2022-11-15T18:11:51-06:00 2021-12-31 346565596 ERNST & YOUNG US LLP 221 E 4TH ST 2900 CINCINNATI OH 45202 990 2021-01-01 311446699 PREMIER HEALTH PARTNERS PREM 9374999942 110 N MAIN ST 500 DAYTON OH 45402 J MICHAEL SIMS VP & CONTROLLER 9374999942 2022-11-15 1 J MICHAEL SIMS 999009999 JULIE L SPARKS P01268401 5136121400 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z PREMIER HEALTH MICHAEL C RIORDAN 110 N MAIN ST 500 DAYTON OH 45402 1820090 0 X WWW.PREMIERHEALTH.COM X 1995 OH WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH QUALITY, COST-COMPETITIVE HEALTH SERVICES. 21 17 15 16 0 36121 834002 127650 4717029 1590021 25000 -24219 225899 102419 5801930 1795871 500 158 0 0 116425048 120480198 0 0 0 108458964 125944357 224884512 246424713 -219082582 -244628842 62759053 58265641 34095759 33782872 28663294 24482769 X WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH QUALITY, COST-COMPETITIVE HEALTH SERVICES. 0 0 212357938 158 1590021 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. 2251300 0 0 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. 214609238 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 X 790 0 1 15 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 21 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X J MICHAEL SIMS 9374999942 110 N MAIN ST 500 DAYTON OH 45402 X MARY H BOOSALIS PRESIDENT & CEO 38.00 2.00 X X 3030456 0 40515 DARIN J PANGALANGAN MD TRUSTEE & SYS VP-CLINICAL SERVICE LINES 0.50 39.50 X 300 566896 3215 SUBODH K WADHWA MD TRUSTEE & PHYSICIAN: SPECIALTY 0.50 39.50 X 0 269671 14735 ANITA J MOORE BOARD CHAIR 0.50 0.50 X X 0 0 0 STEVE BEINLICH TRUSTEE 0.50 0.50 X 0 0 0 KATHLEEN A CARLSON TRUSTEE 0.50 0.50 X 0 0 0 MARVA COSBY TRUSTEE 0.50 0.00 X 0 0 0 GAIL P FOREST TRUSTEE 0.50 0.50 X 0 0 0 MARTIN K FUJIMURA MD TRUSTEE 0.50 0.00 X 0 0 0 JOSEPH M GERAGHTY TRUSTEE 0.50 0.00 X 0 0 0 LARRY L HOLLINGSHEAD TRUSTEE 0.50 0.50 X 0 0 0 DANIEL L HOOD MD TRUSTEE 0.50 1.00 X 0 0 0 JOHN W JACK LOHBECK TRUSTEE 0.50 0.00 X 0 0 0 MITCH MELFI TRUSTEE 0.50 0.00 X 0 0 0 DOUGLAS L MEYER TRUSTEE 0.50 0.50 X 0 0 0 ROWAN R NICKOL MD TRUSTEE 0.50 1.50 X 0 0 0 EDGAR M PURVIS JR TRUSTEE 0.50 0.50 X 0 0 0 COLLEEN RYAN TRUSTEE 0.50 0.00 X 0 0 0 STEVEN STALEY TRUSTEE 0.50 1.00 X 0 0 0 JILL WILSON TRUSTEE 0.50 0.50 X 0 0 0 SUSIE WISE TRUSTEE 0.50 1.00 X 0 0 0 BARBARA A JOHNSON EXECUTIVE VP & COO 38.50 1.50 X 1109672 0 26089 GEOFFREY P WALKER SYSTEM VP-CHIEF LEGAL OFFICER 10.00 30.00 X 924392 0 47873 CRAIG GANGER EXEC VP AND CFO 39.50 0.50 X 590468 9747 50398 MARC R BELCASTRO DO VP MEDICAL AFFAIRS & CMO 10.00 30.00 X 800172 0 35402 MARY M CLANCY CHIEF DIGITAL OFFICER 9.50 30.50 X 660172 0 127089 J MICHAEL SIMS SYS VP & CORPORATE CONTROLLER 10.00 30.00 X 623246 0 48840 MARGARET PEGGY W MARK VP NURSING / CNO / PATIENT EXP 10.00 30.00 X 586889 0 39660 THOMAS R CURTIN SYSTEM VP REVENUE CYCLE 10.00 30.00 X 385866 0 67243 MATTHEW S REEVES SYS VP VALUE BASE SVS & PRES PHG 40.00 0.00 X 575830 0 403889 DIANE L PLEIMAN PRESIDENT & CEO-PHYS COMPANIES 8.00 32.00 X 771104 0 45883 JASON M BAILEY DIRECTOR-VALUE BASED SERVICES 40.00 0.00 X 195946 0 31801 SCOTT A SHELTON FORMER OFFICER 0.00 0.00 X 886751 0 8827 MICHAEL J MAIBERGER FORMER OFFICER 0.00 0.00 X 521201 0 0 JENNIFER J HAULER DO FORMER KEY EMPLOYEE 0.00 40.00 X 0 817844 100077 GARY G GINTER FORMER KEY EMPLOYEE 0.00 40.00 X 0 566099 100663 ELAINE LAINIE M DEAN FORMER KEY EMPLOYEE 0.00 40.00 X 0 511637 26575 BILLIE L LUCENTE-BAKER FORMER KEY EMPLOYEE 0.00 40.00 X 0 320650 34596 THOMAS R PARKER FORMER KEY EMPLOYEE 0.00 0.00 X 0 288611 23566 KIM K STRAHL FORMER KEY EMPLOYEE 0.00 40.00 X 0 207605 23724 11662465 3558760 1300660 13 1 1 0 MCKINSEY & COMPANY INC 140 FOUNDATION PARKWAY N ST PETERSBURG FL 33716 PROFESSIONAL SERVICES 31310600 BESPOKE WORKFORCE LLC 5930 CORNERSTONE CT W 300 SAN DIEGO CA 92121 MEDICAL SERVICES 29995933 DECAPUA ENTERPRISES INC 1114 DUBLIN RD COLUMBUS OH 43215 MEDICAL SERVICES 25063523 ANESTHESIOLOGY SERVICES ONE WYOMING ST DAYTON OH 45409 MEDICAL SERVICES 22334271 MORRISON HEALTHCARE 400 NORTHRIDGE ROAD 600 ATLANTA GA 30350 PROFESSIONAL SERVICES 21141033 469 102244 25406 127650 PATIENT INFORMATION PARTNERS 900099 1581900 1581900 HEALTH EDUCATION 900099 8121 8121 1590021 24219 -24219 -24219 -24219 EMS EDUCATION 900099 33748 33748 PURCHASE DISCOUNTS 900099 23429 23429 CAREFINDERS 900099 4750 4750 40492 40492 102419 1795871 1590021 0 78200 X 158 158 9193127 3051293 6141834 90227471 80462881 9764590 2978009 2655723 322286 11832495 10551960 1280535 6249096 5572807 676289 749075 668009 81066 1307673 1166154 141519 29100 25951 3149 51804832 46198413 5606419 7102443 6333803 768640 2541290 2266267 275023 38415010 34257664 4157346 2230991 1989549 241442 213102 190040 23062 3979 3548 431 61 54 7 13849802 12350950 1498852 2042349 1821322 221027 DUES & SUBSCRIPTIONS 1321904 1178845 143059 TRAINING AND EDUCATION 1261454 1124937 136517 OPERATING SUPPLIES 1172657 1045750 126907 ASSET IMPAIRMENT 624596 557001 67595 1274039 1136159 137880 246424713 214609238 31815475 0 5350177 2306142 182386 115926 16941584 13085821 186273900 152210371 39873166 34063529 411740 8694223 62759053 58265641 33427256 32539851 34706 78568 93785 555229 1149236 34095759 33782872 X 28663294 24482769 28663294 24482769 62759053 58265641 X -244628842 240448317 X 0 1 X 1 0 X X 11 ATRIUM MEDICAL CENTER 311079309 3 1 0 0 MIAMI VALLEY HOSPITAL 310537504 3 1 0 0 UPPER VALLEY MEDICAL CENTER 310537095 3 1 0 0 MIAMI VALLEY HOSPITAL FOUNDATION 311040231 7 1 0 0 FIDELITY HEALTH CARE INC 311075381 10 1 0 0 PREMIER COMMUNITY HEALTH 311122883 10 1 0 0 GOOD SAMARITAN FOUNDATION - DAYTON 237296923 7 1 0 0 SAMARITAN BEHAVIORAL HEALTH INC 020633634 7 1 0 0 UPPER VALLEY PROFESSIONAL CORPORATION 311400963 10 1 0 0 UVPC SPECIALISTS INC 203687536 10 1 0 0 UVMC NURSING CARE INC 311224064 10 1 0 0 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 7500 0 0 1 21600 29100 0 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. 8371998 4262111 4109887 9428 4452 4976 172466082 147943808 24522274 5426392 5426392 34063529 AFFILIATES INVESTMENTS 5120000 DEPOSITS 3364684 DEFERRED COMPENSATION 209539 8694223 ESCROW 475000 TAX LIABILITY 305333 DEFERRED COMPENSATION 209539 CAPTIVE INSURANCE 123500 OTHER 35864 1149236 X PART X, LINE 2: 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. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 85218000 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS 522000 0 0 0 0 0 0 85740000 0 85740000 1 0 0 1 1 0 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. X X X X 1 1 0 0 0 0 0 0 0 MARY H BOOSALIS PRESIDENT & CEO 1231550 0 1757745 0 41161 0 19976 0 20539 0 3070971 0 0 0 BARBARA A JOHNSON EXECUTIVE VP & COO 748165 0 279876 0 81631 0 14445 0 11644 0 1135761 0 0 0 MATTHEW S REEVES SYS VP VALUE BASE SVS & PRES PHG 311440 0 122286 0 142104 0 370893 0 32996 0 979719 0 0 0 GEOFFREY P WALKER SYSTEM VP-CHIEF LEGAL OFFICER 462192 0 149483 0 312717 0 20762 0 27111 0 972265 0 0 0 JENNIFER J HAULER DO FORMER KEY EMPLOYEE 0 558282 0 237009 0 22553 0 97662 0 2415 0 917921 0 0 SCOTT A SHELTON FORMER OFFICER 19025 0 249130 0 618596 0 1860 0 0 0 888611 0 0 0 MARC R BELCASTRO DO VP MEDICAL AFFAIRS & CMO 552833 0 168313 0 79026 0 10837 0 24565 0 835574 0 32810 0 DIANE L PLEIMAN PRESIDENT & CEO-PHYS COMPANIES 422887 0 175579 0 172638 0 19932 0 25951 0 816987 0 0 0 MARY M CLANCY CHIEF DIGITAL OFFICER 461421 0 141346 0 57405 0 100824 0 26265 0 787261 0 0 0 J MICHAEL SIMS SYS VP & CORPORATE CONTROLLER 350568 0 129225 0 143453 0 20415 0 28425 0 672086 0 0 0 GARY G GINTER FORMER KEY EMPLOYEE 0 434057 0 125396 0 6646 0 71972 0 28691 0 666762 0 0 CRAIG GANGER EXEC VP AND CFO 497245 9658 74776 0 18447 89 21301 828 27182 1087 638951 11662 0 0 MARGARET PEGGY W MARK VP NURSING / CNO / PATIENT EXP 385838 0 129004 0 72047 0 11301 0 28359 0 626549 0 28507 0 DARIN J PANGALANGAN MD TRUSTEE & SYS VP-CLINICAL SERVICE LI 300 496576 0 65452 0 4868 0 1149 0 2066 300 570111 0 0 ELAINE LAINIE M DEAN FORMER KEY EMPLOYEE 0 372434 0 117644 0 21559 0 12298 0 14277 0 538212 0 0 MICHAEL J MAIBERGER FORMER OFFICER 0 0 0 0 521201 0 0 0 0 0 521201 0 521201 0 THOMAS R CURTIN SYSTEM VP REVENUE CYCLE 252198 0 131008 0 2660 0 47677 0 19566 0 453109 0 0 0 BILLIE L LUCENTE-BAKER FORMER KEY EMPLOYEE 0 240558 0 79314 0 778 0 19990 0 14606 0 355246 0 0 THOMAS R PARKER FORMER KEY EMPLOYEE 0 0 0 79628 0 208983 0 20942 0 2624 0 312177 0 126836 SUBODH K WADHWA MD TRUSTEE & PHYSICIAN: SPECIALTY 0 240938 0 0 0 28733 0 3670 0 11065 0 284406 0 0 KIM K STRAHL FORMER KEY EMPLOYEE 0 119293 0 86212 0 2100 0 18470 0 5254 0 231329 0 0 JASON M BAILEY DIRECTOR-VALUE BASED SERVICES 161135 0 34295 0 516 0 6486 0 25315 0 227747 0 0 0 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. VALLEY PATHOLOGISTS PARTNERSHIP OWNED BY TRUSTEE, DANIEL L. HOOD, M.D. 3344444 PATHOLOGY SERVICES 0 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. 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