2020-11-16T14:10:28-06:00 2019-12-31 ERNST & YOUNG US LLP 221 E 4TH STREET SUITE 2900 Cincinnati OH 45202 990 2019-01-01 310537504 Miami Valley Hospital % J MICHAEL SIMS MIAM 9374999942 110 N MAIN ST 500 Dayton OH 45402 KRISTINA M KEAN VP FINANCE 9374999942 2020-11-09 true JULIE L SPARKS P01268401 5136121400 2019 2022-09-23 18:48:47Z MICHAEL R UHL 1 WYOMING ST DAYTON OH 45409 1423237564 false X WWW.PREMIERHEALTH.COM X 1890 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. 11 1 11527 820 -89107 -197770 803051 620174 932034525 1137603410 20840493 51762851 13143320 14052754 966821389 1204039189 7551998 20581009 0 0 420378003 426252395 0 0 0 496656100 551016375 924586101 997849779 42235288 206189410 1551078537 1540725759 876974777 929596566 674103760 611129193 WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH SERVICES. false false 972161262 20581009 1137603410 THE PRIMARY EXEMPT PURPOSE OF MIAMI VALLEY HOSPITAL IS TO PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES TO THE RESIDENTS OF MONTGOMERY AND THE SURROUNDING COUNTIES. THE HOSPITAL FURTHERS ITS TAX-EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN MANY WAYS. SEE SCHEDULE H FOR MORE INFORMATION. 972161262 true true false true false false false false false false true true false false true true false true false false true false false false false false true true true false true true false false false false false false false false true true false false false false true true false false false true 305 0 true 11527 true true true false false false false false false false false false false false X 11 1 false true false false true true true true true false false true true true true true true true true true true OH X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 500 Dayton OH 45402 X MICHAEL J MAIBERGER FORMER OFFICER 0.0 40.0 X 0 2292818 1062061 MARY H BOOSALIS TRUSTEE / PREMIER PRES & CEO 0.5 39.5 X 0 1820985 43290 SCOTT A SHELTON FORMER OFFICER 0.0 40.0 X 0 926869 31126 JENNIFER J HAULER D COO - MVH 39.0 1.0 X 893785 0 55776 ELOISE P BRONER SYS VP-CHIEF SUPPORT SERVICES 10.0 30.0 X 878127 0 30024 MICHAEL R UHL PRESIDENT & CEO 39.0 1.0 X X 710746 0 83340 BARBARA A JOHNSON TRUSTEE&PREMIER COO (FROM AUG) 9.5 30.5 X 0 665968 38127 GEOFFREY P WALKER SYS VP - CHIEF LEGAL OFFICER 9.5 30.5 X 0 648904 50342 THOMAS R PARKER FORMER KEY EMPLOYEE 0.0 40.0 X 0 619173 79761 DIANE L PLEIMAN PRESIDENT & CEO-PHYS COMPANIES 0.0 40.0 X 647081 0 29118 MARC R BELCASTRO DO VP MED AFFAIRS & PREMIER CMO 10.0 30.0 X 604996 0 60700 MARY M CLANCY SYS VP - ONCOLOGY SERVICE LINE 40.0 0.0 X 619164 0 35813 GARY G GINTER VP &PREMIER CHIEF INFO OFFICER 10.0 30.0 X 0 553521 98017 MELANIE M GLOVER MD TRUSTEE (FROM MAY) 0.5 39.5 X 0 585170 41456 CRAIG SELF FORMER KEY EMPLOYEE 0.0 0.0 X 0 523869 94857 RENEE P GEORGE FORMER KEY EMPLOYEE 0.0 40.0 X 0 539890 63443 JEFFREY G POULOS MD VP & CHIEF HOSPITAL OFFICER 40.0 0.0 X 549419 0 49145 MARGARET W MARK VP NURSING SERVICE/PREMIER CNO 10.0 30.0 X 0 527720 51383 DALE E CREECH JR FORMER KEY EMPLOYEE 0.0 0.0 X 0 510477 29497 JAMES M PACENTA MD TRUSTEE 0.5 39.5 X 0 492175 41675 J MICHAEL SIMS SYS VP-TREAS & CORP CONTROLLER 8.5 31.5 X 0 461159 53405 TERESA W ZRYD MD VP-ACADEMIC AFFAIRS 40.0 0.0 X 484601 0 20166 THOMAS CURTIN VP REVENUE CYCLE 9.0 31.0 X 0 407459 60214 JOANNE R RINGER TRUSTEE AND COO MVHS 40.0 0.0 X 417242 0 36984 MARY E GARMAN COO - MVHN 40.0 0.0 X 413396 0 35232 MARK W SHAW FORMER KEY EMPLOYEE 0.0 0.0 X 0 418206 22568 KRISTINA M KEAN BOARD TREASURER / VP FINANCE 40.0 0.0 X 356185 0 33927 MARK E WILLIAMS MD FORMER OFFICER 0.0 40.0 X 0 342241 40303 ROBERT M BOWMAN VP HOSPITAL OPERATIONS 40.0 0.0 X 329833 0 49305 CARA W POWERS FORMER OFFICER 40.0 0.0 X 325274 0 53091 KIM K STRAHL SYS VP & CPO 10.0 30.0 X 0 337548 33785 KIMBERLY A HENSLEY VP HOSPITAL OPERATIONS 40.0 0.0 X 326556 0 32768 JEFFERY A MORNEAULT HOSP OPS-PERIOP SVCS (TO MAY) 40.0 0.0 X 264899 0 76852 CHRISTOPHER J DANIS BOARD CHAIR 0.5 39.5 X X 0 295061 42254 BILLIE L LUCENTE-BAKE SYS VP - HR OPS (FROM AUG) 10.0 30.0 X 0 252199 34146 JENNA M DOWNEY ESQ BOARD SECRETARY 38.0 2.0 X 223359 0 21938 YONATHAN KEBEDE VP HOSP OPS (FROM JUL) 40.0 0.0 X 86538 125890 26909 ELAINE M DEAN SYSTEM VP-BUSINESS DEVELOPMENT 10.0 30.0 X 0 178818 8144 MARK S SHAKER FORMER OFFICER 0.0 0.0 X 165359 0 20022 ANDRE T HARRIS MD TRUSTEE 0.5 39.5 X 0 149958 14088 TAREK SABAGH MD TRUSTEE & MED STAFF PRESIDENT 0.5 0.5 X 23333 900 0 A PETER EKEH MD TRUSTEE 0.5 0.0 X 5100 0 0 6218557 11576157 2274952 450 true true false DAWSON HEALTHCARE 1114 Dublin Rd COLUMBUS OH 43215 Medical Services 33283267 ANESTHESIOLOGY SERVICES 1 Wyoming St DAYTON OH 45409 Medical Services 20431270 WRIGHT STATE UNIVERSITY 3640 COLONEL GLENN HWY DAYTON OH 45435 MED SVCS & STAFFING 12351042 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DR W ENGLEWOOD CO 80112 Clinical Engineering 11657499 MIAMI VALLEY EMERG SPECIALISTS 2400 MIAMI VALLEY WAY CENTERVILLE OH 45459 MEDICAL SERVICES 11643011 153 620174 620174 NET PATIENT REVENUE 900099 592903220 592903220 MEDICARE/MEDICAID 900099 523675348 523675348 HOSPITAL FRANCHISE TAX RECOVERIES 900099 20714968 20714968 MEDICAL RECORDS 900099 141501 141501 HEALTH EDUCATION 900099 72837 72837 95536 95536 1137603410 10154740 10154740 0 0 13855593 11238812 2616781 0 2616781 2616781 246530636 1851561 206151737 622349 40378899 1229212 41608111 41608111 0 0 0 0 0 0 1329353 1185477 143876 143876 CAFETERIA SALES 812930 6113043 6113043 PENSION COST (INCOME) 900099 3144850 3144850 PARKING GARAGE 900099 937642 937642 1096562 -89107 1185669 11292097 1204039189 1137603410 -89107 65904712 20581009 20581009 0 0 0 5149007 3719512 1429495 0 362488 362488 343013207 335427531 7585676 20452463 19923426 529037 31831045 31616932 214113 25444185 24536739 907446 298608 221058 77550 95197 95197 0 16883 16883 0 1334925 1334925 88815887 88370976 444911 1533354 1533354 4672153 3410489 1261664 5771726 5253047 518679 0 12994115 12589445 404670 464610 423687 40923 0 0 38327632 38327632 0 74350761 72919098 1431663 537185 467771 69414 OPERATING SUPPLIES 204008232 204008232 PURCHASED SERVICES 88605098 80066533 8538565 HOSPITAL FRANCHISE TAX 15018765 15018765 REPAIRS & MAINTENANCE 4804237 4804237 9367007 8579301 787706 997849779 972161262 25688517 0 40405 41495 57193227 50884766 0 0 162017035 180635602 0 0 0 0 8132309 4477831 9572134 10143476 9413145 835207 1657488670 977079840 714714774 680408830 378643705 391265735 174903757 178160437 0 0 6335203 9166332 30112843 34706048 1551078537 1540725759 103724183 87869483 2042837 13791481 2624130 2636433 637509779 651592405 0 0 0 0 5796317 31414206 0 0 125277531 142292558 876974777 929596566 X 674103760 611129193 0 0 674103760 611129193 1551078537 1540725759 X 206189410 37748481 -306912458 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 16883 false false false 16883 false PART II-B, LINE 1F: PAYMENTS FOR LOBBYING ACTIVITIES INCLUDE DUES PAID TO GREATER DAYTON AREA HOSPITAL ASSOCIATION AND OHIO HOSPITAL ASSOCIATION. 