FIDELITY HEALTH CARE INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- FIDELITY HEALTH CARE INC (EIN 31-1075381)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-16
- IRS object ID
- 202023219349313037
- Schema version
- 2019v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-16T14:12:09-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311075381 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIDELITY HEALTH CARE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FIDE | 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 | RENEE MOCK | PersonNm |
| Person Title | VP & CFO | PersonTitleTxt |
| Phone | 9374999942 | PhoneNum |
| Signature | 2020-11-16 | SignatureDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 184.57.171.100 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-11-16 | IPDt |
| IP Tm | 14:12:04 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 986CFAB4546D7DBDFBAA527D8BCEED6C2968A6DF | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PAULA J THOMPSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3170 KETTERING BLVD | AddressLine1Txt |
| City | MORAINE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45439 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $57,557,624 | 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 | 1983 | 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 | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 793 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $272,115 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$29,820 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $235 | PYContributionsGrantsAmt |
| CY Contributions Grants | $114 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $58,052,224 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $56,992,956 | CYProgramServiceRevenueAmt |
| PY Investment Income | $465 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,451 | CYInvestmentIncomeAmt |
| PY Other Revenue | $339,840 | PYOtherRevenueAmt |
| CY Other Revenue | $393,073 | CYOtherRevenueAmt |
| PY Total Revenue | $58,392,764 | PYTotalRevenueAmt |
| CY Total Revenue | $57,387,594 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $7,750 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $7,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $35,140,078 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $34,843,431 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $23,178,513 | PYOtherExpensesAmt |
| CY Other Expenses | $21,911,894 | CYOtherExpensesAmt |
| PY Total Expenses | $58,326,341 | PYTotalExpensesAmt |
| CY Total Expenses | $56,762,325 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $66,423 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $625,269 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,757,216 | TotalAssetsBOYAmt |
| Total Assets EOY | $24,112,804 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,676,499 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,406,818 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,080,717 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,705,986 | NetAssetsOrFundBalancesEOYAmt |
| 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 | $36,408,567 | ExpenseAmt |
| Grant | $7,000 | GrantAmt |
| Revenue | $44,732,033 | RevenueAmt |
| Desc | FIDELITY HEALTH CARE PERFORMED 252,142 VISITS AND 46,547 HOURS OFSERVICE. FIDELITY HEALTH CARE SERVED 875 INFUSION PATIENTS AND PROVIDED $170,348 IN CHARITY CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $12,164,850 | ExpenseAmt |
| Revenue | $11,992,240 | RevenueAmt |
| Desc | FIDELITY HEALTH CARE OPERATED A RETAIL PHARMACY IN FIVE LOCATIONSWITHIN PREMIER HEALTH AFFILIATED HOSPITALS AND HEALTH CENTERS. THEPHARMACIES PRIMARILY SERVE PATIENTS RECEIVING HEALTH CARE SERVICESAT THESE LOCATIONS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $250,863 | ExpenseAmt |
| Revenue | $140,042 | RevenueAmt |
| Desc | EXPRESSIONS OF HOPE (EOH) IS A SERVICE FOR WOMEN OFFERED BYFIDELITY HEALTH CARE. EOH BOUTIQUE SERVICES ARE DESIGNED TO OFFERWOMEN A WIDE RANGE OF POST MASTECTOMY AND LUMPECTOMY PRODUCTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $48,824,280 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | 0 | 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 | 0 | 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 | 0 | 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 |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 793 | 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 | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | 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 | RENEE MOCK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9375453516 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3170 KETTERING BLVD | AddressLine1Txt |
| City | MORAINE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45439 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JENNIFER J HAULER DO | ||||||||
| TRUSTEE | 0.50 | 39.50 | Yes (X) | $0 | $893,785 | $55,776 | ||
| MICHAEL R UHL | ||||||||
| TRUSTEE | 0.50 | 39.50 | Yes (X) | $0 | $710,746 | $83,340 | ||
| THOMAS R CURTIN | ||||||||
| TRUSTEE | 0.50 | 39.50 | Yes (X) | $0 | $407,459 | $60,214 | ||
| PAULA J THOMPSON | ||||||||
| PRESIDENT & CEO | 32.00 | 8.00 | Yes (X) | $355,833 | $0 | $63,970 | Yes (X) | |
| MARK E WILLIAMS MD | ||||||||
