2020-05-15T07:58:18-05:00 2019-06-30 861065772 DELOITTE TAX LLP 250 EAST FIFTH STREET SUITE 1900 CINCINNATI OH 45202 990 2018-07-01 311438846 TRIHEALTH INC TRIH 5135696575 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 MICHAEL CROFTON VP FINANCE 5135696577 2020-05-15 1 ALICIA JANISCH P00741382 5137847100 216.68.236.9 2020-05-15 07:26:26 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7C4C65F4048F11F90FA55EE4E3CFA51667930AD2 2018 2021-01-29 14:40:06Z MARK CLEMENT 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 273325017 0 X WWW.TRIHEALTH.COM X 1994 OH TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. 13 8 1460 8 477922 0 13588686 1968366 259169076 232049087 3467353 4128971 5380649 9924379 281605764 248070803 1662059 634442 0 0 144460381 138282040 0 0 0 136306875 125478295 282429315 264394777 -823551 -16323974 952867802 1150513364 153360878 157865104 799506924 992648260 X SEE SCHEDULE O 0 0 264394777 634442 235904111 SEE SCHEDULE O 264394777 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 1 296 0 1 1460 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 13 8 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL CROFTON - VP FINANCE 5135696577 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 X SR SALLY DUFFY SECRETARY 1.00 3.00 X X 0 0 0 CRAIG EISENTROUT MD TRUSTEE 1.00 60.00 X 0 570038 48305 WAYNE SHIRCLIFF CHAIRPERSON (END 6/19) 1.00 3.00 X X 0 0 0 RALPH MICHAEL VICE CHAIR/TREASURER 1.00 3.00 X X 0 0 0 MARK CLEMENT PRESIDENT/CEO 25.00 35.00 X X 1463838 0 316037 PHILLIP CASTELLINI TRUSTEE 1.00 3.00 X 0 0 0 LISA KNUTSON TRUSTEE (END 6/19) 1.00 3.00 X 0 0 0 THEODORE TORBECK TRUSTEE 1.00 3.00 X 0 0 0 BOB COLLINS MD TRUSTEE (START 7/18) 1.00 3.00 X 202461 0 27381 PHILIP FOSTER TRUSTEE 1.00 3.00 X 0 0 0 SCOTT FRIEDSTROM MD MED STAFF PRES-GOOD SAM 1.00 60.00 X 0 542743 84672 PHILLIP OBLINGER MD MED STAFF PRES-BETHESDA 1.00 60.00 X 84851 45000 0 QUINT STUDER TRUSTEE (START 7/18) 1.00 3.00 X 0 0 0 ANDREW DEVOE ASST TREASURER/CFO 25.00 35.00 X 772272 0 170726 STEVE GRACEY ASST SECRETARY/SVP LEGAL 25.00 35.00 X 450171 0 125258 MARY IRVIN CHIEF NURSING EXEC. (END 10/18) 60.00 0.00 X 398718 0 130448 JENNIFER SKINNER CHIEF NURSING EXEC. (START 11/18) 60.00 0.00 X 303281 0 62227 GAIL DONOVAN EXEC VP & COO (END 6/19) 55.00 5.00 X 928244 0 200684 DAVID COOK CHIEF HR OFFICER 55.00 5.00 X 460282 0 122582 JOHN WARD CHIEF INFORMATION OFFICER 55.00 5.00 X 497791 0 138545 STEVE MOMBACH SVP-AMBULATORY SERVICES 5.00 10.00 X 525322 0 144871 KEVIN JOSEPH MD CHIEF MEDICAL OFFICER 25.00 35.00 X 643316 0 145667 ROB CERCEK EVP POP HEALTH & PHYSICIAN PRACS 60.00 0.00 X 624765 0 152151 WILLIAM GRONEMAN SENIOR EXEC ADVISOR TO THE CEO 60.00 0.00 X 462416 0 142930 THOMAS TAMI MD TPP PHYSICIAN EXECUTIVE 40.00 20.00 X 403737 282835 139928 BRYAN STRADER MD PHYSICIAN EXECUTIVE - TPP 60.00 0.00 X 607999 0 93156 DENNIS KOLB MD VP-CLINICAL INTEGRATION 60.00 0.00 X 475161 0 93684 RANDY CURNOW JR PRESIDENT-TRIHEALTH PHO 0.00 60.00 X 456961 0 48024 JOHN PROUT FORMER OFFICER 0.00 40.00 X 1853100 0 0 DONNA NIENABER ESQ FORMER OFFICER 25.00 35.00 X 361585 0 31808 MICHAEL CROFTON FORMER OFFICER 60.00 0.00 X 394919 0 118485 GERALD OLIPHANT FORMER KEY EMPLOYEE 0.00 0.00 X 1192978 0 0 WALTER MCLARTY FORMER HIGHEST COMPENSATED 0.00 0.00 X 938472 0 0 JASON NIEHAUS FORMER HIGHEST COMPENSATED 0.00 0.00 X 551194 0 40650 15053834 1440616 2578219 315 1 1 0 CATHOLIC HEALTHCARE INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 CLINICAL ENGINEERING 13933306 NAVIGANT 30 S WACKER DRIVE STE 3100 