47216047 47216047 1080079710 589527330 490552380 2658636 2155223 503413 498172326 385397287 112775039 29361951 29361951 680408830 ALTERNATIVE INVESTMENTS 178160437 F 178160437 0 PENSION OBLIGATION 76189262 SWAP LIABILITY 25338594 MALPRACTICE INSURANCE 21362418 LEASE COMMITMENT 8408063 LOAN GUARANTEE & OTHER LTL 3508605 EST PAY TO 3RD PARTY 2471637 WORKERS COMPESATION 1068295 OTHER 3945684 142292558 X SCHEDULE D, PART X, LINE 2: THE FOLLOWING FOOTNOTE IS FROM THE 2019 AUDITED COMBINED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF MIAMI VALLEY HOSPITAL (MVH). 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 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), UVMC MANAGEMENT CORPORATION AND AFTER HOURS FAMILY CARE, INC. (SUBSIDIARIES OF PHP) THE TAX CUTS AND JOBS ACT (THE ACT) WAS ENACTED ON DECEMBER 22, 2017. FOR TAX-EXEMPT ENTITIES, THE ACT REQUIRES ORGANIZATIONS TO PAY AN EXCISE TAX ON REMUNERATION TO EXECUTIVES ABOVE CERTAIN THRESHOLDS AND REPORT INCOME OR LOSS FROM UNRELATED BUSINESS ACTIVITIES ON AN ACTIVITY-BY-ACTIVITY BASIS, AMONG OTHER PROVISIONS. PHP HAS RECORDED ESTIMATED LIABILITIES AND RELATED EXPENSES FOR ALL EXCISE AND UNRELATED BUSINESS INCOME TAXES IDENTIFIED AT DECEMBER 31, 2019. MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS. Central America and the Caribbean Investments 51703000 Central America and the Caribbean Program Services INSURANCE 25000 51728000 51728000 false false false false false false true true X true X true X true true false true true 29246000 7804000 21442000 0.02150 107566968 20714968 86852000 0.08700 24353000 18008000 6345000 0.00640 161165968 46526968 114639000 0.11490 3220000 528000 2692000 0.00270 39133000 34787000 4346000 0.00440 23430000 23430000 0.02350 7350000 7350000 0.00740 73133000 35315000 37818000 0.03800 234298968 81841968 152457000 0.15290 866000 866000 0.00090 11111000 11111000 0.01110 8000 8000 0.00000 11985000 11985000 0.01200 true 36859096 0 204277000 218607000 -14330000 X true true 3 1 MIAMI VALLEY HOSPITAL ONE WYOMING ST DAYTON OH 45409 WWW.PREMIERHEALTH.COM SEE PART V SEC C X X X X X A 2 MIAMI VALLEY HOSPITAL SOUTH 2400 MIAMI VALLEY DR CENTERVILLE OH 45459 WWW.PREMIERHEALTH.COM SEE PART V SEC C X X X A 3 Miami Valley Hospital North 9000 N MAIN ST DAYTON OH 45415 WWW.PREMIERHEALTH.COM SEE PART V SEC C X X X B A 12 false false true X X X X X X X X X 19 true true true true X SEE PART V, SECTION C X true 20 true SEE PART V, SECTION C false true X 200. 300. X X true true X X X true X SEE PART V, SEC C X SEE PART V, SEC C X SEE PART V, SEC C X X X X X X X true X false X X X X true X false false B 3 true true true X X X X X X X X X 19 true true true true X SEE PART V, SECTION C X true 20 true SEE PART V, SECTION C false true X 200. 300. X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false PART V, SECTION A, LINE 1: THE STATE OF OHIO DOES NOT LICENSE HOSPITALS, BUT THE OHIO DEPARTMENT OF HEALTH DOES REGISTER HOSPITALS. AS PART OF THIS REGISTRATION PROCESS, HOSPITALS IN THE STATE OF OHIO ARE REQUIRED TO COMPLETE AND SUBMIT THE ANNUAL HOSPITAL REGISTRATION AND PLANNING REPORT (AHR) EACH CALENDAR YEAR. MIAMI VALLEY HOSPITAL'S REGISTRATION NUMBER IS 1247. MIAMI VALLEY HOSPITAL SOUTH'S REGISTRATION NUMBER IS 1489. MIAMI VALLEY HOSPITAL NORTH'S REGISTRATION NUMBER IS 1914. PART V, SECTION B, LINE 2 (MIAMI VALLEY HOSPITAL NORTH): MIAMI VALLEY HOSPITAL NORTH WAS PLACED IN SERVICE AS A TAX-EXEMPT HOSPITAL UPON ACQUIRING IN-PATIENT BEDS. PREVIOUSLY THE FACILITY WAS AN EMERGENCY CENTER OFFERING TRANSPORT TO A LOCAL HOSPITAL IF ADMISSION WAS NEEDED. PART V, SECTION B, LINE 3E: MIAMI VALLEY HOSPITAL'S SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND WERE IDENTIFIED THROUGH THE CHNA. PART V, SECTION B, LINE 5: THE CHNA TEAM COLLECTED 140 MEASURES FROM PUBLICLY AVAILABLE SOURCES, STARTING WITH THE COUNTY HEALTH RANKINGS. CRITERIA FOR INCLUSION INCLUDED AVAILABILITY OF TREND DATA AT THE COUNTY LEVEL AND EASE OF COMPARISON AND UPDATING. THE COLLABORATIVE CHNA FOR 2019 SHARES DATA FOR THE WHOLE REGION AS WELL AS DETAILED COUNTY-LEVEL DATA. SERVICE AREAS OF HOSPITALS VARY, AND THIS APPROACH PROVIDES THE MOST THOROUGH PICTURE OF HEALTH NEEDS LOCALLY AND REGIONALLY. AN ADDED BONUS THIS CYCLE IS THE ACTIVE PARTICIPATION OF THE SOUTHWEST OHIO MEMBERS OF THE ASSOCIATION OF OHIO HEALTH COMMISSIONERS. THE CHNA TEAM REACHED OUT TO THEM IN SPRING 2017 TO TAKE THE FIRST STEPS TOWARDS THE STATE OF OHIOS REQUIREMENT THAT HEALTH DEPARTMENTS AND HOSPITALS ALIGN THEIR ASSESSMENTS STARTING IN 2020. AS A RESULT, THE CHNA TEAM HAS RESEARCHED MORE SECONDARY DATA MEASURES, INCLUDED HOSPITAL UTILIZATION DATA, OVERSAMPLED VULNERABLE POPULATIONS, AND ENGAGED MORE PARTICIPANTS. A TOTAL OF 1,416 PEOPLE OR ORGANIZATIONS COMPLETED A SURVEY OR ATTENDED A MEETING. A SIGNIFICANT PART OF THE INCREASE WAS DUE TO LOCAL HEALTH DEPARTMENTS HELPING TO PROMOTE AND CONDUCT MEETINGS. THE PRIMARY DATA COLLECTION AND ANALYSIS USED THE NARRATIVE METHOD AND SPECIFICALLY THE TECHNIQUE OF DISCOURSE ANALYSIS. THE FOCUS WAS ON COLLECTING DATA FROM INDIVIDUALS BASED ON THEIR EXPERIENCE. THERE WERE SEVERAL IMPORTANT STEPS TO ENSURE A CONSISTENT PROCESS: 1) VERBATIM ENTRY OF COMMENTS THIS HAPPENS AUTOMATICALLY WITH THE ONLINE SURVEY PROCESS AND SCRIBES WERE TRAINED TO DO THIS AT THE COMMUNITY MEETINGS. 2) CREATING CUSTOM TAGS TO SUMMARIZE EACH RESPONSE, E.G., CANCER, DIABETES, HEART DISEASE. 3) CREATING THEMES THAT CONNECT SOME OF THE TAGS, E.G., CHRONIC DISEASE. 4) PROOFREADING EACH OTHERS TAGS AND ANALYSIS, WITH REVIEW BY AT LEAST 3 DIFFERENT PEOPLE TO ENSURE OVERALL CONSISTENCY. 5) USE OF SURVEYMONKEY'S 'GOLD' LEVEL ENABLED THE CREATION OF CUSTOM TAGS AND INITIAL SORTING. IT ALSO PROVIDED A CONSISTENT WAY TO COMPARE SURVEY RESULTS WITH MEETING RESPONSES. IT WORKED FOR FACE-TO-FACE VERBAL ENCOUNTERS, SUCH AS IN MEETINGS, AS WELL AS WRITTEN RESPONSES. COMMENTS MADE IN PERSON WERE ENTERED INTO SURVEYMONKEY, TAGGED, AND THEMES IDENTIFIED. THE LEAD CONSULTANT CUSTOMIZED THE TAGGING IN SURVEYMONKEY BECAUSE SHE FOUND THAT ITS AUTOMATIC GROUPING OF IDEAS WAS NOT PRECISE ENOUGH AND COULD NOT ACCOUNT FOR CONTEXT OR ADAPT WHEN RESPONSES USED DIFFERENT WORDS FOR SIMILAR CONCEPTS. 