| TRUSTEE | 0.50 | 39.50 | Yes (X) | $0 | $342,241 | $40,303 | ||
| RENEE L MOCK | ||||||||
| BOARD TREASURER & CFO | 36.00 | 4.00 | $207,801 | $0 | $21,641 | Yes (X) | ||
| ERIC D NAPIER | ||||||||
| DIRECTOR RETAIL PHARMACY | 40.00 | $187,460 | $0 | $28,521 | Yes (X) | |||
| MARY K WALTERS | ||||||||
| VP CHIEF NURSING OFFICER | 40.00 | $196,316 | $0 | $16,307 | Yes (X) | |||
| SHELIA M GRUBB | ||||||||
| MANAGER, CLINICAL OPERATIONS | 40.00 | $148,583 | $0 | $41,427 | Yes (X) | |||
| BENJAMIN A WATSON | ||||||||
| BOARD SECRETARY | 0.50 | 39.50 | $0 | $166,716 | $16,245 | Yes (X) | ||
| SARA L ROBBINS | ||||||||
| PEFUSIONSIST/RN | 40.00 | $133,061 | $0 | $37,383 | Yes (X) | |||
| SANDY M NICKLEY | ||||||||
| COORD-HLTHCARE & CONSUMER PRGM | 40.00 | $101,368 | $0 | $15,769 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,330,422 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,520,947 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $480,896 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 46 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| PREMIER HEALTH CARE SERVICES | |||||
| 811 TIMBERLODGE TRAIL C | DAYTON | OH | 45458 | MEDICAL SERVICES | $1,230,932 |
| NETSMART TECHNOLOGIES INC | |||||
| 11100 NALL AVE | OVERLAND PARK | KS | 66211 | SOFTWARE MAINTENANCE | $799,486 |
| BRIGHTREE LLC | |||||
| 1735 N BROWN RD NW 500 | LAWRENCEVILLE | GA | 30043 | CONSULTING | $149,221 |
| ESCREEN INC | |||||
| 8140 WARD PKWY STE 300 | KANSAS CITY | MO | 64114 | MEDICAL SERVICES | $125,675 |
| PHARMACEUTICAL STRATEGIES | |||||
| 477 MAIN ST | STONEHAM | MA | 02180 | PHARMACY 340B | $119,227 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $114 | RelatedOrganizationsAmt |
| Total Contributions | $114 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT REVENUE | 900099 | $44,860,674 | $44,588,559 | $272,115 |
| PHARMACY | 900099 | $11,992,240 | $11,992,240 | |
| EXPRESSIONS OF HOPE | 900099 | $140,042 | $140,042 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $56,992,956 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,451 | TotalRevenueColumnAmt |
| Exclusion | $1,451 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $419,629 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $170,030 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $249,599 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $249,599 | TotalRevenueColumnAmt |
| Exclusion | $249,599 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICAL ANSWERING SERVICE | 900099 | $118,605 | $118,605 |
| PURCHASE DISCOUNTS | 900099 | $15,592 | $15,592 |
| MEDICAL RECORDS | 900099 | $6,434 | $6,434 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,843 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,843 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $143,474 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $57,387,594 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $56,864,315 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $272,115 | UnrelatedBusinessRevenueAmt |
| Exclusion | $251,050 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,000 | TotalAmt |
| Program Services | $7,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $649,245 | TotalAmt |
| Program Services | $378,117 | ProgramServicesAmt |
| Management And General | $271,128 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,013,852 | TotalAmt |
| Program Services | $22,886,386 | ProgramServicesAmt |
| Management And General | $5,127,466 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $329,680 | TotalAmt |
| Program Services | $329,680 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,378,662 | TotalAmt |
| Program Services | $2,580,691 | ProgramServicesAmt |
| Management And General | $797,971 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,471,992 | TotalAmt |
| Program Services | $2,012,103 | ProgramServicesAmt |
| Management And General | $459,889 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,230 | TotalAmt |
| Program Services | $3,230 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,812 | TotalAmt |
| Management And General | $9,812 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $385,891 | TotalAmt |
| Program Services | $108,587 | ProgramServicesAmt |
| Management And General | $277,304 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,703 | TotalAmt |
| Program Services | $109,703 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $819,993 | TotalAmt |
| Program Services | $683,177 | ProgramServicesAmt |
| Management And General | $136,816 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $847,329 | TotalAmt |
| Program Services | $847,329 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $362,103 | TotalAmt |
| Program Services | $293,027 | ProgramServicesAmt |
| Management And General | $69,076 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,106,738 | TotalAmt |
| Program Services | $1,090,691 | ProgramServicesAmt |
| Management And General | $16,047 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,400 | TotalAmt |
| Program Services | $4,400 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $695,634 | TotalAmt |
| Program Services | $695,634 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,605 | TotalAmt |
| Management And General | $161,605 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| OPERATING SUPPLIES | $16,119,038 | $16,119,038 | |