CHICAGO IL 60606 CONSULTING 5329380 EPIC SYSTEMS CORPORATION 1979 MILKY WAY VERONA WI 53593 SOFTWARE CONSULTING 4134489 PFS GROUP 2600 NORTH LOOP WEST SUITE 150 HOUSTON TX 77092 A/R RECOVERY 3506079 CINCINNATI BELL TECHNOLOGY SOLUTIONS 221 EAST FOURTH STREET CINCINNATI OH 45202 INFORMATION TECHNOLOGY 2955778 151 1949866 18500 1968366 SHARED SERVICES REV 900099 202354500 202354500 AFFILIATED BILLING REV 900099 22952320 22952320 AFFILIATED RENTAL REV 531120 5345276 5345276 AFFILIATED MGMNT FEE 900099 861000 861000 INVESTMENT IN JV 900099 295112 -182810 477922 240879 240879 232049087 2971424 2971424 46157 0 46157 46157 46157 25374047 1037714 24140735 1113479 1233312 -75765 1157547 1157547 VALUE BASED REVENUE 900099 8510688 8510688 PURCHASE CARD REBATES 900099 629797 629797 VENDING REVENUE 900099 200000 200000 537737 537737 9878222 248070803 235904111 477922 9720404 X 634442 634442 9091992 9091992 4640211 4640211 93198494 93198494 5799156 5799156 18523923 18523923 7028264 7028264 27592 27592 3533710 3533710 866700 866700 2500 2500 353741 353741 52134358 52134358 8715163 8715163 7011258 7011258 15743823 15743823 6981580 6981580 837701 837701 449524 449524 1460303 1460303 20092342 20092342 3251375 3251375 ALLOCATION 1531853 1531853 EQUIPMENT 1376940 1376940 DUES & SUBSCRIPTIONS 606787 606787 BUSINESS MEALS 113451 113451 387594 387594 264394777 264394777 0 0 2808483 1698337 1417531 4351585 6572702 9856702 3959106 6215778 338685009 165137415 155381007 173547594 83709611 86308704 19769812 22208995 2250000 2250000 676999550 844075669 952867802 1150513364 66336099 55210204 14651417 20845794 51684450 49564577 20688912 32244529 153360878 157865104 X 799506924 992648260 799506924 992648260 952867802 1150513364 X -16323974 6975317 7300513 195189480 X X 0 1 X 1 0 X X 2 BETHESDA HOSPITAL INC 310537122 3 1 0 94329518 GOOD SAMARITAN HOSPITAL OF CINTI 310537486 3 1 0 95621182 2 0 189950700 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 PART I, LINE 11G, COLUMN (VI) AMOUNT OF OTHER SUPPORT TRIHEALTH, INC. ("TRIHEALTH") WAS CREATED IN 1995 UNDER A JOINT OPERATING AGREEMENT BETWEEN BETHESDA HOSPITAL, INC. ("BETHESDA") AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("GOOD SAMARITAN"). TRIHEALTH'S PRIMARY PURPOSE IS TO OPERATE AND JOINTLY MANAGE BETHESDA, GOOD SAMARITAN AND THEIR VARIOUS SUBSIDIARIES AND AFFILIATES. IN CARRYING OUT ITS CHARITABLE PURPOSES, TRIHEALTH PROVIDES A COMPREHENSIVE AND INTEGRATED PROVIDER BASE TO OPTIMIZE THE HEALTH STATUS OF THE COMMUNITY. TRIHEALTH PROVIDES ADMINISTRATIVE SUPPORT SERVICES INCLUDING GENERAL ADMINISTRATION, INFORMATION SYSTEMS, FINANCE, HUMAN RESOURCES, AND OTHER GENERAL SUPPORT SERVICES TO ITS SUPPORTED ORGANIZATIONS. PART IV, SECTION A, LINE 1 THE AMENDED AND RESTATED ARTICLES OF INCORPORATION OF TRIHEALTH STATE THAT THE SPECIFIC PURPOSE FOR WHICH TRIHEALTH IS FORMED IS TO ACT FOR THE BENEFIT OF, AND TO CARRY OUT THE PURPOSES OF BETHESDA HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND TO CONDUCT ANY ACTIVITIES CONSISTENT WITH SUCH PURPOSE, THE NONPROFIT LAWS OF THE STATE OF OHIO AND INTERNAL REVENUE CODE SECTION 501(C)(3). THE MISSION OF EACH HOSPITAL IS TO IMPROVE THE HEALTH STATUS OF THE PEOPLE THEY SERVE. PART IV, SECTION A, LINE 6 SINCE ITS ESTABLISHMENT IN 1995, TRIHEALTH, AS THE OPERATING ORGANIZATION, HAS DEVELOPED AN INTEGRATED HEALTH CARE SYSTEM CONSISTING OF 5 HOSPITALS, 3 AMBULATORY LOCATIONS AND APPROXIMATELY 125 PRIMARY AND SPECIALIST PHYSICIAN LOCATIONS SERVING GREATER CINCINNATI AND THE SURROUNDING AREA. ALL OF THESE