE VP & COO | 38.50 | 1.50 | Yes (X) | $1,109,672 | $0 | $26,089 | ||||
| GEOFFREY P WALKER | ||||||||||
| SYSTEM VP-CHIEF LEGAL OFFICER | 10.00 | 30.00 | Yes (X) | $924,392 | $0 | $47,873 | ||||
| CRAIG GANGER | ||||||||||
| EXEC VP AND CFO | 39.50 | 0.50 | Yes (X) | $590,468 | $9,747 | $50,398 | ||||
| MARC R BELCASTRO DO | ||||||||||
| VP MEDICAL AFFAIRS & CMO | 10.00 | 30.00 | $800,172 | $0 | $35,402 | Yes (X) | ||||
| MARY M CLANCY | ||||||||||
| CHIEF DIGITAL OFFICER | 9.50 | 30.50 | $660,172 | $0 | $127,089 | Yes (X) | ||||
| J MICHAEL SIMS | ||||||||||
| SYS VP & CORPORATE CONTROLLER | 10.00 | 30.00 | $623,246 | $0 | $48,840 | Yes (X) | ||||
| MARGARET PEGGY W MARK | ||||||||||
| VP NURSING / CNO / PATIENT EXP | 10.00 | 30.00 | $586,889 | $0 | $39,660 | Yes (X) | ||||
| THOMAS R CURTIN | ||||||||||
| SYSTEM VP REVENUE CYCLE | 10.00 | 30.00 | $385,866 | $0 | $67,243 | Yes (X) | ||||
| MATTHEW S REEVES | ||||||||||
| SYS VP VALUE BASE SVS & PRES PHG | 40.00 | 0.00 | $575,830 | $0 | $403,889 | Yes (X) | ||||
| DIANE L PLEIMAN | ||||||||||
| PRESIDENT & CEO-PHYS COMPANIES | 8.00 | 32.00 | $771,104 | $0 | $45,883 | Yes (X) | ||||
| JASON M BAILEY | ||||||||||
| DIRECTOR-VALUE BASED SERVICES | 40.00 | 0.00 | $195,946 | $0 | $31,801 | Yes (X) | ||||
| SCOTT A SHELTON | ||||||||||
| FORMER OFFICER | 0.00 | 0.00 | $886,751 | $0 | $8,827 | Yes (X) | ||||
| MICHAEL J MAIBERGER | ||||||||||
| FORMER OFFICER | 0.00 | 0.00 | $521,201 | $0 | $0 | Yes (X) | ||||
| JENNIFER J HAULER DO | ||||||||||
| FORMER KEY EMPLOYEE | 0.00 | 40.00 | $0 | $817,844 | $100,077 | Yes (X) | ||||
| GARY G GINTER | ||||||||||
| FORMER KEY EMPLOYEE | 0.00 | 40.00 | $0 | $566,099 | $100,663 | Yes (X) | ||||
| ELAINE LAINIE M DEAN | ||||||||||
| FORMER KEY EMPLOYEE | 0.00 | 40.00 | $0 | $511,637 | $26,575 | Yes (X) | ||||
| BILLIE L LUCENTE-BAKER | ||||||||||
| FORMER KEY EMPLOYEE | 0.00 | 40.00 | $0 | $320,650 | $34,596 | Yes (X) | ||||
| THOMAS R PARKER | ||||||||||
| FORMER KEY EMPLOYEE | 0.00 | 0.00 | $0 | $288,611 | $23,566 | Yes (X) | ||||
| KIM K STRAHL | ||||||||||
| FORMER KEY EMPLOYEE | 0.00 | 40.00 | $0 | $207,605 | $23,724 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $11,662,465 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,558,760 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,300,660 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MCKINSEY & COMPANY INC | |||||
| 140 FOUNDATION PARKWAY N | ST PETERSBURG | FL | 33716 | PROFESSIONAL SERVICES | $31,310,600 |
| BESPOKE WORKFORCE LLC | |||||
| 5930 CORNERSTONE CT W 300 | SAN DIEGO | CA | 92121 | MEDICAL SERVICES | $29,995,933 |
| DECAPUA ENTERPRISES INC | |||||
| 1114 DUBLIN RD | COLUMBUS | OH | 43215 | MEDICAL SERVICES | $25,063,523 |
| ANESTHESIOLOGY SERVICES | |||||
| ONE WYOMING ST | DAYTON | OH | 45409 | MEDICAL SERVICES | $22,334,271 |
| MORRISON HEALTHCARE | |||||
| 400 NORTHRIDGE ROAD 600 | ATLANTA | GA | 30350 | PROFESSIONAL SERVICES | $21,141,033 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 469 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $102,244 | RelatedOrganizationsAmt |
| All Other Contributions | $25,406 | AllOtherContributionsAmt |
| Total Contributions | $127,650 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT INFORMATION PARTNERS | 900099 | $1,581,900 | $1,581,900 |
| HEALTH EDUCATION | 900099 | $8,121 | $8,121 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,590,021 | TotalProgramServiceRevenueAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $24,219 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$24,219 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$24,219 | TotalRevenueColumnAmt |
| Exclusion | -$24,219 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| EMS EDUCATION | 900099 | $33,748 | $33,748 |
| PURCHASE DISCOUNTS | 900099 | $23,429 | $23,429 |
| CAREFINDERS | 900099 | $4,750 | $4,750 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,492 | TotalRevenueColumnAmt |
| Exclusion | $40,492 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $102,419 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,795,871 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,590,021 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $78,200 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158 | TotalAmt |
| Program Services | $158 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,193,127 | TotalAmt |
| Program Services | $3,051,293 | ProgramServicesAmt |
| Management And General | $6,141,834 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,227,471 | TotalAmt |
| Program Services | $80,462,881 | ProgramServicesAmt |
| Management And General | $9,764,590 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,978,009 | TotalAmt |
| Program Services | $2,655,723 | ProgramServicesAmt |
| Management And General | $322,286 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,832,495 | TotalAmt |
| Program Services | $10,551,960 | ProgramServicesAmt |
| Management And General | $1,280,535 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,249,096 | TotalAmt |
| Program Services | $5,572,807 | ProgramServicesAmt |
| Management And General | $676,289 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $749,075 | TotalAmt |
| Program Services | $668,009 | ProgramServicesAmt |
| Management And General | $81,066 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,307,673 | TotalAmt |
| Program Services | $1,166,154 | ProgramServicesAmt |
| Management And General | $141,519 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,100 | TotalAmt |
| Program Services | $25,951 | ProgramServicesAmt |
| Management And General | $3,149 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,804,832 | TotalAmt |
| Program Services | $46,198,413 | ProgramServicesAmt |
| Management And General | $5,606,419 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,102,443 | TotalAmt |
| Program Services | $6,333,803 | ProgramServicesAmt |
| Management And General | $768,640 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,541,290 | TotalAmt |
| Program Services | $2,266,267 | ProgramServicesAmt |
| Management And General | $275,023 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,415,010 | TotalAmt |
| Program Services | $34,257,664 | ProgramServicesAmt |
| Management And General | $4,157,346 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,230,991 | TotalAmt |
| Program Services | $1,989,549 | ProgramServicesAmt |
| Management And General | $241,442 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $213,102 | TotalAmt |
| Program Services | $190,040 | ProgramServicesAmt |
| Management And General | $23,062 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,979 | TotalAmt |
| Program Services | $3,548 | ProgramServicesAmt |
| Management And General | $431 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61 | TotalAmt |
| Program Services | $54 | ProgramServicesAmt |
| Management And General | $7 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,849,802 | TotalAmt |
| Program Services | $12,350,950 | ProgramServicesAmt |
| Management And General | $1,498,852 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,042,349 | TotalAmt |
| Program Services | $1,821,322 | ProgramServicesAmt |
| Management And General | $221,027 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DUES & SUBSCRIPTIONS | $1,321,904 | $1,178,845 | $143,059 |
| TRAINING AND EDUCATION | $1,261,454 | $1,124,937 | $136,517 |
| OPERATING SUPPLIES | $1,172,657 | $1,045,750 | $126,907 |
| ASSET IMPAIRMENT | $624,596 | $557,001 | $67,595 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,274,039 | TotalAmt |
| Program Services | $1,136,159 | ProgramServicesAmt |
| Management And General | $137,880 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $246,424,713 | TotalAmt |
| Program Services | $214,609,238 | ProgramServicesAmt |