| PURCHASED SERVICES | $565,312 | $130,607 | $434,705 |
| ASSET IMPAIRMENT | $236,606 | $236,606 | |
| REPAIRS AND MAINTENANCE | $132,928 | $44,783 | $88,145 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $351,572 | TotalAmt |
| Program Services | $263,491 | ProgramServicesAmt |
| Management And General | $88,081 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,762,325 | TotalAmt |
| Program Services | $48,824,280 | ProgramServicesAmt |
| Management And General | $7,938,045 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,949 | BOYAmt |
| EOY | $2,171 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,958,828 | BOYAmt |
| EOY | $9,139,295 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,012,835 | BOYAmt |
| EOY | $7,411,485 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,375,826 | BOYAmt |
| EOY | $1,335,401 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $190,501 | BOYAmt |
| EOY | $389,611 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,634,259 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,816,126 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,580,930 | BOYAmt |
| EOY | $3,818,133 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $208,000 | BOYAmt |
| EOY | $103,999 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,427,347 | BOYAmt |
| EOY | $1,912,709 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,757,216 | BOYAmt |
| EOY | $24,112,804 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,611,693 | BOYAmt |
| EOY | $3,342,343 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,055 | BOYAmt |
| EOY | $64,475 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,751 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,676,499 | BOYAmt |
| EOY | $3,406,818 | 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 | $20,080,717 | BOYAmt |
| EOY | $20,705,986 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,080,717 | BOYAmt |
| EOY | $20,705,986 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,757,216 | BOYAmt |
| EOY | $24,112,804 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $625,269 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $75,439 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $526,957 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $177,065 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $235 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $114 | CurrentTaxYearAmt |
| Total | $779,810 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $45,187,326 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $61,884,232 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $60,698,839 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $58,070,457 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $57,136,430 | CurrentTaxYearAmt |
| Total | $282,977,284 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $66 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus2 Years | $335,126 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $413,428 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $419,629 | CurrentTaxYearAmt |
| Total | $1,168,249 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $45,262,831 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $62,411,189 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $61,211,030 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $58,484,120 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $57,556,173 | CurrentTaxYearAmt |
| Total | $284,925,343 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $284,925,343 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $342 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $430 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $575 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $465 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,451 | CurrentTaxYearAmt |
| Total | $3,263 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $342 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $430 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $575 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $465 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,451 | CurrentTaxYearAmt |
| Total | $3,263 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,876 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,465 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $11,341 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $45,267,049 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $62,419,084 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $61,211,605 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $58,484,585 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $57,557,624 | CurrentTaxYearAmt |
| Total | $284,939,947 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99990 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99990 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00010 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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 | $3,230 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $3,230 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | PAYMENTS FOR LOBBYING ACTIVITIES INCLUDE A PORTION OF DUES PAID TO NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE AND THE OHIO COUNCIL FOR HOME CARE & HOSPICE. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $215,926 | OtherCostOrOtherBasisAmt |