6) REVIEWING TAGS AT THE COUNTY-LEVEL, URBAN LEVEL, AND REGIONAL LEVEL WAS DONE TO ENSURE THAT THE TAGS AND THEMES MADE SENSE AND WERE APPLICABLE AT ALL LEVELS. FOR EXAMPLE, THE CONSULTANTS CREATED TAGS FOR 'ADDICTION,' 'HEROIN,' 'METH' AS SUBSETS OF THE 'SUBSTANCE ABUSE' THEME, BECAUSE OF THEIR APPARENT FREQUENCY AT THE BEGINNING OF THE TAGGING PROCESS. THEY COUNTED EACH TAG AND SAVED THE COUNT, BUT NONE OF THESE TAGS REACHED HIGH ENOUGH NUMBERS (MORE THAN 5% OF MENTIONS) TO WARRANT ITS OWN CATEGORY IN THE FINAL ANALYSIS. SEE APPENDIX K FOR GUIDELINES USED TO ASSIGN CATEGORIES AND FOR SORTING AND TABULATING RESPONSES. 7) SURVEYMONKEYS FILTER OPTIONS FACILITATED THE PROCESS OF SORTING AND ANALYZING BY COUNTY, BY GROUPS OF COUNTIES, BY TYPE OF SURVEY, AND/OR BY SUB-POPULATION. THIS IS A USEFUL OPTION TO CONSIDER CONTEXT OR CULTURE, SUCH AS URBAN RESPONDENTS OR LATINO RESPONDENTS. THE CHNA TEAM INVOLVED FOUR ENTITIES WORKING CLOSELY TOGETHER: THE HEALTH COLLABORATIVE (LEAD AGENCY); THE GREATER DAYTON AREA HOSPITAL ASSOCIATION; GWEN FINEGAN (LEAD CONSULTANT AND PROJECT MANAGER); AND PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY (SECONDARY DATA COLLECTION FOR OHIO COUNTIES). THE HEALTH COLLABORATIVE (THC) CONTRACTED WITH MS. FINEGAN TO CONDUCT A COMPREHENSIVE AND COLLABORATIVE ASSESSMENT FOR THE HEALTHCARE SYSTEMS AND HOSPITALS. THE LEAD CONSULTANT ASSEMBLED A TEAM OF FOUR SUB-CONTRACTORS TO ASSIST HER. BOTH THC AND THE GREATER DAYTON AREA HOSPITAL ASSOCIATION (GDAHA) MANAGED THE RELATIONSHIPS AND SIGNED AGREEMENTS WITH THEIR RESPECTIVE MEMBER HOSPITALS. THE LEAD CONSULTANT INITIATED THE CONNECTION WITH THE SOUTHWEST DISTRICT OF THE ASSOCIATION OF OHIO HEALTH COMMISSIONERS (AOHC), AND BOTH SHE AND THC REPRESENTATIVES ATTENDED SIX AOHC MEETINGS. THE LEAD CONSULTANT WORKED CLOSELY WITH ERIK BALSTER, DIRECTOR FOR THE SW DISTRICT OF AOHC AND HEALTH COMMISSIONER OF PREBLE COUNTY TO INCORPORATE AOHCS REQUESTS AND ENSURE SMOOTH COMMUNICATION. THE LEAD CONSULTANT ALSO WORKED CLOSELY WITH DAWN EBRON, COMMUNITY HEALTH IMPROVEMENT PLANNING AND EPIDEMIOLOGY SUPERVISOR, AND EPIDEMIOLOGISTS KYLE WALLACE, ASHLEY SEYBOLD, AND SUSAN HERZFELD AT PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY TO COORDINATE MEETINGS AND FOR SECONDARY DATA COLLECTION. INTERACT FOR HEALTH PROVIDED DATA FROM THEIR GREATER CINCINNATI HEALTH STATUS SURVEY AS DID PREVENTIONFIRST! FROM ITS PRIDE SURVEY. LOUISE KENT, PLANNING ADMINISTRATOR FOR THE NORTHERN KENTUCKY HEALTH DEPARTMENT, IDENTIFIED ADDITIONAL DATA SOURCES FOR THE COMMONWEALTH OF KENTUCKY AND THE THREE NORTHERN COUNTIES. THE CINCINNATI HEALTH DEPARTMENT GATHERED DATA FOR THE CITY OF CINCINNATI. PART V, SECTION B, LINES 6A & 6B: MIAMI VALLEY HOSPITAL, MIAMI VALLEY HOSPITAL SOUTH, AND MIAMI VALLEY HOSPITAL NORTH PARTNERED WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, PUBLIC HEALTH DEPARTMENTS, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, ADAMS COUNTY HEALTH DEPARTMENT, BROWN COUNTY HEALTH DEPARTMENT, BUTLER COUNTY HEALTH DEPARTMENT, CHAMPAIGN-URBANA COUNTY DEPARTMENT, CINCINNATI HEALTH DEPARTMENT, CITY OF HAMILTON HEALTH DEPARTMENT, CLARK COUNTY COMBINED HEALTH DISTRICT, CLERMONT COUNTY PUBLIC HEALTH, CLINTON COUNTY HEALTH DEPARTMENT, DARKE COUNTY GENERAL HEALTH DISTRICT, FAYETTE COUNTY PUBLIC HEALTH, GREENE COUNTY PUBLIC HEALTH, HAMILTON COUNTY PUBLIC HEALTH, HIGHLAND COUNTY HEALTH DEPARTMENT, MIAMI COUNTY PUBLIC HEALTH, MIDDLETOWN CITY HEALTH DISTRICT, NORWOOD HEALTH DEPARTMENT, PIQUA CITY HEALTH DEPARTMENT, PREBLE COUNTY PUBLIC HEALTH, PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY, SIDNEY SHELBY COUNTY HEALTH DEPARTMENT, SPRINGDALE HEALTH DEPARTMENT & WARREN COUNTY COMBINED HEALTH DISTRICT. PART V, SECTION B, LINES 7A & 10A: THE DIRECT WEBSITE ADDRESS WHERE THE 2019 CHNA AND THE 2020 COMMUNITY HEALTH IMPLEMENTATION PLAN CAN BE ACCESSED IS: HTTPS://WWW.PREMIERHEALTH.COM/ABOUT-PREMIER/COMMUNITY-INVOLVEMENT/ COMMUNITY-HEALTH-IMPROVEMENT PART V, SECTION B, LINE 11: MIAMI VALLEY HOSPITAL (MVH), MIAMI VALLEY HOSPITAL SOUTH (MVHS), AND MIAMI VALLEY HOSPITAL NORTH (MVHN) ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE FOLLOWING PRIORITIZED NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): *ACCESS TO CARE AND/OR SERVICES *CHRONIC DISEASE *HEALTHY BEHAVIORS *SUBSTANCE ABUSE AND MENTAL HEALTH MVH AND MVHN ACCESS TO CARE/SERVICES COMMUNITY PARAMEDICINE PROGRAM METRICS: NUMBER OF HOME ASSESSMENTS. NUMBER OR PERCENT OF PATIENTS CONNECTED TO COMMUNITY RESOURCES. REDUCTION IN NUMBER OF EMERGENCY DEPARTMENT VISITS. DECREASED CALLS TO LOCAL 911 SERVICES. HEALTH ISSUE: PATIENTS WITHOUT ACCESS TO REGULAR MEDICAL CARE OFTEN HAVE UNNECESSARY VISITS TO EMERGENCY DEPARTMENTS AND UNPLANNED HOSPITAL READMISSIONS. INTERVENTIONS GOAL: THE GOAL IS TO MEET THE NEEDS OF VULNERABLE RESIDENTS, WHO ARE NOT ELIGIBLE FOR HOME HEALTH CARE, BY PROVIDING CARE FROM COMMUNITY PARAMEDICS AND CONNECTING THEM TO AVAILABLE RESOURCES. DESCRIPTION: THE PROGRAM HAS BEEN DESIGNED TO PROVIDE THE RESIDENT WITH PERSONALIZED HEALTH AND WELLNESS SUPPORT IN THE COMFORT OF THEIR OWN HOME. THE PROGRAM WILL HELP THEM MANAGE THEIR NEEDS INCLUDING MEDICATIONS, AS WELL AS CONNECTING THE PATIENTS WITH PRIMARY CARE PHYSICIANS, PRENATAL CARE, SENIOR CARE SERVICES, AND MORE. THE TEAM, WHICH COMPRISES A PARAMEDIC AND EMERGENCY MEDICAL TECHNICIAN FROM DAYTON FIRE ALONG WITH A SOCIAL WORKER FROM THE CITY OF DAYTON, WILL VISIT THE HOME AND IDENTIFY BASIC NEEDS SUCH AS FOOD AND SAFETY. THE CREW WILL THEN DEVELOP A CARE PLAN THAT FACTORS IN THE PATIENTS UNIQUE HOME ENVIRONMENT, SUPPORT, AND HEALTH CARE NE 20 MVH Austin Boulevard Emergency Center 300 AUSTIN W BLVD MIAMISBURG OH 45342 EMERGENCY CENTER MVH Jamestown Emergency Center 4940 Cottonville Rd Jamestown OH 45335 Emergency Center, cardiac testing & rehab, medical imaging, LABORATORY TESTING HEALTH CENTER - HUBER HEIGHTS 6251 MIAMI VALLEY WAY HUBER HEIGHTS OH 45424 Cardiac Testing, Diagnostic & Imaging, Rehab Medical Imaging Beavercreek 1244 MEADOW BRIDGE DR BEAVERCREEK OH 45434 CARDIAC TESTING & REHAB, DIAGNOSTIC & IMAGING OUTPATIENT CARDIAC TESTING & REHAB 122 WYOMING ST DAYTON OH 45409 CARDIAC TESTING & REHAB Miami Valley Hospital Diabetes Center 80 E WOODBURY DR ENGLEWOOD OH 45415 Diabetes Center, Sleep Center Clayborune