| Management And General | $31,815,475 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,350,177 | BOYAmt |
| EOY | $2,306,142 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,386 | BOYAmt |
| EOY | $115,926 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,941,584 | BOYAmt |
| EOY | $13,085,821 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $186,273,900 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $152,210,371 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,873,166 | BOYAmt |
| EOY | $34,063,529 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $411,740 | BOYAmt |
| EOY | $8,694,223 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,759,053 | BOYAmt |
| EOY | $58,265,641 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,427,256 | BOYAmt |
| EOY | $32,539,851 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,706 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,568 | BOYAmt |
| EOY | $93,785 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $555,229 | BOYAmt |
| EOY | $1,149,236 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,095,759 | BOYAmt |
| EOY | $33,782,872 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,663,294 | BOYAmt |
| EOY | $24,482,769 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,663,294 | BOYAmt |
| EOY | $24,482,769 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,759,053 | BOYAmt |
| EOY | $58,265,641 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$244,628,842 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $240,448,317 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 11 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (11 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| ATRIUM MEDICAL CENTER | ||||
| 311079309 | 3 | Yes (1) | $0 | $0 |
| MIAMI VALLEY HOSPITAL | ||||
| 310537504 | 3 | Yes (1) | $0 | $0 |
| UPPER VALLEY MEDICAL CENTER | ||||
| 310537095 | 3 | Yes (1) | $0 | $0 |
| MIAMI VALLEY HOSPITAL FOUNDATION | ||||
| 311040231 | 7 | Yes (1) | $0 | $0 |
| FIDELITY HEALTH CARE INC | ||||
| 311075381 | 10 | Yes (1) | $0 | $0 |
| PREMIER COMMUNITY HEALTH | ||||
| 311122883 | 10 | Yes (1) | $0 | $0 |
| GOOD SAMARITAN FOUNDATION - DAYTON | ||||
| 237296923 | 7 | Yes (1) | $0 | $0 |
| SAMARITAN BEHAVIORAL HEALTH INC | ||||
| 020633634 | 7 | Yes (1) | $0 | $0 |
| UPPER VALLEY PROFESSIONAL CORPORATION | ||||
| 311400963 | 10 | Yes (1) | $0 | $0 |
| UVPC SPECIALISTS INC | ||||
| 203687536 | 10 | Yes (1) | $0 | $0 |
| UVMC NURSING CARE INC | ||||
| 311224064 | 10 | Yes (1) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 11 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | 0 | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | 0 | MajorityDirTrstSupportedOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, SECTION A, LINE 1: | THE JANUARY 1, 2018 DEFINITIVE SYSTEM REORGANIZATION AGREEMENT DESIGNATED PREMIER HEALTH (PREMIER) AS THE SOLE CORPORATE MEMBER OF THE THREE SYSTEM HOSPITALS (FIVE LOCATIONS) AND ALL HOSPITAL SUBSIDIARIES AND AFFILIATES UNLESS SPECIFICALLY EXCLUDED. THE HOSPITAL SUBSIDIARIES ARE NOT CALLED OUT BY NAME. |
| PART IV, SECTION C, LINE 1: | THE JANUARY 1, 2018 DEFINITIVE SYSTEM AGREEMENT GRANTS PREMIER THE ABILITY TO APPOINT AND / OR REMOVE BOARD MEMBERS OF THE SUPPORTED ORGANIZATIONS. |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $7,500 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $21,600 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $29,100 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART II-B, LINE 1F: | PAYMENTS FOR LOBBYING ACTIVITIES INCLUDE DUES PAID TO AMERICAN HOSPITAL ASSOCIATION AND DAYTON DEVELOPMENT CORPORATION. |
| PART II-B, LINE 1I: | PREMIER CONTRACTS WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,371,998 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,262,111 | DepreciationAmt |
| Book Value | $4,109,887 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,428 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,452 | DepreciationAmt |