| Book Value | $215,926 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,855,768 | OtherCostOrOtherBasisAmt |
| Depreciation | $536,572 | DepreciationAmt |
| Book Value | $2,319,196 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,104 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,164 | DepreciationAmt |
| Book Value | $6,940 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,115,348 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,268,390 | DepreciationAmt |
| Book Value | $846,958 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $429,113 | OtherCostOrOtherBasisAmt |
| Book Value | $429,113 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,818,133 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | AFFILIATES RECEIVABLE | Desc |
| Book Value | $1,912,709 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,912,709 | TotalBookValueOtherAssetsAmt |
| 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 FROM THE 2019 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF FIDELITY HEALTH CARE, INC. PHP HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE A TAX-EXEMPT NONPROFIT 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. | ExplanationTxt |
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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JENNIFER J HAULER DO | ||||||||||||||
| TRUSTEE | $0 | $519,043 | $0 | $372,959 | $0 | $1,783 | $0 | $52,997 | $0 | $2,779 | $0 | $949,561 | $0 | $0 |
| MICHAEL R UHL | ||||||||||||||
| TRUSTEE | $0 | $513,722 | $0 | $176,180 | $0 | $20,844 | $0 | $53,774 | $0 | $29,566 | $0 | $794,086 | $0 | $0 |
| THOMAS R CURTIN | ||||||||||||||
| TRUSTEE | $0 | $318,812 | $0 | $80,976 | $0 | $7,671 | $0 | $26,866 | $0 | $33,348 | $0 | $467,673 | $0 | $0 |
| PAULA J THOMPSON | ||||||||||||||
| PRESIDENT & CEO | $266,860 | $0 | $82,621 | $0 | $6,352 | $0 | $30,620 | $0 | $33,350 | $0 | $419,803 | $0 | $0 | $0 |
| MARK E WILLIAMS MD | ||||||||||||||
| TRUSTEE | $0 | $323,251 | $0 | $17,541 | $0 | $1,449 | $0 | $12,108 | $0 | $28,195 | $0 | $382,544 | $0 | $0 |
| RENEE L MOCK | ||||||||||||||
| BOARD TREASURER & CFO | $170,105 | $0 | $36,177 | $0 | $1,519 | $0 | $10,356 | $0 | $11,285 | $0 | $229,442 | $0 | $0 | $0 |
| ERIC D NAPIER | ||||||||||||||
| DIRECTOR RETAIL PHARMACY | $159,102 | $0 | $27,832 | $0 | $526 | $0 | $6,903 | $0 | $21,618 | $0 | $215,981 | $0 | $0 | $0 |
| MARY K WALTERS | ||||||||||||||
| VP CHIEF NURSING OFFICER | $163,280 | $0 | $32,457 | $0 | $579 | $0 | $6,478 | $0 | $9,829 | $0 | $212,623 | $0 | $0 | $0 |
| SHELIA M GRUBB | ||||||||||||||
| MANAGER, CLINICAL OPERATIONS | $144,789 | $0 | $2,325 | $0 | $1,469 | $0 | $8,493 | $0 | $32,934 | $0 | $190,010 | $0 | $0 | $0 |
| BENJAMIN A WATSON | ||||||||||||||
| BOARD SECRETARY | $0 | $144,706 | $0 | $21,428 | $0 | $582 | $0 | $6,180 | $0 | $10,065 | $0 | $182,961 | $0 | $0 |
| SARA L ROBBINS | ||||||||||||||
| PEFUSIONSIST/RN | $119,026 | $0 | $14,035 | $0 | $0 | $0 | $5,237 | $0 | $32,146 | $0 | $170,444 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINES 4A-B | FormAndLineReferenceDesc |
| Explanation | 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, FIDELITY HEALTH CARE (FHC) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. FHC 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 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: THOMAS CURTIN $7,888; JENNIFER HAULER $43,676; PAULA THOMPSON $6,216; MICHAEL UHL $43,890; MARK WILLIAMS $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. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | PREMIER HEALTH (PREMIER) AS THE OPERATOR OF FIDELITY HEALTH CARE (FHC) DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR FHC, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. FHC SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. FHC SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. FHC SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF FHC WITH ALL THIRD-PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. FHC 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. FHC MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN FHC'S ACTIVITIES. |
| FORM 990, PART VI, SECTION A, LINE 6 | FHC HAS ONE CORPORATE MEMBER; PREMIER, AN OHIO NON-PROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | PREMIER HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR FHC. PREMIER HAS THE AUTHORITY TO REMOVE SUCH TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE EXPLANATION FOR FORM 990, 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, OF WHICH FHC IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE TAX MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. 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 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, WITH WHICH FHC 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, LINE 15 | COMPENSATION FOR FHC'S CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH FHC 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. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIDELITY NURSING SYSTEMS LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3832 KETTERING BLVD | AddressLine1Txt |
| City | MORAINE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45439 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311075381 | EIN |