Physical Therapy Clinic 1525 E STROOP RD KETTERING OH 45429 REHABILITATION REHABILITATION AT SURECARE MED CENTER 360 W CENTRAL AVE SPRINGBORO OH 45066 REHABILITATION, DIAGNOSTIC, & IMAGING REHABILITATION AT WRIGHT HEALTH BUILDING 1222 S PATTERSON BLVD DAYTON OH 45402 REHABILITATION MVH Center for Sleep and Wake Disorder 6611 CLYO RD DAYTON OH 45459 SLEEP CENTER MVH Medical Imaging - Springboro 630 N MAIN ST SPRINGBORO OH 45066 DIAGNOSTIC & IMAGING Bull Family Diabetes Center 400 SUGAR CAMP CIR 205 OAKWOOD OH 45409 Diabetes Center Outpatient Cardiac Testing - Beavercreek 2619 COMMONS BLVD 102 BEAVERCREEK OH 45431 Cardiac Testing MVH Center - Greenville 742 SWEITZER ST GREENVILLE OH 45331 Cardiac Testing, Diagnostic & Imaging Outpatient Behavioral Health Programs 627 Edwin C Moses Blvd DAYTON OH 45417 Behavioral Health First Care After Hours 1911 N Fairfield Rd 110 BEAVERCREEK OH 45432 After Hours Care ENGLEWOOD After Hours 9000 N Main St G-33 ENGLEWOOD OH 45415 After Hours Care Premier Occupational Health Central 1520 S MAIN ST 210 DAYTON OH 45409 Occupational Health Dayton Heart Center 1530 Needmore Rd 301 HUBER HEIGHTS OH 45414 Diagnostic & Imaging OUTPATIENT PHYSICAL THERAPY & SPORTS MED 90 REMICK BLVD SPRINGBORO OH 45066 REHABILITATION & SPORTS MEDICINE PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT FOR MIAMI VALLEY HOSPITAL IS PART OF THE PREMIER HEALTH REPORT (EIN# 31-1446699). PART I, LINE 7: A COST TO CHARGE RATIO WAS USED TO CALCULATE THIS FINANCIAL ASSISTANCE AT COST. THIS CALCULATION TAKES TOTAL OPERATING EXPENSES LESS OTHER OPERATING REVENUES DIVIDED BY TOTAL GROSS REVENUES. UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENTAL PROGRAMS WERE CALCULATED USING A COST ACCOUNTING SYSTEM. THIS SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND INCLUDES FULLY LOADED COSTS. FOR THE REMAINING ITEMS THE ORGANIZATION USED SPECIFIC NUMBERS FOR EXPENSE PAID DIRECTLY FOR THESE SERVICES. PART I, LINE 7G: MIAMI VALLEY HOSPITAL (MVH) PROVIDES SUBSIDIZED EMERGENCY SERVICES BY OPERATING A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THIS EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL INCURS EXPENSES RELATED TO CALL TIME AND PHYSICIAN SUBSIDIES DUE TO THE LARGE NUMBER OF INDIGENT PATIENTS COMING THROUGH THE EMERGENCY ROOM. FOR 2019, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $23,430,000. PART II: -------- MIAMI VALLEY HOSPITAL (MVH) IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH A VARIETY OF PREVENTION, HEALTH IMPROVEMENT AND ENGAGEMENT PROGRAMS. AS PART OF ITS OVERALL COMMITMENT TO THE COMMUNITY, MVH FOCUSES ON FOUR AREAS OF SERVICE: --INVESTING IN THE COMMUNITY --PREVENTION AND WELLNESS --COMMITMENT TO THE UNDER-SERVED --COMMUNITY ENGAGEMENT SOME OF THE PROGRAMS SUPPORTED BY MVH DURING 2019 INCLUDE: 1) PROJECTS, PROGRAMS, AND POLICIES WILL BE DEVELOPED TO ADVANCE THE DESIRED OUTCOMES FOR THE PHOENIX PROJECT AREA (AS DEFINED BELOW). THE PRIORITY OUTCOMES ARE TO DRIVE ECONOMIC VITALITY, CREATE JOBS, ENHANCE THE IMAGE OF THE AREA, LEVERAGE INVESTMENT, AND PROMOTE HEALTHY LIVING. OTHER DESIRABLE OUTCOMES ARE TO IMPROVE LIVABILITY, PROVIDE AMENITIES, DRAW PEOPLE FROM OUTSIDE THE AREA, EXCITE THE COMMUNITY, IMPROVE SAFETY, ADVANCE EDUCATIONAL SUCCESS, SUPPORT THE WELL-BEING OF YOUTH, SERVE THE DIVERSE DEMOGRAPHICS OF THE NEIGHBORHOODS, PROVIDE AN ATTRACTIVE ENVIRONMENT, ATTRACT, AND SUSTAIN NEW/YOUNG PEOPLE AND PROMOTE ENVIRONMENTAL SUSTAINABILITY. IN ORDER TO MEET THESE GOALS, $815,986 WAS CONTRIBUTED TO PHYSICAL IMPROVEMENTS AND $11,111,100 WAS CONTRIBUTED TO COMMUNITY BUILDING ECONOMIC DEVELOPMENT. 2) NEIGHBORHOOD REVITALIZATION AND DEVELOPMENT THROUGH A CONTRIBUTION OF $50,000 TO THE PHOENIX PROJECT. THE GOALS OF THIS PROJECT ARE TO REDUCE AND DETER CRIME, REVITALIZE THE APPEARANCE OF THE NEIGHBORHOOD AND ACTIVATE LINKAGES FOR PHYSICAL, MENTAL AND SOCIAL HEALTH SERVICES. THIS PROGRAM ALSO PURCHASES PROPERTIES IN THE SURROUNDING AREA, REHABILITATES THEM AND SELLS THEM TO THOSE IN NEED. 3) $7,800 WAS DONATED TO ASSIST IN RECOVERY FROM NATURAL DISASTERS. PART III, LINES 2 & 3: BAD DEBT EXPENSE IS INCURRED WHEN AN ACCOUNT IS TAKEN OUT OF ACCOUNTS RECEIVABLE AND TURNED OVER TO A COLLECTION AGENCY. THIS ACTION MAY OCCUR IF A PATIENT REFUSES PAYMENT ARRANGEMENTS, REFUSES TO APPLY FOR FINANCIAL ASSISTANCE, AND THERE IS NOT AN INSURANCE BALANCE BEING CONTENDED. AN ACCOUNT IS WRITTEN OFF TO BAD DEBT AFTER 130 DAYS IF AN ATTEMPT TO COLLECT FROM THE PATIENT IS MADE WITHIN OUR COLLECTION POLICY. THE COLLECTION AGENCY ATTEMPTS TO COLLECT THE ACCOUNT IN ACCORDANCE WITH ESTABLISHED GUIDELINES. COLLECTION ATTEMPTS ARE CEASED AND THE ACCOUNT RETURNED TO THE ORGANIZATION IF THE PATIENT APPLIES FOR FINANCIAL ASSISTANCE. ANY AMOUNTS COLLECTED FROM THESE ACCOUNTS ARE CREDITED BACK AGAINST BAD DEBT EXPENSE. THE ORGANIZATION RECOGNIZES THERE ARE ACCOUNTS WRITTEN OFF TO BAD DEBT THAT MAY HAVE QUALIFIED FOR CHARITY CARE IF THE PATIENT HAD PROVIDED THE NECESSARY FINANCIAL INFORMATION. TO RESOLVE THIS, THE ORGANIZATION HAS ENGAGED A THIRD-PARTY VENDOR TO ANALYZE DATA BASED ON CREDIT SCORES TO REALLOCATE SOME OF THIS EXPENSE TO CHARITY CARE. A REPRESENTATIVE SAMPLE OF THESE ACCOUNTS IS THEN SENT TO OUR THIRD-PARTY VENDOR WHO GATHERS EXTERNAL CREDIT DATA THAT PRESENTS THE ACCOUNT AS LESS THAN 100% FEDERAL POVERTY LEVEL OR NOT ENOUGH INFORMATION (TYPICALLY INDICATIVE OF INDIGENT). THESE ACCOUNTS ARE RECLASSED FROM BAD DEBT EXPENSE TO CHARITY EXPENSE ON OUR INCOME STATEMENT. ANY CREDIT SCORE THAT PRESENTS THE ACCOUNTS AS GREATER THAN 100% FEDERAL POVERTY LEVEL REMAINS IN BAD DEBT EXPENSE. DUE TO THIS PROCESS, THE ORGANIZATION HAS USED BEST EFFORTS TO NOT REPORT BAD DEBT EXPENSE FOR PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. PART III, LINE 4: THE ORGANIZATION DOES NOT HAVE A FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS WHICH DISCUSSES THIS CALCULATION. PART III, SECTION B, LINES 5, 6, AND 7: THE AMOUNTS REPORTED ON LINES 5, 6, AND 7 DO NOT INCLUDE CERTAIN MEDICARE PROGRAM REVENUES AND COSTS, AND THUS DO NOT REFLECT ALL OF THE ORGANIZATION'S REVENUES AND COSTS ASSOCIATED WITH ITS PARTICIPATION IN MEDICARE PROGRAMS. IN ADDITION TO THE AMOUNTS REPORTED ON LINE 5, 6, AND 7, THE ORGANIZATION RECEIVED REVENUE OF $199,973,000 AND INCURRED COST OF $271,899,000, FOR AN ADDITIONAL NET SHORTFALL OF $71,926,000 ASSOCIATED WITH THESE PROGRAMS. BELOW IS A RECONCILIATION OF THE AMOUNTS ASSOCIATED WITH MEDICARE PROGRAMS. ALLOWABLE MEDICARE REVENUE PER MEDICARE