SAMARITAN BEHAVIORAL HEALTH INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- SAMARITAN BEHAVIORAL HEALTH INC (EIN 02-0633634)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-16
- IRS object ID
- 202043219349312889
- 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 | 2020-11-16T14:01:06-06:00 | 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 | 020633634 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN BEHAVIORAL HEALTH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SAMA | BusinessNameControlTxt |
| Phone | 9372768333 | 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 | TIMOTHY D SNIDER | PersonNm |
| Person Title | BOARD TREASURER | PersonTitleTxt |
| Phone | 9372768333 | 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 | 14:01:01 | 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 | BETH ESPOSITO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 S EDWIN C MOSES BLVD | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45417 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,256,102 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SBHIHELP.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES THAT TOUCH, TEACH AND HEAL | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 292 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,530,103 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,111,542 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,218,338 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,875,341 | CYProgramServiceRevenueAmt |
| PY Investment Income | $11,760 | PYInvestmentIncomeAmt |
| CY Investment Income | $55,739 | CYInvestmentIncomeAmt |
| PY Other Revenue | $272,560 | PYOtherRevenueAmt |
| CY Other Revenue | $213,480 | CYOtherRevenueAmt |
| PY Total Revenue | $15,032,761 | PYTotalRevenueAmt |
| CY Total Revenue | $14,256,102 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,778,853 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,695,406 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,558,687 | PYOtherExpensesAmt |
| CY Other Expenses | $2,493,822 | CYOtherExpensesAmt |
| PY Total Expenses | $15,337,540 | PYTotalExpensesAmt |
| CY Total Expenses | $15,189,228 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$304,779 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$933,126 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,238,560 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,089,710 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,976,699 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,751,700 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,261,861 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,338,010 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE MENTAL HEALTH AND ABUSE SERVICES THAT TOUCH, TEACH AND HEAL | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,822,010 | ExpenseAmt |
| Revenue | $1,762,218 | RevenueAmt |
| Desc | SUBSTANCE ABUSE/115 PROGRAM: SAMARITAN BEHAVIORAL HEALTH'S SUBSTANCE ABUSE SERVICES OFFER THE FOLLOWING TO ANY ADULT LIVING IN MONTGOMERY COUNTY: MEDICATION ASSISTED TREATMENT (MAT) FOR OPIOID ADDICTION USING BUPRENORPHINE/NALOXONE (SUBOXONE) NALTREXONE (VIVITROL); ALL MAT SERVICES REQUIRE PARTICIPATION IN GROUP AND INDIVIDUAL COUNSELING; INDIVIDUAL, GROUP, AND FAMILY COUNSELING, AND CASE MANAGEMENT; SERVICES TO TREAT ABUSE AND ADDICTION TO ALCOHOL, COCAINE, BARBITURATES, MARIJUANA, HEROIN, AND OTHER ADDICTIVE SUBSTANCES; PROJECT DAWN - TRAINING IN THE USE AND DISTRIBUTION OF NALOXONE (NARCAN) KITS, COMBINED SUBSTANCE ABUSE AND MENTAL HEALTH COUNSELING. DURING 2019, 1,494 PATIENTS WERE ADMITTED FOR SERVICES. IN OCT. 2019, SBHI EXPANDED ITS DEPARTMENT TO INCLUDE 115/VERILY AND BECAME THE 115 PROGRAM. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,245,392 | ExpenseAmt |
| Revenue | $1,978,228 | RevenueAmt |
| Desc | INTEGRATED CARE SOLUTIONS: SAMARITAN BEHAVIORAL HEALTH'S YOUTH AND ADULT OUTPATIENT SERVICES OFFER THE FOLLOWING TO ADULTS, ADOLESCENTS AND CHILDREN LIVING IN MONTGOMERY COUNTY: BEHAVIORAL HEALTH ASSESSMENTS TO DETERMINE THE NATURE AND EXTENT OF MENTAL HEALTH PROBLEMS/CONCERNS; RECOMMENDATIONS REGARDING SERVICES THAT ADDRESS PROBLEMS/SYMPTOMS; AN INDIVIDUALIZED SERVICE PLAN WITH THERAPEUTIC GOALS DEVELOPED WITH THE PATIENT/FAMILY; INDIVIDUAL AND FAMILY COUNSELING; REFERRAL TO PSYCHIATRIC SERVICES IF IT APPEARS THAT MEDICATION MAY BE BENEFICIAL; ONGOING PSYCHIATRIC MEDICATION MANAGEMENT, CASE MANAGEMENT (COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT) SERVICES TO FURTHER SUPPORT THERAPEUTIC INTERVENTIONS AND LINK PATIENT/FAMILY TO COMMUNITY RESOURCES. DURING 2019, 4,010 PATIENTS WERE SERVED. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,775,088 | ExpenseAmt |
| Revenue | $768,958 | RevenueAmt |
| Desc | CRISISCARE: SAMARITAN BEHAVIORAL HEALTH'S CRISISCARE PROGRAM OFFERS THE FOLLOWING SERVICES TO ANY ADULT, ADOLESCENT OR CHILD REGARDLESS OF THEIR ABILITY TO PAY: 1) HOTLINE - 24-HOUR SUICIDE PREVENTION AND CRISIS COUNSELING TELEPHONE LINE, 2) WARMLINE - 24-HOUR SUPPORTIVE TELEPHONE COUNSELING SERVICE, 3) SCREENING & TRIAGE - EVALUATION OF CRISIS NEEDS WITH FOLLOW-UP RECOMMENDATIONS FOR SERVICE, 4) EMERGENCY WALK-INS - FACE-TO-FACE CRISIS INTERVENTION, 5) PRE-HOSPITAL SCREENING - HEALTH OFFICERS EVALUATE WHETHER A PERSON NEEDS TO BE HOSPITALIZED DUE TO LIFE THREATENING CIRCUMSTANCES, 6) MOBILE CRISIS SERVICES - CRISIS INTERVENTION SERVICES PROVIDED AT RESIDENCES AND/OR IN THE COMMUNITY FOR THOSE WHO ARE AT RISK OF HARM TO THEMSELVES OR OTHERS, 7) CRISIS COUNSELING - PROVIDES COUNSELING UP TO 4 SESSIONS FOR ACUTE STABILIZATION AND ON-GOING SUPPORT, 8) CRISIS DEBRIEFING - SERVICES ARE AVAILABLE FOR INDIVIDUALS OR GROUPS INVOLVED IN TRAUMATIC EVENTS. CRISISCARE ADMITTED 940 PATIENTS FOR SERVICES AND PROVIDED 5,566 HOURS OF SERVICES FOR 2019. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,963,121 | ExpenseAmt |
| Revenue | $5,581,417 | RevenueAmt |
| Desc | THIS NUMBER REPRESENTS THE BALANCE OF TOTAL EXPENDITURES OF TEMPORARILY RESTRICTED FUNDS FOR SAMARITAN BEHAVIORAL HEALTH (SBHI) NET OF PROGRAMS DESCRIBED IN SERVICE ACCOMPLISHMENTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $5,963,121 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $5,581,417 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $12,805,611 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 20 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 292 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | 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 | J MICHAEL SIMS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| ELOISE P BRONER | |||||||||
| BOARD CHAIR | 0.50 | 39.50 | Yes (X) | Yes (X) | $0 | $878,127 | $30,024 | ||
| THOMAS R CURTIN | |||||||||
| FORMER TRUSTEE & OFFICER | 0.00 | 40.00 | $0 | $407,459 | $60,214 | Yes (X) | |||
| TIMOTHY D SNIDER | |||||||||
| BOARD TREASURER | 0.50 | 39.50 | Yes (X) | $0 | $355,991 | $51,164 | |||
| SUSAN F DAVIS-BROWN MD | |||||||||
| TRUSTEE | 0.50 | 39.50 | Yes (X) | $0 | $309,243 | $30,483 | |||
| ELISABETH ESPOSITO | |||||||||
| VICE CHAIR-PRES&CEO | 40.00 | 0.00 | Yes (X) | Yes (X) | $246,198 | $0 | $38,501 | ||
| NANCY J SMITH DO | |||||||||
| PSYCHIATRIST | 40.00 | 0.00 | $253,305 | $0 | $12,713 | Yes (X) | |||
| V SUE MCGATHA | |||||||||
| FORMER OFFICER | 0.00 | 0.00 | $238,959 | $0 | $19,117 | Yes (X) | |||
| JENNA M DOWNEY ESQ | |||||||||
| BOARD SECRETARY (TO NOV) | 0.50 | 39.50 | Yes (X) | $0 | $223,359 | $21,938 | |||
| LUIS TELLEZ MD | |||||||||
| MEDICAL DIRECTOR-STAFF PSYCHIATRIST | 40.00 | 0.00 | $192,420 | $0 | $30,701 | Yes (X) | |||
| ELLEN W BALLERENE MD | |||||||||
| PSYCHIATRIST | 40.00 | 0.00 | $177,122 | $0 | $39,952 | Yes (X) | |||
| BENJAMIN W SUTHERLY | |||||||||
| TRUSTEE (FROM FEB) | 0.50 | 39.50 | Yes (X) | $0 | $174,080 | $31,323 | |||
| BENJAMIN A WATSON ESQ | |||||||||
| BOARD SECRETARY (FROM NOV) | 0.50 | 39.50 | Yes (X) | $0 | $166,716 | $16,245 | |||
| PHILIP S WHITECAR MD | |||||||||
| PSYCHIATRIST | 40.00 | 0.00 | $125,334 | $0 | $34,342 | Yes (X) | |||
| KAREN D GAINES | |||||||||
| CFO | 40.00 | 0.00 | $130,399 | $0 | $14,472 | Yes (X) | |||
| EVANTHIA STEFFENS | |||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $39,953 | $0 | |||
| CAROL BAUER SC | |||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| GINA MCFARLANE-EL | |||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,363,737 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,554,928 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $431,189 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| QUALIFACTS SYSTEMS INC | |||||
| 315 DEADERICK ST | NASHVILLE | TN | 37238 | MEDICAL SOFTWARE | $227,875 |
| WRIGHT STATE PHYSICIANS | |||||
| 128 E APPLE ST | DAYTON | OH | 45409 | MEDICAL SERVICES | $162,561 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $1,013 | FederatedCampaignsAmt |
| Related Organizations | $118,530 | RelatedOrganizationsAmt |
| Government Grants | $3,844,859 | GovernmentGrantsAmt |
| All Other Contributions | $147,140 | AllOtherContributionsAmt |
| Total Contributions | $4,111,542 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROGRAM SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $9,875,341 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,875,341 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,875,341 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,739 | TotalRevenueColumnAmt |
| Exclusion | $53,739 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,000 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISC REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $213,480 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $213,480 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $213,480 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,256,102 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,090,821 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $53,739 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $284,699 | TotalAmt |
| Program Services | $256,429 | ProgramServicesAmt |
| Management And General | $28,270 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,148,602 | TotalAmt |
| Program Services | $9,016,479 | ProgramServicesAmt |
| Management And General | $1,132,123 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,784 | TotalAmt |
| Program Services | $116,824 | ProgramServicesAmt |
| Management And General | $10,960 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,366,457 | TotalAmt |
| Program Services | $1,126,483 | ProgramServicesAmt |
| Management And General | $239,974 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $767,864 | TotalAmt |
| Program Services | $677,218 | ProgramServicesAmt |
| Management And General | $90,646 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129 | TotalAmt |
| Program Services | $129 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,846 | TotalAmt |
| Management And General | $22,846 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,869 | TotalAmt |
| Program Services | $1,530 | ProgramServicesAmt |
| Management And General | $6,339 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $368,929 | TotalAmt |
| Program Services | $295,096 | ProgramServicesAmt |
| Management And General | $73,833 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,560 | TotalAmt |
| Program Services | $6,560 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,595 | TotalAmt |
| Program Services | $153,938 | ProgramServicesAmt |
| Management And General | $35,657 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,555 | TotalAmt |
| Program Services | $17,574 | ProgramServicesAmt |
| Management And General | $261,981 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $842,131 | TotalAmt |
| Program Services | $750,881 | ProgramServicesAmt |
| Management And General | $91,250 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,607 | TotalAmt |
| Program Services | $71,364 | ProgramServicesAmt |
| Management And General | $13,243 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,083 | TotalAmt |
| Program Services | $95,083 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,242 | TotalAmt |
| Management And General | $129,242 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $313,126 | $89,434 | $223,692 |
| OPERATING SUPPLIES | $98,027 | $98,027 | |
| FLEET EXPENSE | $19,032 | $19,032 | |
| MINOR EQUIPMENT | $10,092 | $1,471 | $8,621 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,999 | TotalAmt |
| Program Services | $12,059 | ProgramServicesAmt |
| Management And General | $14,940 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,189,228 | TotalAmt |
| Program Services | $12,805,611 | ProgramServicesAmt |
| Management And General | $2,383,617 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,973,887 | BOYAmt |
| EOY | $2,268,949 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,203,351 | BOYAmt |
| EOY | $1,783,458 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,960 | BOYAmt |
| EOY | $49,681 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $902,990 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $617,694 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $325,329 | BOYAmt |
| EOY | $285,296 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $614,033 | BOYAmt |
| EOY | $702,326 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,238,560 | BOYAmt |
| EOY | $5,089,710 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,432,092 | BOYAmt |
| EOY | $2,118,103 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,544,607 | BOYAmt |
| EOY | $408,823 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $224,774 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,976,699 | BOYAmt |
| EOY | $2,751,700 | 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 | $2,647,829 | BOYAmt |
| EOY | $1,635,684 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $614,032 | BOYAmt |
| EOY | $702,326 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,261,861 | BOYAmt |
| EOY | $2,338,010 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,238,560 | BOYAmt |
| EOY | $5,089,710 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$933,126 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $44,238 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$34,963 | 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | $2,243,457 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,699,047 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,740,967 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,530,103 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,111,542 | CurrentTaxYearAmt |
| Total | $17,325,116 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,239,165 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,018,058 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,104,174 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,490,895 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,092,847 | CurrentTaxYearAmt |
| Total | $52,945,139 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,482,622 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,717,105 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,845,141 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,020,998 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $14,204,389 | CurrentTaxYearAmt |
| Total | $70,270,255 | 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 | $70,270,255 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,469 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | -$7,559 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $41,184 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,760 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $55,739 | CurrentTaxYearAmt |
| Total | $107,593 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,469 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | -$7,559 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $41,184 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,760 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $55,739 | CurrentTaxYearAmt |
| Total | $107,593 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,489,091 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,709,546 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,886,325 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,032,758 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $14,260,128 | CurrentTaxYearAmt |
| Total | $70,377,848 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99850 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99890 | PublicSupportPY509Pct |
| Investment Income CY | 0.00150 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00110 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $614,033 | BeginningYearBalanceAmt |
| Contributions | $25,280 | ContributionsAmt |
| Investment Earnings Or Losses | $97,977 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $34,963 | OtherExpendituresAmt |
| End Year Balance | $702,327 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $739,591 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$32,999 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $92,559 | OtherExpendituresAmt |
| End Year Balance | $614,033 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $655,485 | BeginningYearBalanceAmt |
| Contributions | $140,048 | ContributionsAmt |
| Investment Earnings Or Losses | $41,184 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $97,126 | OtherExpendituresAmt |
| End Year Balance | $739,591 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $560,623 | BeginningYearBalanceAmt |
| Contributions | $121,814 | ContributionsAmt |
| Investment Earnings Or Losses | -$8,031 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $18,921 | OtherExpendituresAmt |
| End Year Balance | $655,485 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $556,820 | BeginningYearBalanceAmt |
| Contributions | $5,845 | ContributionsAmt |
| Investment Earnings Or Losses | -$603 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,439 | OtherExpendituresAmt |
| End Year Balance | $560,623 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.63460 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.36540 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $375,056 | OtherCostOrOtherBasisAmt |
| Depreciation | $240,868 | DepreciationAmt |
| Book Value | $134,188 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $500,510 | OtherCostOrOtherBasisAmt |
| Depreciation | $376,826 | DepreciationAmt |
| Book Value | $123,684 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,424 | OtherCostOrOtherBasisAmt |
| Book Value | $27,424 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $285,296 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | FUNDS HELD BY GOOD SAMARITAN FOUNDATION - DAYTON | Desc |
| Book Value | $702,326 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $702,326 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTERCOMPANY PAYABLE | Desc |
| Amt | $224,774 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $224,774 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $14,265,374 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $44,238 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$34,966 | OtherRevenueAmt |
| Revenue Not Reported | $9,272 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,256,102 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,256,102 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,189,228 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,189,228 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,189,228 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | SAMARITAN BEHAVIORAL HEALTH, INC. (SBHI) MAKES EVERY EFFORT TO FOLLOW THE INTENT AND WISHES OF ALL ITS DONORS. THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS AND/OR EARNINGS FROM ENDOWMENT FUNDS ARE DRIVEN BY THE WISHES/RESTRICTIONS PLACED ON THE FUNDS BY THE DONOR. PERMANENT ENDOWMENTS RESULT WHEN A DONATION IS RECEIVED WITH A RESTRICTION THAT THE PRINCIPAL OR GIFT AMOUNT IS TO BE RETAINED IN PERPETUITY AND CANNOT BE SPENT. THE EARNINGS FROM THE PERMANENT ENDOWMENTS ARE THEN USED FOR THE PURPOSE SPECIFIED BY THE DONOR. TEMPORARY ENDOWMENTS ARE FUNDS IN WHICH ALL OR PART OF THE PRINCIPAL MAY BE EXPENDED ONLY AFTER THE EXPIRATION OF A STATED PERIOD OF TIME OR OCCURRENCE OF A SPECIFIED EVENT, DEPENDING ON THE DONOR'S WISHES. EARNINGS FROM TEMPORARILY RESTRICTED ENDOWMENTS CAN BE EITHER UNRESTRICTED OR RESTRICTED. SBHI USES THE TEMPORARILY RESTRICTED ENDOWMENTS FOR THE INTENDED PURPOSE SET UP BY THE DONOR, ONLY AFTER THE PERIOD OF TIME OR SPECIFIED EVENT SET BY THE DONOR HAS BEEN MET. THE "CATEGORIES" OF RESTRICTED ENDOWMENTS ARE AS FOLLOWS: SBHI PROGRAM CONSORTIUM (59%); PROGRAM OPERATING EXPENSES (20%); MENTAL HEALTH (14%); AND MISCELLANEOUS (7%). |
| PART X, LINE 2: | THE FOLLOWING FOOTNOTE IS FROM THE 2019 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF SBHI. 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. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | DISTRIBUTIONS - TEMPORARILY RESTRICTED -34,963. ROUNDING -3. |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | CENTRAL AMERICA AND THE CARIBBEAN | RegionTxt |
| Offices | 0 | OfficesCnt |
| Employee | 0 | EmployeeCnt |
| Type Of Activities Conducted | INVESTMENTS | TypeOfActivitiesConductedTxt |
| Region Total Expenditures | $64,000 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 0 | SubtotalEmployeesCnt |
| Continuation Total Office | 0 | ContinuationTotalOfficeCnt |
| Continuation Total Employee | 0 | ContinuationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Subtotal Spent | $64,000 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $64,000 | TotalSpentAmt |
| Transfer To Foreign Corp | Yes (1) | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | Yes (1) | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | 0 | PassiveForeignInvestmestCoInd |
| Foreign Partnership | Yes (1) | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART III ACCOUNTING METHOD: | FormAndLineReferenceDesc |
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 (13 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ELOISE P BRONER | ||||||||||||||
| BOARD CHAIR | $0 | $454,049 | $0 | $229,601 | $0 | $194,477 | $0 | $25,936 | $0 | $4,088 | $0 | $908,151 | $0 | $0 |
| THOMAS R CURTIN | ||||||||||||||
| FORMER TRUSTEE & OFFICER | $0 | $318,812 | $0 | $80,976 | $0 | $7,671 | $0 | $26,866 | $0 | $33,348 | $0 | $467,673 | $0 | $0 |
| TIMOTHY D SNIDER | ||||||||||||||
| BOARD TREASURER | $0 | $255,385 | $0 | $98,141 | $0 | $2,465 | $0 | $25,016 | $0 | $26,148 | $0 | $407,155 | $0 | $0 |
| SUSAN F DAVIS-BROWN MD | ||||||||||||||
| TRUSTEE | $0 | $229,665 | $0 | $42,950 | $0 | $36,628 | $0 | $9,247 | $0 | $21,236 | $0 | $339,726 | $0 | $0 |
| ELISABETH ESPOSITO | ||||||||||||||
| VICE CHAIR-PRES&CEO | $219,755 | $0 | $26,358 | $0 | $85 | $0 | $7,172 | $0 | $31,329 | $0 | $284,699 | $0 | $0 | $0 |
| NANCY J SMITH DO | ||||||||||||||
| PSYCHIATRIST | $251,778 | $0 | $0 | $0 | $1,527 | $0 | $146 | $0 | $12,567 | $0 | $266,018 | $0 | $0 | $0 |
| V SUE MCGATHA | ||||||||||||||
| FORMER OFFICER | $0 | $0 | $41,316 | $0 | $197,643 | $0 | $19,117 | $0 | $0 | $0 | $258,076 | $0 | $0 | $0 |
| JENNA M DOWNEY ESQ | ||||||||||||||
| BOARD SECRETARY (TO NOV) | $0 | $190,262 | $0 | $32,305 | $0 | $792 | $0 | $8,381 | $0 | $13,557 | $0 | $245,297 | $0 | $0 |
| LUIS TELLEZ MD | ||||||||||||||
| MEDICAL DIRECTOR-STAFF PSYCHIATRIST | $191,262 | $0 | $0 | $0 | $1,158 | $0 | $6,366 | $0 | $24,335 | $0 | $223,121 | $0 | $0 | $0 |
| ELLEN W BALLERENE MD | ||||||||||||||
| PSYCHIATRIST | $176,879 | $0 | $0 | $0 | $243 | $0 | $7,236 | $0 | $32,716 | $0 | $217,074 | $0 | $0 | $0 |
| BENJAMIN W SUTHERLY | ||||||||||||||
| TRUSTEE (FROM FEB) | $0 | $147,755 | $0 | $26,011 | $0 | $314 | $0 | $6,297 | $0 | $25,026 | $0 | $205,403 | $0 | $0 |
| BENJAMIN A WATSON ESQ | ||||||||||||||
| BOARD SECRETARY (FROM NOV) | $0 | $144,706 | $0 | $21,428 | $0 | $582 | $0 | $6,180 | $0 | $10,065 | $0 | $182,961 | $0 | $0 |
| PHILIP S WHITECAR MD | ||||||||||||||
| PSYCHIATRIST | $124,720 | $0 | $0 | $0 | $614 | $0 | $1,531 | $0 | $32,811 | $0 | $159,676 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINES 4A-B | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING INDIVIDUAL WAS SELECTED TO PARTICIPATE IN A VOLUNTARY RETIREMENT PROGRAM AND RECEIVED THE FOLLOWING PAYMENT IN 2019: V. SUE MCGATHA $181,130 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, SAMARITAN BEHAVIORAL HEALTH (SBHI) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. SBHI 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 THE TAXATION OF THE EARNED BENEFITS UPON VESTING, CERTAIN INDIVIDUALS RECEIVED A PAYOUT OF THE CUMULATIVE VESTED BENEFITS UNDER THEIR SUPPLEMENTAL PLAN DURING 2019. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2019: ELOISE BRONER $170,828. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2019: SUSAN DAVIS-BROWN $3,545. 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: THOMAS CURTIN $7,888; TIMOTHY SNIDER $3,843. 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 (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | PREMIER HEALTH (PREMIER) AS THE OPERATOR OF SBHI DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR SBHI, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. SBHI SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. SBHI SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. SBHI SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF SBHI WITH ALL THIRD-PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO, INSURERS. SBHI 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. SBHI MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN SBHI'S ACTIVITIES. |
| FORM 990, PART VI, SECTION A, LINE 6 | SBHI 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 SBHI. 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 SBHI 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 SBHI 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 SBHI'S CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH SBHI 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: | DISTRIBUTIONS - TEMPORARILY RESTRICTED -34,963. |
Schedule R IRS990ScheduleR
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 (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 | |
| FIDELITY HEALTH CARE INC (FHC) | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311075381 | HOME HEALTH | OH | 501 (C) (3) | 10 | 0 | PREMIER | |
| PREMIER COMMUNITY HEALTH | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311122883 | HEALTH EDU | OH | 501 (C) (3) | 10 | 0 | FIDELITY HEALTH CARE | |
| SAMARITAN HEALTH PARTNERS (SHP) | |||||||||||
| 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 | |
| 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 | |
| UPPER VALLEY PROFESSIONAL CORP (UVPC) | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311400963 | HEALTH CARE | OH | 501 (C) (3) | 10 | 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 | |
| HEART INSTITUTE OF DAYTON | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 300502367 | EDUCATION | 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 |
| COMPUNET 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 | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |