GOOD SAMARITAN HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN HOSPITAL (EIN 31-0536981)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201723189349305392
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T12:43:36-06:00 | 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 ST 200 | AddressLine1Txt |
| City | GRANDVIEW HEIGHTS | 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 | 310536981 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % J MICHAEL SIMS | InCareOfNm |
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIMOTHY D SNIDER | PersonNm |
| Person Title | TREASURER / 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 | 108.206.163.59 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 31499120173185000005 | 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 | 582F47EFACDD6166E52205D1FBFEA2601660FA18 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Eloise Broner PresidentCEO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2222 PHILADELPHIA DR | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45406 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $482,168,921 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PREMIERHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1932 | 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 HEALTHCARE SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 3521 | TotalEmployeeCnt |
| Total Volunteers | 356 | TotalVolunteersCnt |
| Total Gross UBI | $251,146 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$70,584 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $959,031 | PYContributionsGrantsAmt |
| CY Contributions Grants | $345,570 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $338,862,036 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $358,470,414 | CYProgramServiceRevenueAmt |
| PY Investment Income | $9,042,783 | PYInvestmentIncomeAmt |
| CY Investment Income | $17,152,792 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,213,465 | PYOtherRevenueAmt |
| CY Other Revenue | $4,037,714 | CYOtherRevenueAmt |
| PY Total Revenue | $354,077,315 | PYTotalRevenueAmt |
| CY Total Revenue | $380,006,490 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,363,870 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,209,492 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $154,536,874 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $166,562,040 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $181,444,700 | PYOtherExpensesAmt |
| CY Other Expenses | $208,685,726 | CYOtherExpensesAmt |
| PY Total Expenses | $338,345,444 | PYTotalExpensesAmt |
| CY Total Expenses | $378,457,258 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $15,731,871 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,549,232 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $493,068,205 | TotalAssetsBOYAmt |
| Total Assets EOY | $374,728,116 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $145,021,154 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $59,164,200 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $348,047,051 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $315,563,916 | NetAssetsOrFundBalancesEOYAmt |
| Mission | WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $351,978,453 | ExpenseAmt |
| Grant | $3,209,492 | GrantAmt |
| Revenue | $358,470,414 | RevenueAmt |
| Desc | SEE SCHEDULE H | Desc |
| Total Program Service Expenses | $351,978,453 | 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 | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | 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 | false | TaxExemptBondsInd |
| 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 | Yes (true) | 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 | Yes (true) | 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 | 204 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 3521 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | 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 | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| 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 (29 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| MARTIN FUJIMURA MD | ||||||||||
| BOARD CHAIR | 0.5 | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| ELOISE P BRONER | ||||||||||
| PRESIDENT & CEO | 38.5 | 1.5 | Yes (X) | Yes (X) | $802,556 | $0 | $36,119 | |||
| CAROL BAUER SC | ||||||||||
| TRUSTEE | 39.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||||
| MARY H BOOSALIS | ||||||||||
| TRUSTEE & PREMIER PRESIDENT | 7.5 | 24.5 | Yes (X) | $0 | $0 | $0 | ||||
| GEORGE T BRODERICK JR MD | ||||||||||
| TRUSTEE | 0.5 | 1.5 | Yes (X) | $0 | $0 | $0 | ||||
| ANUJ GOYAL MD | ||||||||||
| TRUSTEE & CHIEF OF STAFF | 0.5 | 0.5 | Yes (X) | $20,000 | $1,425 | $0 | ||||
| JAMES R PANCOAST | ||||||||||
| TRUSTEE & PREMIER CEO | 7.5 | 8.5 | Yes (X) | $0 | $0 | $0 | ||||
| LASZLO TOTH MD | ||||||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| DALE E CREECH | ||||||||||
| BOARD SECRETARY/SYSTEM VP-CLO | 7.5 | 32.5 | Yes (X) | $0 | $708,171 | $62,021 | ||||
| TIMOTHY D SNIDER | ||||||||||
| BOARD TREASURER / CFO | 18.5 | 1.5 | Yes (X) | $133,804 | $0 | $20,099 | ||||
| THOMAS R CURTIN | ||||||||||
| SYSTEM VP - REVENUE CYCLE | 8.0 | 31.0 | $0 | $293,603 | $61,061 | Yes (X) | ||||
| MARY E GARMAN | ||||||||||
| VP OPERATIONS & CNO | 39.5 | 0.5 | $341,896 | $0 | $23,857 | Yes (X) | ||||
| GARY G GINTER | ||||||||||
| SYSTEM VP - CIO | 8.0 | 32.0 | $0 | $537,399 | $73,245 | Yes (X) | ||||
| KATHLEEN M HARPER | ||||||||||
| VP HOSPITAL OPERATIONS | 40.0 | 0.0 | $194,234 | $0 | $27,285 | Yes (X) | ||||
| BARBARA A JOHNSON | ||||||||||
| SYSTEM 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 | 7.5 | 32.5 | $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 | $35,692 | Yes (X) | ||||
| DENA L HELSINGER | ||||||||||
| DEPARTMENT DIRECTOR | 40.0 | 0.0 | $218,214 | $0 | $24,098 | Yes (X) | ||||
| FRANK E SAWYER | ||||||||||
| SYS VP - ONCOLOGY SERVICE LINE | 39.5 | 0.5 | $303,651 | $0 | $34,708 | Yes (X) | ||||
| LAURA F SITTLER | ||||||||||
| VP - CNO | 40.0 | 0.0 | $214,296 | $0 | $58,329 | Yes (X) | ||||
| SHARON K THORNTON | ||||||||||