COST REPORT (PART III, SECTION B) $204,277,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $199,973,000 TOTAL MEDICARE ASSOCIATED REVENUE $404,250,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT (PART III, SECTION B) $218,607,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $271,899,000 TOTAL MEDICARE ASSOCIATED COST $490,506,000 MEDICARE SHORTFALL PER PART III, SECTION B $14,330,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $71,926,000 TOTAL MEDICARE SHORTFALL $86,256,000 PART III, LINE 8: THE ORGANIZATION'S SHORTFALL SHOULD BE CONSIDERED CHARITY CARE BECAUSE IT IS PROVIDING HIGH-QUALITY CARE, IN EXCESS OF THE COST, TO OUR COMMUNITY RESIDENTS THAT NEED CARE. THE MEDICARE POPULATION AT THE ORGANIZATION IS IN EXCESS OF 45% OF NET PATIENT REVENUE. THE ORGANIZATION USED A COST ACCOUNTING SYSTEM TO CALCULATE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: THE ORGANIZATION MAKES REASONABLE EFFORTS TO DETERMINE WHETHER OR NOT AN INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THE STATE OR HOSPITAL FINANCIAL ASSISTANCE POLICY BEFORE ENGAGING IN EXTRAORDINARY COLLECTIVE ACTIONS AGAINST THAT INDIVIDUAL. PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE OFFERED REASONABLE PAYMENT PLAN ARRANGEMENTS FOR ANY REMAINING BALANCES. ANY THIRD-PARTY COLLECTING SELF-PAY RECEIVABLES ON OUR BEHALF IS REQUIRED TO MAKE REASONABLE EFFORTS TO DETERMINE IF THE INDIVIDUAL MEETS THE QUALIFICATIONS OF THE STATE OR OF OUR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS. REASONABLE EFFORTS INCLUDE: A. VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENT HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL. B. DOCUMENTED THAT THE ORGANIZATION HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE UNDER ITS FINANCIAL ASSISTANCE POLICY. C. DOCUMENTED THAT THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE. D. DOCUMENT THAT THE PATIENT HAS BEEN OFFERED AND ACCEPTED TERMS FOR A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. THE FINANCIAL COUNSELORS MEET WITH INPATIENT, OUTPATIENT, SELF-PAY, AND OTHER PATIENTS UPON REQUEST WHO MAY NEED FINANCIAL ASSISTANCE. IN ADDITION TO ASSISTING PATIENTS WHO WANT TO APPLY FOR ASSISTANCE THROUGH THE MEDICAID PROGRAM, THE FINANCIAL COUNSELOR WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 2: THE ORGANIZATION WORKS WITH THE COMMUNITY ON PROGRAMS THAT ADDRESS THE UNDERLYING CAUSES OF PERSISTENT HEALTH PROBLEMS AS PART OF A COMPREHENSIVE STRATEGY TO IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE FOR IDENTIFIED MEMBERS OF THE COMMUNITY WHO ARE ECONOMICALLY DISADVANTAGED, DISENFRANCHISED AND/OR WHO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE ORGANIZATION STRIVES TO WORK WITH PREMIER HEALTH, THE HOSPITAL BOARD OF TRUSTEES, EXECUTIVE MANAGEMENT, MANAGERS, STAFF MEMBERS, COMMUNITY GROUPS, AND INDIVIDUALS TO PROVIDE A COLLABORATIVE APPROACH TO THE GOVERNANCE AND MANAGEMENT OF COMMUNITY BENEFIT ACTIVITIES. PART VI, LINE 3: THERE ARE SEVERAL WAYS IN WHICH OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR SERVICES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FIRST, NOTIFICATION OF SUCH AVAILABLE ASSISTANCE IS CLEARLY POSTED IN REGISTRATION AREAS, AS WELL AS MATERNITY AND EMERGENCY DEPARTMENTS. NEXT, PATIENT ADVOCATES, PATIENT ACCESS STAFF MEMBERS, AND FINANCIAL COUNSELORS IN THE INPATIENT AND EMERGENCY DEPARTMENTS MEET WITH UNINSURED AND UNDERINSURED PATIENTS, AND THOSE WITH ONLY MEDICARE COVERAGE TO DISCUSS ELIGIBILITY FOR ASSISTANCE. FINANCIAL COUNSELORS ALSO DISCUSS OPTIONS TO RESOLVE UNPAID ACCOUNT BALANCES WITH UNINSURED AND UNDERINSURED PATIENTS. THE FINANCIAL ASSISTANCE true CITYWIDE DEVELOPMENT CORP 8 N MAIN ST DAYTON OH 45402 310821189 501(C)(4) 11977086 COMMUNITY DEVELOPMENT FIVE RIVERS HEALTH CENTERS 2261 PHILADELPHIA DR DAYTON OH 45406 450914398 501(C)(3) 4406628 SUPPORT ONEFIFTEEN RECOVERY 6636 LONGSHORE ST 200 DUBLIN OH 43017 833504845 501(C)(3) 1950000 SUPPORT REACH OUT MONTGOMERY COUNTY 25 E FORAKER ST DAYTON OH 45409 311434282 501(C)(3) 142065 RX ASSISTANCE HOMEFULL 33 W FIRST ST 100 DAYTON OH 45402 311236989 501(C)(3) 78780 SUPPORT GALA OF HOPE FOUNDATION - 3500 PENTAGON BLVD 500 BEAVERCREEK OH 45431 464277044 501(C)(3) 78000 SUPPORT MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311040231 501(C)(3) 61230 SUPPORT DAYTON FOUNDATION 40 N MAIN ST 500 DAYTON OH 45423 316027287 501(C)(3) 86875 SUPPORT DAYTON ART INSTITUTE 456 BELMONTE PARK N DAYTON OH 45405 310537480 501(C)(3) 42100 SUPPORT ATRIUM MEDICAL CENTER FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311079213 501(C)(3) 33384 SUPPORT GEM CITY MARKET 33 W 1ST ST 100 DAYTON OH 45402 821168121 NONE 32653 SUPPORT PREMIER COMMUNITY HEALTH 110 N MAIN ST 500 DAYTON OH 45402 311122883 501(C)(3) 31200 SUPPORT UVMC FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311581859 501(C)(3) 23595 SUPPORT FIVE RIVERS METRO PARKS FOUNDATION 1301 E SIEBENTHALER AVE DAYTON OH 45414 310937070 GOVT 23400 SUPPORT BRIGIDS PATH INC 3601 S DIXIE DR KETTERING OH 45439 471200761 501(C)(3) 19500 SUPPORT WILBERFORCE UNIVERSITY 1055 N BICKETT RD WILBERFORCE OH 45384 310604719 501(C)(3) 19500 SUPPORT OTTERBEIN HOMES 580 N SR 741 LEBANON OH 45036 310549058 501(C)(3) 15600 SUPPORT EQUITAS HEALTH 15 W FOURTH ST DAYTON OH 45402 311126780 501(C)(3) 15600 SUPPORT FRIENDS OF THE CASTLE 133 N MAIN ST CENTERVILLE OH 45459 311337923 501(C)(3) 15600 SUPPORT MARY SCOTT NURSING CENTER INC 3109 CAMPUS DR DAYTON OH 45406 316010222 501(C)(3) 15600 SUPPORT MISSION OF MARY COOPERATIVE 619 SILVER LN DAYTON OH 45410 462231133 501(C)(3) 15163 SUPPORT WARREN COUNTY FOUNDATION 118 E MAIN ST LEBANON OH 45036 311565086 501(C)(3) 14898 SUPPORT ST PETER CATHOLIC CHURCH - 6161 CHAMBERSBURG RD HUBER HEIGHTS OH 45424 310626310 501(C)(3) 14430 SUPPORT YWCA OF DAYTON 141 W THIRD ST DAYTON OH 45402 310537168 501(C)(3) 12090 SUPPORT ARBOGAST PERFORMING ART CENTER 700 S DORSET RD TROY OH 45373 830889260 501(C)(3) 11700 SUPPORT HOSPICE OF MIAMI COUNTY 500 SUMMIT AVE 101 TROY OH 45373 311031277 501(C)(3) 10530 SUPPORT DAYTON CONTEMPORARY DANCE COMPANY 840 GERMANTOWN ST DAYTON OH 45402 237220259 501(C)(3) 16380 SUPPORT SC MINISTRY FOUNDATION 345 NEEB RD CINCINNATI OH 45233 311185570 501(C)(3) 10140 SUPPORT DECOLORES MONTESSORI SCHOOL 312 CENTRAL AVE GREENVILLE OH 45331 311166242 501(C)(3) 9555 SUPPORT ALZHEIMERS ASSOCIATION MIAMI VALLEY CHAPTER 31 W WHIPP RD DAYTON OH 45459 311031867 501(C)(3) 8960 SUPPORT AMERICAN RED CROSS 370 W FIRST ST DAYTON OH 45402 530196605 