| Book Value | $4,976 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $172,466,082 | OtherCostOrOtherBasisAmt |
| Depreciation | $147,943,808 | DepreciationAmt |
| Book Value | $24,522,274 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,426,392 | OtherCostOrOtherBasisAmt |
| Book Value | $5,426,392 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $34,063,529 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| AFFILIATES INVESTMENTS | $5,120,000 |
| DEPOSITS | $3,364,684 |
| DEFERRED COMPENSATION | $209,539 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $8,694,223 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| ESCROW | $475,000 |
| TAX LIABILITY | $305,333 |
| DEFERRED COMPENSATION | $209,539 |
| CAPTIVE INSURANCE | $123,500 |
| OTHER | $35,864 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,149,236 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING FOOTNOTE IS TAKEN FROM THE 2021 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. 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), *GOOD SAMARITAN HOSPITAL AND UVMC MANAGEMENT CORPORATION (SUBSIDIARIES OF PHP) MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp (2 entries)
| RegionRegionTxt | OfficesOfficesCnt | EmployeeEmployeeCnt | Type Of Activities ConductedTypeOfActivitiesConductedTxt | Region Total ExpendituresRegionTotalExpendituresAmt |
|---|---|---|---|---|
| CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, | 0 | 0 | INVESTMENTS | $85,218,000 |
| EUROPE (INCLUDING ICELAND & GREENLAND) | 0 | 0 | INVESTMENTS | $522,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 0 | SubtotalEmployeesCnt |
| Continuation Total Office | 0 | ContinuationTotalOfficeCnt |
| Continuation Total Employee | 0 | ContinuationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Subtotal Spent | $85,740,000 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $85,740,000 | TotalSpentAmt |
| Transfer To Foreign Corp | Yes (1) | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | 0 | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | Yes (1) | PassiveForeignInvestmestCoInd |
| Foreign Partnership | Yes (1) | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III ACCOUNTING METHOD: | |
| PART I, LINE 3: | THE INVESTMENTS LISTED IN SCHEDULE F ARE NOT REPORTED ON PREMIER'S 990, PART X, BUT ARE INSTEAD REPORTED ON THE THREE HOSPITALS WHERE PREMIER IS THE MEMBER. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (22 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARY H BOOSALIS | ||||||||||||||
| PRESIDENT & CEO | $1,231,550 | $0 | $1,757,745 | $0 | $41,161 | $0 | $19,976 | $0 | $20,539 | $0 | $3,070,971 | $0 | $0 | $0 |
| BARBARA A JOHNSON | ||||||||||||||
| EXECUTIVE VP & COO | $748,165 | $0 | $279,876 | $0 | $81,631 | $0 | $14,445 | $0 | $11,644 | $0 | $1,135,761 | $0 | $0 | $0 |
| MATTHEW S REEVES | ||||||||||||||
| SYS VP VALUE BASE SVS & PRES PHG | $311,440 | $0 | $122,286 | $0 | $142,104 | $0 | $370,893 | $0 | $32,996 | $0 | $979,719 | $0 | $0 | $0 |
| GEOFFREY P WALKER | ||||||||||||||
| SYSTEM VP-CHIEF LEGAL OFFICER | $462,192 | $0 | $149,483 | $0 | $312,717 | $0 | $20,762 | $0 | $27,111 | $0 | $972,265 | $0 | $0 | $0 |
| JENNIFER J HAULER DO | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $558,282 | $0 | $237,009 | $0 | $22,553 | $0 | $97,662 | $0 | $2,415 | $0 | $917,921 | $0 | $0 |
| SCOTT A SHELTON | ||||||||||||||
| FORMER OFFICER | $19,025 | $0 | $249,130 | $0 | $618,596 | $0 | $1,860 | $0 | $0 | $0 | $888,611 | $0 | $0 | $0 |
| MARC R BELCASTRO DO | ||||||||||||||
| VP MEDICAL AFFAIRS & CMO | $552,833 | $0 | $168,313 | $0 | $79,026 | $0 | $10,837 | $0 | $24,565 | $0 | $835,574 | $0 | $32,810 | $0 |
| DIANE L PLEIMAN | ||||||||||||||
| PRESIDENT & CEO-PHYS COMPANIES | $422,887 | $0 | $175,579 | $0 | $172,638 | $0 | $19,932 | $0 | $25,951 | $0 | $816,987 | $0 | $0 | $0 |
| MARY M CLANCY | ||||||||||||||
| CHIEF DIGITAL OFFICER | $461,421 | $0 | $141,346 | $0 | $57,405 | $0 | $100,824 | $0 | $26,265 | $0 | $787,261 | $0 | $0 | $0 |
| J MICHAEL SIMS | ||||||||||||||
| SYS VP & CORPORATE CONTROLLER | $350,568 | $0 | $129,225 | $0 | $143,453 | $0 | $20,415 | $0 | $28,425 | $0 | $672,086 | $0 | $0 | $0 |
| GARY G GINTER | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $434,057 | $0 | $125,396 | $0 | $6,646 | $0 | $71,972 | $0 | $28,691 | $0 | $666,762 | $0 | $0 |
| CRAIG GANGER | ||||||||||||||
| EXEC VP AND CFO | $497,245 | $9,658 | $74,776 | $0 | $18,447 | $89 | $21,301 | $828 | $27,182 | $1,087 | $638,951 | $11,662 | $0 | $0 |
| MARGARET PEGGY W MARK | ||||||||||||||
| VP NURSING / CNO / PATIENT EXP | $385,838 | $0 | $129,004 | $0 | $72,047 | $0 | $11,301 | $0 | $28,359 | $0 | $626,549 | $0 | $28,507 | $0 |
| DARIN J PANGALANGAN MD | ||||||||||||||
| TRUSTEE & SYS VP-CLINICAL SERVICE LI | $300 | $496,576 | $0 | $65,452 | $0 | $4,868 | $0 | $1,149 | $0 | $2,066 | $300 | $570,111 | $0 | $0 |
| ELAINE LAINIE M DEAN | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $372,434 | $0 | $117,644 | $0 | $21,559 | $0 | $12,298 | $0 | $14,277 | $0 | $538,212 | $0 | $0 |
| MICHAEL J MAIBERGER | ||||||||||||||
| FORMER OFFICER | $0 | $0 | $0 | $0 | $521,201 | $0 | $0 | $0 | $0 | $0 | $521,201 | $0 | $521,201 | $0 |
| THOMAS R CURTIN | ||||||||||||||
| SYSTEM VP REVENUE CYCLE | $252,198 | $0 | $131,008 | $0 | $2,660 | $0 | $47,677 | $0 | $19,566 | $0 | $453,109 | $0 | $0 | $0 |
| BILLIE L LUCENTE-BAKER | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $240,558 | $0 | $79,314 | $0 | $778 | $0 | $19,990 | $0 | $14,606 | $0 | $355,246 | $0 | $0 |
| THOMAS R PARKER | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $0 | $0 | $79,628 | $0 | $208,983 | $0 | $20,942 | $0 | $2,624 | $0 | $312,177 | $0 | $126,836 |
| SUBODH K WADHWA MD | ||||||||||||||
| TRUSTEE & PHYSICIAN: SPECIALTY | $0 | $240,938 | $0 | $0 | $0 | $28,733 | $0 | $3,670 | $0 | $11,065 | $0 | $284,406 | $0 | $0 |
| KIM K STRAHL | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $119,293 | $0 | $86,212 | $0 | $2,100 | $0 | $18,470 | $0 | $5,254 | $0 | $231,329 | $0 | $0 |
| JASON M BAILEY | ||||||||||||||
| DIRECTOR-VALUE BASED SERVICES | $161,135 | $0 | $34,295 | $0 | $516 | $0 | $6,486 | $0 | $25,315 | $0 | $227,747 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4A: | THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT IN 2021: THOMAS R. PARKER $49,154; MATTHEW REEVES $120,887. |
| 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, PREMIER HEALTH (PREMIER) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. PREMIER 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 2021. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2021: MARY CLANCY $52,772; DIANE PLEIMAN $150,883; SCOTT SHELTON $614,357; MICHAEL SIMS $117,016; GEOFFREY WALKER $305,647. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2021: MARC BELCASTRO, M.D. $68,706; BARBARA JOHNSON $67,504; MARGARET MARK $45,747; THOMAS PARKER $159,829. THE FOLLOWING SERP AMOUNTS WERE DEFERRED ON THE PARTICIPANTS' BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNTS ARE VESTED: MARK BELCASTRO, M.D. $1,364; THOMAS CURTIN $29,333; CRAIG GANGER $8,269; GARY GINTER $50,882; JENNIFER HAULER, D.O. $87,168; BILLIE LUCENTE-BAKER $1,377; MARGARET MARK $1,038; THOMAS R. PARKER $5,272; MATTHEW REEVES $32,258. 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 L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VALLEY PATHOLOGISTS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | PARTNERSHIP OWNED BY TRUSTEE, DANIEL L. HOOD, M.D. | RelationshipDescriptionTxt |
| Transaction | $3,344,444 | TransactionAmt |
| Transaction | PATHOLOGY SERVICES | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART I, LINE 7B & PART VIII, COLUMN C: | NET UNRELATED BUSINESS TAXABLE INCOME /(LOSS) COMPRISES AMOUNTS FROM PARTNERSHIP INVESTMENTS THAT ARE NOT RECOGNIZED FOR BOOK PURPOSES, THEREFORE NO UNRELATED BUSINESS INCOME/(LOSS) FROM PARTNERSHIP INVESTMENTS APPEARS ON PART VIII. |
| FORM 990, PART III, LINE 4A (CONTINUED): | AS SUCH, PREMIER IS RESPONSIBLE FOR OVERSIGHT OF THE THREE HOSPITAL ENTITIES AS ITS CHARITABLE GOAL, AND THE INFORMATION BELOW IS CUMULATIVE OF THEIR SEPARATE REPORTS: QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT COMMUNITY BENEFIT SUMMARY FROM RELATED HOSPITALS SCHEDULE H FOR THE YEAR ENDED DECEMBER 31, 2021. CHARITY AND MEANS-TESTED GOVERNMENT PROGRAMS AND CERTAIN OTHER COMMUNITY BENEFITS AT COST: $ 16,578,000 CHARITY CARE AT COST $158,162,000 UNREIMBURSED MEDICAID $ 7,024,000 UNREIMBURSED COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS ------------ $181,764,000 TOTAL OTHER COMMUNITY BENEFITS: $ 3,589,000 COMMUNITY HEALTH IMPROVEMENT SERVICES & COMMUNITY BENEFIT OPERATIONS $ 34,256,000 SUBSIDIZED HEALTH SERVICES $ 6,395,000 CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY GROUPS ------------ $ 44,240,000 TOTAL ------------ $226,004,000 GRAND TOTAL PROGRAM & OTHER COMMUNITY BENEFITS COMMUNITY BUILDING ACTIVITIES: $ 4,000 PHYSICAL IMPROVEMENTS ------------ $ 4,000 TOTAL COMMUNITY BUILDING ACTIVITIES $ 13,038,000 UNPAID COST OF MEDICARE (ALLOWABLE COST AND REIMBURSEMENTS REPORTED ON MEDICARE COST REPORT) $160,376,000 OTHER UNPAID COST OF MEDICARE (COST AND REIMBURSEMENTS NOT REPORTED ON MEDICARE COST REPORT) ------------ $173,414,000 TOTAL UNPAID COST OF MEDICARE ------------ $399,422,000 TOTAL COMMUNITY BENEFIT INCLUDING THE UNPAID COSTS OF MEDICARE ------------ |
| FORM 990, PART V, LINE 1A: | PART V, LINE 1A IS SUBSTANTIALLY HIGHER THAN PREVIOUS YEARS. PREMIER HEALTH MAKES PAYMENTS ON BEHALF OF THE OTHER ENTITIES IN THE PREMIER HEALTH NETWORK. TREAS. REG. 1.6041-1(E) DEEMS A PERSON THAT MAKES A PAYMENT IN THE COURSE OF ITS TRADE OR BUSINESS ON BEHALF OF ANOTHER PERSON AS THE PAYOR THAT MUST ISSUE FORMS 1099. AS SUCH, BEGINNING WITH THE 2021 YEAR, ALL FORMS 1099 FROM THE NETWORK WILL BE ISSUED BY PREMIER HEALTH. |
| FORM 990, PART VI, SECTION A, LINE 6 | PREMIER HEALTH (PREMIER) HAS FOUR CORPORATE MEMBERS: MEDAMERICA HEALTH SYSTEMS, CATHOLIC HEALTH INITIATIVES, ATRIUM HEALTH SYSTEM, AND UVMC. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEDAMERICA HEALTH SYSTEMS ELECTS 8 BOARD MEMBERS, CATHOLIC HEALTH INITIATIVES ELECTS 7 BOARD MEMBERS, ATRIUM HEALTH SYSTEM ELECTS 3 BOARD MEMBERS AND UVMC ELECTS 3 BOARD MEMBERS. THE MEMBERS MUST APPROVE ANY DISSOLUTION OF ASSETS AND ANY CHANGES IN THE CODE OF REGULATIONS OR ARTICLES OF INCORPORATION. THE MEMBERS DO NOT APPROVE ANY OPERATIONAL DECISIONS OF THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE EXPLANATION FOR PART VI, SECTION A, LINE 7A |
| FORM 990, PART VI, SECTION B, LINE 11B | THIS 990 FILING AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE TAX DEPARTMENT OF PREMIER. THE RETURN IS REVIEWED BY THE MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. THE RETURN IS CONCURRENTLY SENT TO ERNST & YOUNG U.S. LLP FOR THEIR REVIEW. 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 SENT TO ERNST & YOUNG U.S. LLP FOR A FINAL REVIEW AND THEN 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 12C | PREMIER 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 B, LINE 15 | THE ANNUAL REVIEW PROCESS PERFORMED BY PREMIER FOLLOWS A MARKET BASED COMPENSATION PHILOSOPHY DESIGNED TO ATTRACT AND RETAIN THE EXECUTIVE TALENT REQUIRED TO MEET THE HIGH-PERFORMANCE STANDARDS OF OUR BOARD AND OUR COMMUNITY. PREMIER ANNUALLY REVIEWS EXECUTIVE COMPENSATION SURVEY DATA FOR A REGIONAL PEER GROUP OF SYSTEMS AND HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO PREMIER AND ITS AFFILIATES. THE DATA FOR THE SURVEY IS PROVIDED BY A THIRD-PARTY CONSULTANT GROUP THAT IS INDEPENDENT OF PREMIER. THIS REPORT INCLUDES COMPARABILITY DATA FOR KEY EXECUTIVES, VICE PRESIDENTS, AND DIRECTOR LEVEL POSITIONS. THE INDEPENDENT COMPARABILITY DATA IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THIS