| SYSTEM VP - ERP OPERATIONS | 40.0 | 0.0 | $228,035 | $0 | $18,668 | Yes (X) | ||||
| DARLENE WISEMAN | ||||||||||
| VP FINANCE - SUPPORT SERVICES | 40.0 | 0.0 | $212,574 | $0 | $37,048 | 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) | ||||
| DANIEL L SCHOULTIES MD | ||||||||||
| FORMER KEY EMPLOYEE | 0.0 | 40.0 | $0 | $460,321 | $379,110 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,669,260 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $6,098,540 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,250,467 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 116 | 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 |
|---|---|---|---|---|---|
| DAWSON HEALTHCARE | |||||
| 1114 DUBLIN RD | COLUMBUS | OH | 43215 | AGENCY STAFF | $9,390,343 |
| MESSER CONSTRUCTION CO | |||||
| 4801 HEMPSTEAD STATION DR | DAYTON | OH | 45429 | CONSTRUCTION | $4,656,930 |
| ANESTHESIA ASSOCIATION OF NW DAYTON | |||||
| 3180 KETTERING BLVD | DAYTON | OH | 45439 | MEDICAL SERVICES | $4,218,416 |
| EMERGENCY PROFESSIONAL SERVICES INC | |||||
| PO BOX 634850 | CINCINNATI | OH | 45263 | MEDICAL SERVICES | $1,773,914 |
| WENCO CONSTRUCTION CO LLC | |||||
| 1807 DALTON DR | NEW CARLISLE | OH | 45344 | CONSTRUCTION | $1,444,419 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 66 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $235,570 | RelatedOrganizationsAmt |
| Government Grants | $110,000 | GovernmentGrantsAmt |
| Total Contributions | $345,570 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT REVENUE | 621110 | $178,334,581 | $178,098,814 | $235,767 |
| MEDICARE/MEDICAID | 621110 | $155,625,309 | $155,625,309 | |
| JOINT OPERATING AGREEMENT | 423000 | $16,151,000 | $16,151,000 | |
| FRANCHISE TAX RECOVERIES | 812930 | $8,242,464 | $8,242,464 | |
| HEALTH EDUCATION | 561499 | $91,006 | $91,006 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,054 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,054 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $358,470,414 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,331,676 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $15,379 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,316,297 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,019,561 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,503,611 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $515,950 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $515,950 | TotalRevenueColumnAmt |
| Exclusion | $515,950 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $110,552,137 | SecuritiesAmt |
| Other | $594,608 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $96,839,147 | SecuritiesAmt |
| Other | $486,482 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $13,712,990 | SecuritiesAmt |
| Other | $108,126 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,821,116 | TotalRevenueColumnAmt |
| Exclusion | $13,821,116 | 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 | $426,510 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $333,191 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $93,319 | TotalRevenueColumnAmt |
| Exclusion | $93,319 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 721110 | $2,377,982 | $2,377,982 |
| PARKING GARAGE | 812930 | $300,505 | $300,505 |
| DISCOUNTS / REBATES | 900099 | $165,562 | $165,562 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $584,396 | TotalRevenueColumnAmt |
| Exclusion | $584,396 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,428,445 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $380,006,490 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $358,234,647 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $251,146 | UnrelatedBusinessRevenueAmt |
| Exclusion | $21,175,127 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,209,492 | TotalAmt |
| Program Services | $3,209,492 | 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 | $1,599,850 | TotalAmt |
| Program Services | $1,459,064 | ProgramServicesAmt |
| Management And General | $140,786 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,695 | TotalAmt |
| Program Services | $172,090 | ProgramServicesAmt |
| Management And General | $16,605 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,863,672 | TotalAmt |
| Program Services | $116,611,669 | ProgramServicesAmt |
| Management And General | $11,252,003 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,211,083 | TotalAmt |
| Program Services | $7,488,508 | ProgramServicesAmt |
| Management And General | $722,575 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,487,333 | TotalAmt |
| Program Services | $17,772,448 | ProgramServicesAmt |
| Management And General | $1,714,885 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,211,407 | TotalAmt |
| Program Services | $8,400,803 | ProgramServicesAmt |
| Management And General | $810,604 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,136,665 | TotalAmt |
| Program Services | $3,772,638 | ProgramServicesAmt |
| Management And General | $364,027 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $331,947 | TotalAmt |
| Program Services | $302,736 | ProgramServicesAmt |
| Management And General | $29,211 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,771 | TotalAmt |
| Management And General | $154,771 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,532 | TotalAmt |
| Program Services | $25,532 | ProgramServicesAmt |
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 | $459,836 | TotalAmt |
| Management And General | $459,836 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,089,895 | TotalAmt |
| Program Services | $30,177,984 | ProgramServicesAmt |
| Management And General | $2,911,911 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,063,758 | TotalAmt |
| Program Services | $3,063,758 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,817,220 | TotalAmt |
| Program Services | $1,657,305 | ProgramServicesAmt |
| Management And General | $159,915 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,332,311 | TotalAmt |
| Program Services | $7,599,068 | ProgramServicesAmt |
| Management And General | $733,243 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,300,146 | TotalAmt |