501(C)(3) 8190 SUPPORT BELLBROOK MUSIC BOOSTERS 3772 GRAND OAK TRL DAYTON OH 45440 201637658 501(C)(3) 8190 SUPPORT GOOD SAMARITAN FOUNDATION - DAYTON 110 N MAIN ST 500 DAYTON OH 45402 237296923 501(C)(3) 7995 SUPPORT DAYTON FIRST EVENTS INC 40 N MAIN ST 900 DAYTON OH 45423 454231032 NONE 7800 SUPPORT PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY 117 S MAIN ST DAYTON OH 45422 316000172 GOVT 7400 SUPPORT DEWINE HUSTED INAUGURAL COMMITTEE 2168 SUTTER PKWY DUBLIN OH 43016 832479480 GOVT 7400 SUPPORT DAYTON PERFORMING ARTS ALLIANCE 109 N MAIN ST 200 DAYTON OH 45402 316000101 501(C)(3) 7020 SUPPORT PLANNED PARENTHOOD SOUTHWEST OHIO 224 N WILKINSON ST DAYTON OH 45402 310536688 501(C)(3) 7020 SUPPORT DAYTON EARLY COLLEGE ACADEMY INC 300 COLLEGE PARK AVE DAYTON OH 45469 260463618 501(C)(3) 6630 SUPPORT MIAMI COUNTY YMCA 223 W HIGH ST PIQUA OH 45356 310537179 501(C)(3) 6435 SUPPORT UNIVERSITY OF DAYTON 300 COLLEGE PARK DAYTON OH 45469 310536715 501(C)(3) 6357 SUPPORT HOSPICE OF DAYTON FOUNDATION 324 WILMINGTON AVE DAYTON OH 45420 311769696 501(C)(3) 6240 SUPPORT DAYBREAK 605 PATTERSON BLVD DAYTON OH 45402 310864474 501(C)(3) 6240 SUPPORT PROJECT HOPE INC 1510 N MAIN ST DAYTON OH 45405 341421548 501(C)(3) 5850 SUPPORT VICTORIA THEATRE ASSOCIATION 138 N MAIN ST DAYTON OH 45402 310897638 501(C)(3) 5720 SUPPORT SOUTHBROOK CHRISTIAN CHURCH - 9095 WASHINGTON CHRUCH RD MIAMISBURG OH 45342 311177033 501(C)(3) 5460 SUPPORT RONALD MCDONALD HOUSE 555 VALLEY ST DAYTON OH 45404 310964793 501(C)(3) 5460 SUPPORT TROY FOUNDATION 216 W FRANKLIN ST TROY OH 45373 316018703 501(C)(3) 5265 SUPPORT HEALTH POLICY INSTITUTE OF OHIO 10 W BROAD ST 1050 COLUMBUS OH 43215 300186863 GOVT 5260 SUPPORT WITH GOD'S GRACE 622 SPRINGFIELD ST DAYTON OH 45403 810896817 501(C)(3) 5180 SUPPORT CATHOLIC SOCIAL SERVICES OF THE MIAMI VALLEY 922 W RIVERVIEW AVE DAYTON OH 45402 310536645 501(C)(3) 5070 SUPPORT 48 3 SCHEDULE I, PART I, LINE 2: 1) DISBURSEMENTS ARE ANALYZED MONTHLY THROUGH VARIOUS REPORTS AND COMMITTEE MEETINGS. 2) INVOICES ARE RECEIVED IN ACCOUNTS PAYABLE AND APPROVED AND DISBURSED PER ORGANIZATIONAL POLICY. 3) GRANT SPENDING IS MONITORED AGAINST BUDGETED AMOUNTS ON AN ONGOING BASIS. SCHEDULE I, PART II, LINE 1(A)(1) PAGE 1, CITYWIDE DEVELOPMENT CORP: MIAMI VALLEY HOSPITAL CONTRIBUTES FUNDS TO SUPPORT REDEVELOPMENT OF THE GOOD SAMARITAN HOSPITAL AREA. SCHEDULE I, PART II, LINE 1(A)(10) PAGE 1, GEM CITY MARKETPLACE: MIAMI VALLEY HOSPITAL CONTRIBUTES FUNDS TO SUPPORT THE OPENING OF THE GEM CITY MARKETPLACE IN DOWNTOWN DAYTON (A FOOD DESERT). SCHEDULE I, PART II, LINE 1(A)(10) PAGE 3, DAYTON FIRST EVENTS INC: MIAMI VALLEY HOSPITAL CONTRIBUTES FUNDS TO SUPPORT THE WRIGHT PATTERSON AIR FORCE BASE APPRECIATION NIGHT AND CONCERT (HOMETOWN HEROES PROGRAM). X X X X true true false false false false false false false MICHAEL J MAIBERGER FORMER OFFICER 0 564689 0 520375 0 1207754 0 1031331 0 30730 0 3354879 0 831140 MARY H BOOSALIS TRUSTEE / PREMIER PRES & CEO 0 1152156 0 616657 0 52172 0 22778 0 20512 0 1864275 0 0 SCOTT A SHELTON FORMER OFFICER 0 505156 0 269139 0 152574 0 13302 0 17824 0 957995 0 0 JENNIFER J HAULER DO COO - MVH 519043 0 372959 0 1783 0 52997 0 2779 0 949561 0 0 0 ELOISE P BRONER SYS VP-CHIEF SUPPORT SERVICES 454049 0 229601 0 194477 0 25936 0 4088 0 908151 0 0 0 MICHAEL R UHL PRESIDENT & CEO 513722 0 176180 0 20844 0 53774 0 29566 0 794086 0 0 0 BARBARA A JOHNSON TRUSTEE&PREMIER COO (FROM AUG) 0 476627 0 149539 0 39802 0 27000 0 11127 0 704095 0 0 GEOFFREY P WALKER SYS VP - CHIEF LEGAL OFFICER 0 411905 0 140011 0 96988 0 23811 0 26531 0 699246 0 0 THOMAS R PARKER FORMER KEY EMPLOYEE 0 399599 0 168998 0 50576 0 66901 0 12860 0 698934 0 0 DIANE L PLEIMAN PRESIDENT & CEO-PHYS COMPANIES 415889 0 178508 0 52684 0 21465 0 7653 0 676199 0 0 0 MARC R BELCASTRO DO VP MED AFFAIRS & PREMIER CMO 462541 0 114180 0 28275 0 34127 0 26573 0 665696 0 8289 0 MARY M CLANCY SYS VP - ONCOLOGY SERVICE LINE 414771 0 132309 0 72084 0 23386 0 12427 0 654977 0 0 0 GARY G GINTER VP &PREMIER CHIEF INFO OFFICER 0 408643 0 140815 0 4063 0 69684 0 28333 0 651538 0 0 MELANIE M GLOVER MD TRUSTEE (FROM MAY) 0 575181 0 8000 0 1989 0 11297 0 30159 0 626626 0 0 CRAIG SELF FORMER KEY EMPLOYEE 0 0 0 148256 0 375613 0 74192 0 20665 0 618726 0 300262 RENEE P GEORGE FORMER KEY EMPLOYEE 0 387083 0 151484 0 1323 0 50260 0 13183 0 603333 0 0 JEFFREY G POULOS MD VP & CHIEF HOSPITAL OFFICER 457091 0 90287 0 2041 0 22805 0 26340 0 598564 0 0 0 MARGARET W MARK VP NURSING SERVICE/PREMIER CNO 0 376334 0 137400 0 13986 0 23441 0 27942 0 579103 0 0 DALE E CREECH JR FORMER KEY EMPLOYEE 0 0 0 82482 0 427995 0 17945 0 11552 0 539974 0 151924 JAMES M PACENTA MD TRUSTEE 0 368825 0 38975 0 84375 0 10267 0 31408 0 533850 0 0 J MICHAEL SIMS SYS VP-TREAS & CORP CONTROLLER 0 303223 0 68302 0 89634 0 24054 0 29351 0 514564 0 0 TERESA W ZRYD MD VP-ACADEMIC AFFAIRS 324797 0 140791 0 19013 0 8964 0 11202 0 504767 0 0 0 THOMAS CURTIN VP REVENUE CYCLE 0 318812 0 80976 0 7671 0 26866 0 33348 0 467673 0 0 JOANNE R RINGER TRUSTEE AND COO MVHS 293847 0 107940 0 15455 0 25075 0 11909 0 454226 0 0 0 MARY E GARMAN COO - MVHN 301660 0 108958 0 2778 0 22565 0 12667 0 448628 0 0 0 MARK W SHAW FORMER KEY EMPLOYEE 0 0 0 30246 0 387960 0 16713 0 5855 0 440774 0 38000 KRISTINA M KEAN BOARD TREASURER / VP FINANCE 253871 0 100096 0 2218 0 23450 0 10477 0 390112 0 0 0 MARK E WILLIAMS MD FORMER OFFICER 0 323251 0 17541 0 1449 0 12108 0 28195 0 382544 0 0 JEFFERY A MORNEAULT HOSP OPS-PERIOP SVCS (TO MAY) 66144 0 67179 0 131576 0 47862 0 28990 0 341751 0 0 0 ROBERT M BOWMAN VP HOSPITAL OPERATIONS 238868 0 75566 0 15399 0 22152 0 27153 0 379138 0 0 0 CARA W POWERS FORMER OFFICER 251193 0 73236 0 845 0 25766 0 27325 0 378365 0 0 0 KIM K STRAHL SYS VP & CPO 0 233940 0 100231 0 3377 0 21635 0 12150 0 371333 0 0 KIMBERLY A HENSLEY VP HOSPITAL OPERATIONS 245543 0 78716 0 2297 0 22768 0 10000 0 359324 0 0 0 CHRISTOPHER J DANIS MD BOARD CHAIR 0 281220 0 10000 0 3841 0 10282 0 31972 0 337315 0 0 BILLIE L LUCENTE-BAKER SYS VP - HR OPS (FROM AUG) 0 215099 0 35605 0 1495 0 20083 0 14063 0 286345 0 0 JENNA M DOWNEY ESQ BOARD SECRETARY 190262 0 32305 0 792 0 8381 0 13557 0 245297 0 0 0 YONATHAN KEBEDE VP HOSP OPS (FROM JUL) 86174 86889 0 30729 364 8272 6318 1484 10618 8489 103474 135863 0 0 ELAINE M DEAN SYSTEM VP-BUSINESS DEVELOPMENT 0 178094 0 0 0 724 0 2692 0 5452 0 186962 0 0 MARK S SHAKER FORMER OFFICER 0 0 0 0 165359 0 20022 0 0 0 185381 0 0 0 ANDRE T HARRIS MD TRUSTEE 0 149245 0 0 0 713 0 0 0 14088 0 164046 0 0 PART I, LINE 4A: THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT: JEFFERY MORNEAULT $130,368 IN 2019 AND WILL RECEIVE $81,480 IN 2020; CRAIG SELF RECEIVED $381,414 IN 2019; MARK SHAKER RECEIVED $11,212 IN 2019. THE FOLLOWING INDIVIDUALS WERE SELECTED TO PARTICIPATE IN A VOLUNTARY RETIREMENT PROGRAM AND RECEIVED THE FOLLOWING PAYMENTS IN 2019: DALE CREECH JR $234,232; MICHAEL MAIBERGER RECEIVED $221,850; MARK SHAW $103,000. 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, MIAMI VALLEY HOSPITAL (MVH) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. MVH 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 2019. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2019: MARC BELCASTRO, D.O. $21,189; ROBERT BOWMAN $12,121; ELOISE BRONER $170,828; MARY CLANCY $67,599; DALE CREECH JR $196,960; BARBARA JOHNSON $25,958; MICHAEL MAIBERGER $18,567; MARGARET MARK $5,206; THOMAS PARKER $22,946; DIANE PLEIMAN $49,329; JOANN RINGER $11,115; MARK SHAKER $157,147; MARK SHAW $286,638; SCOTT SHELTON $144,480; J. MICHAEL SIMS $65,725; GEOFFREY WALKER $90,728. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2019: MICHAEL MAIBERGER $111,125. IN ADDITION, THE FOLLOWING SERP AMOUNTS WERE DEFERRED ON THE PARTICIPANTS' BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNTS ARE VESTED AND PAID TO THE SERP PARTICIPANTS: MARC BELCASTRO, D.O. $24,931; THOMAS CURTIN $7,888; MARY GARMAN $12,718; RENEE GEORGE $38,933; GARY GINTER $47,436; JENNIFER HAULER, M.D. $43,676; KIMBERLY HENSLEY $2,912; BARBARA JOHNSON $11,541; KRISTINA KEAN $3,008; MICHAEL MAIBERGER $83,348; MARGARET MARK $13,181; THOMAS PARKER $43,947; JEFFREY POULOS, M.D. $16,494; CARA POWERS $7,342; CRAIG SELF $65,158; MICHAEL UHL $43,890; MARK WILLIAMS, M.D. $875. 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. ANY PAYMENTS MADE AFTER THE 2-1/2 MONTHS WERE PROPERLY REPORTED ON PRIOR YEARS' FILED IRS FORM 990 RETURNS, DISCLOSING COMPENSATION EARNED BY THESE INDIVIDUALS UNDER THE PLANS FOR EACH SUCH YEAR. A COUNTY OF MONTGOMERY OH 316000172 613520LO6 2019-09-24 314459788 SEE PART VI - NOTE A false false false B COUNTY OF MONTGOMERY OH 316000172 613549JL9 2011-04-12 106431124 SEE PART VI - Note B false false false A 0 0 314459788 3034299 0 0 2774994 0 0 12000000 296650495 0 2019 true false true true B 5135000 0 106431124 0 0 0 1203000 0 0 105228124 0 0 2011 false false true true A false true false false 0 0.00869 0.00869 false false false true B false false false false 0 false false false true A false true false false true true BARCLAYS WFB & PNC 26.5 true false false 0 false true B false false false true false true BarclaysWells Fargo 17. true false false 0 false true A true B true NOTE A, PART 1, LINE A, COLUMN E: ISSUE PRICE IS NOT IDENTICAL TO THE ISSUE PRICE LISTED ON FORM 8038 DUE TO THE SERIES 2019A BONDS' PROCEEDS BEING SPLIT BETWEEN MIAMI VALLEY HOSPITAL, ATRIUM MEDICAL CENTER, AND UPPER VALLEY MEDICAL CENTER. NOTE A, PART I, LINE A, COLUMN F: REFUNDED THE FOLLOWING SERIES BONDS: SERIES 2009B BONDS - ISSUE DATE 02/24/2009 SERIES 2012A BONDS - ISSUE DATE 11/20/2012 SERIES 2016C BONDS - ISSUE DATE 08/31/2016 SERIES 2016D BONDS - ISSUE DATE 08/31/2016 SERIES 2018 BONDS - ISSUE DATE 12/20/2018 SERIES 2016E BONDS - ISSUE DATE 08/31/2016 SERIES 2016F BONDS - ISSUE DATE 08/31/2016 REIMBURSEMENT OF PROJECT COSTS. NOTE B, PART 1, LINE B, COLUMN F: PROVIDE FUNDS TO CONSTRUCT THE SOUTHEAST TOWER ON THE HOSPITAL'S CAMPUS. PART IV, ARBITRAGE, LINE 2C: COMPUTATION DATE WAS APRIL 12, 2016 FOR THE 2011A. MARC R BELCASTRO II CHILD OF OFFICER MARC R. BELCASTRO, D.O 54050 EMPLOYMENT false ANGELA BOWMAN SPOUSE OF KEY EMPLOYEE ROBERT BOWMAN 74940 EMPLOYMENT false JULIA PARKER SPOUSE OF FORMER KEY EMPLOYEE THOMAS PARKER 184114 EMPLOYMENT false ANDRE T HARRIS MD TRUSTEE 158707 HORIZONS WOMEN'S HEALTHCARE false SCHEDULE L - PART IV: MIAMI VALLEY HOSPITAL CONTRACTS WITH HORIZONS WOMEN'S HEALTHCARE FOR OBGYN SERVICES. ANDRE T. HARRIS, M.D. IS A 51% OWNER. IN ADDITION, ANDRE T. HARRIS, M.D. IS A TRUSTEE OF MIAMI VALLEY HOSPITAL. THE AMOUNTS PAID UNDER THIS CONTRACT ARE COMPETITIVE AND THE TRANSACTION IS AT ARMS-LENGTH. THE TOTAL AMOUNT PAID IN 2019 WAS $158,707. FORM 990, PART VI, SECTION A, LINE 3: PREMIER HEALTH (PREMIER), AS THE OPERATOR OF MIAMI VALLEY HOSPITAL (MVH) DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR MVH, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. MVH SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. MVH SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. MVH SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF MVH WITH ALL THIRD-PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. MVH MUST HAVE APPROVAL FROM PREMIER TO BORROW IN ANY FISCAL YEAR, GUARANTEE IN ANY YEAR, OR INCUR ANY LIEN OR OTHER ENCUMBRANCE ON ANY PROPERTY IN AN AMOUNT EQUAL TO OR GREATER THAN $1,000,000. MVH MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN MVH'S ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 6: MIAMI VALLEY HOSPITAL HAS ONE CORPORATE MEMBER: PREMIER HEALTH, AN OHIO NON-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINES 7A & 7B: PREMIER HEALTH (PREMIER) HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR MIAMI VALLEY HOSPITAL (MVH). PREMIER HAS THE AUTHORITY TO REMOVE SUCH TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. 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 HEALTH (PREMIER), OF WHICH MIAMI VALLEY HOSPITAL IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE TAX 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 GROUPS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER AND THE CHIEF FINANCIAL OFFICER OF THIS ENTITY. 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 HEALTH (PREMIER), WITH WHICH MIAMI VALLEY HOSPITAL IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, MEDICAL DIRECTORS, SUPPLY CHAIN DIVISION MEMBERS, AUTHORIZED SIGNERS, DIRECTORS, EXECUTIVES, MEDICAL EXECUTIVE COMMITTEE MEMBERS, MEDICAL DEPARTMENT AND SECTION CHAIRS, PHYSICIAN PARTNERSHIP COMMITTEE MEMBERS, PHYSICIAN GUIDANCE GROUP MEMBERS, AND ALL EMPLOYED PHYSICIANS TO ANNUALLY REVIEW THE PREMIER COMPREHENSIVE CONFLICT OF INTEREST STATEMENT, AN EXPLANATORY MEMORANDUM, THE ANTITRUST COMPLIANCE POLICY, AND COMPLETE AN INDIVIDUAL QUESTIONNAIRE DISCLOSING ANY POTENTIAL CONFLICTS AS DEFINED IN THE CONFLICT OF INTEREST POLICY. THIS IS ACCOMPLISHED EITHER BY WAY OF AN ELECTRONIC COMMUNICATION SENT OUT DIRECTLY BY THE CORPORATE COMPLIANCE DEPARTMENT OR BY WAY OF A MEMO SENT OUT FROM THE CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER OF PREMIER. IT ALSO INCLUDES AN EXPLANATORY MEMORANDUM OF SPECIFIC ACTIVITIES THAT MIGHT GIVE CAUSE TO A CONFLICT AND AN INDIVIDUAL QUESTIONNAIRE TO DISCLOSE ALL SUCH ACTIVITIES. THIS QUESTIONNAIRE MUST BE COMPLETED AND SIGNED BY THE INDIVIDUAL. THIS CORRESPONDENCE INCLUDES A COPY OF THE ANTITRUST COMPLIANCE POLICY THAT MUST BE SIGNED BY THE INDIVIDUAL. ALL OF THESE DOCUMENTS ARE SENT TO THE CORPORATE COMPLIANCE DEPARTMENT. THE CORPORATE COMPLIANCE DEPARTMENT ENSURES ALL FORMS ARE RETURNED AND RETAINS THE DOCUMENTS FOR FIVE YEARS. IN ADDITION, AT EACH MEETING OF THE BOARD OR ANY BOARD COMMITTEE, FOLLOWING APPROVAL OF THE PREVIOUS MEETING'S MINUTES, THE BOARD OR COMMITTEE CHAIR SHALL REQUEST ANY BOARD MEMBER WHO PERCEIVES A POTENTIAL CONFLICT OF INTEREST ON ANY OF THE MEETING'S AGENDA ITEMS TO DISCLOSE THE POTENTIAL CONFLICT. ADDITIONALLY, AT ANY BOARD OR BOARD COMMITTEE MEETING WHERE THE SUBJECT OF CONFLICT OF INTEREST IS DISCUSSED, THE MINUTES SHALL CONTAIN THE NAME OF THE PARTY DISCUSSING A POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE POTENTIAL CONFLICT OF INTEREST AND WHETHER A CONFLICT OF INTEREST WAS FOUND TO EXIST. IF A CONFLICT OF INTEREST IS DETERMINED BY THE BOARD TO EXIST, THE MEMBER WILL BE EXCUSED FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON THE PARTICULAR AGENDA ITEM. THE CHIEF COMPLIANCE AND ENTERPRISE RISK OFFICER REPORTS THE RESULTS OF THE PREMIER CONFLICT OF INTEREST QUESTIONNAIRES NO LESS THAN ANNUALLY TO THE BOARD OF TRUSTEES BY WAY OF THE COMPLIANCE AND AUDIT COMMITTEE. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE MEETING. PERIODICALLY, THE INTERNAL AUDIT DEPARTMENT WILL REVIEW A SAMPLE OF COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND REPORT THE RESULTS TO THE COMPLIANCE AND AUDIT COMMITTEE. THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE INDIVIDUALLY SUMMARIZED IN A DOCUMENT AND SENT ELECTRONICALLY TO THE FINANCE DEPARTMENT FOR ANY NECESSARY DISCLOSURES REQUIRED ON THE 990 FILING. FORM 990, PART VI, SECTION B, LINES 15A AND 15B: COMPENSATION FOR MIAMI VALLEY HOSPITAL'S (MVH) CEO IS REVIEWED AND APPROVED BY PREMIER HEALTH (PREMIER), WITH WHICH MVH IS AN AFFILIATE, ON AN ANNUAL BASIS. THE 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 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 IS COMPRISED OF 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 XI, LINE 9: EQUITY TRANSFER (298,729,418) PENSION FASB 158 ADJUSTMENT (10,612,117) FOUNDATION ADJUSTMENT (620,174) SWAP AMORTIZATION (138,920) CAPTIVE INSURANCE ADJUSTMENT 1,346,836 TRANSFERS FROM AFFILIATES 1,841,335 TOTAL (306,912,458) DIALYSIS CENTERS OF DAYTON LLC 110 N MAIN ST 500 DAYTON OH 45402 311607686 DIALYSIS OH 0 0 MVH PREMIER HEALTH PARTNERS (PREMIER) 110 N MAIN ST 500 DAYTON OH 45402 311446699 PARENT OH 501(C)(3) 12B NA false MEDAMERICA HEALTH SYSTEMS CORP (MAHS) 110 N MAIN ST 500 DAYTON OH 45402 311040228 SUPPORT ORG OH 501(C)(3) 12B NA false MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311040231 Foundation OH 501(C)(3) 7 PREMIER false PREMIER COMMUNITY HEALTH 110 N MAIN ST 500 DAYTON OH 45402 311122883 Health Educat OH 501(C)(3) 10 FHC false FIDELITY HEALTH CARE (FHC) 110 N MAIN ST 500 DAYTON OH 45402 311075381 HOME HEALTH OH 501(C)(3) 10 PREMIER false SAMARITAN HEALTH PARTNERS (SHP) 110 N MAIN ST 500 DAYTON OH 45402 311107411 SUPPORT ORG OH 501(C)(3) 12B PREMIER false GOOD SAMARITAN FOUNDATION - DAYTON 110 N MAIN ST 500 DAYTON OH 45402 237296923 FOUNDATION OH 501(C)(3) 7 PREMIER false HEART INSTITUTE OF DAYTON 110 N MAIN ST 500 DAYTON OH 45402 300502367 EDUCATION OH 501(C)(3) 10 PREMIER false SAMARITAN BEHAVIORAL HEALTH INC 110 N MAIN ST 500 DAYTON OH 45402 020633634 BEHAVIORAL HE OH 501(C)(3) 7 PREMIER false ATRIUM HEALTH SYSTEM (AHS) 110 N MAIN ST 500 DAYTON OH 45402 310537492 SUPPORT ORG OH 501(C)(3) 12B NA false ATRIUM MEDICAL CENTER 110 N MAIN ST 500 DAYTON OH 45402 311079309 HOSPITAL OH 501(C)(3) 3 PREMIER false UVMC 110 N MAIN ST 500 DAYTON OH 45402 341850683 SUPPORT ORG OH 501(C)(3) 12B NA false UPPER VALLEY MEDICAL CENTER 110 N MAIN ST 500 DAYTON OH 45402 310537095 HOSPITAL OH 501(C)(3) 3 PREMIER false UPPER VALLEY PROFESSIONAL CORP (UVPC) 110 N MAIN ST 500 DAYTON OH 45402 311400963 HEALTH CARE OH 501(C)(3) 10 PREMIER false UVPC SPECIALISTS INC 110 N MAIN ST 500 DAYTON OH 45402 203687536 HEALTH CARE OH 501(C)(3) 10 UVPC false UVMC NURSING CARE INC 110 N MAIN ST 500 DAYTON OH 45402 311224064 NURSING HOME OH 501(C)(3) 10 PREMIER false Premier Plaza LLC 110 N MAIN ST 500 Dayton OH 45402 800708185 HOLDING COMPANY OH MAHS EXCLUDED 61780 0 false 0 false 0.01000 COMPUNET CLINICAL LABORATORIES LLC 2308 SANDRIDGE DR MORAINE OH 45439 321258010 MEDICAL LABS OH MVHE INC RELATED 0 0 false 0 false 0.00000 SWEITZER STREET LLC 110 N MAIN ST 500 DAYTON OH 45402 454700417 REAL ESTATE OH MVHE INC EXCLUDED 0 0 false 0 false 0.00000 SWEITZER MOB LLC 110 N MAIN ST 500 DAYTON OH 45402 474554657 REAL ESTATE OH MVHE INC EXCLUDED 0 0 false 0 false 0.00000 MVHE INC 110 N MAIN ST 400 DAYTON OH 45402 311185270 PHYSICIAN SVC OH PREMIER HOLDING C CORP 0 0 0.00000 false PREMIER HEALTH SPECIALISTS 110 N MAIN ST 400 DAYTON OH 45402 061744704 PHYSICIAN SVC OH PREMIER HOLDING C CORP 0 0 0.00000 false SAMARITAN FAMILY CARE 110 N MAIN ST 400 DAYTON OH 45402 311299450 PHYSICIAN SVC OH PREMIER HOLDING C CORP 0 0 0.00000 false AFTER HOURS FAMILY CARE 110 N MAIN ST 500 DAYTON OH 45402 311269483 HEALTH CARE OH UVPC C CORP 0 0 0.00000 false UVMC MANAGEMENT CORP 110 N MAIN ST 500 DAYTON OH 45402 311360489 MANAGEMENT CO OH PREMIER C CORP 0 0 0.00000 false PREMIER HEALTH URGENT CARE INC 110 N MAIN ST 900 DAYTON OH 45402 822079409 URGENT CARE OH PREMIER HOLDING C CORP 0 0 0.00000 false PREMIER HEALTH PLAN INC 110 N MAIN ST 500 DAYTON OH 45402 463024049 HEALTH INSURANCE OH PHIC C CORP 0 0 0.00000 false PREMIER HEALTH ACO OF OHIO 110 N MAIN ST 500 DAYTON OH 45402 474049773 MEDICARE ACO OH PREMIER C CORP 0 0 0.00000 false PREMIER HEALTH HOLDING CO 110 N MAIN ST 400 DAYTON OH 45402 812419110 HOLDING COMPANY OH PREMIER C CORP 0 0 0.00000 false PREMIER HEALTH INSURING CO (PHIC) 110 N MAIN ST 500 DAYTON OH 45402 464766841 HEALTH INSURANCE OH PREMIER C CORP 0 0 0.00000 false GOOD SAMARITAN HOSPITAL 110 N MAIN ST 500 DAYTON OH 45402 310536981 HOSPITAL OH PREMIER C CORP 0 0 0.00000 false false true true false false false false false true true true true true true true true true true true