ORGANIZATIONS AND/OR LOCATIONS ARE PART OF ORGANIZATIONS THAT ARE RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) (SEE SCHEDULE R, PART II). ALTHOUGH NOT SPECIFICALLY IDENTIFIED BY NAME IN TRIHEALTH'S GOVERNING DOCUMENTS, TRIHEALTH SUPPORTS RELATED ORGANIZATIONS AND ACTIVITIES OF SUCH RELATED ORGANIZATIONS IN FURTHERANCE OF ITS CHARITABLE PURPOSE AND CONSISTENT WITH INTERNAL REVENUE CODE SECTION 501(C)(3). WITH RESPECT TO THESE ORGANIZATIONS, TRIHEALTH PROVIDES SUPPORT SERVICES INCLUDING GENERAL ADMINISTRATION, INFORMATION SYSTEMS, FINANCE, HUMAN RESOURCES, AND OTHER GENERAL SUPPORT SERVICES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2500 0 0 1 7463 9963 0 PART II-B, LINE 1: 1F) DURING THE TAX YEAR, TRIHEALTH, INC. PROVIDED A CONTRIBUTION TO THE CAMPAIGN FOR ISSUE #9 - CHILDREN'S SERVICES IN AN ATTEMPT TO GET THE LEVY PASSED. THE MONEY FROM THE LEVY WOULD BE USED TO PROVIDE SERVICES TO ABUSED AND NEGLECTED CHILDREN AND THEIR FAMILIES IN HAMILTON COUNTY, OHIO. THE SERVICES ARE MANDATED BY THE FEDERAL GOVERNMENT, BUT FUNDED AT THE LOCAL LEVEL. 1I) TRIHEALTH, INC. PAID ANNUAL MEMBERSHIP DUES TO VARIOUS NATIONAL, STATE AND LOCAL ORGANIZATIONS, A PORTION OF WHICH RELATED TO LOBBYING ACTIVITIES. 65875682 15197886 50677796 34621440 5951267 28670173 187951275 141773463 46177812 50236612 2214799 48021813 173547594 DUE FROM RELATED ORGANIZATIONS 810984613 INVESTMENT IN UNCONSOLIDATED ORGANIZATIONS 29194809 ESCROW DEPOSIT 457400 MALPRACTICE ASSET 3438847 844075669 ACCRUED EIB 4282687 ACCRUED WORKERS COMPENSATION 803812 MALPRACTICE LIABILITY 17535384 ACCRUED PENSION OBLIGATION 9622646 32244529 X PART X, LINE 2: FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE AUDITED COMBINED FINANCIAL STATEMENTS OF TRIHEALTH THAT REPORTS ITS AND ITS SUBSIDIARIES AND AFFILIATES LIABILITY, IF APPLICABLE, FOR UNCERTAIN TAX POSITIONS UNDER ASC 740-10-25: TRIHEALTH PERFORMED AN ANALYSIS OF UNCERTAIN TAX POSITIONS AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE COMBINED FINANCIAL STATEMENTS AT JUNE 30, 2019 OR 2018. 1 UPTOWN CONSORTIUM INC 619 OAK STREET SUITE 1100 CINCINNATI OH 45206 200688727 501(C)(3) 293027 GENERAL PURPOSES LEGAL AID SOCIETY OF CINCINNATI 215 EAST NINTH STREET SUITE 200 CINCINNATI OH 45202 310536673 501(C)(3) 62500 M-HELP PROGRAM FUNDING CENTER FOR RESPITE CARE INC PO BOX 141301 CINCINNATI OH 45250 202544994 501(C)(3) 50000 GENERAL SUPPORT FREESTORE FOODBANK INC 1141 CENTRAL PARKWAY CINCINNATI OH 45202 237122205 501(C)(3) 28115 SPONSORSHIP MARVIN LEWIS COMMUNITY FUND 700 WEST PETE ROSE WAY SUITE 560 CINCINNATI OH 45203 202704690 501(C)(3) 25000 SPONSORSHIP AMERICAN CANCER SOCIETY INC 250 WILLIAMS STREET NW SUITE 400 ATLANTA GA 30303 131788491 501(C)(3) 20000 SPONSORSHIP OVARIAN CANCER ALLIANCE OF GREATER CINCINNATI 4918 COOPER ROAD CINCINNATI OH 45242 311287785 501(C)(3) 20000 SPONSORSHIP CINCINNATI BLUE LINE FOUNDATION 1900 CENTRAL PARKWAY CINCINNATI OH 45214 822744999 501(C)(3) 20000 SPONSORSHIP PEOPLE WORKING COOPERATIVELY 4612 PADDOCK RD CINCINNATI OH 45229 310859104 501(C)(3) 16000 GENERAL SUPPORT XAVIER UNIVERSITY 3800 VICTORY PARKWAY CINCINNATI OH 452074531 310537516 501(C)(3) 10000 SPONSORSHIP EPISCOPAL RETIREMENT HOMES INC 3870 VIRGINA AVE CINCINNATI OH 45227 310554071 501(C)(3) 10000 SPONSORSHIP HEALTHY MOMS & BABES INC 2270 BANNING ROAD NO 200 CINCINNATI OH 45239 311155292 501(C)(3) 10000 SPONSORSHIP MARCH OF DIMES 10806 KENWOOD ROAD CINCINNATI OH 45242 131846366 501(C)(3) 10000 SPONSORSHIP INTERFAITH HOSPITALITY NETWORK OF GREATER CINCINNATI 