UPPER VALLEY MEDICAL CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- UPPER VALLEY MEDICAL CENTER (EIN 31-0537095)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201733189349306628
- Schema version
- 2016v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule F
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T13:44:22-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 YARD STREET SUITE 200 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43212 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310537095 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Upper Valley Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % J MICHAEL SIMS | InCareOfNm |
| Business Name Control | UPPE | BusinessNameControlTxt |
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N Main St Suite 500 | AddressLine1Txt |
| City | Dayton | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIMOTHY D SNIDER | PersonNm |
| Person Title | VP-CFO | PersonTitleTxt |
| Phone | 9374999942 | PhoneNum |
| Signature | 2017-11-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DIANE L BEAN | PreparerPersonNm |
| PTIN | P00104972 | PTIN |
| Phone | 6142245678 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 208.102.97.33 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 31499120173185000015 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2017-11-14 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 582F47EFACDD6166E52205D1FBFEA2601660FA18 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 8EFF0C77748B9BD402565CEF41270569F54FE33A | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | REBECCA A RICE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3130 N COUNTY RD 25 A | AddressLine1Txt |
| City | TROY | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45373 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $173,507,415 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.premierhealth.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1926 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 1594 | TotalEmployeeCnt |
| Total Volunteers | 156 | TotalVolunteersCnt |
| Total Gross UBI | $199,663 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$25,650 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $183,580 | PYContributionsGrantsAmt |
| CY Contributions Grants | $172,769 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $141,924,880 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $147,916,213 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,311,629 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,070,570 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,369,812 | PYOtherRevenueAmt |
| CY Other Revenue | $1,738,653 | CYOtherRevenueAmt |
| PY Total Revenue | $146,789,901 | PYTotalRevenueAmt |
| CY Total Revenue | $151,898,205 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $771,390 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $550,292 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $74,933,197 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $76,668,833 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $61,062,476 | PYOtherExpensesAmt |
| CY Other Expenses | $67,469,708 | CYOtherExpensesAmt |
| PY Total Expenses | $136,767,063 | PYTotalExpensesAmt |
| CY Total Expenses | $144,688,833 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $10,022,838 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,209,372 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $182,294,753 | TotalAssetsBOYAmt |
| Total Assets EOY | $187,350,287 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $97,392,118 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $105,229,559 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $84,902,635 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $82,120,728 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $133,652,161 | ExpenseAmt |
| Grant | $550,292 | GrantAmt |
| Revenue | $147,916,213 | RevenueAmt |
| Desc | See Schedule H and Schedule O. | Desc |
| Total Program Service Expenses | $133,652,161 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | Yes (true) | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 105 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1594 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | J MICHAEL SIMS | PersonNm |
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST SUITE 500 | AddressLine1Txt |
| City | Dayton | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ROWAN R NICKOL MD | ||||||||||
| BOARD CHAIR | 0.5 | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| REBECCA A RICE | ||||||||||
| PRESIDENT & CEO | 38.0 | 2.0 | Yes (X) | Yes (X) | $511,177 | $0 | $54,827 | |||
| RAFAY ATIQ | ||||||||||
| TRUSTEE | 0.5 | 39.5 | Yes (X) | $0 | $464,432 | $38,479 | ||||
| DANIEL S BAILEY MD | ||||||||||
| TRUSTEE & CMO (TO AUG) | 39.5 | 0.5 | Yes (X) | $244,544 | $0 | $32,606 | ||||
| DONALD D DELCAMP MD | ||||||||||
| TRUSTEE & PRES MEDICAL STAFF | 0.5 | 39.5 | Yes (X) | $0 | $513,201 | $35,778 | ||||
| JENNIFER J HAULER MD | ||||||||||
| TRUSTEE & CMO (FROM AUG) | 39.5 | 0.5 | Yes (X) | $98,459 | $0 | $1,152 | ||||
| RONAL MANIS JR MD | ||||||||||
| TRUSTEE (TO JAN) | 0.5 | 0.5 | Yes (X) | $55,800 | $0 | $0 | ||||
| JAMES R PANCOAST | ||||||||||
| TRUSTEE & PREMIER CEO | 7.5 | 8.5 | Yes (X) | $0 | $0 | $0 | ||||
| SCOTT SWABB DO | ||||||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $15,417 | $0 | $0 | ||||
| DALE E CREECH | ||||||||||
| BOARD SECRETARY | 7.5 | 31.5 | Yes (X) | $0 | $708,171 | $62,021 | ||||
| DIANE L PLEIMAN | ||||||||||
| COO | 39.5 | 0.5 | Yes (X) | $284,925 | $0 | $33,132 | ||||
| TIMOTHY D SNIDER-SEE SCH O | ||||||||||
| BOARD TREASURER & CFO | 18.0 | 2.0 | Yes (X) | $267,607 | $0 | $40,198 | ||||
| BENJAMIN A WATSON | ||||||||||
| BOARD RECORDING SECRETARY | 0.5 | 2.0 | Yes (X) | $0 | $0 | $0 | ||||
| THOMAS R CURTIN | ||||||||||
| SYSTEM VP - REVENUE CYCLE | 8.0 | 31.0 | $0 | $293,603 | $61,061 | Yes (X) | ||||
| GARY G GINTER | ||||||||||
| SYSTEM VP - CIO | 8.0 | 32.0 | $0 | $537,399 | $73,246 | Yes (X) | ||||
| BARBARA A JOHNSON | ||||||||||
| SYS VP - HR OPERATIONS | 8.0 | 32.0 | $0 | $523,006 | $30,879 | Yes (X) | ||||
| TAMMY S LUNDSTROM MD | ||||||||||
| SYSTEM VP - CMO | 8.0 | 32.0 | $0 | $716,856 | $59,414 | Yes (X) | ||||
| THOMAS R PARKER | ||||||||||
| SYS VP- CHF EXPERIENCE OFFICER | 8.0 | 32.0 | $0 | $496,641 | $54,594 | Yes (X) | ||||
| CRAIG SELF | ||||||||||
| SYS VP -CHIEF STRATEGY OFFICER | 8.0 | 32.0 | $0 | $497,273 | $39,370 | Yes (X) | ||||
| MARK W SHAW | ||||||||||
| SYSTEM VP - MANAGED CARE | 8.0 | 32.0 | $0 | $458,030 | $61,038 | Yes (X) | ||||
| SCOTT A SHELTON | ||||||||||
| SYSTEM VP - CPO | 8.0 | 32.0 | $0 | $358,074 | $32,224 | Yes (X) | ||||
| SYLVAIN TREPANIER DNP RN CENP | ||||||||||
| SYSTEM VP - CNO | 8.0 | 31.0 | $0 | $398,678 | $35,691 | Yes (X) | ||||
| THOMAS D BIGLEY | ||||||||||
| DIRECTOR - PHARMACY | 40.0 | 0.0 | $208,518 | $0 | $103,171 | Yes (X) | ||||
| ROBERT H BLYTHE | ||||||||||
| STAFF PHARMACIST | 40.0 | 0.0 | $147,228 | $0 | $33,256 | Yes (X) | ||||
| TERRY R FRY | ||||||||||
| VP - CNO | 40.0 | 0.0 | $234,309 | $0 | $33,824 | Yes (X) | ||||
| KATHLEEN J SCARBROUGH | ||||||||||
| PRESIDENT, UVMC FOUNDATION | 10.0 | 30.0 | $115,034 | $39,000 | $37,429 | Yes (X) | ||||
| MELISSA M TALMAGE | ||||||||||
| DIR-NRS SURG/ICU/PCU | 40.0 | 0.0 | $167,995 | $0 | $32,059 | Yes (X) | ||||
| RENEE P GEORGE | ||||||||||
| FORMER KEY EMPLOYEE | 0.0 | 40.0 | $0 | $324,102 | $24,786 | Yes (X) | ||||
| J NICK LAIR | ||||||||||
| FORMER KEY EMPLOYEE | 0.0 | 40.0 | $0 | $324,961 | $56,822 | Yes (X) | ||||
| MICHAEL J MAIBERGER | ||||||||||
| FORMER KEY EMPLOYEE | 0.0 | 40.0 | $0 | $887,043 | $94,748 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,351,013 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $7,540,470 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,161,805 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 35 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| COMPUNET CLINICAL LABORATORIES | |||||
| 2308 SANDRIDGE DR | MORAINE | OH | 45349 | CLINICAL LAB | $1,157,285 |
| PDT ARCHITECTS LLC | |||||
| 300 W 4TH ST | CINCINNATI | OH | 45202 | ARCHITECTURAL DESIGN | $257,108 |
| BLACK BOX NETWORK SERVICES | |||||
| 1000 PARK DR | LAWRENCE | PA | 15055 | COMMUNICATIONS UPDAT | $222,576 |
| FIRSTSOURCE SOLUTIONS USA LLC | |||||
| 1661 LYNDON FARM CT | LOUISVILLE | KY | 40223 | COLLECTIONS | $215,959 |
| POWER SOLUTIONS GROUP LTD | |||||
| 425 KERR RD | TIPP CITY | OH | 45371 | ELECTRICAL MAINT | $209,830 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $172,769 | RelatedOrganizationsAmt |
| Total Contributions | $172,769 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT CARE REVENUE | 621110 | $77,313,674 | $77,124,817 | $188,857 |
| MEDICARE/MEDICAID | 621110 | $67,468,487 | $67,468,487 | |
| HOSPITAL FRANCHISE TAX RECOVERIES | 900099 | $3,060,269 | $3,060,269 | |
| MEDICAL RECORDS | 900099 | $37,169 | $37,169 | |
| HEALTH EDUCATION | 900099 | $1,740 | $1,740 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,874 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,874 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $147,916,213 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $759,947 | TotalRevenueColumnAmt |
| Exclusion | $759,947 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $89,533 | TotalRevenueColumnAmt |
| Exclusion | $89,533 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,438,358 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,949,546 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $488,812 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $488,812 | TotalRevenueColumnAmt |
| Exclusion | $488,812 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $20,410,622 | SecuritiesAmt |
| Other | $154,798 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $19,225,405 | SecuritiesAmt |
| Other | $118,925 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,185,217 | SecuritiesAmt |
| Other | $35,873 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,221,090 | TotalRevenueColumnAmt |
| Exclusion | $1,221,090 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $306,670 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $315,334 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$8,664 | TotalRevenueColumnAmt |
| Exclusion | -$8,664 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| CAFETERIA SALES | 721210 | $705,360 | $705,360 | |
| PURCHASE DISCOUNTS | 900099 | $41,044 | $41,044 | |
| ALL OTHER REVENUE | 900099 | $512,101 | $501,295 | $10,806 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,258,505 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $151,898,205 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $147,727,356 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $199,663 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,798,417 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $550,292 | TotalAmt |
| Program Services | $550,292 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,639,844 | TotalAmt |
| Program Services | $1,495,537 | ProgramServicesAmt |
| Management And General | $144,307 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,391,615 | TotalAmt |
| Program Services | $53,253,153 | ProgramServicesAmt |
| Management And General | $5,138,462 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,651,873 | TotalAmt |
| Program Services | $3,330,508 | ProgramServicesAmt |
| Management And General | $321,365 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,933,538 | TotalAmt |
| Program Services | $8,147,387 | ProgramServicesAmt |
| Management And General | $786,151 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,051,963 | TotalAmt |
| Program Services | $3,695,390 | ProgramServicesAmt |
| Management And General | $356,573 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,659 | TotalAmt |
| Program Services | $85,417 | ProgramServicesAmt |
| Management And General | $8,242 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,703 | TotalAmt |
| Program Services | $150,209 | ProgramServicesAmt |
| Management And General | $14,494 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,563 | TotalAmt |
| Management And General | $60,563 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,608 | TotalAmt |
| Program Services | $11,498 | ProgramServicesAmt |
| Management And General | $1,110 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,657 | TotalAmt |
| Management And General | $127,657 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,573,339 | TotalAmt |
| Program Services | $6,906,885 | ProgramServicesAmt |
| Management And General | $666,454 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $943,664 | TotalAmt |
| Program Services | $943,664 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $855,344 | TotalAmt |
| Program Services | $780,074 | ProgramServicesAmt |
| Management And General | $75,270 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,161,065 | TotalAmt |
| Program Services | $3,794,891 | ProgramServicesAmt |
| Management And General | $366,174 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,333,913 | TotalAmt |
| Program Services | $2,128,529 | ProgramServicesAmt |
| Management And General | $205,384 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,855 | TotalAmt |
| Program Services | $131,196 | ProgramServicesAmt |
| Management And General | $12,659 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $243 | TotalAmt |
| Program Services | $222 | ProgramServicesAmt |
| Management And General | $21 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,555,699 | TotalAmt |
| Program Services | $1,555,699 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,729,000 | TotalAmt |
| Program Services | $9,784,848 | ProgramServicesAmt |
| Management And General | $944,152 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| OPERATING SUPPLIES | $16,065,775 | $16,065,775 | |
| JOINT OPERATING AGREEMENT | $10,507,000 | $9,582,384 | $924,616 |
| PURCHASED SERVICES | $7,318,456 | $6,674,432 | $644,024 |
| HOSPITAL FRANCHISE TAX | $2,107,327 | $2,107,327 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,715,838 | TotalAmt |
| Program Services | $2,476,844 | ProgramServicesAmt |
| Management And General | $238,994 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,688,833 | TotalAmt |
| Program Services | $133,652,161 | ProgramServicesAmt |
| Management And General | $11,036,672 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,860 | BOYAmt |
| EOY | $2,860 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,545,712 | BOYAmt |
| EOY | $3,808,655 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,070,179 | BOYAmt |
| EOY | $21,116,723 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,597 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $743,192 | BOYAmt |
| EOY | $503,818 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,463,932 | BOYAmt |
| EOY | $1,493,024 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $200,775,621 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $109,290,028 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,562,100 | BOYAmt |
| EOY | $91,485,593 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,408,530 | BOYAmt |
| EOY | $48,768,299 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,072,143 | BOYAmt |
| EOY | $14,696,404 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,354,508 | BOYAmt |
| EOY | $5,474,911 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,294,753 | BOYAmt |
| EOY | $187,350,287 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,776,297 | BOYAmt |
| EOY | $10,782,754 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $357,735 | BOYAmt |
| EOY | $279,110 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,856 | BOYAmt |
| EOY | $51,388 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,982,492 | BOYAmt |
| EOY | $63,100,490 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $899,595 | BOYAmt |
| EOY | $350,903 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,226,143 | BOYAmt |
| EOY | $30,664,914 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,392,118 | BOYAmt |
| EOY | $105,229,559 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,902,635 | BOYAmt |
| EOY | $82,120,728 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,902,635 | BOYAmt |
| EOY | $82,120,728 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,294,753 | BOYAmt |
| EOY | $187,350,287 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $7,209,372 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,275,947 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$11,267,226 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $10,178 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $2,430 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $12,608 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1F: | FormAndLineReferenceDesc |
| Explanation | PAYMENTS FOR LOBBYING ACTIVITIES INCLUDE DUES PAID TO GREATER DAYTON AREA HOSPITAL ASSOCIATION, DAYTON DEVELOPMENT COALITION, AMERICAN HOSPITAL ASSOCIATION, AND OHIO HOSPITAL ASSOCIATION. PART II-B, LINE 1I: THE HOSPITAL CONTRACTS WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,284,133 | OtherCostOrOtherBasisAmt |
| Book Value | $1,284,133 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $114,324,654 | OtherCostOrOtherBasisAmt |
| Depreciation | $62,232,179 | DepreciationAmt |
| Book Value | $52,092,475 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $69,381,027 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,057,849 | DepreciationAmt |
| Book Value | $22,323,178 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,785,807 | OtherCostOrOtherBasisAmt |
| Book Value | $15,785,807 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $91,485,593 | TotalBookValueLandBuildingsAmt |
| Financial Derivatives | FinancialDerivativesGrp | |
| Closely Held Equity Interests | CloselyHeldEquityInterestsGrp |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ALTERNATIVE INVESTMENTS | Desc |
| Book Value | $14,696,404 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $14,696,404 | TotalBookValueSecuritiesAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)
| DescDesc | AmtAmt |
|---|---|
| PENSION OBLIGATION | $12,645,341 |
| JOINT OPERATING AGREEMENT | $10,507,000 |
| MALPRACTICE INSURANCE | $3,150,466 |
| DEFERRED COMPENSATION | $2,117,953 |
| CONSTRUCTION RESERVE | $758,885 |
| SETTLEMENT - 3RD PARTY PAYORS | $328,504 |
| WORKER'S COMP RESERVE | $985,852 |
| OTHER | $170,913 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $30,664,914 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING FOOTNOTE IS FROM THE AUDITED COMBINED FINANCIAL STATEMENTS FOR PREMIER HEALTH AND AFFILIATES. UVMC IS THE PARENT ORGANIZATION OF UPPER VALLEY MEDICAL CENTER: PREMIER HEALTH (PREMIER), MEDAMERICA HEALTH SYSTEMS (MAHS), samaritan health partners (shp), ATRIUM HEALTH SYSTEM (AHS), AND UVMC have been determined by the Internal Revenue Service to be tax-exempt nonprofit corporations and public charities under Sections 501(c)(3) and 509(a), respectively, of the Internal Revenue Code. As tax-exempt organizations, their income is exempt from federal income tax except to the extent of any unrelated business activities. PREMIER, SHP, AND UVMC ALSO OWN OR CONTROL CERTAIN SUBSIDIARIES, WHICH ARE FOR-PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. Taxes payable at December 31, 2016 and 2015, for such unrelated business activities are not significant. Management annually reviews the tax positions and has determined that there are no material uncertain tax positions. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp (3 entries)
| RegionRegionTxt | Type Of Activities ConductedTypeOfActivitiesConductedTxt | Region Total ExpendituresRegionTotalExpendituresAmt | Specific Services ProvidedSpecificServicesProvidedTxt |
|---|---|---|---|
| Central America and the Caribbean | Investments | $10,390,000 | |
| Europe (Including Iceland and Greenland) | Investments | $4,868,000 | |
| Central America and the Caribbean | Program Services | $25,000 | INSURANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Spent | $15,283,000 | SubtotalSpentAmt |
| Total Spent | $15,283,000 | TotalSpentAmt |
| Transfer To Foreign Corp | false | TransferToForeignCorpInd |
| Interest In Foreign Trust | false | InterestInForeignTrustInd |
| Foreign Corp Ownership | false | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | false | PassiveForeignInvestmestCoInd |
| Foreign Partnership | false | ForeignPartnershipInd |
| Boycott Countries | false | BoycottCountriesInd |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,083,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,458,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,625,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01810 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,261,269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,856,269 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,405,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05810 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,011,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $896,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $115,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $32,355,269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,210,269 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,145,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07700 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $393,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $393,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,692,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,692,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01860 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $109,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $109,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,204,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,204,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02220 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $35,559,269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,210,269 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,349,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09920 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $14,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,500 | NetCommunityBenefitExpnsAmt |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $900 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $900 | NetCommunityBenefitExpnsAmt |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $268,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $268,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $304,400 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $304,400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,067,251 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $28,169,000 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $30,749,000 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,580,000 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPPER VALLEY MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PREMIERHEALTH.COM | WebsiteAddressTxt |
| State License | SEE PART V SECT C | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPPER VALLEY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Section C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Section C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400. | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SEC C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SEC C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SEC C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Section B, Line 1: | FormAndLineReferenceDesc |
| Explanation | 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. UPPER VALLEYS REGISTRATION NUMBER IS 1036. PART V, SECTION B, LINE 5: 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 UPPER VALLEY MEDICAL CENTER, The Health Collaborative in Cincinnati, Ohio, Miami County Public Health District, Shelby County Health Department, Darke County General Health District, and the Greater Dayton Area Hospital Association with its member hospitals. The participating hospitals invited a broad range of nonprofit agencies and organizations, which serve the medically underserved, low-income and minority populations, to attend community meetings and complete surveys. PART V, SECTION B, LINE 6A & 6B: UPPER VALLEY MEDICAL CENTER partnered with member hospitals of the Greater Dayton Area Hospital Association, The Health Collaborative in Cincinnati, Ohio, Miami County Public Health District, Shelby County Health Department, Darke County General Health District, and The Greater Dayton Area Hospital Association, Xavier University and an independent consultant to prepare the community health needs assessment. PART V, SECTION B, LINE 7A & 10A: The direct website address where the 2016 CHNA and the 2017 Community Health Improvement Plan can be accessed is: http://www.premierhealth.com/Our-Community/Making-a-Difference/ Community-Health-Improvement/ PART V, SECTION B, LINE 11: Upper Valley Medical Center (Upper Valley), 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, Miami County Public Health District, Shelby County Health Department, Darke County General Health District, and The Health Collaborative in Cincinnati, Ohio, The Greater Dayton Area Hospital Association, Xavier University and an independent consultant to prepare the community health needs assessment. Based on the results of this assessment, Upper Valley Medical Center has adopted an implementation strategy to address the following prioritized needs: * Behavioral Health/Substance Abuse * Chronic Diseases Health issue: Behavioral Health ----------------- Upper Valley Medical Center (Upper Valley) is working with the local ADAMHS board to improve access to, and integration of, primary care and behavioral health in the tri-county area. One Wellness Place is a planned new facility on County Road 25-A between Troy and Piqua. Developed by the ADAMHS Tri-County Board of Recovery and Mental Health Services, it will house mental health and addiction treatment providers, public health, and an array of wraparound support services in an integrated, easy-to-navigate facility. There may be an opportunity to house Upper Valleys proposed Federally Qualified Health Center in this facility to support both physical and behavioral health issues. Upper Valley shares many of these clients with the agencies contractually supported by the ADAMHS board. Additional partners in this project include Community Housing Inc., NAMI of Darke, Miami and Shelby counties, Recovery & Wellness Center of Midwest Ohio, Miami County Recovery Council, Miami County Dental Clinic, Miami County Public Health, and Safehaven Inc. Upper Valley also supports the local county schools in their efforts to combat bullying and violence in the school setting through Rachels Challenge. Rachels Challenge is a program designed to make schools safer, more connected places where bullying and violence are replaced with kindness and respect. Upper Valley supports delivery of this K-12 program in eight school districts, plus two faith-based schools, for a total of 29-36 school buildings participating, depending upon the year. For the 2017-2018 school year, the hospital is planning for Chain Reaction Days (all-day training programs for adults and students) at middle and high schools in the eight public school districts. Upper Valley has pledged to continue funding this program in area schools through the 2018-2019 academic year. Upper Valleys affiliate, Samaritan Behavioral Health, Inc., also provides three full-time mental health therapists who work in Piqua and Milton Union schools to provide behavioral health services for students covered by Medicaid. Health issue: Behavioral Health and Substance Abuse ------------------------------------- Upper Valley Medical Center 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 offer education in the community. In addition to assistance from the ADAMHS Board, resources will be obtained from Samaritan Behavioral Health, physician practices, and the Heroin Coalitions of Darke, Miami, and Shelby counties. Health issue: Chronic Diseases ---------------- Upper Valley will partner with local school districts to plan two Wellness initiatives aimed at reducing obesity in school-aged children. In one program, the hospital will build on its existing relationship with the Miami County Dental Clinic and their Traveling Smiles Program to introduce the Drinking Water Challenge initiative. The Drinking Water challenge (also known as "cavity-free kids") is a public oral health educational campaign focused on drinking water instead of sugar-sweetened beverages (soft drinks, sports drinks, and fruit juices). The Public Education Campaign includes billboards, news articles, local radio stations, PSA's, and flyers. The initiative will engage schools, local dentists, dental clinics, pediatricians and family practice physicians, local communities, etc. The second program, known as CATCH (Coordinated Approach To Child Health), is an evidence-based, coordinated school health program designed to promote physical activity and healthy food choices and to prevent tobacco use in children from preschool through grade eight. By teaching children that eating healthy and being physically active every day can be fun, the CATCH program has proven that establishing healthy habits in childhood can promote behavior changes that can last a lifetime. For more than 25 years, the CATCH platform has been proven to launch kids and communities toward healthier lifestyles. CATCH is supported by more than 120 academic papers, indicating as much as an 11 percent decrease in overweight and obese individuals in the environments in which it has been implemented. Upper Valley will collaborate with eight local public school districts, two faith-based schools, and the Miami County Dental Clinic in the planning and implementation of this program. In the broader community, Upper Valley Medical Center will implement a strategy to increase the amount of healthy food available for people with health related nutritional needs. The short-term objectives are 1) to ensure that all eligible patients are signed up for Supplemental Nutritional Assistance Program (SNAP) and/or Women Infant Children (WIC) benefits; and 2) to increase the availability of fresh produce in partnership with local food pantries, area farmers, and/or community gardens. The hospital may begin screening for hunger to ascertain the scope of the problem. If determined feasible, the hospital, along with its affiliates in Premier Health, would like to 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. Major local food pantries in Miami County will be used as resources to implement this strategy. Upper Valley Medical Center is one of five hospitals in the Premier Health system. All five hospitals participated with other health care organizations to create a collaborative Community Health Needs Assessment (CHNA). Based on the results of the Assessment, the five 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, Transportatio | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| HYATT CENTER | ||||
| 450 HYATT ST | TIPP CITY | OH | 45371 | LABORATORY, IMAGING, SPORTS MEDICINE, SURGERY |
| OUTPATIENT CARE CENTER NORTH | ||||
| 280 LOONEY RD | PIQUA | OH | 45356 | LABORATORY, IMAGING, REHABILITATIVE THERAPY |
| OUTPATIENT CARE CENTER SOUTH | ||||
| 998 S DORSET RD | TROY | OH | 45373 | LABORATORY, IMAGING OCCUPATIONAL HEALTH REHABILITATIVE THERAPY |
| STANFIELD PLACE | ||||
| 31 STANFIELD RD | TROY | OH | 45373 | IMAGING |
| JACOB DETTMER BUILDING | ||||
| 3130 N COUNTY RD 25A | TROY | OH | 45373 | Behavorial Health |
| VERSAILLES CENTER | ||||
| 471 MARKER RD | VERSAILLES | OH | 45380 | LABORATORY |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, line 6a: | FormAndLineReferenceDesc |
| Explanation | THE COMMUNITY BENEFIT REPORT FOR UPPER VALLEY MEDICAL CENTER 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: UPPER VALLEY MEDICAL CENTER 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 2016, THE AMOUNTS PAID FOR CALL TIME AND SUBSIDIES WERE $2,644,000. PART II, LINE 2: Upper Valley Medical Center (Upper Valley) 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, Upper Valley 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 Upper Valley during 2016 include: 1) Ongoing efforts to improve the economic condition in Dayton and the Miami Valley. A total of $14,000 was contributed toward a capital campaign project to build and develop a new community center. The center will be located in an under-privileged community where approximately 30% of the families live below the poverty level. The community center will reinforce early learning, inter-generational and family engagement, population health and advocacy and workforce development. 2) Funding of $5,000 was contributed towards the economic development and revitalization of an urban community within the hospitals service area. This project includes construction of a performing arts pavilion that will provide free concerts to the surrounding communities. 3) Providing free healthcare to uninsured and underinsured residents of Miami County, Ohio through a local clinic. Services provided at the clinic include appointments with physicians and other health care professionals, diagnostic lab testing, pharmacy and prescription assistance, nursing visits, and medication reviews. Upper Valley provided $93,000 in support of this program in 2016. 4) Contributions of $65,000 to a local dental clinics program which provides education and prevention for local children who have limited or no access to dental care. Preventative and restorative dental care is provided to the uninsured, underinsured and low-income children in Miami County in the local school setting. Participating children are treated regardless of their ability to pay. 5) support of the local hospice program totaling $25,000 in their mission to improve the quality of life for people and families facing life-limiting illnesses, regardless of the patients insurance coverage or ability to pay. 6) Funding of local charitable organizations through the hospitals Board Charitable Credit Fund. As part of Upper Valley's community partnership activity, board members of the hospital are granted charitable credits to be donated in the name of the board member with priorities to not-for-profit, tax-exempt 501(c)(3) health and human services organizations, arts and culture organizations, as well as other community activities in the hospital systems area. Also suggested are organizations that focus on supporting youth, education, underserved groups, and safe neighborhoods. The amount of support provided in 2016 was $81,000. PART III, LINE 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 back 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 that there are accounts written off to bad debt that may have qualified for charity care if the patient had provided the necessary financial information. In order 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 $17,937,000 AND INCURRED COST OF $23,425,000, FOR AN ADDITIONAL NET SHORTFALL OF $5,488,000 ASSOCIATED WITH THESE PROGRAMS. BELOW IS A RECONCILIATION OF THE AMOUNTS ASSOCIATED WITH MEDICARE PROGRAMS. ALLOWABLE MEDICARE REVENUE PER MEDICARE COST REPORT (PART III, SECTION B) $28,169,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $17,937,000 TOTAL MEDICARE ASSOCIATED REVENUE $46,106,000 ALLOWABLE MEDICARE COST PER MEDICARE COST Report (PART III, SECTION B) $30,749,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $23,425,000 TOTAL MEDICARE ASSOCIATED COST $54,174,000 MEDICARE SHORTFALL PER PART III, SECTION B $2,580,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $5,488,000 TOTAL MEDICARE SHORTFALL $8,068,000 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 42% 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 | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (21 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| HEALTH PARTNERS FREE CLINIC | |||||||
| 1300 N CO RD 25A | TROY | OH | 45373 | 311596731 | 501(C)(3) | $107,000 | SUPPORT |
| SAMARITAN BEHAVIORAL HEALTH INC | |||||||
| 601 S EDWIN C MOSES BLVD | DAYTON | OH | 45408 | 020633634 | 501(C)(3) | $91,325 | SUPPORT |
| MIAMI COUNTY DENTAL CLINIC | |||||||
| 1364 W MAIN ST | TROY | OH | 45373 | 204901192 | 501(C)(3) | $67,500 | SUPPORT |
| MIAMI COUNTY RECOVERY COUNCIL INC | |||||||
| 1059 N MARKET ST | TROY | OH | 45373 | 310917327 | 501(C)(3) | $62,983 | SUPPORT |
| HOSPICE OF MIAMI COUNTY INC | |||||||
| 550 SUMMIT AVE 101 | TROY | OH | 45373 | 311031277 | 501(C)(3) | $36,500 | SUPPORT |
| UVMC FOUNDATION | |||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 311581859 | 501(C)(3) | $17,863 | SUPPORT |
| TROY COMMUNITY DEVELOPMENT | |||||||
| 405 SW PUBLIC SQUARE 330 | TROY | OH | 45373 | 311736034 | 501(C)(3) | $15,000 | SUPPORT |
| MIAMI VALLEY HOSPITAL | |||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 310537504 | 501(C)(3) | $14,667 | MAHOGANY CHILD & BRIDGE PROGRAM |
| EDISON FOUNDATION | |||||||
| 1973 EDISON DR | PIQUA | OH | 45356 | 311379781 | 501(C)(3) | $13,500 | SUPPORT |
| OMEGA COMMUNITY DEVELOPMENT | |||||||
| 1800 HARVARD BLVD | DAYTON | OH | 45406 | 311561713 | 501(C)(3) | $13,500 | CAPITAL RENOVATION |
| REACH OUT MONTGOMERY COUNTY | |||||||
| 25 E FORAKER ST | DAYTON | OH | 45409 | 311434282 | 501(C)(3) | $10,753 | RX ASSISTANCE FOR INDIGENT |
| BRUKNER NATURE CENTER | |||||||
| 5995 HORSESHOE BEND RD | TROY | OH | 45373 | 310732613 | 501(C)(3) | $10,295 | SUPPORT |
| THE BARN MINISTRY INC | |||||||
| 2140 N RENCH RD | PLEASANT HILL | OH | 45359 | 311671150 | 501(C)(3) | $10,000 | SUPPORT |
| MIAMI COUNTY FOUNDATION | |||||||
| 317 N WAYNE ST | PIQUA | OH | 45356 | 311142558 | 501(C)(3) | $10,000 | SUPPORT |
| GALA OF HOPE FOUNDATION - 3500 | |||||||
| PENTAGON BLVD 500 | BEAVERCREEK | OH | 45431 | 464277044 | 501(C)(3) | $9,000 | SUPPORT |
| MIAMI COUNTY YMCA | |||||||
| 223 W HIGH ST | PIQUA | OH | 45356 | 310537179 | 501(C)(3) | $7,500 | SUPPORT |
| GOODWILL EASTER SEALS MIAMI VALLEY | |||||||
| 660 S MAIN ST | DAYTON | OH | 45402 | 310537112 | 501(C)(3) | $6,930 | SUPPORT |
| DAYTON ART INSTITUTE | |||||||
| 456 BELMONTE PARK N | DAYTON | OH | 45405 | 310537480 | 501(C)(3) | $6,554 | SUPPORT |
| TROY FOUNDATION | |||||||
| 216 W FRANKLIN ST | TROY | OH | 45373 | 316018703 | 501(C)(3) | $6,000 | SUPPORT |
| HABITAT FOR HUMANITY INTERNATIONAL INC | |||||||
| 115 W RIVERVIEW | DAYTON | OH | 45405 | 311352522 | 501(C)(3) | $5,500 | SUPPORT |
| PIQUA EDUCATION FOUNDATION | |||||||
| 719 E ASH ST | PIQUA | OH | 45356 | 311117501 | 501(C)(3) | $5,500 | SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 21 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (24 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| REBECCA A RICE | ||||||||||||||
| PRESIDENT & CEO | $317,890 | $0 | $161,267 | $0 | $32,020 | $0 | $40,939 | $0 | $13,888 | $0 | $566,004 | $0 | $0 | $0 |
| RAFAY ATIQ | ||||||||||||||
| TRUSTEE | $0 | $350,804 | $0 | $111,645 | $0 | $1,983 | $0 | $9,730 | $0 | $28,749 | $0 | $502,911 | $0 | $0 |
| DANIEL S BAILEY MD | ||||||||||||||
| TRUSTEE & CMO (TO AUG) | $174,568 | $0 | $59,747 | $0 | $10,229 | $0 | $11,149 | $0 | $21,457 | $0 | $277,150 | $0 | $0 | $0 |
| DONALD D DELCAMP MD | ||||||||||||||
| TRUSTEE & PRES MEDICAL STAFF | $0 | $489,806 | $0 | $0 | $0 | $23,395 | $0 | $7,541 | $0 | $28,237 | $0 | $548,979 | $0 | $0 |
| DALE E CREECH | ||||||||||||||
| BOARD SECRETARY | $0 | $384,517 | $0 | $157,999 | $0 | $165,655 | $0 | $35,724 | $0 | $26,297 | $0 | $770,192 | $0 | $0 |
| DIANE L PLEIMAN | ||||||||||||||
| COO | $223,032 | $0 | $56,968 | $0 | $4,925 | $0 | $27,386 | $0 | $5,746 | $0 | $318,057 | $0 | $0 | $0 |
| TIMOTHY D SNIDER-SEE SCH O | ||||||||||||||
| BOARD TREASURER & CFO | $198,405 | $0 | $68,205 | $0 | $997 | $0 | $14,231 | $0 | $25,967 | $0 | $307,805 | $0 | $0 | $0 |
| THOMAS R CURTIN | ||||||||||||||
| SYSTEM VP - REVENUE CYCLE | $0 | $217,200 | $0 | $73,402 | $0 | $3,001 | $0 | $31,381 | $0 | $29,680 | $0 | $354,664 | $0 | $0 |
| GARY G GINTER | ||||||||||||||
| SYSTEM VP - CIO | $0 | $371,557 | $0 | $162,212 | $0 | $3,630 | $0 | $47,670 | $0 | $25,576 | $0 | $610,645 | $0 | $0 |
| BARBARA A JOHNSON | ||||||||||||||
| SYS VP - HR OPERATIONS | $0 | $358,532 | $0 | $148,857 | $0 | $15,617 | $0 | $21,090 | $0 | $9,789 | $0 | $553,885 | $0 | $0 |
| TAMMY S LUNDSTROM MD | ||||||||||||||
| SYSTEM VP - CMO | $0 | $511,262 | $0 | $200,578 | $0 | $5,016 | $0 | $57,992 | $0 | $1,422 | $0 | $776,270 | $0 | $0 |
| THOMAS R PARKER | ||||||||||||||
| SYS VP- CHF EXPERIENCE OFFICER | $0 | $369,275 | $0 | $103,016 | $0 | $24,350 | $0 | $42,604 | $0 | $11,990 | $0 | $551,235 | $0 | $0 |
| CRAIG SELF | ||||||||||||||
| SYS VP -CHIEF STRATEGY OFFICER | $0 | $361,101 | $0 | $134,279 | $0 | $1,893 | $0 | $12,640 | $0 | $26,730 | $0 | $536,643 | $0 | $0 |
| MARK W SHAW | ||||||||||||||
| SYSTEM VP - MANAGED CARE | $0 | $297,362 | $0 | $94,038 | $0 | $66,630 | $0 | $35,596 | $0 | $25,442 | $0 | $519,068 | $0 | $0 |
| SCOTT A SHELTON | ||||||||||||||
| SYSTEM VP - CPO | $0 | $241,172 | $0 | $85,638 | $0 | $31,264 | $0 | $28,797 | $0 | $3,427 | $0 | $390,298 | $0 | $0 |
| SYLVAIN TREPANIER DNP RN CENP | ||||||||||||||
| SYSTEM VP - CNO | $0 | $317,525 | $0 | $78,603 | $0 | $2,550 | $0 | $9,718 | $0 | $25,973 | $0 | $434,369 | $0 | $0 |
| THOMAS D BIGLEY | ||||||||||||||
| DIRECTOR - PHARMACY | $154,583 | $0 | $25,479 | $0 | $28,456 | $0 | $92,663 | $0 | $10,508 | $0 | $311,689 | $0 | $0 | $0 |
| ROBERT H BLYTHE | ||||||||||||||
| STAFF PHARMACIST | $143,583 | $0 | $0 | $0 | $3,645 | $0 | $7,944 | $0 | $25,312 | $0 | $180,484 | $0 | $0 | $0 |
| TERRY R FRY | ||||||||||||||
| VP - CNO | $172,026 | $0 | $41,652 | $0 | $20,631 | $0 | $24,978 | $0 | $8,846 | $0 | $268,133 | $0 | $0 | $0 |
| KATHLEEN J SCARBROUGH | ||||||||||||||
| PRESIDENT, UVMC FOUNDATION | $78,462 | $26,601 | $26,701 | $9,052 | $9,871 | $3,347 | $13,567 | $4,801 | $14,112 | $4,949 | $142,713 | $48,750 | $0 | $0 |
| MELISSA M TALMAGE | ||||||||||||||
| DIR-NRS SURG/ICU/PCU | $147,098 | $0 | $20,220 | $0 | $677 | $0 | $13,917 | $0 | $18,142 | $0 | $200,054 | $0 | $0 | $0 |
| RENEE P GEORGE | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $248,408 | $0 | $74,875 | $0 | $819 | $0 | $12,854 | $0 | $11,932 | $0 | $348,888 | $0 | $0 |
| J NICK LAIR | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $221,875 | $0 | $74,484 | $0 | $28,602 | $0 | $25,951 | $0 | $30,871 | $0 | $381,783 | $0 | $0 |
| MICHAEL J MAIBERGER | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $363,714 | $0 | $239,684 | $0 | $283,645 | $0 | $65,488 | $0 | $29,260 | $0 | $981,791 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I LINE 4A: | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING INDIVIDUAL ELECTED TO PARTICIPATE IN A VOLUNTARY RETIREMENT PROGRAM, AND RECEIVED THE FOLLOWING PAYMENTS: Thomas Bigley $6,808 in 2016, and will receive $81,696 in 2017. 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, UPPER VALLEY MEDICAL CENTER (UPPER VALLEY) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENTS THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. UPPER VALLEY 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 2016. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2016: Dale Creech $159,735; J. Nick Lair $9,782; Diane Pleiman $3,376; Mark Shaw $53,557; Scott Shelton $28,038. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2016: Daniel Bailey, M.D. $7,699; Barbara Johnson $10,303; Michael Maiberger $34,406; Rebecca Rice $6,314. 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: Danny Bailey, M.D. $668; Thomas Curtin $1,493; Renee George $1,610; Gary Ginter $18,847; Barbara Johnson $10,811; Tammy Lundstrom $49,100; Michael Maiberger $50,476; Thomas Parker $14,575; Rebecca Rice $9,476; Craig Self $1,462; Timothy Snider $594. 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. Part II, Line 7: TIMOTHY SNIDER SERVES AS AN OFFICER FOR BOTH UPPER VALLEY MEDICAL CENTER AND ANOTHER UNRELATED HOSPITAL. HOWEVER, 100% OF HIS COMPENSATION IS PAID BY UPPER VALLEY MEDICAL CENTER. MR. SNIDER SPENDS APPROXIMATELY ONE-HALF OF HIS WORKING HOURS AT EACH HOSPITAL. THE COMPENSATION REPORTED ON PART VII & SCHEDULE J INCLUDES ALL OF HIS REPORTABLE COMPENSATION, EVEN THOUGH UPPER VALLEY MEDICAL CENTER IS REIMBURSED BY THE UNRELATED HOSPITAL FOR HIS TIME SPENT AT THAT INSTITUTION. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | County of Miami Ohio | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 316000055 | BondIssuerEIN |
| Bond Issued | 2016-08-31 | BondIssuedDt |
| Issue Price | $33,210,000 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $0 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $33,210,000 | TotalProceedsAmt |
| In Reserve Fund | $0 | InReserveFundAmt |
| Capitalized Interest | $0 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $111,568 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $0 | CapitalExpendituresAmt |
| Other Spent Proceeds | $33,098,432 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2009 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | Yes (true) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (true) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (true) | EngageBondCounselContractsInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00050 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00230 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00280 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (true) | RebateNotDueYetInd |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | Yes (true) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | Yes (true) | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BOAML | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 0. | TermOfHedgePct |
| Superintegrated Hedge | Yes (true) | SuperintegratedHedgeInd |
| Hedge Terminated | Yes (true) | HedgeTerminatedInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
GIC Provider Name GICProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | Yes (true) | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART I, LINE A, COLUMN F PURPOSE OF BOND: | FormAndLineReferenceDesc |
| Explanation | THE BOND ISSUE OF 08/31/2016 WAS USED TO CURRENTLY REFUND THE 2006 SERIES BOND. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, PART III, LINE 4A: | THE PRIMARY EXEMPT PURPOSE OF UPPER VALLEY MEDICAL CENTER IS TO PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES TO THE RESIDENTS OF MIAMI AND THE SURROUNDING COUNTIES. THE HOSPITAL FURTHERS ITS TAX-EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN MANY WAYS. SEE SCHEDULE H FOR MORE INFORMATION. FORM 990, PART VI, SECTION A, LINE 3: PREMIER HEALTH (PREMIER) AS THE OPERATOR OF UPPER VALLEY MEDICAL CENTER (UPPER VALLEY), DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR UPPER VALLEY, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. UPPER VALLEY SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. UPPER VALLEY SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. UPPER VALLEY SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF UPPER VALLEY WITH ALL THIRD PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. UPPER VALLEY 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. UPPER VALLEY 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 2016, Upper Valley Medical Centers Code of Regulations were modified. Listed below are the significant changes: * An attendance requirement was added for the Trustees, requiring at least 75% attendance of the board meetings or is considered to have resigned. In addition, the board members must attend at least 75% of each meeting, with an exception for Physicians addressing urgent patient care needs. In such an event, the physician must attend at least 50% of the meeting to be considered present. * No Trustee shall be entitled to receive compensation for services provided as a Trustee, other than reasonable, out-of-pocket expenses incurred in connection with his/her service as a Trustee. * All actions taken by the Executive Committee must be by unanimous vote. * The officers of the Corporation shall be: (a) a Chair of the Board of Trustees, (b) a President and Chief Executive Officer, (c) a Secretary, (d) a Treasurer, and (e) other such officers, including one (1) or more Assistant Secretaries and one (1) or more Assistant Treasurers. FORM 990, PART VI, SECTION A, LINE 6: UPPER VALLEY MEDICAL CENTER HAS TWO CORPORATE MEMBERS. ONE MEMBER IS UVMC. THE SECOND MEMBER IS PREMIER HEALTH, AN OHIO NONPROFIT CORPORATION, FORMED PURSUANT TO THE JOINT OPERATING AGREEMENT. UVMC HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES OF THE CORPORATION. PREMIER HAS THE GENERAL AUTHORITY TO OPERATE AND MANAGE THE OPERATIONAL ACTIVITIES OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A & 7B: UVMC HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR UPPER VALLEY MEDICAL CENTER FROM AMONG THOSE RECOMMENDED BY THE NOMINATING COMMITTEE SET FORTH IN THE JOINT OPERATING AGREEMENT. UVMC HAS THE AUTHORITY TO REMOVE SUCH TRUSTEES AT ANY REGULAR OR SPECIAL BOARD MEETING OR BY WRITTEN CONSENT. FORM 990, PART VI, SECTION B, LINE 11B: THIS 990 TAX RETURN AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE PREMIER HEALTH (PREMIER) TAX DEPARTMENT, OF WHICH UPPER VALLEY 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 QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 TAX RETURN IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, LINE 12C: PREMIER HEALTH (PREMIER), WITH WHICH UPPER VALLEY MEDICAL CENTER IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, OFFICERS, EXECUTIVE DIRECTORS, VICE PRESIDENTS, DIRECTORS, PURCHASING DEPARTMENT STAFF, AUTHORIZED PURCHASERS, MEDICAL DIRECTORS, DEPARTMENT AND SECTIONS CHAIRS, 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 TAX RETURN. FORM 990, PART VI, SECTION B, LINE 15A & 15B: COMPENSATION FOR UPPER VALLEY MEDICAL CENTERS (UPPER VALLEY) CEO IS REVIEWED AND APPROVED BY PREMIER HEALTH (PREMIER), OF WHICH UPPER VALLEY 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 STRATEGY OFFICER, CHIEF INTEGRATION 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 19A: 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 ON WWW.PREMIERHEALTH.COM. |
| FORM 990, PART VII, LINE 1A, ITEM 12: | TIMOTHY SNIDER SERVES AS AN OFFICER FOR BOTH UPPER VALLEY MEDICAL CENTER AND ANOTHER UNRELATED HOSPITAL. HOWEVER, 100% OF HIS COMPENSATION IS PAID BY UPPER VALLEY MEDICAL CENTER. MR. SNIDER SPENDS APPROXIMATELY ONE-HALF OF HIS WORKING HOURS AT EACH HOSPITAL. THE COMPENSATION REPORTED ON PART VIII INCLUDES ALL OF HIS REPORTABLE COMPENSATION, EVEN THOUGH UPPER VALLEY MEDICAL CENTER IS REIMBURSED BY THE UNRELATED HOSPITAL FOR HIS TIME SPENT AT THAT INSTITUTION. Form 990, Part XI, Line 9: EQUITY TRANSFERS (11,879,845) FOUNDATION ADJUSTMENT (172,769) PHG EQUITY TRANSFER (118,639) CHANGE IN UVMC AUXILIARY CASH POSITION (20,954) OTHER 9,882 GAIN ON SALE-DIALYSIS CENTER 126,000 TRANSFER FROM AFFILIATE 143,480 PENSION FASB 158 ADJUSTMENT 645,619 ----------- TOTAL (11,267,226) |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| UVMC | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 341850683 | PARENT | OH | 501(c)(3) | 12C III FI | NA | false |
| UVMC FOUNDATION | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311581859 | FOUNDATION | OH | 501(c)(3) | 7 | NA | false |
| PREMIER HEALTH | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 311446699 | JOA PARENT | OH | 501(c)(3) | 12A I | NA | false |
| UPPER VALLEY PROFESSIONAL CORP (UVPC) | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 311400963 | HEALTH CARE | OH | 501(c)(3) | 10 | UVMC | Yes (true) |
| UVPC SPECIALISTS INC | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 203687536 | HEALTH CARE | OH | 501(c)(3) | 10 | UVPC | Yes (true) |
| UVMC NURSING CARE INC | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 311224064 | NURSING HOME | OH | 501(c)(3) | 10 | UVMC | Yes (true) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| UVMC MANAGEMENT CORPORATION | ||||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 311360489 | MGT COMPANY | OH | UVMC | C CORP | $0 | $0 | 0.00000 | Yes (true) |
| AFTER HOURS FAMILY CARE | ||||||||||||
| 110 N MAIN ST 500 | Dayton | OH | 45402 | 311269483 | Health Care | OH | UVPC | C Corp | $0 | $0 | 0.00000 | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (20 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| UVMC FOUNDATION | ||
| C | $316,249 | FMV |
| UVMC FOUNDATION | ||
| Q | $414,480 | FMV |
| UVMC FOUNDATION | ||
| R | $332,368 | FMV |
| UPPER VALLEY PROFESSIONAL CORP | ||
| J | $65,525 | FMV |
| UPPER VALLEY PROFESSIONAL CORP | ||
| O | $118,942 | FMV |
| UPPER VALLEY PROFESSIONAL CORP | ||
| Q | $5,880,607 | FMV |
| UPPER VALLEY PROFESSIONAL CORP | ||
| S | $380,635 | FMV |
| AFTER HOURS FAMILY CARE | ||
| P | $244,756 | FMV |
| UVPC SPECIALISTS INC | ||
| O | $1,106,580 | FMV |
| UVPC SPECIALISTS INC | ||
| P | $585,059 | FMV |
| UVPC SPECIALISTS INC | ||
| Q | $2,689,196 | FMV |
| UVMC MANAGEMENT CORP | ||
| B | $148,741 | FMV |
| UVMC MANAGEMENT CORP | ||
| O | $849,073 | FMV |
| UVMC MANAGEMENT CORP | ||
| Q | $784,400 | FMV |
| UVMC NURSING CARE INC | ||
| Q | $55,532 | FMV |
| PREMIER HEALTH | ||
| B | $108,473 | FMV |
| UVPC SPECIALISTS INC | ||
| B | $5,385,519 | FMV |
| UPPER VALLEY PROFESSIONAL CORP | ||
| B | $6,616,394 | FMV |
| AFTER HOURS FAMILY CARE | ||
| B | $574,587 | FMV |
| UVMC | ||
| C | $696,654 | CASH |