| Primary Activities | PRIVATE PAY | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Total Income | $1,128,498 | TotalIncomeAmt |
| End Of Year Assets | $99,361 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FHC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PREMIER HEALTH PARTNERS (PREMIER) | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311446699 | PARENT | OH | 501 (C) (3) | 12B | N/A | 0 | |
| MEDAMERICA HEALTH SYSTEMS CO (MAHS) | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311040228 | SUPPORT ORG | OH | 501 (C) (3) | 12B | N/A | 0 | |
| MIAMI VALLEY HOSPITAL (MVH) | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 310537504 | HOSPITAL | OH | 501 (C) (3) | 3 | 0 | PREMIER | |
| MIAMI VALLEY HOSPITAL FOUNDATION | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311040231 | FOUNDATION | OH | 501 (C) (3) | 7 | 0 | PREMIER | |
| PREMIER COMMUNITY HEALTH | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311122883 | HEALTH EDU | OH | 501 (C) (3) | 10 | Yes (1) | FIDELITY HEALTH CARE | |
| SAMARITAN HEALTH PARTNERS | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311107411 | SUPPORT ORG | OH | 501 (C) (3) | 12B | 0 | PREMIER | |
| GOOD SAMARTIAN FOUNDATION - DAYTON | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 237296923 | FOUNDATION | OH | 501 (C) (3) | 7 | 0 | PREMIER | |
| HEART INSTITUTE OF DAYTON | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 300502367 | HEALTH EDU | OH | 501 (C) (3) | 10 | 0 | PREMIER | |
| SAMARITAN BEHAVIORAL HEALTH INC | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 020633634 | BEHAVIOR HLTH | OH | 501 (C) (3) | 7 | 0 | PREMIER | |
| ATRIUM HEALTH SYSTEM | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 310537492 | SUPPORT ORG | OH | 501 (C) (3) | 12B | N/A | 0 | |
| ATRIUM MEDICAL CENTER | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311079309 | HOSPITAL | OH | 501 (C) (3) | 3 | 0 | PREMIER | |
| UVMC | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 341850683 | SUPPORT ORG | OH | 501 (C) (3) | 12B | N/A | 0 | |
| UPPER VALLEY MEDICAL CENTER | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 310537095 | HOSPITAL | OH | 501 (C) (3) | 3 | 0 | PREMIER | |
| UVPC SPECIALISTS | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 203687536 | HEALTH CARE | OH | 501 (C) (3) | 10 | 0 | UPPER VALLEY PROFESSIONAL CORP | |
| UVMC NURSING CARE INC | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311224064 | NURSING HOME | OH | 501 (C) (3) | 10 | 0 | PREMIER | |
| UPPER VALLEY PROFESSIONAL CORP (UVPC) | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311400963 | HEALTH CARE | OH | 501 (C) (3) | 10 | 0 | PREMIER | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| PREMIER PLAZA LLC | ||||||||||
| 110 N MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 800708185 | HOLDING COMPANY | OH | MAHS | EXCLUDED | 0 | 0 |
| COMPUNENT CLINICAL LABORATORIES | ||||||||||
| 2308 SANDRIDGE DRIVE | MORAINE | OH | 45439 | 311258010 | MEDICAL LABS | OH | MVHE INC | RELATED | 0 | 0 |
| SWEITZER STREET LLC | ||||||||||
| 110 N MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 454700417 | REAL ESTATE | OH | MVHE INC | EXCLUDED | 0 | 0 |
| SWEITZER MOB LLC | ||||||||||
| 110 N MAIN STREET SUITE 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 |
|---|---|---|---|---|---|---|---|---|---|
| MVHE INC | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311185270 | PHYSICIAN SVCS | OH | PREMIER HOLDING | C | 0 |
| PREMIER HEALTH SPECIALISTS | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 061744704 | PHYSICIAN SVCS | OH | PREMIER HOLDING | C | 0 |
| SAMARITAN FAMILY CARE | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311299450 | PHYSICIAN SVCS | OH | PREMIER HOLDING | C | 0 |
| AFTER HOURS FAMILY CARE | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311269483 | HEALTH CARE | OH | UVPC | C | 0 |
| UVMC MANAGEMENT CORP | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311360489 | MANAGEMENT COMPANY | OH | PREMIER | C | 0 |
| PREMIER HEALTH URGENT CARE INC | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 822079409 | URGENT CARE | OH | PREMIER HOLDING | C | 0 |
| PREMIER HEALTH PLAN INC | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 463024049 | HEALTH INSURANCE | OH | PHIC | C | 0 |
| GOOD SAMARITAN HOSPITAL | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 310536981 | HOSPITAL | OH | PREMIER | C | 0 |
| PREMIER HEALTH ACO OF OHIO | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 474049773 | MEDICARE ACO | OH | PREMIER | C | 0 |
| PREMIER HEALTH HOLDING (PREMIER HOLDING) | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 812419110 | HOLDING CO | OH | PREMIER | C | 0 |
| PREMIER HEALTH INSURING CO (PHIC) | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 464766841 | HEALTH INSURANCE | OH | PREMIER | C | 0 |
| 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 | 0 | 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 | Yes (1) | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| PREMIER COMMUNITY HEALTH | ||
| M | $75,770 | FMV |
| PREMIER COMMUNITY HEALTH | ||
| O | $3,074,224 | FMV |
| PREMIER COMMUNITY HEALTH | ||
| P | $136,150 | FMV |
| PREMIER COMMUNITY HEALTH | ||
| Q | $2,005,748 | FMV |
| PREMIER COMMUNITY HEALTH | ||
| R | $4,265,766 | FMV |