990 NASSAU STREET CINCINNATI OH 45206 311335474 501(C)(3) 10000 DIREST SERVICES TO HOMELESS FAMILIES MAYFIELD EDUCATION & RESEARCH FOUNDATION 3825 EDWARDS RD CINCINNATI OH 45209 310921099 501(C)(3) 10000 SPONSORSHIP KAREN WELLINGTON MEMORIAL FOUNDATION FOR LIVING W BREAST CANCER 312 WALNUT ST NO 1800 CINCINNATI OH 45202 263768567 501(C)(3) 8000 SPONSORSHIP AMERICAN LUNG ASSOCIATION 4050 EXECUTIVE PARK DRIVE SUITE 402 402 CINCINNATI OH 45241 131632524 501(C)(3) 7500 SPONSORSHIP 17 0 PART I, LINE 2: TRIHEALTH OBTAINS AND STORES ALL NECESSARY INFORMATION FROM THE RECIPIENT ORGANIZATION RELATIVE TO HOW THE FUNDS WILL BE SPENT. X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 CRAIG EISENTROUT MD TRUSTEE 0 554870 0 8331 0 6837 0 24946 0 23359 0 618343 0 0 MARK CLEMENT PRESIDENT/CEO 1107242 0 290035 0 66561 0 296751 0 19286 0 1779875 0 0 0 BOB COLLINS MD TRUSTEE (START 7/18) 12259 0 0 0 190202 0 26020 0 1361 0 229842 0 142080 0 SCOTT FRIEDSTROM MD MED STAFF PRES-GOOD SAM 0 458855 0 31795 0 52093 0 53930 0 30742 0 627415 0 0 ANDREW DEVOE ASST TREASURER/CFO 556794 0 151014 0 64464 0 140748 0 29978 0 942998 0 0 0 STEVE GRACEY ASST SECRETARY/SVP LEGAL 354959 0 69720 0 25492 0 95586 0 29672 0 575429 0 0 0 MARY IRVIN CHIEF NURSING EXEC. (END 10/18) 319189 0 64450 0 15079 0 110735 0 19713 0 529166 0 0 0 JENNIFER SKINNER CHIEF NURSING EXEC. (START 11/18) 252891 0 41282 0 9108 0 44950 0 17277 0 365508 0 0 0 GAIL DONOVAN EXEC VP & COO (END 6/19) 717014 0 165900 0 45330 0 191343 0 9341 0 1128928 0 0 0 DAVID COOK CHIEF HR OFFICER 369012 0 75090 0 16180 0 93499 0 29083 0 582864 0 0 0 JOHN WARD CHIEF INFORMATION OFFICER 386484 0 93695 0 17612 0 112776 0 25769 0 636336 0 0 0 STEVE MOMBACH SVP-AMBULATORY SERVICES 394154 0 109753 0 21415 0 127239 0 17632 0 670193 0 0 0 KEVIN JOSEPH MD CHIEF MEDICAL OFFICER 508057 0 119688 0 15571 0 115848 0 29819 0 788983 0 0 0 ROB CERCEK EVP POP HEALTH & PHYSICIAN PRACS 498005 0 113877 0 12883 0 126283 0 25868 0 776916 0 0 0 WILLIAM GRONEMAN SENIOR EXEC ADVISOR TO THE CEO 306929 0 87289 0 68198 0 119197 0 23733 0 605346 0 35213 0 THOMAS TAMI MD TPP PHYSICIAN EXECUTIVE 303098 180760 0 97238 100639 4837 86277 40773 8414 4464 498428 328072 0 0 BRYAN STRADER MD PHYSICIAN EXECUTIVE - TPP 552590 0 50160 0 5249 0 63127 0 30029 0 701155 0 0 0 DENNIS KOLB MD VP-CLINICAL INTEGRATION 283898 0 62807 0 128456 0 78508 0 15176 0 568845 0 0 0 RANDY CURNOW JR PRESIDENT-TRIHEALTH PHO 363238 0 77942 0 15781 0 38665 0 9359 0 504985 0 0 0 JOHN PROUT FORMER OFFICER 0 0 0 0 1853100 0 0 0 0 0 1853100 0 1793100 0 DONNA NIENABER ESQ FORMER OFFICER 164891 0 0 0 196694 0 31603 0 205 0 393393 0 0 0 MICHAEL CROFTON FORMER OFFICER 307398 0 73892 0 13629 0 90608 0 27877 0 513404 0 0 0 GERALD OLIPHANT FORMER KEY EMPLOYEE 0 0 0 0 1192978 0 0 0 0 0 1192978 0 1192978 0 WALTER MCLARTY FORMER HIGHEST COMPENSATED 0 0 0 0 938472 0 0 0 0 0 938472 0 938472 0 JASON NIEHAUS FORMER HIGHEST COMPENSATED 321048 0 81827 0 148319 0 15949 0 24701 0 591844 0 0 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS UP PAYMENTS: ALL DIRECTORS IN AN EMPLOYMENT POSITION OF VICE PRESIDENT AND HIGHER WITHIN TRIHEALTH, INC. ARE ELIGIBLE TO RECEIVE TAX GROSS-UP PAYMENTS ON THE FOLLOWING BENEFITS: * SUPPLEMENTAL OR SPLIT DOLLAR LIFE INSURANCE * EXECUTIVE HEALTH PROGRAM SERVICES * LONG-TERM DISABILITY INSURANCE * LONG-TERM CARE INSURANCE * FINANCIAL COUNSELING * BUSINESS CLUB MEMBERSHIPS * HEALTH CLUB MEMBERSHIPS IN ADDITION, DURING THE CALENDAR YEAR 2018, WILLIAM GRONEMAN RECEIVED A TAX INDEMNIFICATION AND GROSS UP PAYMENT ON A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PAYMENT. TRIHEALTH, INC. INCLUDED THE ENTIRE TAX INDEMNIFICATION AND GROSS UP PAYMENT AS TAXABLE INCOME ON THE INDIVIDUAL'S FORM W-2 FOR 2018. HEALTH OR SOCIAL CLUB OR INITIATION FEES: TRIHEALTH, INC. MAINTAINS A MEMBERSHIP IN A LOCAL SOCIAL CLUB IN THE NAME OF THE PRESIDENT & CEO AS THE SOCIAL CLUB REQUIRES THE MEMBERSHIP TO BE IN AN INDIVIDUAL'S NAME. THIS MEMBERSHIP IS A BUSINESS MEMBERSHIP FOR THE BENEFIT OF TRIHEALTH, INC. AS SUCH, THE MONTHLY DUES ARE PAID BY TRIHEALTH, INC. DURING THE CURRENT YEAR, THERE WAS NOT ANY PERSONAL USE BY THE PRESIDENT & CEO. PART I, LINES 4A-B ELIGIBLE EXECUTIVES (GENERALLY VICE PRESIDENT AND ABOVE) PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FOLLOWING INDIVIDUALS LISTED IN SCHEDULE J, PART II, RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH WAS TREATED AS TAXABLE COMPENSATION BY TRIHEALTH, INC.: JOHN PROUT - $1,793,100 GERALD OLIPHANT - $1,192,879 WALTER MCLARTY - $938,472 BOB COLLINS, MD - $142,080 WILLIAM GRONEMAN - $35,213 PART I, LINE 4A: THE ORGANIZATION HAS A STANDARD EMPLOYEE SEVERANCE PACKAGE. GENERAL SEVERANCE PAY IS BASED ON LENGTH OF SERVICE. IN ADDITION, NOTICE PAY, IF APPLICABLE UNDER TRIHEALTH, INC. POLICY, MAY BE ADDED TO THE SEVERANCE PACKAGE AND THE AMOUNT OF NOTICE PAY WILL BE DETERMINED BY HUMAN RESOURCES IN ACCORDANCE WITH TRIHEALTH, INC. POLICY. PAYMENTS OF SEVERANCE ARE CONDITIONED UPON SIGNING A SEPARATION AND RELEASE AGREEMENT. DURING THE 2018 CALENDAR YEAR, THE FOLLOWING REPORTABLE INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM TRIHEALTH, INC.: DONNA NIENABER - $190,434 JASON NIEHAUS - $83,736 DENNIS KOLB, MD - $52,230 TERRI CROFTON FAMILY MEMBER MICHAEL CROFTON FORMER OFFICER 30661 EMPLOYEE 0 MICHAEL CROFTON JR FAMILY MEMBER MICHAEL CROFTON FORMER OFFICER 52330 EMPLOYEE 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: THE AMOUNTS SHOWN IN PART IV, COLUMN (C) ARE AT FAIR MARKET VALUE. FORM 990, PART III, LINE 1 THE MISSION OF TRIHEALTH, INC. IS TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. WE PURSUE OUR MISSION BY PROVIDING A FULL RANGE OF HEALTH RELATED SERVICES INCLUDING PREVENTION, WELLNESS AND EDUCATION. CARE IS PROVIDED WITH COMPASSION CONSISTENT WITH THE VALUES OF OUR ORGANIZATION. TRIHEALTH, INC. SERVES AS THE ENTITY THAT PROVIDES JOINT MANAGEMENT OF BETHESDA HOSPITAL AND GOOD SAMARITAN HOSPITAL UNDER AN AFFILIATION AGREEMENT BETWEEN BETHESDA, INC. AND CATHOLIC HEALTH INITIATIVES. FORM 990, PART III, LINE 4A TRIHEALTH, INC. ("TRIHEALTH") COMBINES THE STRENGTHS OF TWO OF GREATER CINCINNATI'S FINEST HEALTH CARE ORGANIZATIONS, BETHESDA HOSPITAL, INC. ("BETHESDA") AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("GOOD SAMARITAN"). FORMED IN 1995, TRIHEALTH CREATED AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE IT SERVES, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. TRIHEALTH IS DEDICATED TO DELIVERING THE BEST CARE POSSIBLE. BETHESDA AND GOOD SAMARITAN HAVE VALUES ROOTED IN SPIRITUAL HERITAGE AND COMPASSIONATE SERVICES TO THE COMMUNITY. BETHESDA WAS FOUNDED IN 1896 BY GERMAN METHODIST DEACONESSES TO CARE FOR CINCINNATI'S SICK AND POOR. A CATHOLIC ORGANIZATION, GOOD SAMARITAN WAS ESTABLISHED IN 1852 UNDER THE SPONSORSHIP OF THE SISTERS OF CHARITY TO PROVIDE CARE FOR THE POOR AND MEDICALLY UNDERSERVED. IN KEEPING WITH THESE EARLY PURPOSES, TRIHEALTH CONTINUES TO PROVIDE UNCOMPENSATED CARE TO THOSE IN NEED. THE "TRI" IN TRIHEALTH REPRESENTS ITS HOSPITALS, PHYSICIANS AND COMMUNITY WORKING