COMMITTEE CONTAINS THREE MEMBERS, ALL OF WHOM ARE INDEPENDENT. THIS COMMITTEE REVIEWS IN DETAIL THE COMPENSATION FOR THE PREMIER CEO, COO, CFO, CHIEF INTEGRATION OFFICER, CHIEF STRATEGY OFFICER, AND THE HOSPITAL CEOS. OTHER POSITIONS ARE REVIEWED AT A HIGH LEVEL FOR REASONABLENESS. ALL THE MEETING MINUTES ARE DOCUMENTED AND KEPT ON FILE ALONG WITH ANY COMPARABILITY DATA AND THE CONSULTANT REPORT. AFTER THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION ACTIONS, THE PROCESS IS AUDITED BY THE INTERNAL AUDIT DEPARTMENT. THE EXECUTIVE COMPENSATION COMMITTEE PRESENTS THE COMPENSATION ACTIONS TO THE PREMIER BOARD ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE 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 VII, SECTION A, SYSTEM KEY EMPLOYEES: | THE SYSTEM KEY EMPLOYEES' TOTAL COMPENSATION AMOUNT IS ACCURATELY REPORTED ON THE VARIOUS ENTITIES THEY SERVE. THE KEY EMPLOYEES' COMPENSATION IS BEING REPORTED AS PAID BY PREMIER AS THE PAYMASTER OF THEIR APPLICABLE AFFILIATED ORGANIZATION IN ORDER TO MORE CLEARLY REFLECT THEIR RESPONSIBILITIES ACROSS THE PREMIER SYSTEM. COMPENSATION AND RELATED PAYROLL REPORTING REQUIREMENTS FOR SYSTEM KEY EMPLOYEES ARE PROCESSED AND FILED BY AFFILIATES OF PREMIER. |
| FORM 990, PART VII, SECTION B, LINE 2: | PART VII, SECTION B, LINE 2 IS SUBSTANTIALLY HIGHER THAN PREVIOUS YEARS. PREMIER HEALTH MAKES PAYMENTS ON BEHALF OF THE OTHER ENTITIES IN THE PREMIER HEALTH NETWORK. TREAS. REG. 1.6041-1(E) DEEMS A PERSON THAT MAKES A PAYMENT IN THE COURSE OF ITS TRADE OR BUSINESS ON BEHALF OF ANOTHER PERSON AS THE PAYOR THAT MUST ISSUE FORMS 1099. AS SUCH, BEGINNING WITH THE 2021 YEAR, ALL FORMS 1099 FROM THE NETWORK WILL BE ISSUED BY PREMIER HEALTH. |
| FORM 990, PART IX, LINE 11G | CONSULTANT FEES: PROGRAM SERVICE EXPENSES 34,156,032. MANAGEMENT AND GENERAL EXPENSES 4,145,015. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,301,047. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 8,259,608. MANAGEMENT AND GENERAL EXPENSES 1,002,346. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,261,954. PURCHASED LABOR: PROGRAM SERVICE EXPENSES 1,483,716. MANAGEMENT AND GENERAL EXPENSES 180,057. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,663,773. CREDIT CARD FEES: PROGRAM SERVICE EXPENSES 1,330,099. MANAGEMENT AND GENERAL EXPENSES 161,414. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,491,513. COLLECTION COSTS: PROGRAM SERVICE EXPENSES 647,245. MANAGEMENT AND GENERAL EXPENSES 78,546. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 725,791. OTHER FEES: PROGRAM SERVICE EXPENSES 321,713. MANAGEMENT AND GENERAL EXPENSES 39,041. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 360,754. |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFER 240,448,317. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PREMIER HEALTH GROUP LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 461428664 | EIN |
| Primary Activities | DR NETWORK | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $5,167 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PREMIER HEALTH | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MEDAMERICA HEALTH SYSTEMS CO | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311040228 | SUPPORT ORG | OH | 501(C)(3) | 12B | N/A | 0 | |
| MIAMI VALLEY HOSPITAL | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 310537504 | HOSPITAL | OH | 501(C)(3) | 3 | Yes (1) | PREMIER HEALTH | |
| MIAMI VALLEY HOSPITAL FOUNDATION | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311040231 | FOUNDATION | OH | 501(C)(3) | 7 | Yes (1) | PREMIER HEALTH | |
| FIDELITY HEALTH CARE INC | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311075381 | HOME HEALTH | OH | 501(C)(3) | 10 | Yes (1) | PREMIER HEALTH | |
| PREMIER COMMUNITY HEALTH | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311122883 | HEALTH EDUCATION | OH | 501(C)(3) | 10 | Yes (1) | FIDELITY HEALTH CARE | |
| GOOD SAMARITAN FOUNDATION - DAYTON | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 237296923 | FOUNDATION | OH | 501(C)(3) | 7 | Yes (1) | PREMIER HEALTH | |
| ATRIUM HEALTH SYSTEM | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 310537492 | SUPPORT ORG | OH | 501(C)(3) | 12B | N/A | 0 | |
| ATRIUM MEDICAL CENTER | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311079309 | HOSPITAL | OH | 501(C)(3) | 3 | Yes (1) | PREMIER HEALTH | |
| UVMC | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 341850683 | SUPPORT ORG | OH | 501(C)(3) | 12B | N/A | 0 | |
| UPPER VALLEY MEDICAL CENTER | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 310537095 | HOSPITAL | OH | 501(C)(3) | 3 | Yes (1) | PREMIER HEALTH | |
| UPPER VALLEY PROFESSIONAL CORP | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311400963 | HEALTH CARE | OH | 501(C)(3) | 10 | Yes (1) | PREMIER HEALTH HOLDING CO | |
| UVPC SPECIALISTS | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 203687536 | HEALTH CARE | OH | 501(C)(3) | 10 | Yes (1) | PREMIER HEALTH HOLDING CO | |
| UVMC NURSING CARE INC | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311224064 | NURSING HOME | OH | 501(C)(3) | 10 | Yes (1) | PREMIER HEALTH | |
| COMPUNET CLINICAL LABORATORIES LLC (MAR 09 TO DEC 31) | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311258010 | LAB | OH | 501(C)(3) | 12B | Yes (1) | PREMIER HEALTH | |
| SAMARITAN BEHAVIORAL HEALTH INC | |||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 020633634 | BEHAVIORAL HEALTH | OH | 501(C)(3) | 7 | Yes (1) | PREMIER HEALTH | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SWEITZER STREET LLC | ||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 454700417 | REAL ESTATE | OH | MVHE INC | EXCLUDED | 0 | 0 |
| SWEITZER MOB LLC | ||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 474554657 | REAL ESTATE | OH | MVHE INC | EXCLUDED | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | OwnershipOwnershipPct | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MVHE INC | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311185270 | PHYSICIAN SVCS | OH | PREMIER HEALTH HOLDING CO | C | 0 | |||
| PREMIER HEALTH SPECIALISTS | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 061744704 | PHYSICIAN SVCS | OH | PREMIER HEALTH HOLDING CO | C | 0 | |||
| SAMARITAN FAMILY CARE | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311299450 | PHYSICIAN SVCS | OH | PREMIER HEALTH HOLDING CO | C | 0 | |||
| AFTER HOURS FAMILY CARE | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311269483 | HEALTH CARE | OH | UPPER VALLEY PROFESSIONAL CORP | C | 0 | |||
| UVMC MANAGEMENT CORP | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 311360489 | MANAGEMENT COMPANY | OH | PREMIER HEALTH | C | 0 | 1.00000 | ||
| PREMIER HEALTH URGENT CARE INC | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 822079409 | URGENT CARE | OH | PREMIER HEALTH HOLDING CO | C | 0 | |||
| PREMIER HEALTH PLAN INC | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 463024049 | HEALTH INSURANCE | OH | PREMIER HEALTH INSURING CO | C | 0 | |||
| GOOD SAMARITAN HOSPITAL | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 310536981 | HOSPITAL | OH | PREMIER HEALTH | C | 0 | 1.00000 | $6,159,106 | $10,681,429 |
| PREMIER HEALTH ACO OF OHIO | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 474049773 | MEDICARE ACO | OH | PREMIER HEALTH | C | 0 | 1.00000 | ||
| PREMIER HEALTH HOLDING CO | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 812419110 | HOLDING CO | OH | PREMIER HEALTH | C | 0 | 1.00000 | $249,290,951 | $151,680,020 |
| PREMIER HEALTH INSURING CO | ||||||||||||
| 110 N MAIN STREET 500 | DAYTON | OH | 45402 | 464766841 | HEALTH INSURANCE | OH | PREMIER HEALTH | C | 0 | 1.00000 | -$202,313 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN FOUNDATION - DAYTON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $65,405 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |