2019-11-15T07:41:47-06:00 2018-12-31 ERNST & YOUNG US LLP 221 E 4TH STREET SUITE 2900 CINCINNATI OH 45202 990 2018-01-01 311079309 ATRIUM MEDICAL CENTER % J MICHAEL SIMS ATRI 9374999942 110 N MAIN ST 500 DAYTON OH 45402 J MICHAEL SIMS VP TREAS, CONTROLLER 9374999942 2019-10-30 true JULIE L SPARKS P01268401 5136121400 108.206.163.59 31499120193195000004 2019-11-15 P 770194AAF055F9EA87E64CA02E08FE540289067F 770194AAF055F9EA87E64CA02E08FE540289067F 2018 2020-04-17 16:48:07Z KEITH BRICKING MD 1 MEDICAL CENTER DR MIDDLETOWN OH 45005 286218627 false X WWW.PREMIERHEALTH.COM X 1983 OH WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. 11 1 2055 281 291790 192851 589494 229244406 223424893 3908083 3275698 2295948 6174302 235641288 233464387 441869 449165 0 0 104802971 101729336 0 0 0 124178595 126617928 229423435 228796429 6217853 4667958 362165607 363615202 241907431 253985972 120258176 109629230 ATRIUM MEDICAL CENTER WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. false false 208104450 449165 223424893 THE PRIMARY EXEMPT PURPOSE OF ATRIUM MEDICAL CENTER IS TO PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES TO THE RESIDENTS OF BUTLER AND WARREN COUNTIES. THE HOSPITAL FURTHERS ITS TAX-EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN MANY WAYS. SEE SCHEDULE H FOR MORE INFORMATION. 208104450 true true false true false false false false false true true true false true true true false true false false true false false false false false true true true false true true false false false false false false false false false true false false false false false true false false false true 121 0 true 2055 true true true false false false false false false false false false false false X 11 1 false true true false true true true true true false false true true true true true true true true true true OH X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 500 DAYTON OH 45402 X BARRY ROBERTSON MD BOARD CHAIR 0.5 0.5 X X 0 0 0 MICHAEL R UHL PRESIDENT 38.0 2.0 X X 591930 0 48840 MARQUITA L TURNER COO & CNO 40.0 0.0 X X 345287 0 19082 BARBARA L STEEL MD BOARD VICE-CHAIR 0.5 0.0 X 0 0 0 WILLIAM ANDREW MD TRUSTEE 0.5 0.0 X 50000 0 0 DALE J BLOCK MD TRUSTEE 0.5 39.5 X 0 265739 40951 MARY H BOOSALIS TRUSTEE & PREMIER PRESIDENT 0.5 39.5 X 0 1877611 40298 JOHN M MILLER MD TRUSTEE 0.5 39.5 X 8924 746669 39644 PERCY DAVID MITCHELL JR MD TRUSTEE 0.5 0.0 X 30000 0 0 MATTHEW S REEVES DO TRUSTEE / VP OPS AND CMO 40.0 0.0 X 384719 0 22285 RHONDA L SEIDENSCHMIDT TRUSTEE / VP OPERATIONS 39.5 0.5 X 230372 0 24411 LYNDSEY A PITTMAN BOARD TREAS / DIRECTOR-FINANCE 39.5 0.5 X 98404 0 5255 DALE E CREECH JR SYS VP-CHF LGL OFFICER-TO JUL 8.0 32.0 X 0 712176 198521 THOMAS R CURTIN VP REVENUE CYCLE 8.0 32.0 X 0 334595 54623 GARY G GINTER VP &PREMIER CHIEF INFO OFFICER 8.0 32.0 X 0 554305 50289 JENNIFER J HAULER MD VP MEDICAL AFFAIRS&PREMIER CMO 8.0 32.0 X 0 648598 16249 BARBARA A JOHNSON SYS VP - HR OPERATIONS 8.0 32.0 X 0 575983 25035 RENEE M JOHNSON SYS VP-MANAGED CARE (FROM APR) 8.0 32.0 X 0 185662 20889 MARGARET W MARK VP NURSING SERVICE/PREMIER CNO 8.0 32.0 X 0 588511 32768 CRAIG SELF CHF STRATEGY OFFICER (TO NOV) 8.0 32.0 X 0 787777 360014 MARK W SHAW SYS VP - MANAGED CARE (TO APR) 8.0 32.0 X 0 683676 83843 SCOTT A SHELTON SYS VP CPO-TO JUL/ PREMIER CFO 8.0 32.0 X 0 527994 21072 J MICHAEL SIMS SYS VP-TREAS & CORP CONTROLLER 8.0 32.0 X 0 401849 53110 KIM K STRAHL SYS VP & CPO (FROM JUL) 8.0 32.0 X 0 268169 34030 GEOFFREY P WALKER SYS VP-CHF LGL OFFICER-FRM JUL 8.0 32.0 X 0 426301 48447 DONNA L BANKS VP OPERATIONS 40.0 0.0 X 322784 0 21314 JOANNE R MORGAN SYSTEM VP - PHARMACY OPS 40.0 0.0 X 251364 0 23335 DOROTHY C PERRY DIRECTOR HUMAN RESOURCES 40.0 0.0 X 184378 0 8591 ROBYN S MYERS DEPARTMENT DIRECTOR 40.0 0.0 X 176627 0 29506 JAN E SCHUSTER SYSTEM DIRECTOR-LAB 39.5 0.5 X 175431 0 20901 JEFFREY S ZOLLETT MD FORMER OFFICER 0.0 40.0 X 0 152616 8658 RENEE P GEORGE FORMER KEY 0.0 40.0 X 0 571367 37650 TAMMY S LUNDSTROM MD FORMER KEY 0.0 40.0 X 0 445094 10973 MICHAEL J MAIBERGER FORMER KEY 0.0 40.0 X 0 1208794 48670 MARK S SHAKER FORMER KEY 0.0 0.0 X 0 814710 25970 THOMAS R PARKER FORMER KEY 0.0 40.0 X 0 600098 43008 2850220 13378294 1518232 65 true true false DAWSON HEALTHCARE 1114 DUBLIN RD COLUMBUS OH 43215 MEDICAL SERVICES 5011500 MIDDLETOWN ANESTHESIA 3180 KETTERING BLVD DAYTON OH 45439 MEDICAL SERVICES 2001326 EMERGENCY ACUTE CARE MED CO NE IN 440 STEVENS AVE 150 SOLANA BEACH CA 92075 MEDICAL SERVICES 1917703 COMPUNET CLINICAL LABORATORIES 2308 SANDRIDGE DR DAYTON OH 45349 CLINICAL LAB 1361873 MIAMI VALLEY EMERGENCY SPECIALISTS 2400 MIAMI VALLEY WAY 220 CENTERVILLE OH 45459 MEDICAL SERVICES 1224272 48 589494 589494 NET PATIENT SERVICE REVENUE 900099 115046947 114756364 290583 MEDICARE/MEDICAID PAYMENTS 900099 104928095 104928095 HOSPITAL FRANCHISE TAX RECOVERIES 900099 3386171 3386171 MEDICAL RECORDS 900099 24028 24028 MISCELLANEOUS 900099 39652 39652 223424893 1759071 1759071 0 0 2271976 2329371 -57395 0 -57395 -57395 50273160 1643061 49005097 1394497 1268063 248564 1516627 1516627 0 0 0 0 0 0 19636 25275 -5639 -5639 GAIN ON INTEREST SWAP ADJ 900099 4862081 4862081 CAFETERIA SALES 900099 970438 1207 969231 ALL OTHER REVENUE 900099 404817 404817 6237336 233464387 223134310 291790 9448793 449165 449165 0 0 0 1859509 1035080 824429 0 0 81153647 71897110 9256537 1918204 1685261 232943 10977381 8649802 2327579 5820595 5051310 769285 71107 71107 224653 224653 133138 133138 9040 9040 0 213433 213433 20488149 18643492 1844657 2030528 2030528 1269010 756263 512747 7700046 6764966 935080 0 3690844 3335145 355699 162781 91682 71099 0 918 34 884 8342677 8342677 0 21361711 21361711 540593 379164 161429 OPERATING SUPPLIES 41491105 41491105 PURCHASED SERVICES 11424514 9083343 2341171 HOSPITAL FRANCHISE TAX 4059609 4059609 ASSET IMPAIRMENT 961513 961513 2442559 1964383 478176 228796429 208104450 20691979 0 11320 10320 2327828 1529211 0 0 35401385 31448952 0 0 0 0 12020 63748 1794439 2227768 2789426 3153177 419460752 224160024 205973901 195300728 64582931 72310599 18199681 27124227 0 0 9199143 8874147 21873533 21572325 362165607 363615202 16321647 19182131 424827 326400 459923 235093 190972104 188255359 0 0 0 0 17207018 16909516 0 0 16521912 29077473 241907431 253985972 X 120126836 109497890 131340 131340 0 0 120258176 109629230 362165607 363615202 X 4667958 -6867925 -8428979 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X false false false false false true 4990 false false true 4050 9040 false false PART II-B, LINE 1F: PAYMENTS FOR LOBBYING ACTIVITIES INCLUDE DUES PAID TO GREATER DAYTON AREA HOSPITAL ASSOCIATION, DAYTON DEVELOPMENT COALITION, AND OHIO HOSPITAL ASSOCIATION PART II-B, LINE 1I: THE HOSPITAL CONTRACTS WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. 131340 131340 131340 131340 133659 328 2647 131340 132575 3734 2650 133659 133055 5860 6340 132575 0.00000 0.00000 1.00000 false false 25472332 25472332 246298416 110200446 136097970 945345 605588 339757 138312716 113353990 24958726 8431943 8431943 195300728 ALTERNATIVE INVESTMENTS 27124227 F 27124227 DUE FROM AFFILIATES 18521968 REBATES RECEIVABLE 1941789 DEFERRED COMPENSATION 675420 MISC AR 263148 DEPOSITS 140000 OTHER INVESTMENTS 30000 21572325 0 PENSION OBLIGATION & DEFERRED 13932198 SWAP LIABILITY 6430077 SELF INSURANCE RESERVE 5273287 LEASE LIABILITIES 1423434 ACCRUED MANAGED CARE LIAB 1204383 MEDICAL STAFF FEES 298440 WORKERS COMP RESERVE 199278 OTHER 316376 29077473 X PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE DESIGNATED TO SUPPORT SPECIFIC HEALTHCARE SERVICES OR CAPITAL NEEDS. SCHEDULE D, PART X, LINE 2: THE FOLLOWING FOOTNOTE IS FROM THE 2018 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF ATRIUM MEDICAL CENTER (AMC). 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. The Tax Cuts and Jobs Act (the Act) was enacted on December 22, 2017. For tax-exempt entities, the Act requires organizations to categorize certain fringe benefit expenses as a source of unrelated business income, pay an excise tax on remuneration above certain thresholds that is paid to executives by the organization, and report income or loss from unrelated business activities on an activity-by-activity basis, among other provisions. Certain regulatory guidance provides for a measurement period of up to one year, during which the accounting for the tax effects of the Act may be completed. PHP may record further adjustments in future periods upon obtaining, preparing, or analyzing additional information about facts and circumstances that existed as of the date of enactment. PHP will continue to revise and refine the calculations as additional IRS guidance is issued; however, PHP does not anticipate any material impact to the consolidated financial statements. Management annually reviews the tax positions and has determined that there are no material uncertain tax positions. Central America and the Caribbean Investments 9569000 Central America and the Caribbean Program Services INSURANCE 27000 9596000 9596000 false false false false false false true true X true X true X true true true false true true 5484000 3890000 1594000 0.00700 47974171 29072171 18902000 0.08260 3116000 2412000 704000 0.00310 56574171 35374171 21200000 0.09270 405340 32340 373000 0.00160 9142000 9142000 0.04000 311000 311000 0.00140 9858340 32340 9826000 0.04300 66432511 35406511 31026000 0.13570 8000 8000 0.00000 2000 2000 0.00000 10000 10000 0.00000 true 7633462 0 50252000 53096000 -2844000 X true true 1 1 ATRIUM MEDICAL CENTER ONE MEDICAL CENTER DRIVE MIDDLETOWN OH 45044 WWW.PREMIERHEALTH.COM SEE PART V SEC C X X X A ATRIUM MEDICAL CENTER 1 false false true X X X X X X X X X 16 true true true true X SEE SCHED H, PART V, SECTION C X true 17 true SEE SCHED H, PART V, SECTION C false true X 200. 300. X X true true X X X true X SEE SCHED H, PART V, SECT C X SEE SCHED H, PART V, SECT C X SEE SCHED H, PART V, SECT C X X X X X X X true X false X X X X true X false false PART V, SECTION A, LINE 1: THE STATE OF OHIO DOES NOT LICENSE HOSPITALS, BUT THE OHIO DEPARTMENT OF HEALTH DOES REGISTER HOSPITALS. AS PART OF THIS REGISTRATION PROCESS, HOSPITALS IN THE STATE OF OHIO ARE REQUIRED TO COMPLETE AND SUBMIT THE ANNUAL HOSPITAL REGISTRATION AND PLANNING REPORT (AHR) EACH CALENDAR YEAR. ATRIUM MEDICAL CENTER'S REGISTRATION NUMBER IS 1116. PART V, SECTION B, LINE 3E: ATRIUM MEDICAL CENTERS SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND WERE IDENTIFIED THROUGH THE CHNA. PART V, SECTION B, LINE 5: The CHNA Team collected 106 measures from publicly available sources, starting with the County Health Rankings. Criteria for inclusion included availability of trend data at the county level and ease of comparison and updating. Primary data collection involved interviews of public health officials; online and paper surveys; and community focus groups. There were four distinct stakeholder groups with separate analysis for comparison: 1) consumers and organizations which attended focus group meetings, 2) individuals surveyed, 3) organizations surveyed, and 4) health departments. All respondents answered questions about serious health issues, issues handled well, issues not addressed enough, and barriers to care. PARTNERING IN THE DATA REVIEW PROCESS AND IN THE PROCESS FOR IDENTIFYING AND PRIORITIZING COMMUNITY HEALTH NEEDS AND SERVICES WERE THE BOARD OF TRUSTEES AND EXECUTIVE LEADERSHIP OF ATRIUM MEDICAL CENTER, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, WARREN COUNTY COMBINED HEALTH DISTRICT, BUTLER COUNTY BOARD OF HEALTH, AND THE GREATER DAYTON AREA HOSPITAL ASSOCIATION WITH ITS MEMBER HOSPITALS. THE PARTICIPATING HOSPITALS INVITED A BROAD RANGE OF NONPROFIT AGENCIES AND ORGANIZATIONS, WHICH ASSIST THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS, TO ATTEND COMMUNITY MEETINGS AND COMPLETE SURVEYS. PART V, SECTION B, LINES 6A & 6B: ATRIUM MEDICAL CENTER PARTNERED WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, WARREN COUNTY COMBINED HEALTH DISTRICT, BUTLER COUNTY BOARD OF HEALTH, THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, XAVIER UNIVERSITY AND AN INDEPENDENT CONSULTANT TO PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT. PART V, SECTION B, LINES 7A & 10A: THE WEBSITE ADDRESS WHERE THE 2016 CHNA AND THE 2017 COMMUNITY HEALTH IMPLEMENTATION PLAN CAN BE ACCESSED IS: https://www.premierhealth.com/about-premier/community-involvement/communit y-health-improvement PART V, SECTION B, LINE 11: ATRIUM MEDICAL CENTER (AMC), AS A MEMBER OF THE PREMIER HEALTH (PREMIER) SYSTEM, WAS PART OF A COLLABORATION IN 2016 WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, XAVIER UNIVERSITY, WARREN COUNTY COMBINED HEALTH DISTRICT, BUTLER COUNTY BOARD OF HEALTH AND AN INDEPENDENT CONSULTANT TO PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT. BASED ON THE RESULTS OF THIS ASSESSMENT, ATRIUM MEDICAL CENTER ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE FOLLOWING PRIORITIZED NEEDS: * BIRTH OUTCOMES * BEHAVIORAL HEALTH/SUBSTANCE ABUSE * CHRONIC DISEASES HEALTH ISSUE: BIRTH OUTCOMES -------------- ATRIUM MEDICAL CENTER WILL IMPROVE THE HEALTH AND WELL-BEING OF WOMEN AND INFANTS WITH THE "CENTERINGPREGNANCY" PROGRAM. THIS PROGRAM WAS DEVELOPED BY CATHOLIC SOCIAL SERVICES AND PROVIDES GROUP PRENATAL CARE. THE "CENTERINGPREGNANCY" PROGRAM PROVIDES AN OPPORTUNITY TO IDENTIFY ALL THE NEEDS OF MOTHERS AND THEIR BABIES DURING 10+ PRENATAL VISITS. OTHER BENEFITS INCLUDE MORE ONE-ON-ONE TIME TO IDENTIFY THE NEEDS OF MOTHERS AND BABIES, SCREENINGS (E.G., HUNGER, DRUG ADDICTION, DEPRESSION), REFERRALS, ENCOURAGEMENT FOR BREASTFEEDING, TRANSPORTATION, AND CHILDCARE. AMC WILL WORK WITH THE OHIO DEPARTMENT OF FAMILIES FIRST, PREGNANCY CENTER, PARENT RESOURCE CENTER, BUTLER COUNTY REGIONAL TRANSIT AUTHORITY, YMCA, CITY OF MIDDLETOWN AND ITS HEROIN SUMMIT, OPIOID REDUCTION TASK FORCES IN WARREN AND CLINTON COUNTIES, AND MENTAL HEALTH RECOVERY SERVICES OF WARREN AND CLINTON COUNTIES TO FURTHER DEVELOP THIS PROGRAM. HEALTH ISSUE: BIRTH OUTCOMES AND CHRONIC DISEASES ----------------------------------- AMC WILL IMPLEMENT A STRATEGY TO INCREASE THE AMOUNT OF HEALTHY FOOD FOR PEOPLE WITH HEALTH-RELATED NUTRITIONAL NEEDS. THE SHORT-TERM OBJECTIVES ARE 1) TO ENSURE THAT ALL ELIGIBLE PATIENTS ARE SIGNED UP FOR SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) AND/OR WOMEN INFANT CHILDREN (WIC) BENEFITS, AND 2) TO START SCREENING FOR HUNGER AMONG THE VULNERABLE POPULATIONS OF PREGNANT WOMEN AND THE ELDERLY. THE HOSPITAL IS ALSO SUPPORTING ONE MARKET ONE BISTRO TO CONSTRUCT A NOVEL SOLUTION TO HUNGER THROUGH DONATIONS OR WORK-FOR-FOOD OPTIONS. FUTURE SERVICES MIGHT INCLUDE A FOOD PHARMACY, NUTRITION COUNSELING, COOKING CLASSES, AND CONNECTION TO COMMUNITY RESOURCES. HEALTH ISSUE: CHRONIC DISEASES AND BEHAVIORAL HEALTH -------------------------------------- THE HOSPITAL RECENTLY CONSTRUCTED AND OPENED A SPECIALLY-DESIGNED, EIGHT-BED EMERGENCY CARE AREA TO PROVIDE QUALITY CARE FOR GERIATRIC PATIENTS. SERVICES WILL INCLUDE CASE MANAGEMENT, SOCIAL SERVICES, AND REFERRALS TO COMMUNITY RESOURCES. SERVICES MAY BE EXPANDED TO INCLUDE SCREENINGS FOR DEPRESSION, CAREGIVER STRAIN, COGNITIVE ABILITY, HUNGER, AND ANXIETY. EXTENDED CARE FACILITIES IN THE COMMUNITY PROVIDED INPUT DURING THE PLANNING AND DEVELOPMENT PHASES OF THIS STRATEGY. HEALTH ISSUE: BEHAVIORAL HEALTH AND SUBSTANCE ABUSE ------------------------------------- ATRIUM MEDICAL CENTER WILL PROVIDE EDUCATION THAT ADDICTION IS A DISEASE, AND AS A RESULT, CHANGE PERCEPTIONS OF HOSPITAL PERSONNEL AND MEDICAL PROFESSIONALS. THE OBJECTIVES ARE TO PROVIDE CEUS TO FRONT-LINE STAFF AND PHYSICIANS FOR EDUCATION ON THIS TOPIC, WITH CURRICULUM DELIVERED BY ADAMHS. THE HOSPITAL MAY CONSIDER EXTENDING IT FOR THE BENEFIT OF COMMUNITY MEMBERS OR ORGANIZATIONS. ONCE ALL STAFF RECEIVE THE EDUCATION, THE NEXT STEP MAY BE HOSPITAL TRAINING ON TRAUMA-INFORMED CARE. IN ADDITION TO ASSISTANCE FROM THE ADAMHS BOARD, RESOURCES WILL BE OBTAINED FROM THE CITY OF MIDDLETOWN AND ITS HEROIN SUMMIT, OPIOID REDUCTION TASK FORCES IN WARREN AND CLINTON COUNTIES, AND MENTAL HEALTH RECOVERY SERVICES OF WARREN & CLINTON COUNTIES. ATRIUM MEDICAL CENTER IS ONE OF THE HOSPITALS IN THE PREMIER HEALTH SYSTEM. ALL OF THE HOSPITALS PARTICIPATED WITH OTHER HEALTH CARE ORGANIZATIONS TO CREATE A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). BASED ON THE RESULTS OF THE ASSESSMENT, THE PREMIER HOSPITALS JOINTLY IDENTIFIED THREE SHARED HEALTH CARE NEED PRIORITIES THAT ARE CRITICAL THROUGHOUT THE PREMIER SERVICE AREA: BIRTH OUTCOMES, CHRONIC DISEASES AND BEHAVIORAL HEALTH/SUBSTANCE ABUSE. THE REMAINING HEALTH CARE NEEDS IDENTIFIED IN THE ASSESSMENT ARE SHARED WITH MANY LOCAL HEALTH DEPARTMENTS IN OUR REGION, AS WELL AS STATE AGENCIES. THESE INCLUDE ACCESS TO CARE, SOCIAL DETERMINANTS, PROVIDER SHORTAGES, TRANSPORTATION, CARE FOR CHILDREN / CHILD HEALTH, IMMUNIZATIONS, AND ACCIDENTS. THE LEADERSHIP OF THE PREMIER HOSPITALS RECOGNIZE NO ONE ENTITY CAN SINGLE-HANDEDLY EFFECT DRAMATIC CHANGE IN ALL OF THESE SERIOUS AREAS WITHIN THE THREE-YEAR TIMEFRAME OF THE CHNA PROCESS. THEREFORE, PREMIER WILL DIRECT AND FOCUS ITS RESOURCES ON THE THREE PRIORITIES THAT ARE MOST PREVALENT IN ITS SURROUNDING COMMUNITIES. PART V, SECTION B, LINES 16 A, B, AND C: THE DIRECT WEBSITE ADDRESS WHERE A COPY OF THE FINANCIAL ASSISTANCE POLICY, THE APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY CAN BE ACCESSED IS: https://www.premierhealth.com/patient-and-visitor-guide/patient-guide/ costs-and-insurance/billing/financial-assistance PART V, SECTION B, LINE 16J: THE HOSPITAL WIDELY DISTRIBUTES INFORMATION ABOUT ITS FINANCIAL ASSISTANCE POLICY WITHIN THE AREA THAT IT SERVES. THIS INFORMATION INCLUDES THE METHOD OF APPLYING FOR AND ACCESSING FINANCIAL ASSISTANCE. NOTICES ARE PUBLICIZED IN PATIENTS' BILLS AND ARE POSTED IN THE EMERGENCY ROOM, ADMITTING AND REGISTRATION AREAS, AS WELL AS OTHER PUBLIC AREAS. THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FINANCIAL COUNSELORS, PATIENT ADVOCATES, AND CUSTOMER SERVICE REPRESENTATIVES DISCUSS THE FINANCIAL ASSISTANCE POLICY WITH ALL UNINSURED PATIENTS, AND ANY PATIENT WHO EXPRESSES FINANCIAL HARDSHIP WITH PAYING THEIR BILL. APPLICATIONS FOR FINANCIAL ASSISTANCE POLICY ARE AVAILABLE IN BOTH ENGLISH AND SPANISH. 3 SOUTHWEST OHIO AMBULATORY SURGERY CENTER 295 N BREIEL BLVD MIDDLETOWN OH 45042 GENERAL MEDICAL & SURGICAL OUTPATIENT FACILITY MASON EMERGENCY CENTER (TO JULY) 7450 Mason Montgomery Rd MASON OH 45040 EMERGENCY CENTER ATRIUM HEALTH CENTER TRENTON 3590 BUSENBARK RD TRENTON OH 45067 HEALTH CENTER PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT FOR ATRIUM MEDICAL CENTER IS PART OF THE PREMIER HEALTH (PREMIER) REPORT (EIN# 31-1446699). PART I, LINE 7: A COST TO CHARGE RATIO WAS USED TO CALCULATE THIS FINANCIAL ASSISTANCE AT COST. THIS CALCULATION TAKES TOTAL OPERATING EXPENSES LESS OTHER OPERATING REVENUES DIVIDED BY TOTAL GROSS REVENUES. UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENTAL PROGRAMS WERE CALCULATED USING A COST ACCOUNTING SYSTEM. THIS SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND INCLUDES FULLY LOADED COSTS. FOR THE REMAINING ITEMS THE ORGANIZATION USED SPECIFIC NUMBERS FOR EXPENSE PAID DIRECTLY FOR THESE SERVICES. PART I, LINE 7G: ATRIUM MEDICAL CENTER (AMC) PROVIDES SUBSIDIZED EMERGENCY SERVICES BY OPERATING A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THIS EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL INCURS EXPENSES RELATED TO CALL TIME AND PHYSICIAN SUBSIDIES DUE TO THE LARGE NUMBER OF INDIGENT PATIENTS COMING THROUGH THE EMERGENCY ROOM. FOR 2018, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $9,142,000. PART II: -------- ATRIUM MEDICAL CENTER (AMC) IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH A VARIETY OF PREVENTION, HEALTH IMPROVEMENT AND ENGAGEMENT PROGRAMS. AS PART OF ITS OVERALL COMMITMENT TO THE COMMUNITY, AMC FOCUSES ON FOUR AREAS OF SERVICE: --INVESTING IN THE COMMUNITY --PREVENTION AND WELLNESS --COMMITMENT TO THE UNDER-SERVED --COMMUNITY ENGAGEMENT SOME OF THE PROGRAMS SUPPORTED BY AMC DURING 2018 INCLUDE: 1) FUNDING OF $7,500 WAS CONTRIBUTED TO ASSIST THOSE LIVING IN POVERTY TO WORK TOWARDS ECONOMIC SELF-SUFFICIENCY THROUGH EMPLOYMENT. 2) $2,000 WAS DONATED TO ASSIST IN RECOVERY FROM NATURAL DISASTERS. PART III, LINES 2 & 3: BAD DEBT EXPENSE IS INCURRED WHEN AN ACCOUNT IS TAKEN OUT OF ACCOUNTS RECEIVABLE AND TURNED OVER TO A COLLECTION AGENCY. THIS ACTION MAY OCCUR IF A PATIENT REFUSES PAYMENT ARRANGEMENTS, REFUSES TO APPLY FOR FINANCIAL ASSISTANCE, AND THERE IS NOT AN INSURANCE BALANCE BEING CONTENDED. AN ACCOUNT IS WRITTEN OFF TO BAD DEBT AFTER 130 DAYS IF AN ATTEMPT TO COLLECT FROM THE PATIENT IS MADE WITHIN OUR COLLECTION POLICY. THE COLLECTION AGENCY ATTEMPTS TO COLLECT THE ACCOUNT IN ACCORDANCE WITH ESTABLISHED GUIDELINES. COLLECTION ATTEMPTS ARE CEASED AND THE ACCOUNT RETURNED TO THE ORGANIZATION IF THE PATIENT APPLIES FOR FINANCIAL ASSISTANCE. ANY AMOUNTS COLLECTED FROM THESE ACCOUNTS ARE CREDITED BACK AGAINST BAD DEBT EXPENSE. THE ORGANIZATION RECOGNIZES THERE ARE ACCOUNTS WRITTEN OFF TO BAD DEBT THAT MAY HAVE QUALIFIED FOR CHARITY CARE IF THE PATIENT HAD PROVIDED THE NECESSARY FINANCIAL INFORMATION. TO RESOLVE THIS, THE ORGANIZATION HAS ENGAGED A THIRD-PARTY VENDOR TO ANALYZE DATA BASED ON CREDIT SCORES TO REALLOCATE SOME OF THIS EXPENSE TO CHARITY CARE. A REPRESENTATIVE SAMPLE OF THESE ACCOUNTS IS THEN SENT TO OUR THIRD-PARTY VENDOR WHO GATHERS EXTERNAL CREDIT DATA THAT PRESENTS THE ACCOUNT AS LESS THAN 100% FEDERAL POVERTY LEVEL OR NOT ENOUGH INFORMATION (TYPICALLY INDICATIVE OF INDIGENT). THESE ACCOUNTS ARE RECLASSED FROM BAD DEBT EXPENSE TO CHARITY EXPENSE ON OUR INCOME STATEMENT. ANY CREDIT SCORE THAT PRESENTS THE ACCOUNTS AS GREATER THAN 100% FEDERAL POVERTY LEVEL REMAINS IN BAD DEBT EXPENSE. DUE TO THIS PROCESS, THE ORGANIZATION HAS USED BEST EFFORTS TO NOT REPORT BAD DEBT EXPENSE FOR PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. PART III, LINE 4: THE ORGANIZATION DOES NOT HAVE A FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS WHICH DISCUSSES THIS CALCULATION. PART III, SECTION B, LINES 5, 6, AND 7: THE AMOUNTS REPORTED ON LINES 5, 6, AND 7 DO NOT INCLUDE CERTAIN MEDICARE PROGRAM REVENUES AND COSTS, AND THUS DO NOT REFLECT ALL OF THE ORGANIZATION'S REVENUES AND COSTS ASSOCIATED WITH ITS PARTICIPATION IN MEDICARE PROGRAMS. IN ADDITION TO THE AMOUNTS REPORTED ON LINE 5, 6, AND 7, THE ORGANIZATION RECEIVED REVENUE OF $41,912,000 AND INCURRED COST OF $34,603,000, FOR AN ADDITIONAL NET SHORTFALL OF $15,409,000 ASSOCIATED WITH THESE PROGRAMS. BELOW IS A RECONCILIATION OF THE AMOUNTS ASSOCIATED WITH MEDICARE PROGRAMS. ALLOWABLE MEDICARE REVENUE PER MEDICARE COST REPORT IN PART III, SECTION B $50,252,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $41,912,000 TOTAL MEDICARE ASSOCIATED REVENUE $92,164,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT IN PART III, SECTION B $53,096,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $57,321,000 TOTAL MEDICARE ASSOCIATED COST $110,417,000 ALLOWABLE MEDICARE SHORTFALL IN PART III, SECTION B $2,844,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $15,409,000 TOTAL MEDICARE SHORTFALL $18,253,000 PART III, LINE 8: THE ORGANIZATION'S SHORTFALL SHOULD BE CONSIDERED CHARITY CARE BECAUSE IT IS PROVIDING HIGH-QUALITY CARE IN EXCESS OF THE COST TO OUR COMMUNITY RESIDENTS THAT NEED CARE. THE MEDICARE POPULATION AT THE ORGANIZATION IS IN EXCESS OF 51% OF NET PATIENT REVENUE. THE ORGANIZATION USED A COST ACCOUNTING SYSTEM TO CALCULATE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: THE ORGANIZATION MAKES REASONABLE EFFORTS TO DETERMINE WHETHER OR NOT AN INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THE STATE OR HOSPITAL FINANCIAL ASSISTANCE POLICY BEFORE ENGAGING IN EXTRAORDINARY COLLECTIVE ACTIONS AGAINST THAT INDIVIDUAL. PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE OFFERED REASONABLE PAYMENT PLAN ARRANGEMENTS FOR ANY REMAINING BALANCES. ANY THIRD-PARTY COLLECTING SELF-PAY RECEIVABLES ON OUR BEHALF IS REQUIRED TO MAKE REASONABLE EFFORTS TO DETERMINE IF THE INDIVIDUAL MEETS THE QUALIFICATIONS OF THE STATE OR OF OUR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS. REASONABLE EFFORTS INCLUDE: A. VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENT HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL. B. DOCUMENTING THAT THE ORGANIZATION HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE UNDER ITS FINANCIAL ASSISTANCE POLICY. C. DOCUMENT THAT THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE. D. DOCUMENT THAT THE PATIENT HAS BEEN OFFERED AND ACCEPTED TERMS FOR A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. THE FINANCIAL COUNSELORS MEET WITH INPATIENT, OUTPATIENT, SELF-PAY, AND OTHER PATIENTS UPON REQUEST WHO MAY NEED FINANCIAL ASSISTANCE. IN ADDITION TO ASSISTING PATIENTS WHO WANT TO APPLY FOR ASSISTANCE THROUGH THE MEDICAID PROGRAM, THE FINANCIAL COUNSELOR WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 2: THE ORGANIZATION WORKS WITH THE COMMUNITY ON PROGRAMS THAT ADDRESS THE UNDERLYING CAUSES OF PERSISTENT HEALTH PROBLEMS AS PART OF A COMPREHENSIVE STRATEGY TO IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE FOR IDENTIFIED MEMBERS OF THE COMMUNITY WHO ARE ECONOMICALLY DISADVANTAGED, DISENFRANCHISED AND/OR WHO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE ORGANIZATION STRIVES TO WORK WITH PREMIER, THE HOSPITAL BOARD OF TRUSTEES, EXECUTIVE MANAGEMENT, MANAGERS, STAFF MEMBERS, COMMUNITY GROUPS, AND INDIVIDUALS TO PROVIDE A COLLABORATIVE APPROACH TO THE GOVERNANCE AND MANAGEMENT OF COMMUNITY BENEFIT ACTIVITIES. PART VI, LINE 3: THERE ARE SEVERAL WAYS IN WHICH OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR SERVICES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FIRST, NOTIFICATION OF SUCH AVAILABLE ASSISTANCE IS CLEARLY POSTED IN REGISTRATION AREAS, AS WELL AS MATERNITY AND EMERGENCY DEPARTMENTS. NEXT, PATIENT ADVOCATES, PATIENT ACCESS STAFF MEMBERS, AND FINANCIAL COUNSELORS IN THE INPATIENT AND EMERGENCY DEPARTMENTS MEET WITH UNINSURED AND UNDERINSURED PATIENTS, AND THOSE WITH ONLY MEDICARE COVERAGE TO DISCUSS ELIGIBILITY FOR ASSISTANCE. FINANCIAL COUNSELORS ALSO DISCUSS OPTIONS TO RESOLVE UNPAID ACCOUNT BALANCES WITH UNINSURED AND UNDERINSURED PATIENTS. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE, ALONG WITH INFORMATION ON HOW TO OBTAIN AN APPLICATION. WHEN A PATIENT RECEIVES A BILL, THE REVERSE SIDE OF THE BILL CONTAINS INFORMATION ABOUT THE STATE OF OHIO FREE CARE PROGRAM (CARE ASSURANCE) AND A FINANCIAL ASSISTANCE APPLICATION. THE BILLING STATEMENTS OFFER THE FINANCIAL ASSISTANCE OPTIONS AVAILABLE, AND THE CONTACT INFORMATION FOR ASSISTANCE. PART VI, LINE 4: ATRIUM MEDICAL CENTER IS LOCATED IN MIDDLETOWN OHIO, SERVICING BUTLER AND WARREN COUNTIES. THE POPULATION OF ATRIUM MEDICAL CENTERS SERVICE AREA IS APPROXIMATELY 581,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME OF WARREN COUNTY IS JUST BELOW $79,400 PER YEAR, WITH APPROXIMATELY 4.7% OF ITS CITIZENS LIVING BELOW THE FEDERAL POVERTY LEVEL. THE MEDIAN HOUSEHOLD INCOME OF BUTLER COUNTY IS JUST BELOW $62,200 PER YEAR, WITH APPROXIMATELY 10.7% OF ITS CITIZENS LIVING BELOW THE FEDERAL POVERTY LEVEL. FOR 2018, MEDICARE PATIENTS REPRESENTED 51.2% OF GROSS PATIENT REVENUE AND MEDICAID REPRESENTED 19.5% OF GROSS PATIENT REVENUE. PART VI, LINE 5: ATRIUM MEDICAL CENT true MIDDLETOWN TRANSIT SYSTEM 3045 MOSER CT HAMILTON OH 45011 316000139 GOVT 75248 TRAVEL ASSISTANCE ATRIUM MEDICAL CENTER FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311079213 501(C)(3) 70019 SUPPORT REACH OUT MONTGOMERY COUNTY 25 E FORAKER ST DAYTON OH 45409 311434282 501(C)(3) 40863 RX ASSIST FOR INDIGENT MIAMI VALLEY HOSPITAL 110 N MAIN ST 500 DAYTON OH 45402 310537504 501(C)(3) 31596 AFRICAN AMERICAN WOMEN'S HEALTH PROGRAM & BRIDGE PROGRAMS UNITED WAY OF GREATER DAYTON AREA 33 W FIRST ST 500 DAYTON OH 45402 310536658 501(C)(3) 12000 SUPPORT DAYTON FOUNDATION 40 N MAIN ST 500 DAYTON OH 45423 316027287 501(C)(3) 11640 SUPPORT MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311040231 501(C)(3) 10280 SUPPORT EAST END COMMUNITY SERVICES 624 XENIA AVE DAYTON OH 45410 311508554 501(C)(3) 10000 SUPPORT GALA OF HOPE FOUNDATION 3500 PENTAGON BLVD 500 BEAVERCREEK OH 45431 464277044 501(C)(3) 10000 SUPPORT COMMUNITY BUILDING INSTITUTE 800 LAFAYETTE AVE MIDDLETOWN OH 45044 465205808 501(C)(3) 10000 SUPPORT ELIZABETHS NEW LIFE CENTER INC 2201 N MAIN ST DAYTON OH 45405 311381901 501(C)(3) 8000 SUPPORT UNITED WAY GREATER CINCINNATI 2400 READING RD CINCINNATI OH 45202 310537502 501(C)(3) 7000 SUPPORT DAYTON ART INSTITUTE 456 BELMONTE PARK N DAYTON OH 45405 310537480 501(C)(3) 6119 SUPPORT WESLEY COMMUNITY CENTER 3730 DELPHOS AVE DAYTON OH 45417 300203259 501(C)(3) 6000 SUPPORT 14 0 SCHEDULE I, PART I, LINE 2: 1) DISBURSEMENTS ARE ANALYZED MONTHLY THROUGH VARIOUS REPORTS AND COMMITTEE MEETINGS. 2) INVOICES ARE RECEIVED IN ACCOUNTS PAYABLE AND APPROVED AND DISBURSED PER ORGANIZATIONAL POLICY. 3) GRANT SPENDING IS MONITORED AGAINST BUDGETED AMOUNTS ON AN ONGOING BASIS. X X X X true true false false false false false false false MICHAEL R UHL PRESIDENT 380420 0 192099 0 19411 0 19594 0 29246 0 640770 0 0 0 MARQUITA L TURNER COO & CNO 278028 0 65842 0 1417 0 14218 0 4864 0 364369 0 0 0 DALE J BLOCK MD TRUSTEE 0 242678 0 20640 0 2421 0 8424 0 32527 0 306690 0 0 MARY H BOOSALIS TRUSTEE & PREMIER PRESIDENT 0 1098492 0 744674 0 34445 0 24572 0 15726 0 1917909 0 0 JOHN M MILLER MD TRUSTEE 8924 690016 0 35553 0 21100 0 10736 0 28908 8924 786313 0 0 MATTHEW S REEVES DO TRUSTEE / VP OPS AND CMO 302923 0 61588 0 20208 0 2183 0 20102 0 407004 0 0 0 RHONDA L SEIDENSCHMIDT TRUSTEE / VP OPERATIONS 160095 0 68867 0 1410 0 7372 0 17039 0 254783 0 0 0 DALE E CREECH JR SYS VP-CHF LGL OFFICER-TO JUL 0 226848 0 163898 0 321430 0 173749 0 24772 0 910697 0 0 THOMAS R CURTIN VP REVENUE CYCLE 0 255614 0 72332 0 6649 0 21583 0 33040 0 389218 0 0 GARY G GINTER VP &PREMIER CHIEF INFO OFFICER 0 397507 0 152860 0 3938 0 23309 0 26980 0 604594 0 0 JENNIFER J HAULER MD VP MEDICAL AFFAIRS&PREMIER CMO 0 518950 0 127987 0 1661 0 13812 0 2437 0 664847 0 0 BARBARA A JOHNSON SYS VP - HR OPERATIONS 0 387494 0 159514 0 28975 0 14183 0 10852 0 601018 0 0 RENEE M JOHNSON SYS VP-MANAGED CARE (FROM APR) 0 157107 0 27452 0 1103 0 12055 0 8834 0 206551 0 0 MARGARET W MARK VP NURSING SERVICE/PREMIER CNO 0 362886 0 216282 0 9343 0 12540 0 20228 0 621279 0 0 CRAIG SELF CHF STRATEGY OFFICER (TO NOV) 0 385642 0 369777 0 32358 0 332468 0 27546 0 1147791 0 0 MARK W SHAW SYS VP - MANAGED CARE (TO APR) 0 124054 0 136382 0 423240 0 59456 0 24387 0 767519 0 0 SCOTT A SHELTON SYS VP CPO-TO JUL/ PREMIER CFO 0 360128 0 122854 0 45012 0 15941 0 5131 0 549066 0 0 J MICHAEL SIMS SYS VP-TREAS & CORP CONTROLLER 0 288061 0 74913 0 38875 0 23763 0 29347 0 454959 0 0 KIM K STRAHL SYS VP & CPO (FROM JUL) 0 187401 0 78137 0 2631 0 22405 0 11625 0 302199 0 0 GEOFFREY P WALKER SYS VP-CHF LGL OFFICER-FRM JUL 0 317976 0 88247 0 20078 0 22722 0 25725 0 474748 0 0 DONNA L BANKS VP OPERATIONS 236033 0 84515 0 2236 0 10959 0 10355 0 344098 0 0 0 JOANNE R MORGAN SYSTEM VP - PHARMACY OPS 195172 0 34715 0 21477 0 11970 0 11365 0 274699 0 0 0 DOROTHY C PERRY DIRECTOR HUMAN RESOURCES 158210 0 24694 0 1474 0 5978 0 2613 0 192969 0 0 0 ROBYN S MYERS DEPARTMENT DIRECTOR 150648 0 19898 0 6081 0 7384 0 22122 0 206133 0 0 0 JAN E SCHUSTER SYSTEM DIRECTOR-LAB 149396 0 24029 0 2006 0 6912 0 13989 0 196332 0 0 0 RENEE P GEORGE FORMER KEY 0 383206 0 186870 0 1291 0 24090 0 13560 0 609017 0 0 TAMMY S LUNDSTROM MD FORMER KEY 0 215866 0 227220 0 2008 0 10115 0 858 0 456067 0 0 MICHAEL J MAIBERGER FORMER KEY 0 827405 0 361953 0 19436 0 16296 0 32374 0 1257464 0 0 MARK S SHAKER FORMER KEY 0 0 0 97534 0 717176 0 23763 0 2207 0 840680 0 0 JEFFREY S ZOLLETT MD FORMER OFFICER 0 150836 0 0 0 1780 0 6080 0 2578 0 161274 0 0 THOMAS R PARKER FORMER KEY 0 419601 0 152940 0 27557 0 36092 0 6916 0 643106 0 0 PART I, LINE 4A: THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT: CRAIG SELF RECEIVED $16,230 IN 2018 AND WILL RECEIVE $381,414 IN 2019; MARK SHAKER RECEIVED $583,003 IN 2018 AND WILL RECEIVE $11,212 IN 2019. THE FOLLOWING INDIVIDUALS WERE SELECTED TO PARTICIPATE IN A VOLUNTARY RETIREMENT PROGRAM AND RECEIVED THE FOLLOWING PAYMENTS IN 2018: DALE CREECH JR $205,770; MARK SHAW $247,000. PART I, LINE 4B: DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, CERTAIN PERSONS ARE LIMITED IN THE AMOUNT OF BENEFIT THAT CAN BE EARNED UNDER A QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, ATRIUM MEDICAL CENTER (AMC) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. AMC SUPPLEMENTS THE AFFECTED EXECUTIVES THROUGH A PENSION RESTORATION PLAN AND A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE BENEFITS UNDER THESE SUPPLEMENTAL NONQUALIFIED PLANS ARE SUBJECT TO MULTI-YEAR VESTING AND A PARTICIPANT CAN FORFEIT BENEFITS EARNED IF VESTING REQUIREMENTS ARE NOT SATISFIED. UNDER THE TERMS OF THE SUPPLEMENTAL PLANS, AND BECAUSE OF TAX RULES PERTAINING TO TAXATION OF THE EARNED BENEFITS UPON VESTING, CERTAIN INDIVIDUALS RECEIVED A PAYOUT OF THE CUMULATIVE VESTED BENEFITS UNDER THEIR SUPPLEMENTAL PLAN DURING 2018. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2018: DALE CREECH, JR $112,018; BARBARA JOHNSON $23,417; MARGARET MARK $1,276; MARK SHAKER $134,793; MARK SHAW $173,140; SCOTT SHELTON $40,846; MICHAEL SIMS $15,913; GEOFFREY WALKER $17,073. THERE WERE NO INDIVIDUALS WHO HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PLAN PAYMENT IN 2018. 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 $2,634; RENEE GEORGE $13,523; JENNIFER HAULER, M.D. $6,140; BARBARA JOHNSON $(1,815); TAMMY LUNDSTROM, M.D. $877; MARGARET MARK $3,852; THOMAS PARKER $12,494; CRAIG SELF $22,957; MARQUITA TURNER $2,207; MICHAEL UHL $10,312. BASED ON THE GUIDANCE PROVIDED IN THE INSTRUCTIONS TO THE FORM 990, ANY PAYMENTS TO THE PARTICIPANTS RELATED TO THESE PLANS THAT WERE MADE WITHIN 2-1/2 MONTHS AFTER THE END OF THE ORGANIZATION'S TAX YEAR ARE NOT TREATED AS DEFERRED COMPENSATION FOR PURPOSES OF SCHEDULE J. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. ANY PAYMENTS MADE AFTER THE 2-1/2 MONTHS WERE PROPERLY REPORTED ON PRIOR YEARS' FILED IRS FORM 990 RETURNS, DISCLOSING COMPENSATION EARNED BY THESE INDIVIDUALS UNDER THE PLANS FOR EACH SUCH YEAR. A CITY OF MIDDLETOWN OH 316000139 597146AH2 2008-11-21 111000000 REFUND SERIES 2007 A & B false false false B CITY OF MIDDLETOWN OH 316000139 597146AP4 2016-08-31 86392792 REFUND SERIES 2010 false false false A 28450000 0 111000000 0 0 0 1513169 0 0 0 109486832 0 2008 true false true true B 3452792 0 86392792 0 0 0 400067 0 0 0 85992725 0 2010 true false true true A false true false true true 0.00045 0.00163 0.00209 false false false true B false false false true true 0.00045 0.00163 0.00209 false false false true A false false false true true true MERRYL LYNCH 20.9 true false false 0 false true B false true false false true BARCLAYS 26.9 false false false 0 false true A true B true PART IV ARBITRAGE - LINE 2C: Computation date is November 13, 2018 for the series 2008 A&B BARBARA STEEL MD TRUSTEE 296025 APPLIED BLOOD MANAGEMENT, LLC false FORM 990, PART VI, SECTION A, LINE 3: PREMIER HEALTH (PREMIER) AS THE OPERATOR OF ATRIUM MEDICAL CENTER (AMC) DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR AMC, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. AMC SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. AMC SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. AMC SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF AMC WITH ALL THIRD-PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. AMC 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. AMC MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN PREMIER'S ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 4: IN 2018, ATRIUM MEDICAL CENTERS (AMC) CODE OF REGULATIONS WERE MODIFIED. LISTED BELOW ARE THE SIGNIFICANT CHANGES: * THE SOLE MEMBER OF THE CORPORATION SHALL BE PREMIER, WHICH SHALL BE AN OHIO NONPROFIT CORPORATION. * IN THE EVENT OF DISSOLUTION OF THE CORPORATION, THE BOARD OF TRUSTEES AFTER PAYING OR MAKING PROVISION FOR THE PAYMENT OF ALL OF THE LIABILITIES OF THE CORPORATION, SHALL DISTRIBUTE, IN ANY PROPORTIONS CONSIDERED PRUDENT, ALL OF THE ASSETS OF THE CORPORATION TO PREMIER, IF THEN IN EXISTENCE AND IF QUALIFIED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION A, LINE 6: ATRIUM MEDICAL CENTER HAS ONE CORPORATE MEMBER; PREMIER, AN OHIO NON-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINES 7A & 7B: PREMIER HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR ATRIUM MEDICAL CENTER (AMC). PREMIER HAS THE AUTHORITY TO REMOVE SUCH TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. FORM 990, PART VI, SECTION B, LINE 11B: THIS 990 FILING AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE TAX DEPARTMENT OF PREMIER, OF WHICH ATRIUM MEDICAL CENTER IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE TAX MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. THE RETURN IS CONCURRENTLY SENT TO ERNST & YOUNG U.S. LLP FOR THEIR REVIEW. AFTER ALL CHANGES FROM THE ABOVE GROUPS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER AND THE CHIEF FINANCIAL OFFICER OF THIS ENTITY. A FINAL VERSION OF THE RETURN IS SENT TO ERNST & YOUNG U.S. LLP FOR A FINAL REVIEW AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT A BOARD OF TRUSTEES MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESSES ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 FILING IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, LINE 12C: PREMIER, WITH WHICH ATRIUM MEDICAL CENTER IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, MEDICAL DIRECTORS, SUPPLY CHAIN DIVISION MEMBERS, AUTHORIZED SIGNERS, DIRECTORS, EXECUTIVES, MEDICAL EXECUTIVE COMMITTEE MEMBERS, MEDICAL DEPARTMENT AND SECTION CHAIRS, PHYSICIAN PARTNERSHIP COMMITTEE MEMBERS, PHYSICIAN GUIDANCE GROUP MEMBERS, AND ALL EMPLOYED PHYSICIANS TO ANNUALLY REVIEW THE PREMIER COMPREHENSIVE CONFLICT OF INTEREST STATEMENT, AN EXPLANATORY MEMORANDUM, THE ANTITRUST COMPLIANCE POLICY, AND COMPLETE AN INDIVIDUAL QUESTIONNAIRE DISCLOSING ANY POTENTIAL CONFLICTS AS DEFINED IN THE CONFLICT OF INTEREST POLICY. THIS IS ACCOMPLISHED EITHER BY WAY OF AN ELECTRONIC COMMUNICATION SENT OUT DIRECTLY BY THE CORPORATE COMPLIANCE DEPARTMENT OR BY WAY OF A MEMO SENT OUT FROM THE CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER OF PREMIER. IT ALSO INCLUDES AN EXPLANATORY MEMORANDUM OF SPECIFIC ACTIVITIES THAT MIGHT GIVE CAUSE TO A CONFLICT AND AN INDIVIDUAL QUESTIONNAIRE TO DISCLOSE ALL SUCH ACTIVITIES. THIS QUESTIONNAIRE MUST BE COMPLETED AND SIGNED BY THE INDIVIDUAL. THIS CORRESPONDENCE INCLUDES A COPY OF THE ANTITRUST COMPLIANCE POLICY THAT MUST BE SIGNED BY THE INDIVIDUAL. ALL OF THESE DOCUMENTS ARE SENT TO THE CORPORATE COMPLIANCE DEPARTMENT. THE CORPORATE COMPLIANCE DEPARTMENT ENSURES ALL FORMS ARE RETURNED AND RETAINS THE DOCUMENTS FOR FIVE YEARS. IN ADDITION, AT EACH MEETING OF THE BOARD OR ANY BOARD COMMITTEE, FOLLOWING APPROVAL OF THE PREVIOUS MEETING'S MINUTES, THE BOARD OR COMMITTEE CHAIR SHALL REQUEST ANY BOARD MEMBER WHO PERCEIVES A POTENTIAL CONFLICT OF INTEREST ON ANY OF THE MEETING'S AGENDA ITEMS TO DISCLOSE THE POTENTIAL CONFLICT. ADDITIONALLY, AT ANY BOARD OR BOARD COMMITTEE MEETING WHERE THE SUBJECT OF CONFLICT OF INTEREST IS DISCUSSED, THE MINUTES SHALL CONTAIN THE NAME OF THE PARTY DISCUSSING A POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE POTENTIAL CONFLICT OF INTEREST AND WHETHER A CONFLICT OF INTEREST WAS FOUND TO EXIST. IF A CONFLICT OF INTEREST IS DETERMINED BY THE BOARD TO EXIST, THE MEMBER WILL BE EXCUSED FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON THE PARTICULAR AGENDA ITEM. THE CHIEF COMPLIANCE AND ENTERPRISE RISK OFFICER REPORTS THE RESULTS OF THE PREMIER CONFLICT OF INTEREST QUESTIONNAIRES NO LESS THAN ANNUALLY TO THE BOARD OF TRUSTEES BY WAY OF THE COMPLIANCE AND AUDIT COMMITTEE. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE MEETING. PERIODICALLY, THE INTERNAL AUDIT DEPARTMENT WILL REVIEW A SAMPLE OF COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND REPORT THE RESULTS TO THE COMPLIANCE AND AUDIT COMMITTEE. THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE INDIVIDUALLY SUMMARIZED IN A DOCUMENT AND SENT ELECTRONICALLY TO THE FINANCE DEPARTMENT FOR ANY NECESSARY DISCLOSURES REQUIRED ON THE 990 FILING. FORM 990, PART VI, SECTION B, LINES 15A AND 15B: COMPENSATION FOR ATRIUM MEDICAL CENTER'S (AMC) CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH AMC 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: PENSION FASB 158 ADJUSTMENT (23,438,670) FOUNDATION ADJUSTMENT (589,494) TRANSFER FROM AFFILIATE 183,587 EQUITY TRANSFERS TO AFFILIATES 15,415,598 ------------ TOTAL (8,428,979) PREMIER HEALTH PARTNERS (PREMIER) 110 N MAIN ST 500 DAYTON OH 45402 311446699 PARENT OH 501(C)(3) 12B NA false ATRIUM HEALTH SYSTEM (AHS) 110 N MAIN ST 500 DAYTON OH 45402 310537492 SUPPORT ORG OH 501(C)(3) 12B NA false MedAmerica Health Systems Co (MAHS) 110 N MAIN ST 500 DAYTON OH 45402 311040228 SUPPORT ORG OH 501(C)(3) 12B NA false MIAMI VALLEY HOSPITAL 110 N MAIN ST 500 DAYTON OH 45402 310537504 HOSPITAL OH 501(C)(3) 3 PREMIER false Miami Valley Hospital Foundation 110 N Main St 500 DAYTON OH 45402 311040231 FOUNDATION OH 501(C)(3) 7 PREMIER false Fidelity Health Care Inc (FHC) 110 N MAIN ST 500 DAYTON OH 45402 311075381 HOME HEALTH OH 501(C)(3) 10 PREMIER false Premier Community Health 110 N MAIN ST 500 DAYTON OH 45402 311122883 HEALTH EDUCAT OH 501(C)(3) 10 FHC false Samaritan Health Partners (SHP) 110 N Main St 500 DAYTON OH 45402 311107411 SUPPORT ORG OH 501(C)(3) 12B PREMIER false Good Samaritan Hospital (GSH) 110 N Main St 500 DAYTON OH 45402 310536981 HOSPITAL OH 501(C)(3) 3 PREMIER false Good Samaritan Hospital Foundation - Day 110 N Main St 500 DAYTON OH 45402 237296923 FOUNDATION OH 501(C)(3) 7 PREMIER false Heart Institute of Dayton 110 N Main St 500 DAYTON OH 45402 300502367 EDUCATION OH 501(C)(3) 10 PREMIER false Samaritan Behavioral Health Inc 110 N Main St 500 DAYTON OH 45402 020633634 BEHAVORIAL HE OH 501(C)(3) 7 PREMIER false UVMC 110 N Main St 500 DAYTON OH 45402 341850683 SUPPORT ORG OH 501(C)(3) 12B NA false Upper Valley Medical Center 110 N Main St 500 DAYTON OH 45402 310537095 HOSPITAL OH 501(C)(3) 3 PREMIER false Upper Valley Professional Corp (UVPC) 110 N Main St 500 DAYTON OH 45402 311400963 HEALTH CARE OH 501(C)(3) 10 PREMIER false UVPC Specialists Inc 110 N Main St 500 DAYTON OH 45402 203687536 HEALTH CARE OH 501(C)(3) 10 UVPC false UVMC Nursing Care Inc 110 N Main St 500 DAYTON OH 45402 311224064 NURSING HOME OH 501(C)(3) 10 PREMIER false Premier Plaza LLC 110 N Main St 500 DAYTON OH 45402 800708185 HOLDING CO OH MAHS EXCLUDED 0 0 false 0 false 0.00000 SW OHIO NEONATAL COLLABORATIVE LLC 110 N Main St 500 DAYTON OH 45402 463231330 NEONATOLOGY OH MVH RELATED 0 0 false 0 false 0.00000 Samaritan North Surgery Center 9000 N Main St DAYTON OH 45415 311618587 O/P SURGERY OH GSH RELATED 0 0 false 0 false 0.00000 Compunet Clinical Laboratories LLC 2308 Sandridge Dr MORAINE OH 45439 311258010 MEDICAL LABS OH MVHE INC RELATED 0 0 false 0 false 0.00000 Sweitzer Street LLC 110 N Main St 1250 DAYTON OH 45402 454700417 REAL ESTATE OH MVHE INC EXCLUDED 0 0 false 0 false 0.00000 Sweitzer MOB LLC 110 N Main St 1250 DAYTON OH 45402 474554657 REAL ESTATE OH MVHE INC EXCLUDED 0 0 false 0 false 0.00000 MVHE INC 110 N Main St 400 DAYTON OH 45402 311185270 PHYSICIAN SVCS OH PREMIER HOLDING C CORP 0 0 0.00000 false Premier Health Specialists 110 N Main St 400 DAYTON OH 45402 061744704 PHYSICIAN SVCS OH PREMIER HOLDING C CORP 0 0 0.00000 false Samaritan Family Care 110 N Main St 400 DAYTON OH 45402 311299450 PHYSICIAN SVCS OH PREMIER HOLDING C CORP 0 0 0.00000 false After Hours Family Care 110 N Main St 500 DAYTON OH 45402 311269483 HEALTH CARE OH UVPC C CORP 0 0 0.00000 false UVMC Management Corp 110 N Main St 500 DAYTON OH 45402 311360489 MANAGEMENT CO OH PREMIER C CORP 0 0 0.00000 false Premier Health Urgent Care Inc 110 N Main St 900 DAYTON OH 45402 822079409 URGENT CARE OH PREMIER HOLDING C CORP 0 0 0.00000 false Premier Health Plan Inc 110 N Main St 500 DAYTON OH 45402 463024049 HEALTH INSURANCE OH PHIC C CORP 0 0 0.00000 false Premier Health ACO of Ohio 110 N Main St 500 DAYTON OH 45402 474049773 MEDICARE ACO OH PREMIER C CORP 0 0 0.00000 false Premier Health Holding (premier holding) 110 N Main St 400 DAYTON OH 45402 812419110 HOLDING CO OH PREMIER C CORP 0 0 0.00000 false Premier Health Insuring Co (PHIC) 110 N Main St 500 DAYTON OH 45402 464766841 HEALTH INSURANCE OH PREMIER C CORP 0 0 0.00000 false false true true false false false false false false true false false false false false true true true true