TOGETHER TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE IT SERVES. THE "TRI" ALSO EXPRESSES OUR COMMITMENT TO THE PHYSICAL, MENTAL AND SPIRITUAL ASPECTS OF HEALTH. IN SERVING THE COMMUNITY'S NEEDS, TRIHEALTH OFFERS COMPREHENSIVE SERVICES AT MORE THAN 130 CONVENIENT LOCATIONS IN THE GREATER CINCINNATI AND TRISTATE AREA. ITS SITES INCLUDE FIVE HOSPITAL LOCATIONS AND PHYSICIAN OFFICE BUILDINGS IN ADDITION TO FITNESS, REHABILITATION, OCCUPATIONAL HEALTH AND OUTPATIENT CENTERS. TRIHEALTH ALSO PROVIDES SERVICES IN THE HOME AND IN THE WORKPLACE AND DELIVERS CARE AND EDUCATION COOPERATIVELY THROUGH COMMUNITY-BASED ORGANIZATIONS, SUCH AS CHURCHES, SCHOOLS, CLINICS AND SOCIAL AGENCIES. TRIHEALTH HOSPITALS HAVE BEEN RECOGNIZED LOCALLY AND NATIONALLY AS TOP-RATED IN MATERNITY CARE, NEONATAL INTENSIVE CARE, CARDIAC SURGERY AND CARDIOLOGY, ORTHOPEDICS, UROLOGY, NEUROLOGY/NEUROSURGERY, AND ENDOCRINOLOGY. TRIHEALTH PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR BOTH BETHESDA AND GOOD SAMARITAN AS WELL AS VARIOUS SUBSIDIARIES AND AFFILIATES. THE ADMINISTRATIVE SUPPORT SERVICES INCLUDE GENERAL ADMINISTRATION, INFORMATION SYSTEMS, FINANCE, HUMAN RESOURCES AND OTHER GENERAL SUPPORT SERVICES. THESE COSTS ARE ALLOCATED TO THE VARIOUS TRIHEALTH ENTITIES AND THE ENTITIES REIMBURSE TRIHEALTH AT COST. IN ADDITION, BETHESDA AND GOOD SAMARITAN EQUALLY FUND THE CASH FLOWS OF TRIHEALTH AND AS SUCH THE COSTS ALLOCATED BY TRIHEALTH ARE RECORDED AS EXPENSES ON THE FINANCIAL STATEMENTS OF BETHESDA AND GOOD SAMARITAN. THEREFORE, THE ALLOCATED SERVICE COSTS ARE PRESENTED ON TRIHEALTH'S FORM 990, PARTS VIII AND IX IN THE AGGREGATE AS THE EXPENSES ARE PRESENTED AS MANAGEMENT AND GENERAL EXPENSES ON THE FORMS 990 FOR BETHESDA AND GOOD SAMARITAN. FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS, DIRECTORS AND TRUSTEES OF TRIHEALTH, INC. LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARDS OF BETHESDA HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, BOTH AFFILIATED ENTITIES OF TRIHEALTH, INC. AS WELL AS TRIHEALTH HOSPITAL, INC. A SUBSIDIARY OF TRIHEALTH, INC. KEVIN JOSEPH, MD, MARK CLEMENT, GAIL DONOVAN, ROB CERCEK AND STEVE GRACEY HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE MCCULLOUGH-HYDE MEMORIAL HOSPITAL, AN AFFILIATED ENTITY OF TRIHEALTH, INC. WAYNE SHIRCLIFF, QUINT STUDER, PHILLIP OBLINGER, MD, CRAIG EISENTROUT, MD, LISA KNUTSON, AND BOB COLLINS, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA, INC., THE SINGLE CORPORATE MEMBER OF BETHESDA HOSPITAL, INC. MARK CLEMENT, MARY IRVIN, AND SR. SALLY DUFFY HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE GOOD SAMARITAN COLLEGE OF NURSING AND HEALTH SCIENCE, AN AFFILIATED ENTITY OF TRIHEALTH, INC. MARK CLEMENT, ANDREW DEVOE, STEVE GRACEY, DAVID COOK, KEVIN JOSEPH, MD, ROB CERCEK, GAIL DONOVAN, CRAIG EISENTROUT, MD, SCOTT FRIEDSTROM, MD, PHILLIP OBLINGER, MD, STEVE MOMBACH, JOHN WARD, JENNIFER SKINNER AND MARY IRVIN HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED ENTITY BOARDS OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES AS WELL AS BEING EMPLOYED BY TRIHEALTH, INC. OR ITS AFFILIATES/SUBSIDIARIES. MARK CLEMENT AND CRAIG EISENTROUT, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE BETHESDA FOUNDATION, INC., AN AFFILIATED ENTITY. FORM 990, PART VI, SECTION A, LINE 6 TRIHEALTH, INC. HAS TWO CORPORATE MEMBERS, BETHESDA, INC. AND CATHOLIC HEALTH INITIATIVES, THE PARENT ORGANIZATION OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. FORM 990, PART VI, SECTION A, LINE 7A TRIHEALTH, INC. HAS TWO CORPORATE MEMBERS, BETHESDA, INC. AND CATHOLIC HEALTH INITIATIVES, THE PARENT ORGANIZATION OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, WHO HAVE THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF TRIHEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7B TRIHEALTH, INC. HAS TWO CORPORATE MEMBERS, BETHESDA, INC. AND CATHOLIC HEALTH INITIATIVES, THE PARENT ORGANIZATION OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, WHO MUST APPROVE AMENDMENTS TO TRIHEALTH INC.'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B MEMBERS OF THE BOARD ARE PROVIDED AN ELECTRONIC COPY OF FORM 990 PRIOR TO FILING AFTER REVIEW BY THE FINANCE AND AUDIT COMMITTEE OF THE BOARD, ALONG WITH THE COMMITTEE'S SUMMARY OF THE FORM 990. HOWEVER, FOR THE PROTECTION OF DONOR PRIVACY, SCHEDULE B - SCHEDULE OF CONTRIBUTORS WAS REMOVED FROM THE COPY PROVIDED TO THE BOARD. SUBSEQUENT TO PRESENTATION TO THE BOARD, THE ORGANIZATION FILES THE RETURNS MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH NON-SUBSTANTIVE CHANGES ARE NOT SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE CERTAIN FINANCIAL INTERESTS AND FIDUCIARY RELATIONSHIPS. THE EXECUTIVE COMMITTEE AND CORPORATE COUNSEL REVIEW RESPONSES, CONDUCT FURTHER INVESTIGATION (IF NECESSARY), AND DETERMINE WHEN A CONFLICT EXISTS WITH RESPECT TO A CERTAIN TRANSACTION. IF A CONFLICT EXISTS, THE TRANSACTION IS NOT TO BE ENTERED INTO UNLESS ALTERNATIVES ARE FULLY INVESTIGATED, AND IN THEIR ABSENCE, THE BOARD, WITHOUT THE PARTICIPATION OF THE INTERESTED MEMBER(S), DETERMINES THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. PLANS TO MANAGE THE CONFLICT DURING THE RELATIONSHIP ARE IMPLEMENTED. ALL DISCUSSIONS ARE APPROPRIATELY DOCUMENTED. ALL DIRECTORS AND MANAGERS, WHICH INCLUDE OFFICERS AND KEY EMPLOYEES, ARE REQUIRED TO ANNUALLY DISCLOSE ANY CIRCUMSTANCES, INCLUDING FAMILY AND BUSINESS RELATIONSHIPS, THAT MAY CREATE A CONFLICT OF INTEREST FOR THE ORGANIZATION. THESE RESPONSES ARE REVIEWED AND ACTED UPON BY A CONFLICT OF INTEREST COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, THE ANNUAL PROCESS PERFORMED BY TRIHEALTH, INC. INCLUDED: COMPENSATION COMMITTEE; INDEPENDENT COMPENSATION CONSULTANT; COMPENSATION SURVEY OR STUDY; AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. ADDITIONALLY, ALL DISCUSSIONS AND DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 TRIHEALTH, INC.'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, LINE 16B DURING THE YEAR, TRIHEALTH, INC. PARTICIPATED IN A JOINT VENTURE WITH ONE OR MORE TAXABLE PERSONS AND/OR ORGANIZATIONS. AS OF THE END OF THE FISCAL YEAR, TRIHEALTH, INC. HAD NOT ADOPTED A WRITTEN POLICY OR PROCEDURE THAT REQUIRES THE ORGANIZATION TO NEGOTIATE, IN ITS TRANSACTIONS AND ARRANGEMENTS WITH OTHER MEMBERS OF THE VENTURE OR ARRANGEMENT, SUCH TERMS AND SAFEGUARDS AS ARE ADEQUATE TO ENSURE THAT THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED. HOWEVER, ALL JOINT VENTURES, WHEN ENTERED INTO, HAVE OUTSIDE LEGAL COUNSEL REVIEW OF THE OPERATING AGREEMENT OR OTHER ORGANIZATIONAL DOCUMENTS TO ENSURE THAT THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED PRIOR TO THE COMMENCEMENT OF THE JOINT VENTURE. ONCE THE JOINT VENTURE COMMENCES, TRIHEALTH, INC. PERSONNEL MONITORS ITS ACTIVITIES TO ENSURE THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED. FORM 990, PART VII, SECTION A - AVERAGE HOURS PER WEEK DIRECTORS (AS NOTED WITH A "MED STAFF PRES" REFERENCE) FOR TRIHEALTH, INC. SERVE ON THE BOARD IN THEIR CAPACITY AS MEDICAL STAFF PRESIDENT FOR EITHER BETHESDA HOSPITAL, INC. OR THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. COMPENSATION SHOWN OF $45,000 IS FOR HIS/HER DUTIES AS MEDICAL STAFF PRESIDENT OF THE RESPECTIVE HOSPITAL AND NOT FOR SERVING AS A DIRECTOR. IN ADDITION, THESE INDIVIDUALS ARE ALSO EMPLOYEES OF THE TRIHEALTH SYSTEM AND ANY REMAINING COMPENSATION SHOWN IS FOR THOSE DUTIES AND NOT FOR SERVING AS A DIRECTOR. FORM 990, PART IX, LINE 11G MEDICARE COMPLIANCE: PROGRAM SERVICE EXPENSES 389,423. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 389,423. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 26,541,580. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,541,580. COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 6,826,587. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,826,587. CONSULTING: PROGRAM SERVICE EXPENSES 15,178,326. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,178,326. STAFFING: PROGRAM SERVICE EXPENSES 894,502. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 894,502. LINGUISTIC SERVICES: PROGRAM SERVICE EXPENSES 1,130,926. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,130,926. CATERING: PROGRAM SERVICE EXPENSES 240,959. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 240,959. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 932,055. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 932,055. FORM 990, PART XI, LINE 9: CAPITAL CONTRIBUTION UNDER JOINT OPERATING AGREEMENT 182,903,161. TRIHEALTH WAY OF LEADING FUNDING DEFERRAL REVERSAL 11,356,442. CHANGE IN PENSION PLAN/SERP FUNDED STATUS 5,392,429. NET INCOME OF GOOD SAMARITAN HOSPITAL FREE CLINIC (FILES FORM 990) 59,386. NON-FINANCIAL INSURANCE ADJUSTMENT -4,521,938. FORM 990, PART VI, LINE 1A THE BOARD OF TRUSTEES OF TRIHEALTH, INC. ("THE CORPORATION"), ESTABLISHED AN EXECUTIVE COMMITTEE WHICH MAY EXERCISE SUCH POWER AND AUTHORITY OF THE BOARD OF TRUSTEES IN INTERVALS BETWEEN MEETINGS OF THE BOARD AS AUTHORIZED BY THE BOARD. THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT & CEO, SECRETARY AND TWO OTHER BOARD MEMBERS ALL IN ACCORDANCE WITH THE NETWORK AFFILIATION AGREEMENT. FORM 990, PART XII, LINE 2C THE FINANCIAL STATEMENTS OF TRIHEALTH, INC. ARE AUDITED WITH ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). TRIHEALTH HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF BOTH ITS AND ITS SUBSIDIARIES AND AFFILIATES FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF THE INDEPENDENT AUDITOR. DURING THE TAX YEAR, THERE WAS NOT A CHANGE IN THE PROCESS OF AUDIT OVERSIGHT AND/OR SELECTION OF AN INDEPENDENT AUDITOR BY TRIHEALTH. BETHESDA HOSPITAL INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 310537122 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 1 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 310537486 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN ENTERPRISE CORP 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311383365 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 10 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN INSTITUTE 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311074519 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 10 TRIHEALTH INC 1 GOOD SAMARITAN HOSPITAL FREE CLINIC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 273893817 FREE CLINIC OH SECTION 501(C)(3) SCHEDULE A, LINE 7 TRIHEALTH INC 1 TRIHEALTH HOSPITAL INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 461393755 INPATIENT AND OUTPATIENT SERVICES OH SECTION 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