2019-11-15T07:42:43-06:00 2018-12-31 ERNST & YOUNG US LLP 221 E 4TH STREET SUITE 2900 Cincinnati OH 45202 990 2018-01-01 310536981 GOOD SAMARITAN HOSPITAL % J MICHAEL SIMS GOOD 9374999942 110 N MAIN ST 500 DAYTON OH 45402 TIMOTHY D SNIDER TREASURER / CFO 9374999942 2019-10-18 true JULIE L SPARKS P01268401 5136121400 108.206.163.59 31499120193195000011 2019-11-15 P 770194AAF055F9EA87E64CA02E08FE540289067F 770194AAF055F9EA87E64CA02E08FE540289067F 2018 2020-03-31 21:24:44Z J MICHAEL SIMS 110 N MAIN ST 500 DAYTON OH 45402 289015353 false 0928 X WWW.PREMIERHEALTH.COM X 1932 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. X 7 2 3056 118 90459 -19931 370968 227482 382542402 154114624 7043536 4586933 3455170 1683565 393412076 160612604 3144614 1489125 0 0 155097700 92676625 0 0 0 250320350 119555613 408562664 213721363 -15150588 -53108759 324444512 43357685 45607690 37779215 278836822 5578470 X WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. false true 185076695 1489125 154114624 THE PRIMARY EXEMPT PURPOSE OF GOOD SAMARITAN HOSPITAL WAS TO PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES TO THE RESIDENTS OF MONTGOMERY AND THE SURROUNDING COUNTIES. THE HOSPITAL FURTHERS ITS TAX-EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN MANY WAYS. SEE SCHEDULE H AND SCHEDULE O, PART III, LINE 3 FOR MORE INFORMATION. 185076695 true true false true false false false false false false true false false true true true false true false false true false false false false false true true true false true false false false false false false true false false false false true false true false false false true 152 0 true 3056 true true true false false false false false false false false false false false X 7 2 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 MARTIN FUJIMURA MD BOARD CHAIR 0.5 0.5 X X 0 0 0 ELOISE P BRONER PRESIDENT & CEO (TO JUL) 38.5 1.5 X X 616049 227114 28702 CAROL BAUER SC TRUSTEE 39.0 1.0 X 0 0 0 MARY H BOOSALIS TRUSTEE & PREMIER PRES & CEO 0.5 39.5 X 0 1877611 40298 GEORGE T BRODERICK JR MD TRUSTEE 0.5 39.5 X 2601 779409 22123 MARK OXMAN DO TRUSTEE & MED STAFF PRESIDENT 0.5 0.5 X 110000 0 0 LASZLO TOTH MD TRUSTEE 0.5 39.5 X 0 452187 40204 DALE E CREECH JR CLO (TO JUL) & BOARD SECRETARY 7.5 32.5 X 0 712176 198521 MARY E GARMAN COO GSH NORTH (TO JUL) 40.0 0.0 X 383462 0 10779 TIMOTHY D SNIDER BOARD TREASURER / CFO (TO JUL) 7.0 33.0 X 0 311990 36292 THOMAS R CURTIN SYSTEM 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 KATHLEEN M HARPER VP NORTH OPERATIONS (TO JUL) 40.0 0.0 X 109416 177971 26655 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 SYSTEM VP - CPO 8.0 32.0 X 0 527994 21072 J MICHAEL SIMS SYS VP-TREAS & CORP CONTROLLER 7.5 32.5 X 0 401849 53110 KIM K STRAHL SYS VP & CPO (FROM JUL) 8.0 32.0 X 0 268169 34030 GEOFFREY P WALKER SYSTEM VP - CLO (FROM JUL) 8.0 32.0 X 0 426301 48447 SHARON K THORNTON ERP OPERATIONS LEADER 40.0 0.0 X 242157 0 18403 JASON E MERRITT DIR NURSING-EMERG SVCS(TO APR) 40.0 0.0 X 58065 161772 13876 JEFFERY A MORNEAULT DIR SURGICAL SERVICES (TO APR) 40.0 0.0 X 71857 142552 34999 DARLENE WISEMAN VP FINANCE - SUPPORT SERVICES 40.0 0.0 X 213595 0 38657 CHRISTOPHER W SNIDER DIR FACILITIES SVCS (TO JUL) 40.0 0.0 X 99797 66606 8879 RENEE P GEORGE FORMER KEY EMPLOYEE 0.0 40.0 X 0 571367 37650 TAMMY S LUNDSTROM MD FORMER KEY EMPLOYEE 0.0 40.0 X 0 445094 10973 MICHAEL J MAIBERGER FORMER KEY EMPLOYEE 0.0 40.0 X 0 1208794 48670 THOMAS R PARKER FORMER KEY EMPLOYEE 0.0 40.0 X 0 600098 43008 DANIEL L SCHOULTIES MD FORMER KEY EMPLOYEE 0.0 40.0 X 0 100164 0 MARK S SHAKER FORMER KEY EMPLOYEE 0.0 0.0 X 0 814710 25970 1906999 14633035 1485028 11 true true false SHOOK CONSTRUCTION 4977 NORTHCUTT PLACE DAYTON OH 45414 CONSTRUCTION 22091126 DAWSON HEALTHCARE 1114 DUBLIN RD COLUMBUS OH 43215 AGENCY STAFF 8313238 EMERGENCY PROFESSIONAL SERVICES INC 307 S EVERGREEN AVE WOODBURY NJ 08096 MEDICAL SERVICES 4076895 CATHOLIC HEALTH INITIATIVES 3900 OLYMPIC BLVD 400 ERLANGER KY 41018 CLINICAL ENGINEERING 3692623 ANESTHESIOLOGY SERVICES 1 WYOMING ST 3SW TOWER DAYTON OH 45409 MEDICAL SERVICES 2357439 49 227482 227482 NET PATIENT REVENUE 621110 78191187 78100728 90459 MEDICARE/MEDICAID 621110 71313950 71313950 FRANCHISE TAX RECOVERIES 621110 4565730 4565730 HEALTH EDUCATION 561499 32092 32092 ATHLETIC PERFORMANCE / TRAINING 561499 9220 9220 2445 2445 154114624 1187465 1187465 0 0 3054421 3029650 24771 0 24771 24771 127142620 1351900 123547513 1547539 3595107 -195639 3399468 3399468 0 0 0 0 0 0 371059 278047 93012 93012 CAFETERIA 721100 1096400 1096400 PARKING GARAGE 812930 105453 105453 RETAIL LAUNDRY 812320 24754 24754 339175 339175 1565782 160612604 154024165 90459 6270498 1489125 1489125 0 0 0 1260194 627789 632405 0 194098 194098 73466548 58825255 14641293 5414251 4310477 1103774 6451273 5136088 1315185 5890261 4135549 1754712 43939 34981 8958 413596 413596 253063 253063 21524 21524 0 191323 191323 20629823 17267259 3362564 3482370 3482370 1283761 525105 758656 10332686 8226218 2106468 0 3980953 3402671 578282 145054 59561 85493 0 2291 610 1681 168034 168034 0 15437767 15437767 661348 383920 277428 OPERATING SUPPLIES 25326223 25326223 ASSET IMPAIRMENT 20523683 20523683 PURCHASED SERVICES 9587773 9263722 324051 HOSPITAL FRANCHISE TAX 4271707 4271707 2798695 1962959 835736 213721363 185076695 28644668 0 17690 0 7684524 4496332 0 0 45398455 5010201 0 0 0 0 1309081 0 4571313 0 3303000 4050155 285917931 270946252 118327355 14971679 64250782 9279185 11344123 0 0 0 3376413 2831129 64861776 2719004 324444512 43357685 23668348 9316838 1059334 0 428016 1912368 0 0 0 0 0 0 3855352 754171 0 0 16596640 25795838 45607690 37779215 X 278836822 5578470 0 0 0 0 278836822 5578470 324444512 43357685 X -53108759 -4274289 -60000 -215815304 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 15044 false false true 6480 21524 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. 1940831 1940831 198202258 198202258 0 220668 220668 0 80695137 67664289 13030848 4859037 4859037 0 14971679 HCAP ACCRUAL 1535020 OTHER A/R 893574 DEFERRED COMPENSATION 249918 AFFILIATES INVESTMENT 30000 OTHER ASSETS 10492 2719004 0 AFFILIATES PAYABLE 17104304 MALPRACTICE INSURANCE 7842365 WORKERS COMPENSATION RESERVE 599251 DEFERRED COMPENSATION 249918 25795838 X PART X, LINE 2: THE FOLLOWING FOOTNOTE IS FROM THE 2018 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS A MEMBER OF GOOD SAMARITAN HOSPITAL (GSH). 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 Program Services INSURANCE 27000 27000 27000 false false false false false false true true X true X true X true true false true true 3104000 3075000 29000 0.00010 35744730 23083730 12661000 0.05920 1284000 803000 481000 0.00230 40132730 26961730 13171000 0.06160 421983 3983 418000 0.00200 7967000 7967000 0 0.00000 5369000 5369000 0.02510 1113000 1113000 0.00520 14870983 7970983 6900000 0.03230 55003713 34932713 20071000 0.09390 12000 12000 0.00010 12000 12000 0.00010 true 5004081 32274000 43034000 -10760000 X true true SAM NORTH SURG CTR SURGICAL SERVICES 0.8 0.0 0.2 1 1 GOOD SAMARITAN HOSPITAL 2222 PHILADELPHIA DR Dayton Ohio OH 45406 WWW.PREMIERHEALTH.COM SEE PART V SEC C X X X X Good Samaritan Hospital 1 false false true X X X X X X X X X 16 true true true true X SEE PART V, SECTION C X true 17 true SEE PART V, SECTION C false true X 200. 300. X X true true X X X true X SEE PART V, SEC C X SEE PART V, SEC C X SEE PART V, SEC C X X X X X X X true X false X X X X true X false false PART V, SECTION B, 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. GOOD SAMARITAN'S REGISTRATION NUMBER IS 1245. PART V, SECTION B, LINE 3E: GOOD SAMARITAN HOSPITALS 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 GOOD SAMARITAN HOSPITAL, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, DAYTON-MONTGOMERY COUNTY PUBLIC HEALTH DEPARTMENT, DARKE COUNTY GENERAL HEALTH DISTRICT, MIAMI COUNTY PUBLIC 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: GOOD SAMARITAN HOSPITAL PARTNERED WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, DAYTON-MONTGOMERY COUNTY PUBLIC HEALTH DEPARTMENT, DARKE COUNTY GENERAL HEALTH DISTRICT, MIAMI COUNTY PUBLIC 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 DIRECT 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: GOOD SAMARITAN HOSPITAL (GSH), AS A MEMBER OF THE PREMIER HEALTH 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, DAYTON-MONTGOMERY COUNTY PUBLIC HEALTH, DARKE COUNTY GENERAL HEALTH DISTRICT, MIAMI COUNTY PUBLIC HEALTH, AND AN INDEPENDENT CONSULTANT TO PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT. BASED ON THE RESULTS OF THIS ASSESSMENT, GSH ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE FOLLOWING PRIORITIZED NEEDS: * BIRTH OUTCOMES * BEHAVIORAL HEALTH/SUBSTANCE ABUSE * CHRONIC DISEASES HEALTH ISSUE: BIRTH OUTCOMES -------------- GSH WILL IMPROVE THE HEALTH AND WELL-BEING OF WOMEN AND INFANTS WITH THE "CENTERINGPREGNANCY" PROGRAM. THIS PROGRAM IS DEVELOPED BY THE CATHOLIC SOCIAL SERVICES AND PROVIDES GROUP PRENATAL CARE AND HOME VISITS. LIFESTAGES SAMARITAN CENTERS FOR WOMEN OPERATES "CENTERINGPREGNANCY" AT GSH AND GOOD SAMARITAN NORTH HEALTH CENTER (GSHN). ADDITIONAL FEATURES INCLUDE SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT (SBIRT), DEPRESSION SCREENING, AND TRANSPORTATION AND CHILDCARE VOUCHERS. THE PROGRAM TARGETS WOMEN WHO LIVE IN THE ZIP CODES WHERE THE MOST INFANT DEATHS HAVE OCCURRED. THIS PROGRAM LEVERAGES RESOURCES FROM LIFESTAGES SAMARITAN CENTERS FOR WOMEN, CATHOLIC SOCIAL SERVICES OF THE MIAMI VALLEY, FIVE RIVERS HEALTH CENTER FOR WOMEN'S HEALTH, GSHN, MONTGOMERY COUNTY INFANT MORTALITY COALITION, AND OHIO PERINATAL QUALITY COLLABORATIVE. THE FAMILY BIRTHING CENTER AND LIFESTAGES SAMARITAN CENTERS FOR WOMEN AT GSH WORK WITH A TEAM OF OTHER COMMUNITY ORGANIZATIONS TO INCREASE THE NUMBER OF WOMEN WHO BREASTFEED THEIR BABIES. THE OBJECTIVES ARE 1) TO INCREASE THE FREQUENCY OF EDUCATION ABOUT BREASTFEEDING BEFORE BIRTH, AND 2) TO PROVIDE LACTATION SUPPORT AFTER BIRTH. BREASTFED CHILDREN HAVE FEWER ILLNESSES AND LESS RISK OF SUDDEN INFANT DEATH SYNDROME, CHILDHOOD CANCERS, AND DIABETES. MOTHERS HAVE LESS RISK OF BREAST CANCER, OVARIAN CANCER, ANEMIA, AND OSTEOPOROSIS. THE FAMILY SAVES MONEY SINCE BREAST MILK IS READILY AVAILABLE AND FREE. THE MOTHER AND HER SIGNIFICANT OTHER OR PERSON OF CHOICE (GRANDPARENT, FRIEND) ARE ENCOURAGED TO ATTEND MONTHLY BREASTFEEDING CLASSES. THIS IS IMPORTANT TO COMBAT MYTHS THAT SURROUND BREASTFEEDING. MOTHERS NEW TO BREASTFEEDING BENEFIT FROM LACTATION CONSULTING AFTER BIRTH AND AT HOME. GSH HAS BEEN RECOGNIZED AS A FIVE-STAR HOSPITAL THROUGH THE "TEN STEPS FOR SUCCESSFUL BREASTFEEDING" PROMOTION BY BABY FRIENDLY USA AS PART OF THE OHIO FIRST STEPS FOR HEALTHY BABIES, A COLLABORATIVE OF THE OHIO HOSPITAL ASSOCIATION AND THE OHIO DEPARTMENT OF HEALTH. OTHER TEAM MEMBERS INCLUDE PREMIER COMMUNITY HEALTH, CATHOLIC SOCIAL SERVICES OF THE MIAMI VALLEY, WIC, AND OHIO FIRST STEPS FOR HEALTHY BABIES. HEALTH ISSUE: BEHAVIORAL HEALTH / SUBSTANCE ABUSE ----------------------------------- GSH WILL PROVIDE EDUCATION THAT ADDICTION IS A DISEASE, AND AS A RESULT, CHANGE PERCEPTIONS FIRST OF HOSPITAL PERSONNEL AND MEDICAL PROFESSIONALS, AND THEN OF THE COMMUNITY. THE OBJECTIVES ARE 1) TO PROVIDE CEU'S TO FRONT-LINE STAFF AND PHYSICIANS FOR EDUCATION ON THIS TOPIC, WITH CURRICULUM DELIVERED BY ADAMHS, AND 2) TO EDUCATE HEALTH MINISTRIES STAFF IN A 'TRAIN THE TRAINER' APPROACH SO THEY CAN PROVIDE TRAINING THROUGH A NETWORK OF HUNDREDS OF CHURCHES. IN ADDITION TO ASSISTANCE FROM THE ADAMHS BOARD, RESOURCES WILL BE OBTAINED FROM HEALTH MINISTRIES, SAMARITAN BEHAVIORAL HEALTH, INC., PHYSICIAN PRACTICES, AND LOCAL CHURCHES. HEALTH ISSUE: CHRONIC DISEASES ---------------- GSH WILL WORK WITH THE AMERICAN HEART ASSOCIATION AND THE HEART INSTITUTE OF DAYTON TO TRAIN MORE PEOPLE IN HOW TO PROVIDE CPR THROUGH INSTALLATIONS OF EDUCATIONAL KIOSKS IN CERTAIN PUBLIC AREAS. AN INTERACTIVE KIOSK FEATURES A TOUCH SCREEN WITH A VIDEO PROGRAM THAT GIVES A BRIEF "HOW-TO" FOLLOWED BY A PRACTICE SESSION AND A 30-SECOND CPR TEST. WITH THE HELP OF A RUBBER TORSO, THE KIOSK GIVES FEEDBACK ABOUT THE DEPTH AND RATE OF COMPRESSIONS AND PROPER HAND PLACEMENT - FACTORS THAT INFLUENCE THE EFFECTIVENESS OF CPR. THE KIOSK IS AN INTERACTIVE TRAINING OPPORTUNITY WITH NO ON-SITE STAFF. MORE WIDESPREAD CPR TRAINING IS IMPORTANT BECAUSE ONLY ABOUT 46 PERCENT OF PEOPLE WHO EXPERIENCE AN OUT-OF-HOSPITAL CARDIAC ARREST GET THE HELP THEY NEED BEFORE THE AMBULANCE ARRIVES. SURVIVAL RATES DROP AS MUCH AS 10 PERCENT FOR EACH MINUTE WITHOUT INTERVENTION. THE SECOND CHRONIC ISSUE TARGETED BY GSH IS FOOD HARDSHIPS IN THE COMMUNITY. ACCORDING TO THE FOOD RESEARCH & ACTION CENTER, DAYTON RANKED 11TH OUT OF 109 METROPOLITAN AREAS FOR HOUSEHOLDS EXPERIENCING FOOD HARDSHIP. TO ADDRESS THIS NEED, THE HOSPITAL WILL WORK WITH OTHER COMMUNITY ORGANIZATIONS 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) FOOD ASSISTANCE BENEFITS, AND 2) TO INCREASE THE AVAILABILITY OF FRESH PRODUCE IN PARTNERSHIP WITH LOCAL FOOD PANTRIES AND FARMERS. THE HOSPITAL MAY BEGIN SCREENING FOR HUNGER TO ASCERTAIN THE SCOPE OF THE PROBLEM. IF DETERMINED FEASIBLE, GSH, ALONG WITH ITS AFFILIATES IN PREMIER HEALTH, WOULD CREATE A FOOD PHARMACY, OR SIMILAR PRESCRIPTION FOR FOOD PROGRAM BY 2019. A FOOD PHARMACY ACCEPTS PEOPLE WITH A PHYSICIAN REFERRAL AND OFFERS TWO TO THREE DAYS' WORTH OF FOOD PER VISIT. PATIENTS CAN RETURN TO THE FOOD PHARMACY ONCE PER MONTH FOR UP TO SIX MONTHS, AT WHICH TIME THEY CAN RETURN TO THEIR PHYSICIAN FOR ANOTHER REFERRAL IF THEY ARE STILL IN NEED. OTHER SERVICES MAY INCLUDE NUTRITION COUNSELING, COOKING CLASSES, AND CONNECTION TO COMMUNITY RESOURCES. GSH WILL COLLABORATE WITH DAYTON-MONTGOMERY COUNTY FOOD & HUNGER COALITION, CATHOLIC SOCIAL SERVICES OF THE MIAMI VALLEY FOOD PANTRY, GRACE CHURCH, SINCLAIR COLLEGE, SNAP, AND WIC IN THIS MISSION. GOOD SAMARITAN HOSPITAL 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 THE THREE SHARED 7 GOOD SAMARITAN NORTH HEALTH CENTER 9000 N MAIN ST DAYTON OH 45415 GENERAL MEDICAL AND SURGICAL SAMARITAN NORTH SURGERY CENTER 9000 N MAIN ST DAYTON OH 45415 GENERAL MEDICAL AND SURGICAL GOOD SAMARITAN HEALTH CTR-HUBER HEIGHTS 6521 GOOD SAMARITAN WAY BRANDT PIKE HUBER HEIGHTS OH 45424 GENERAL MEDICAL AND SURGICAL GSH Medical Imaging - Needmore 1530 Needmore Road Suite 200 30 Dayton OH 45414 X-ray GSH Medical Imaging - Beavercreek 2619 Commons Blvd - Suite 102 Beavercreek OH 45431 X-Ray GSH Medical Imaging - Greenville 742 Sweitzer Street Suite 3 Greenville OH 45331 Echocardiograms & X-Rays Samaritan SleepDiabetes Center 80 East Woodbury Dayton OH 45415 Joint Sleep & Diabetes Center PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT FOR GOOD SAMARITAN HOSPITAL IS PART OF THE PREMIER HEALTH REPORT (EIN# 31-1446699). PART I, LINE 7: A COST TO CHARGE RATIO WAS USED TO CALCULATE THIS FINANCIAL ASSISTANCE AT COST. THIS CALCULATION TAKES TOTAL OPERATING EXPENSES LESS OTHER OPERATING REVENUES DIVIDED BY TOTAL GROSS REVENUES. UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENTAL PROGRAMS WERE CALCULATED USING A COST ACCOUNTING SYSTEM. THIS SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND INCLUDES FULLY LOADED COSTS. FOR THE REMAINING ITEMS THE ORGANIZATION USED SPECIFIC NUMBERS FOR EXPENSE PAID DIRECTLY FOR THESE SERVICES. PART I, LINE 7G: GOOD SAMARITAN HOSPITAL PROVIDED SUBSIDIZED EMERGENCY SERVICES BY OPERATING A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THIS EMERGENCY ROOM WAS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL INCURRED 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 $5,369,000. PART II: GOOD SAMARITAN HOSPITAL (GSH) 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, GSH FOCUSES ON FOUR AREAS OF SERVICE: --INVESTING IN THE COMMUNITY --PREVENTION AND WELLNESS --COMMITMENT TO THE UNDER-SERVED --COMMUNITY ENGAGEMENT THE PROGRAMS SUPPORTED BY GSH DURING 2018 INCLUDED FUNDING OF $12,000 WAS CONTRIBUTED TO ASSIST THOSE LIVING IN POVERTY TO WORK TOWARDS ECONOMIC SELF-SUFFICIENCY THROUGH EMPLOYMENT. 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 $34,410,000 AND INCURRED COST OF $49,297,000, FOR AN ADDITIONAL NET SHORTFALL OF $14,887,000 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 $32,274,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $34,410,000 TOTAL MEDICARE ASSOCIATED REVENUE $66,684,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT IN PART III, SECTION B $43,034,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $49,297,000 TOTAL MEDICARE ASSOCIATED COST $92,331,000 MEDICARE SHORTFALL PER PART III, SECTION B $10,760,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $14,887,000 TOTAL MEDICARE SHORTFALL $25,647,000 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 54% 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 HEALTH, THE HOSPITAL BOARD OF TRUSTEES, EXECUTIVE MANAGEMENT, MANAGERS, STAFF MEMBERS, COMMUNITY GROUPS, AND INDIVIDUALS TO PROVIDE A COLLABORATIVE APPROACH TO THE GOVERNANCE AND MANAGEMENT OF COMMUNITY BENEFIT ACTIVITIES. PART VI, LINE 3: THERE ARE SEVERAL WAYS IN WHICH OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR SERVICES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FIRST, NOTIFICATION OF SUCH AVAILABLE ASSISTANCE IS CLEARLY POSTED IN REGISTRATION AREAS, AS WELL AS MATERNITY AND EMERGENCY DEPARTMENTS. NEXT, PATIENT ADVOCATES, PATIENT ACCESS STAFF MEMBERS, AND FINANCIAL COUNSELORS IN THE INPATIENT AND EMERGENCY DEPARTMENTS MEET WITH UNINSURED AND UNDERINSURED PATIENTS, AND THOSE WITH ONLY MEDICARE COVERAGE TO DISCUSS ELIGIBILITY FOR ASSISTANCE. FINANCIAL COUNSELORS ALSO DISCUSS OPTIONS TO RESOLVE UNPAID ACCOUNT BALANCES WITH UNINSURED AND UNDERINSURED PATIENTS. THE FINANCIAL ASSISTANCE 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: THE ORGANIZATION IS LOCATED IN DAYTON, OHIO. OUR TARGET POPULATION INCLUDES CITIZENS OF DAYTON, AS WELL AS SURROUNDING COMMUNITIES. A LARGE POPULATION OF OUR PATIENTS ARE INDIGENT. AS COMPANIES CONTINUE TO MOVE OUT OF THE DAYTON MARKET, WE CONTINUE TO SEE HIGHER UNEMPLOYMENT RATES AND THEREFORE, MORE UNINSURED CITIZENS. UNEMPLOYMENT RATES ARE APPROXIMATELY 5% FOR MONTGOMERY COUNTY. THE ORGANIZATION IS COMMITTED TO SUPPORTING THE COMMUNITY AS WE FACE THESE CHALLENGES THROUGH VARIOUS PROGRAMS. OUR MAJOR STRATEGIES INCLUDE WORKING WITH THE CITY OF DAYTON TO DEVELOP A BETTER COMMUNITY AROUND THE HOSPITAL. THIS INCLUDES PROVIDING ADDITIONAL POLICING AND REVITALIZING THE SURROUNDING NEIGHBORHOOD. AS A RESULT, WE HAVE SEEN A DECLINE IN CRIME AROUN true FIVE RIVERS HEALTH CENTERS 2261 PHILADELPHIA DR DAYTON OH 45406 450914398 501(C)(3) 958385 SUPPORT MIAMI VALLEY HOSPITAL 110 N MAIN ST 500 DAYTON OH 45402 310537504 501(C)(3) 29754 AFRICAN AMERICAN WOMEN'S HEALTH PROGRAM REACH OUT MONTGOMERY COUNTY 25 E FORAKER ST DAYTON OH 45409 311434282 501(C)(3) 28955 RX ASSIST FOR INDIGENT UNITED WAY OF GREATER DAYTON AREA 33 W FIRST ST 500 DAYTON OH 45402 310536658 501(C)(3) 19200 SUPPORT DAYTON FOUNDATION 40 N MAIN ST 500 DAYTON OH 45423 316027287 501(C)(3) 18624 SUPPORT MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311040231 501(C)(3) 16848 SUPPORT GOOD SAMARITAN HOSPITAL FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 237296923 501(C)(3) 12510 SUPPORT ATRIUM MEDICAL CENTER FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311079213 501(C)(3) 8230 SUPPORT WRIGHT STATE UNIVERSITY FOUNDATION 3640 COLONEL GLENN HWY DAYTON OH 45435 237019799 501(C)(3) 7320 SUPPORT ST PETER CATHOLIC CHURCH - 6161 CHAMBERSBURG RD HUBER HEIGHTS OH 45424 310626310 501(C)(3) 6840 SUPPORT DAYTON RIGHT TO LIFE FOUNDATION 425 N FINDLAY ST DAYTON OH 45404 310918872 501(C)(3) 5750 SUPPORT 11 0 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 ELOISE P BRONER PRESIDENT & CEO (TO JUL) 262425 190898 176795 25000 176829 11216 14622 10723 1734 1623 632405 239460 0 0 MARY H BOOSALIS TRUSTEE & PREMIER PRES & CEO 0 1098492 0 744674 0 34445 0 24572 0 15726 0 1917909 0 0 GEORGE T BRODERICK JR MD TRUSTEE 2601 678615 0 76732 0 24062 0 9239 0 12884 2601 801532 0 0 LASZLO TOTH MD TRUSTEE 0 412489 0 10000 0 29698 0 10356 0 29848 0 492391 0 0 DALE E CREECH JR CLO (TO JUL) & BOARD SECRETARY 0 226848 0 163898 0 321430 0 173749 0 24772 0 910697 0 0 MARY E GARMAN COO GSH NORTH (TO JUL) 298861 0 81742 0 2859 0 7533 0 3246 0 394241 0 0 0 TIMOTHY D SNIDER BOARD TREASURER / CFO (TO JUL) 0 228185 0 81615 0 2190 0 20001 0 16291 0 348282 0 0 THOMAS R CURTIN SYSTEM 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 KATHLEEN M HARPER VP NORTH OPERATIONS (TO JUL) 96593 120280 12500 57299 323 392 3420 4664 8111 10460 120947 193095 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 SYSTEM VP - CPO 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 SYSTEM VP - CLO (FROM JUL) 0 317976 0 88247 0 20078 0 22722 0 25725 0 474748 0 0 SHARON K THORNTON ERP OPERATIONS LEADER 167058 0 55724 0 19375 0 7920 0 10483 0 260560 0 0 0 JASON E MERRITT DIR NURSING-EMERG SVCS(TO APR) 35075 142278 22791 18750 199 744 2451 6653 1102 3670 61618 172095 0 0 JEFFERY A MORNEAULT DIR SURGICAL SERVICES (TO APR) 47209 121995 23973 18750 675 1807 2330 4401 9785 18483 83972 165436 0 0 DARLENE WISEMAN VP FINANCE - SUPPORT SERVICES 189364 0 22741 0 1490 0 18805 0 19852 0 252252 0 0 0 CHRISTOPHER W SNIDER DIR FACILITIES SVCS (TO JUL) 71849 53822 27623 12540 325 244 2848 2088 2325 1618 104970 70312 0 0 RENEE P GEORGE FORMER KEY EMPLOYEE 0 383206 0 186870 0 1291 0 24090 0 13560 0 609017 0 0 TAMMY S LUNDSTROM MD FORMER KEY EMPLOYEE 0 215866 0 227220 0 2008 0 10115 0 858 0 456067 0 0 MICHAEL J MAIBERGER FORMER KEY EMPLOYEE 0 827405 0 361953 0 19436 0 16296 0 32374 0 1257464 0 0 THOMAS R PARKER FORMER KEY EMPLOYEE 0 419601 0 152940 0 27557 0 36093 0 6915 0 643106 0 0 DANIEL L SCHOULTIES MD FORMER KEY EMPLOYEE 0 0 0 0 0 100164 0 0 0 0 0 100164 0 100164 MARK S SHAKER FORMER KEY EMPLOYEE 0 0 0 97534 0 717176 0 23763 0 2207 0 840680 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, GOOD SAMARITAN HOSPITAL (GSH) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. GSH 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: ELOISE BRONER $164,913; DALE CREECH JR. $112,018; BARBARA JOHNSON $23,417; MARGARET MARK $1,276; MARK SHAKER $134,793; MARK SHAW $173,140; SCOTT SHELTON $40,845; J. MICHAEL SIMS $15,913; GEOFFREY WALKER $17,073. 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; MARY GARMAN $(1,676); RENEE GEORGE $13,523; JENNIFER HAULER $6,140; BARBARA JOHNSON $(1,815); TAMMY LUNDSTROM, M.D. $877; MARGARET MARK $3,852; THOMAS PARKER $12,494; CRAIG SELF $22,957; TIMOTHY SNIDER $1,028. 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. JULIA E PARKER SPOUSE OF FORMER KEY EMPLOYEE THOMAS R. PARKER 194098 EMPLOYMENT false LAND 2018-08-01 14855684 NET BOOK VALUE 310537504 MIAMI VALLEY HOSPITAL 110 N MAIN ST 500 DAYTON OH 45402 501(C)(3) BUILDING & IMPROVEMENTS 2018-08-01 121843297 NET BOOK VALUE 310537504 MIAMI VALLEY HOSPITAL 110 N MAIN ST 500 DAYTON OH 45402 501(C)(3) LEASEHOLD IMPROVEMENTS 2018-08-01 604921 NET BOOK VALUE 310537504 MIAMI VALLEY HOSPITAL 110 N MAIN ST 500 DAYTON OH 45402 501(C)(3) EQUIPMENT 2018-08-01 87350816 NET BOOK VALUE 310537504 MIAMI VALLEY HOSPITAL 110 N MAIN ST 500 DAYTON OH 45402 501(C)(3) BUILDING & IMPROVEMENTS 2018-08-01 68385 NET BOOK VALUE 311079309 ATRIUM MEDICAL CENTER 110 N MAIN ST 500 DAYTON OH 45402 501(C)(3) EQUIPMENT 2018-08-01 2788067 NET BOOK VALUE 311079309 ATRIUM MEDICAL CENTER 110 N MAIN ST 500 DAYTON OH 45402 501(C)(3) EQUIPMENT 2018-08-01 1681017 NET BOOK VALUE 310537095 UPPER VALLEY MEDICAL CENTER 110 N MAIN ST 500 DAYTON OH 45402 501(C)(3) false true false true Part II, Line 2B and 2D: 1) Eloise Broner Transferred Premier Chief of Shared Services, received $25,000 retention bonus. 2) Mary Garman Transferred Miami Valley Hospital North COO, received $12,500 retention bonus. 3) Kathleen Harper Transferred Premier VP Marketing & Communications, received $12,500 retention bonus. FORM 990, PART III, LINE 3: Good Samaritan Hospitals Philadelphia Drive location ceased operations and closed on July 23, 2018. The hospitals services will stay in Dayton, shifting to nearby Miami Valley Hospital a move designed to maintain nearby residents access to care, minimize disruptions for staff, and reaffirm Premier Healths commitment to serve Dayton, including its inner core. Premier Health will be working with CityWide Development Corporation, a long-time partner on community revitalization projects, and has engaged planning NEXT, an experienced firm specializing in property redevelopment to help guide the process of repurposing the site. The process will include community input to align community need with redevelopment possibilities. FORM 990, PART VI, SECTION A, LINE 3: PREMIER HEALTH (PREMIER), AS THE OPERATOR OF GOOD SAMARITAN HOSPITAL (GSH), DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR GSH, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. GSH SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. GSH SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. GSH SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF GSH WITH ALL THIRD-PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. GSH 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. GSH MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN GSH'S ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 4: IN 2018, GSHS CODE OF REGULATIONS WERE MODIFIED. LISTED BELOW ARE THE SIGNIFICANT CHANGES: * THE BOARD MEMBERS ARE SELECTED BY THE PREMIER HEALTH PRESIDENT AND CHIEF EXECUTIVE OFFICER (OR HIS/HER DESIGNEE). FORM 990, PART VI, SECTION A, LINE 6: GSH HAS TWO CORPORATE MEMBERS. ONE MEMBER IS SAMARITAN HEALTH PARTNERS (SHP). THE SECOND MEMBER IS PREMIER, AN OHIO NON-PROFIT CORPORATION INITIALLY FORMED PURSUANT TO THE JOINT OPERATING AGREEMENT AND NOW PURSUANT TO A DEFINITIVE SYSTEM REORGANIZATION AGREEMENT. FORM 990, PART VI, SECTION A, LINES 7A & 7B: PREMIER HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR GSH. 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, WITH WHICH GSH IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE TAX MANAGER AND THE 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 THE BOARD OF TRUSTEES MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESS 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 GSH 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 GSH'S CEO WAS REVIEWED AND APPROVED BY PREMIER, WITH WHICH GSH IS AN AFFILIATE, ON AN ANNUAL BASIS. THE REVIEW PROCESS PERFORMED BY PREMIER FOLLOWS A MARKET BASED COMPENSATION PHILOSOPHY DESIGNED TO ATTRACT AND RETAIN THE EXECUTIVE TALENT REQUIRED TO MEET THE HIGH-PERFORMANCE STANDARDS OF OUR BOARD AND OUR COMMUNITY. PREMIER ANNUALLY REVIEWS EXECUTIVE COMPENSATION SURVEY DATA FOR A REGIONAL PEER GROUP OF SYSTEMS AND HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO PREMIER AND ITS AFFILIATES. THE DATA FOR THE SURVEY IS PROVIDED BY A THIRD-PARTY CONSULTANT GROUP THAT IS INDEPENDENT OF PREMIER. THIS REPORT INCLUDES COMPARABILITY FOR KEY EXECUTIVES, VICE PRESIDENTS, AND DIRECTOR LEVEL POSITIONS. THE INDEPENDENT COMPARABILITY DATA IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THIS COMMITTEE IS COMPRISED OF THREE MEMBERS, ALL OF WHOM ARE INDEPENDENT. THIS COMMITTEE REVIEWS IN DETAIL THE COMPENSATION FOR THE PREMIER CEO, COO, CFO, CHIEF INTEGRATION OFFICER, CHIEF STRATEGY OFFICER, AND THE HOSPITAL CEOS. OTHER POSITIONS ARE REVIEWED AT A HIGH LEVEL FOR REASONABLENESS. ALL THE MEETING MINUTES ARE DOCUMENTED AND KEPT ON FILE ALONG WITH ANY COMPARABILITY DATA AND THE CONSULTANT REPORT. AFTER THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION ACTIONS, THE PROCESS IS AUDITED BY THE INTERNAL AUDIT DEPARTMENT. THE EXECUTIVE COMPENSATION COMMITTEE PRESENTS THE COMPENSATION ACTIONS TO THE PREMIER BOARD ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19: THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC WHEN REQUIRED BY LAW OR FOR ACCREDITATION PURPOSES. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS $(230,915,763) FOUNDATION ADJUSTMENT $(227,482) TRANSFERS FROM AFFILIATES $339,882 DISTRIBUTIONS / LIQUIDATIONS $2,907,483 PENSION FUND ADJUSTMENT $12,080,576 TOTAL $(215,815,304) PREMIER HEALTH PARTNERS (PREMIER) 110 N MAIN ST 500 DAYTON OH 45402 311446699 PARENT 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 (MVH) 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 PREMIER COMMUNITY HEALTH 110 N MAIN ST 500 DAYTON OH 45402 311122883 HEALTH EDU OH 501(c)(3) 10 FHC false FIDELITY HEALTH CARE INC (FHC) 110 N MAIN ST 500 DAYTON OH 45402 311075381 HOME HEALTH OH 501(c)(3) 10 PREMIER false SAMARITAN HEALTH PARTNERS (SHP) 110 N MAIN ST 500 DAYTON OH 45402 311107411 SUPPORT ORG OH 501(C)(3) 12B PREMIER false GOOD SAMARITAN 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 HEALTH EDU OH 501(C)(3) 10 PREMIER false SAMARITAN BEHAVIORAL HEALTH INC 110 N MAIN ST 500 DAYTON OH 45402 020633634 BEHAVIOR HLTH OH 501(C)(3) 7 PREMIER false ATRIUM HEALTH SYSTEM (AHS) 110 N MAIN ST 500 DAYTON OH 45402 310537492 SUPPORT ORG OH 501(C)(3) 12B NA false ATRIUM MEDICAL CENTER 110 N MAIN ST 500 DAYTON OH 45402 311079309 HOSPITAL OH 501(C)(3) 3 PREMIER false UVMC 110 N MAIN ST 500 DAYTON OH 45402 341850683 SUPPORT ORG OH 501(C)(3) 12B NA false UPPER VALLEY MEDICAL CENTER 110 N MAIN ST 500 DAYTON OH 45402 310537095 HOSPITAL OH 501(C)(3) 3 PREMIER false UPPER VALLEY PROFESSIONAL CORP (UVPC) 110 N MAIN ST 500 DAYTON OH 45402 311400963 HEALTH CARE OH 501(C)(3) 10 PREMIER false UVPC SPECIALISTS INC 110 N MAIN ST 500 DAYTON OH 45402 203687536 HEALTH CARE OH 501(C)(3) 10 UVPC false UVMC NURSING CARE INC 110 N MAIN ST 500 DAYTON OH 45402 311224064 NURSING HOME OH 501(C)(3) 10 PREMIER false PREMIER PLAZA LLC 110 N MAIN ST 500 DAYTON OH 45402 800708185 HOLDING CO OH MAHS EXCLUDED 0 0 false 0 false 0.00000 SOUTHWEST OHIO NEONATAL COLLABORATIVE 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 2911356 2961738 false 0 true 0.80000 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 SERVICE OH PREMIER HOLDING C CORP 0 0 0.00000 false PREMIER HEALTH SPECIALISTS 110 N Main St 400 DAYTON OH 45402 061744704 PHYSICIAN SERVICE OH PREMIER HOLDING C CORP 0 0 0.00000 false SAMARITAN FAMILY CARE 110 N Main St 400 DAYTON OH 45402 311299450 PHYSICIAN SERVICE 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 true true true false false true false false false false false false true false true true true true false SAMARITAN NORTH SURGERY CENTER A-IV 715258 FMV SAMARITAN NORTH SURGERY CENTER B 1532570 FMV SAMARITAN NORTH SURGERY CENTER F 1614674 FMV