| Program Services | $4,833,733 | ProgramServicesAmt |
| Management And General | $466,413 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200,617 | TotalAmt |
| Program Services | $182,963 | ProgramServicesAmt |
| Management And General | $17,654 | 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 | $621 | TotalAmt |
| Program Services | $566 | ProgramServicesAmt |
| Management And General | $55 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,832,039 | TotalAmt |
| Program Services | $2,832,039 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,700,614 | TotalAmt |
| Program Services | $25,262,960 | ProgramServicesAmt |
| Management And General | $2,437,654 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $905,534 | TotalAmt |
| Program Services | $825,847 | ProgramServicesAmt |
| Management And General | $79,687 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| OPERATING SUPPLIES | $69,382,146 | $69,382,146 | |
| PENSION SETTLEMENT | $20,670,858 | $18,851,822 | $1,819,036 |
| PURCHASED SERVICES | $18,359,051 | $16,743,455 | $1,615,596 |
| HOSPITAL FRANCHISE TAX | $5,418,325 | $5,418,325 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,503,840 | TotalAmt |
| Program Services | $5,931,502 | ProgramServicesAmt |
| Management And General | $572,338 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $378,457,258 | TotalAmt |
| Program Services | $351,978,453 | ProgramServicesAmt |
| Management And General | $26,478,805 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,640 | BOYAmt |
| EOY | $17,538 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,697,230 | BOYAmt |
| EOY | $17,335,268 | 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 | $54,106,496 | BOYAmt |
| EOY | $50,439,667 | 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 | $1,035,262 | BOYAmt |
| EOY | $783,320 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,959,164 | BOYAmt |
| EOY | $5,175,076 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,993,308 | BOYAmt |
| EOY | $4,003,413 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $527,985,045 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $338,019,268 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,946,434 | BOYAmt |
| EOY | $189,965,777 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $135,998,165 | BOYAmt |
| EOY | $69,239,856 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,773,937 | BOYAmt |
| EOY | $13,773,753 | 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 | $3,376,413 | BOYAmt |
| EOY | $3,376,413 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,164,156 | BOYAmt |
| EOY | $20,618,035 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $493,068,205 | BOYAmt |
| EOY | $374,728,116 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,472,947 | BOYAmt |
| EOY | $27,985,549 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,408,687 | BOYAmt |
| EOY | $846,443 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,168,573 | BOYAmt |
| EOY | $348,679 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | 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 | $92,605,491 | BOYAmt |
| EOY | $616,899 | 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 | $25,365,456 | BOYAmt |
| EOY | $29,366,630 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $145,021,154 | BOYAmt |
| EOY | $59,164,200 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $348,047,051 | BOYAmt |
| EOY | $315,563,916 | 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 | $348,047,051 | BOYAmt |
| EOY | $315,563,916 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $493,068,205 | BOYAmt |
| EOY | $374,728,116 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,549,232 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$6,755,142 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$27,277,225 | 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 | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
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 | $19,322 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $6,210 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $25,532 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Lines 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 | $7,691,110 | OtherCostOrOtherBasisAmt |
| Book Value | $7,691,110 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $310,103,669 | OtherCostOrOtherBasisAmt |
| Depreciation | $190,016,089 | DepreciationAmt |
| Book Value | $120,087,580 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,400,186 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,024,149 | DepreciationAmt |
| Book Value | $376,037 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $197,676,512 | OtherCostOrOtherBasisAmt |
| Depreciation | $144,979,030 | DepreciationAmt |
| Book Value | $52,697,482 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,113,568 | OtherCostOrOtherBasisAmt |
| Book Value | $9,113,568 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $189,965,777 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| JOINT OPERATING AGREEMENT | $16,447,000 |
| OTHER A/R | $2,101,229 |
| HCAP ACCRUAL | $1,806,408 |
| DEFERRED COMPENSATION | $233,398 |
| AFFILIATES INVESTMENT | $30,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $20,618,035 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)
| DescDesc | AmtAmt |
|---|---|
| AFFILIATES PAYABLE | $15,981,676 |
| MALPRACTICE INSURANCE | $8,662,283 |
| PENSION OBLIGATION | $1,115,410 |
| SETTLEMENT-3RD PARTY PAYORS | $944,889 |
| LOAN GUARANTEE & OTHER LTL | $746,037 |
| WORKERS COMPENSATION RESERVE | $658,799 |
| CONSTRUCTION RETAINAGE | $375,079 |
| OTHER | $882,457 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $29,366,630 | 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. SAMARITAN HEALTH PARTNERS IS THE PARENT ORGANIZATION OF GOOD SAMARITAN HOSPITAL (GSH): PREMIER HEALTH (PREMIER), MEDAMERICA HEALTH SYSTEMS (MAHS), ATRIUM HEALTH SYSTEM (AHS), SAMARITAN HEALTH PARTNERS (SHP), 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 (10 entries)
| RegionRegionTxt | Type Of Activities ConductedTypeOfActivitiesConductedTxt | Region Total ExpendituresRegionTotalExpendituresAmt | Specific Services ProvidedSpecificServicesProvidedTxt |
|---|---|---|---|
| Central America and the Caribbean | Investments | $1,184,000 | |
| East Asia and the Pacific | Investments | $4,041,000 | |
| Europe (Including Iceland and Greenland) | Investments | $9,336,000 | |
| Middle East and North Africa | Investments | $139,000 | |
| North America | Investments | $906,000 | |
| Russia and the Newly Independent States | Investments | $348,000 | |
| South America | Investments | $766,000 | |
| South Asia | Investments | $418,000 | |
| Sub-Saharan Africa | Investments | $139,000 | |
| Central America and the Caribbean | Program Services | $25,000 | INSURANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Spent | $17,302,000 | SubtotalSpentAmt |
| Total Spent | $17,302,000 | TotalSpentAmt |
| Transfer To Foreign Corp | Yes (true) | TransferToForeignCorpInd |
| Interest In Foreign Trust | false | InterestInForeignTrustInd |
| Foreign Corp Ownership | Yes (true) | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | false | PassiveForeignInvestmestCoInd |
| Foreign Partnership | Yes (true) | 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 | $7,887,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,806,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,081,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01610 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $72,749,464 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $54,484,464 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,265,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04830 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,952,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,099,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $853,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $83,588,464 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $58,389,464 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $25,199,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06670 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $898,411 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $44,411 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $854,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,585,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,585,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03060 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,921,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,921,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,404,411 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $44,411 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,360,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03800 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $97,992,875 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $58,433,875 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $39,559,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10470 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $432,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $432,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $575 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $575 | NetCommunityBenefitExpnsAmt |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,926 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,926 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,500 | NetCommunityBenefitExpnsAmt |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,300 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,300 | NetCommunityBenefitExpnsAmt |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $211,795 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $211,795 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $693,096 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $693,096 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $6,267,266 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $71,625,000 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $84,571,000 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$12,946,000 | 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 |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAM NORTH SURG CTR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | SURGICAL SERVICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.8 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.2 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | GOOD SAMARITAN HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2222 PHILADELPHIA DR | AddressLine1Txt |
| City | Dayton Ohio | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45406 | 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 |
| Teaching Hospital | Yes (X) | TeachingHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | 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. Good Samaritan's REGISTRATION NUMBER IS 1245. 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 GOOD SAMARITAN HOSPITAL, The Health Collaborative in Cincinnati, Ohio, Dayton-Montgomery County Public Health Department, Darke County General Health District, Miami County Public Health, and the Greater Dayton Area Hospital Association with its member hospitals. The participating hospitals invited a broad range of nonprofit agencies and organizations, which serve the medically underserved, low-income and minority populations, to attend community meetings and complete surveys. Part V, Section B, LINE 6A & 6B: Good Samaritan Hospital partnered with member hospitals of the Greater Dayton Area Hospital Association, The Health Collaborative in Cincinnati, Ohio, Dayton-Montgomery County Public Health Department, Darke County General Health District, Miami County Public Health, The Greater Dayton Area Hospital Association, Xavier University and an independent consultant to prepare the community health needs assessment. PART V, Section B, LINE 7A & 10A: The 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: Good Samaritan Hospital (GSH), as a member of the Premier Health system, was part of a collaboration in 2016 with member hospitals of the Greater Dayton Area Hospital Association, The Health Collaborative in Cincinnati, Ohio, The Greater Dayton Area Hospital Association, Xavier University, Dayton-Montgomery County Public Health Department, Darke County General Health District, Miami County Public Health, and an independent consultant to prepare the community health needs assessment. Based on the results of this assessment, GSH has adopted an implementation strategy to address the following prioritized needs: * Birth Outcomes * Behavioral Health/Substance Abuse * Chronic diseases Health issue: Birth Outcomes -------------- GSH will improve the health and well-being of women and infants with the CenteringPregnancy program. This program is developed by Catholic Social Services and provides group prenatal care and home visits. Lifestages Samaritan Centers for Women operates CenteringPregnancy at GSH and Good Samaritan North Health Center (GSHN). Additional features include screening, brief intervention and referral to treatment (SBIRT), depression screening, and transportation and childcare vouchers. The program targets women who live in the ZIP Codes where the most infant deaths have occurred. This program leverages resources from Lifestages Samaritan Centers for Women, Catholic Social Services of the Miami Valley, Five Rivers Health Center for Womens Health, GSHN, Montgomery County Infant Mortality Coalition, and Ohio Perinatal Quality Collaborative. The Family Birthing Center and Lifestages Samaritan Centers for Woman at GSH work with a team of other community organizations to increase the number of women who breastfeed their babies. The objectives are 1) to increase the frequency of education about breastfeeding before birth, and 2) to provide lactation support after birth. Breastfed children have fewer illnesses and less risk of Sudden Infant Death Syndrome, childhood cancers, and diabetes. Mothers have less risk of breast cancer, ovarian cancer, anemia, and osteoporosis. The family saves money since breast milk is readily available and free. The mother and her significant other or person of choice (grandparent, friend) are encouraged to attend monthly breastfeeding classes. This is important to combat myths that surround breastfeeding. Mothers new to breastfeeding benefit from lactation consulting after birth and at home. GSH has completed 6 of the 10 steps required for recognition through the "Ten Steps for Successful Breasfeeding" promotion by Baby Friendly USA as part of the Ohio First Steps for Healthy Babies, a collaborative of the Ohio Hospital Association and the Ohio Department of Health. Other team members include Premier Community Health, Catholic Social Services of the Miami Valley, WIC, and Ohio First Steps for Healthy Babies. Health issue: Behavioral Health / Substance Abuse ----------------------------------- GSH will provide education that addiction is a disease, and as a result, change perceptions first of hospital personnel and medical professionals, and then of the community. The objectives are 1) to provide CEUs to front-line staff and physicians for education on this topic, with curriculum delivered by ADAMHS, and 2) to educate Health Ministries staff in a 'train the trainer' approach so they can provide training through a network of hundreds of churches. In addition to assistance from the ADAMHS Board, resources will be obtained from Health Ministries, Samaritan Behavioral Health, Inc., physician practices, and local churches. Health issue: Chronic Diseases ---------------- GSH will work with the American Heart Association and The Heart Institute of Dayton to train more people in how to provide CPR through installations of educational kiosks in certain public areas. An interactive kiosk features a touch screen with a video program that gives a brief "how-to" followed by a practice session and a 30-second CPR test. With the help of a rubber torso, the kiosk gives feedback about the depth and rate of compressions and proper hand placement factors that influence the effectiveness of CPR. The kiosk is an interactive training opportunity with no on-site staff. More widespread CPR training is important because only about 46 percent of people who experience an out-of-hospital cardiac arrest get the help they need before the ambulance arrives. Survival rates drop as much as 10 percent for each minute without intervention. The second chronic issue targeted by GSH is food hardships in the community. According to the Food Research & Action Center, Dayton ranked 11th out of 109 metropolitan areas for households experiencing food hardship. To address this need, the hospital will work with other community organizations to increase the amount of healthy food for people with health-related nutritional needs. The short-term objectives are 1) to ensure that all eligible patients are signed up for Supplemental Nutrition Assistance Program (SNAP) and/or Women Infant Children (WIC) food assistance benefits, and 2) to increase the availability of fresh produce in partnership with local food pantries and farmers. The hospital may begin screening for hunger to ascertain the scope of the problem. If determined feasible, GSH, along with its affiliates in Premier Health, would create a food pharmacy, or similar prescription for food program by 2019. A food pharmacy accepts people with a physician referral and offers two to three days worth of food per visit. Patients can return to the food pharmacy once per month for up to six months, at which time they can return to their physician for another referral if they are still in need. Other services may include nutrition counseling, cooking classes, and connection to community resources. GSH will collaborate with Dayton-Montgomery County Food & Hunger Coalition, Catholic Social Services of the Miami Valley Food Pantry, Grace Church, Sinclair College, SNAP, and WIC in this mission. Good Samaritan Hospital is one of 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, Transportation, Care for Children / Child Health, Immunizations, and Accidents. The leadership of the Premier hospitals recognize no one entity can single-handedly effect dramatic change in all of these serious areas within the three-year timeframe of the CHNA process. Therefore, Premier will direct and focus its resources on the three priorities that are most prevalent in its surrounding communities. PART V, SECTION B, LINE 16 A, B, AND C: The direct website address where a copy of the financial assistance policy (FAP), FAP Applicatio | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| GOOD SAMARITAN NORTH HEALTH CENTER | ||||
| 9000 N MAIN ST | DAYTON | OH | 45415 | GENERAL MEDICAL AND SURGICAL |
| GOOD SAMARITAN NORTH SURGERY CENTER | ||||
| 9000 N MAIN ST | DAYTON | OH | 45415 | GENERAL MEDICAL AND SURGICAL |
| GOOD SAMARITAN HEALTH CTR-HUBER HEIGHTS | ||||
| 6521 GOOD SAMARITAN WAY BRANDT PIKE | HUBER HEIGHTS | OH | 45424 | GENERAL MEDICAL AND SURGICAL |
| GSH Medical Imaging- N Main (closed Apr) | ||||
| 7271 North Main Street | Dayton | OH | 45415 | X-Ray |
| GSH Medical Imaging - Needmore | ||||
| 1530 Needmore Road Suite 200 30 | Dayton | OH | 45414 | X-ray |
| GSH Medical Imaging - Beavercreek | ||||
| 2619 Commons Blvd - Suite 102 | Beavercreek | OH | 45431 | X-Ray |
| GSH Medical Imaging - Greenville | ||||
| 742 Sweitzer Street Suite 3 | Greenville | OH | 45331 | Echocardiograms & X-Rays |
| Samaritan SleepDiabetes Center | ||||
| 80 East Woodbury | Dayton | OH | 45415 | Joint Sleep & Diabetes Center |
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 GOOD SAMARITAN HOSPITAL IS PART OF THE PREMIER HEALTH REPORT (EIN# 31-1446699). PART I, LINE 7: A cost to charge ratio was used to calculate this financial assistance at cost. This calculation takes total operating expenses less other operating revenues divided by total gross revenues. Unreimbursed Medicaid and other means-tested governmental programs were calculated using a cost accounting system. This system addresses all patient segments and includes fully loaded costs. For the remaining items, the organization used specific numbers for expense paid directly for these services. PART I, LINE 7G: Good Samaritan Hospital 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 amount paid for call and subsidies was $11,585,000. PART II: Good Samaritan Hospital (GSH) is committed to improving the health of the communities it serves through a variety of prevention, health improvement and engagement programs. As part of its overall commitment to the community, GSH focuses on four areas of service: --Investing in the community --Prevention and wellness --Commitment to the under-served --Community engagement Some of the programs supported by GSH during 2016 include: 1) Ongoing efforts to improve the economic condition in Dayton and the Miami Valley. A total of $35,000 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) Neighborhood revitalization and development through a contribution of $432,000 to the Phoenix Project. The goals of this project are to reduce and deter crime, revitalize the appearance of the neighborhood and activate linkages for physical, mental and social health services. This program also purchases properties in the surrounding area, rehabilitates them and sells them to those in need. 3) Funding of $12,000 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. 4) Funding of local charitable organizations through the hospitals Board Charitable Credit Fund. As part of GSH'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 $207,000. 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 $71,874,000 AND INCURRED COST OF $100,928,000, FOR AN ADDITIONAL NET SHORTFALL OF $29,054,000 ASSOCIATED WITH THESE PROGRAMS. BELOW IS A RECONCILIATION OF THE AMOUNTS ASSOCIATED WITH MEDICARE PROGRAMS. ALLOWABLE MEDICARE REVENUE PER MEDICARE COST REPORT IN PART III, SECTION B $71,625,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $71,874,000 TOTAL MEDICARE ASSOCIATED REVENUE $143,499,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT IN PART III, SECTION B $84,571,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $100,928,000 TOTAL MEDICARE ASSOCIATED COST $185,499,000 MEDICARE SHORTFALL PER PART III, SECTION B $12,946,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $29,054,000 TOTAL MEDICARE SHORTFALL $42,000,000 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 52% 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. DOCUMENTED 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 not honored the terms of that plan. THE FINANCIAL COUNSELORS MEET WITH INPATIENT, OUTPATIENT SELF-PAY, AND OTHER PATIENTS UPON REQUEST WHO MAY NEED FINANCIAL ASSISTANCE. IN ADDITION TO ASSISTING PATIENTS WHO WANT TO APPLY FOR ASSISTANCE THROUGH THE MEDICAID PROGRAM, THE FINANCIAL COUNSELOR WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 2: The organization works with the community on programs that address the underlying causes of persistent health problems as part of a comprehensive strategy to improve the health status and quality of life for identified members of the community who are economically disadvantaged, disenfranchised and/or who have disproportionate unmet health needs. The organization strives to work with Premier Health, the THE GOOD SAMARITAN HOSPITAL Board of Trustees, executive management, managers, staff members, community groups, and individuals to provide a collaborative approach to the governance and management of community benefit activities. PART VI, LINE 3: There are several ways in which our organization informs and educates patients who may be billed for services about eligibility for assistance under federal, state, or local government programs, or under the hospital's financial assistance policy. First, notification of | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (17 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| FIVE RIVERS HEALTH CENTERS | |||||||
| 2261 PHILADELPHIA DR | DAYTON | OH | 45406 | 450914398 | 501(C)(3) | $1,772,196 | SUPPORT |
| CITYWIDE DEVELOPMENT CORP | |||||||
| 8 N MAIN ST | DAYTON | OH | 45402 | 310821189 | 501(C)(4) | $432,000 | COMMUNITY DEVELOPMENT |
| PREMIER COMMUNITY HEALTH co Fidelity Health Care | |||||||
| 3170 KETTERING BLVD | Dayton | OH | 45439 | 311122883 | 501(C)(3) | $240,148 | COMMUNITY HEALTH |
| MIAMI VALLEY HOSPITAL | |||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 310537504 | 501(C)(3) | $37,483 | AFRICAN AMERICAN WOMEN'S HEALTH PROGRAM |
| OMEGA COMMUNITY DEVELOPMENT | |||||||
| 1800 HARVARD BLVD | DAYTON | OH | 45406 | 311561713 | 501(C)(3) | $34,500 | CAPITAL RENOVATION |
| CATHOLIC SOCIAL SERVICES | |||||||
| 922 W RIVERVIEW AVE | DAYTON | OH | 45402 | 310536968 | 501(C)(3) | $31,246 | SUPPORT |
| REACH OUT MONTGOMERY COUNTY | |||||||
| 25 E FORAKER ST | DAYTON | OH | 45409 | 311434282 | 501(C)(3) | $32,479 | RX ASSISTANCE FOR INDIGENT |
| GALA OF HOPE FOUNDATION - 3500 PENTAGON | |||||||
| BLVD 500 | BEAVERCREEK | OH | 45431 | 464277044 | 501(C)(3) | $23,000 | SUPPORT |
| GOODWILL EASTER SEALS MIAMI VALLEY | |||||||
| 660 S MAIN ST | DAYTON | OH | 45402 | 310537112 | 501(C)(3) | $17,710 | SUPPORT |
| THE DAYTON FOUNDATION | |||||||
| 40 N MAIN ST 500 | DAYTON | OH | 45423 | 316027287 | 501(C)(3) | $11,500 | SUPPORT |
| DAYBREAK | |||||||
| 605 S PATTERSON BLVD | DAYTON | OH | 45402 | 310864474 | 501(C)(3) | $11,373 | SUPPORT |
| DAYTON ART INSTITUTE | |||||||
| 456 BELMONTE PARK N | DAYTON | OH | 45405 | 310537480 | 501(C)(3) | $11,638 | SUPPORT |
| EQUITAS HEALTH | |||||||
| 15 W FOURTH ST | DAYTON | OH | 45402 | 311126780 | 501(C)(3) | $11,500 | SUPPORT |
| PROJECT HOPE | |||||||
| 1510 N MAIN ST | DAYTON | OH | 45405 | 341421548 | 501(C)(3) | $11,900 | SUPPORT |
| GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON | |||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 237296923 | 501(C)(3) | $16,575 | SUPPORT |
| BIG BROTHERS BIG SISTERS | |||||||
| 22 S JEFFERSON ST | DAYTON | OH | 45402 | 310641306 | 501(C)(3) | $5,345 | SUPPORT |
| SAINT PETER CATHOLIC CHURCH | |||||||
| 6161 CHAMBERSBURG RD | HUBER HGHTS | OH | 45424 | 310626310 | 501(C)(3) | $20,250 | SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 16 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, 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 (22 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ELOISE P BRONER | ||||||||||||||
| PRESIDENT & CEO | $429,630 | $0 | $186,519 | $0 | $186,407 | $0 | $33,264 | $0 | $2,855 | $0 | $838,675 | $0 | $0 | $0 |
| DALE E CREECH | ||||||||||||||
| BOARD SECRETARY/SYSTEM VP-CLO | $0 | $384,517 | $0 | $157,999 | $0 | $165,655 | $0 | $35,724 | $0 | $26,297 | $0 | $770,192 | $0 | $0 |
| TIMOTHY D SNIDER | ||||||||||||||
| BOARD TREASURER / CFO | $99,202 | $0 | $34,103 | $0 | $499 | $0 | $7,116 | $0 | $12,983 | $0 | $153,903 | $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 |
| MARY E GARMAN | ||||||||||||||
| VP OPERATIONS & CNO | $275,964 | $0 | $63,306 | $0 | $2,626 | $0 | $11,676 | $0 | $12,181 | $0 | $365,753 | $0 | $0 | $0 |
| GARY G GINTER | ||||||||||||||
| SYSTEM VP - CIO | $0 | $371,557 | $0 | $162,212 | $0 | $3,630 | $0 | $47,670 | $0 | $25,575 | $0 | $610,644 | $0 | $0 |
| KATHLEEN M HARPER | ||||||||||||||
| VP HOSPITAL OPERATIONS | $173,715 | $0 | $19,643 | $0 | $876 | $0 | $4,581 | $0 | $22,704 | $0 | $221,519 | $0 | $0 | $0 |
| BARBARA A JOHNSON | ||||||||||||||
| SYSTEM 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 | $25,974 | $0 | $434,370 | $0 | $0 |
| DENA L HELSINGER | ||||||||||||||
| DEPARTMENT DIRECTOR | $186,246 | $0 | $27,351 | $0 | $4,617 | $0 | $20,105 | $0 | $3,993 | $0 | $242,312 | $0 | $0 | $0 |
| FRANK E SAWYER | ||||||||||||||
| SYS VP - ONCOLOGY SERVICE LINE | $232,260 | $0 | $70,795 | $0 | $596 | $0 | $9,389 | $0 | $25,319 | $0 | $338,359 | $0 | $0 | $0 |
| LAURA F SITTLER | ||||||||||||||
| VP - CNO | $42,421 | $0 | $14,532 | $0 | $157,343 | $0 | $39,288 | $0 | $19,041 | $0 | $272,625 | $0 | $0 | $0 |
| SHARON K THORNTON | ||||||||||||||
| SYSTEM VP - ERP OPERATIONS | $162,915 | $0 | $47,539 | $0 | $17,581 | $0 | $9,525 | $0 | $9,143 | $0 | $246,703 | $0 | $0 | $0 |
| DARLENE WISEMAN | ||||||||||||||
| VP FINANCE - SUPPORT SERVICES | $171,709 | $0 | $39,990 | $0 | $875 | $0 | $17,736 | $0 | $19,312 | $0 | $249,622 | $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 |
| DANIEL L SCHOULTIES MD | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $311,772 | $0 | $53,204 | $0 | $95,345 | $0 | $351,801 | $0 | $27,309 | $0 | $839,431 | $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: DANIEL SCHOULTIES, M.D. $13,730 IN 2016 AND WILL RECEIVE $343,260 IN 2017; SEVERANCE PAYMENTS WERE MADE TO THE FOLLOWING INDIVIDUAL: LAURA SITTLER $157,152 IN 2016 AND WILL RECEIVE $39,288 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, GOOD SAMARITAN HOSPITAL (GSH) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. GSH SUPPLEMENTS 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: ELOISE BRONER $164,035; DALE CREECH $159,735; J. NICK LAIR $9,782; 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 PAYMENTS IN 2016: BARBARA JOHNSON $10,303; DANIEL SCHOULTIES M.D. $19,953. In addition, the following SERP amounts were deferred on the participants behalf during the year and will be held until the incremental amounts are vested and paid to the SERP participants: Thomas Curtin $1,493; Mary Garman $1,275; Renee George $1,610; Gary Ginter $18,847; Barbara Johnson $10,811; Tammy Lundstrom, M.D. $49,100; Thomas Parker $14,575; Daniel Schoulties, M.D. $1,843; Craig Self $1,462. BASED ON THE GUIDANCE PROVIDED IN THE INSTRUCTIONS TO THE FORM 990, ANY PAYMENTS TO THE PARTICIPANTS RELATED TO THESE PLANS THAT WERE MADE WITHIN 2-1/2 MONTHS AFTER THE END OF THE ORGANIZATION'S TAX YEAR ARE NOT TREATED AS DEFERRED COMPENSATION FOR PURPOSES OF SCHEDULE J. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. ANY PAYMENTS MADE AFTER THE 2-1/2 MONTHS WERE PROPERLY REPORTED ON PRIOR YEARS' FILED IRS FORM 990 RETURNS, DISCLOSING COMPENSATION EARNED BY THESE INDIVIDUALS UNDER THE PLANS FOR EACH SUCH YEAR. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Thomas R Parker | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Wife | RelationshipDescriptionTxt |
| Transaction | $188,695 | TransactionAmt |
| Transaction | Salary | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3: | Premier Health (Premier), as the operator of Good Samaritan Hospital (GSH), develops and oversees the implementation of the strategic plan for GSH, which includes (but is not limited to) such matters as location of clinical and administrative expenses and the consolidation of such services. GSH shall comply with and implement this plan and shall not take any action that materially departs from this plan without Premier's approval. GSH shall implement any capital and operating budget so approved and/or revised for it by Premier. GSH shall implement the business plan approved by Premier. Premier is the sole agent to negotiate all relationships with payors on behalf of GSH with all third-party payors and alternative delivery systems including, but not limited to insurers. GSH must have approval from Premier to borrow in any fiscal year, guarantee in any year, or incur any lien or other encumbrance on any property in an amount equal to or greater than $1,000,000. GSH must seek Premier's approval for any acquisitions, sale or transfer of any material asset used in Premier's activities. FORM 990, PART VI, SECTION A, LINE 4: In 2016, Good Samaritan Hospitals (GSH) Code of Regulations were modified. Listed below are the significant changes: 1) The Board of Trustees will be comprised of the President & CEO of Premier Health (or designee), the President & CEO of GSH, and the President of the Medical Staff of GSH; all as Ex-Officio members with vote. In addition, at least one "At Large" executive from either Premier Health or GSH and at least two "At Large" physicians from the Medical Staff shall be nominated. There shall always be one more physician than executive on the Board of Trustees. 2) Officers of the Corporation shall be Chair of the Board of Trustees, President & CEO, Secretary, Treasurer, Assistant Secretary(ies) and Assistant Treasurer(s). 3) Committee members shall be appointed by the Chair of the Board of Trustees. 4) An attendance requirement was added for the Trustees, requiring at least 75% attendance of the Board meetings. If this requirement is not met, the Trustee is considered to have resigned. In addition, the Trustees 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. 5) The Executive Committee may exercise the full powers, duties, responsibilities and authority of the Board of Trustees, except where prohibited by law, and provide written reports to the Board of Trustees of all actions taken on the Boards behalf. All actions taken by the Executive Committee must be by unanimous vote. 6) Successors to Board vacancies are selected by the Nominating Committee of GSHs Board of Trustees and approved by Samaritan Health Partners (the parent of GSH). 7) The Board of Trustees may designate the formation of auxillary organization(s). 8) In the event of dissolution of GSH, the Board of Trustees shall distribute the assets of GSH first to Samaritan Health Partners, followed by other local charitable tax-exempt organizations. Any remaining assets shall be disposed of by a local court. Premier Health has no right as a Co-Member of GSH to receive any distribution of property upon dissolution of GSH. FORM 990, PART VI, SECTION A, LINE 6: GOOD SAMARITAN HOSPITAL HAS TWO CORPORATE MEMBERS. ONE MEMBER IS SAMARITAN HEALTH PARTNERS. THE SECOND MEMBER IS PREMIER HEALTH (PREMIER), AN OHIO NON-PROFIT CORPORATION FORMED PURSUANT TO THE JOINT OPERATING AGREEMENT. SAMARITAN HEALTH PARTNERS 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: Samaritan Health Partners (SHP) has the sole authority to elect the Board of Trustees for Good Samaritan Hospital from among those recommended by the nominating committee set forth in the Joint Operating Agreement. SHP has the authority to remove such trustees at any regular or special meeting or by written consent. FORM 990, PART VI, SECTION B, LINE 11B: THIS 990 TAX RETURN AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE TAX DEPARTMENT OF PREMIER HEALTH (PREMIER), WITH WHICH GOOD SAMARITAN HOSPITAL IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE TAX MANAGER AND THE DIRECTOR OF TAX COMPLIANCE OF PREMIER. THE RETURN IS CONCURRENTLY SENT TO ERNST & YOUNG U.S. LLP FOR THEIR REVIEW. AFTER ALL CHANGES FROM THE ABOVE GROUPS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER AND THE CHIEF FINANCIAL OFFICER OF THIS ENTITY. A FINAL VERSION OF THE RETURN IS SENT TO ERNST & YOUNG U.S. LLP FOR A FINAL REVIEW AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT THE BOARD OF TRUSTEES MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESS ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 TAX RETURN IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, LINE 12C: PREMIER HEALTH (PREMIER), OF WHICH GOOD SAMARITAN HOSPITAL 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, LINES 15A AND 15B: | COMPENSATION FOR GOOD SAMARITAN HOSPITALS (GSH) CEO IS REVIEWED AND APPROVED BY PREMIER HEALTH (PREMIER), WITH WHICH GSH IS AN AFFILIATE, ON AN ANNUAL BASIS. THE REVIEW PROCESS PERFORMED BY PREMIER FOLLOWS A MARKET BASED COMPENSATION PHILOSOPHY DESIGNED TO ATTRACT AND RETAIN THE EXECUTIVE TALENT REQUIRED TO MEET THE HIGH-PERFORMANCE STANDARDS OF OUR BOARD AND OUR COMMUNITY. PREMIER ANNUALLY REVIEWS EXECUTIVE COMPENSATION SURVEY DATA FOR A REGIONAL PEER GROUP OF SYSTEMS AND HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO PREMIER AND ITS AFFILIATES. THE DATA FOR THE SURVEY IS PROVIDED BY A THIRD-PARTY CONSULTANT GROUP THAT IS INDEPENDENT OF PREMIER. THIS REPORT INCLUDES COMPARABILITY FOR KEY EXECUTIVES, VICE PRESIDENTS, AND DIRECTOR LEVEL POSITIONS. THE INDEPENDENT COMPARABILITY DATA IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THIS COMMITTEE IS COMPRISED OF THREE MEMBERS, ALL OF WHOM ARE INDEPENDENT. THIS COMMITTEE REVIEWS IN DETAIL THE COMPENSATION FOR THE PREMIER CEO, COO, CFO, CHIEF 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 19: THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC WHEN REQUIRED BY LAW OR FOR ACCREDITATION PURPOSES. THE CONFLICT OF INTEREST POLICY IS AVAILABLE ON WWW.PREMIERHEALTH.COM. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS $(19,319,718) PHIC EQUITY TRANSFER $(15,668,000) PHO EQUITY TRANSFER $(8,780,000) PHG EQUITY TRANSFER $(578,286) FOUNDATION ADJUSTMENT $(235,570) TRANSFER FROM AFFILIATE $130,758 JOA DIALYSIS CENTER SALE $296,000 MINORITY INTEREST DISTRIBUTION $487,040 DISTRIBUTIONS TO PARENT $5,080,000 PENSION FUND ADJUSTMENT $11,310,551 TOTAL $(27,277,225) |
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 |
|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN HEALTH PARTNERS (SHP) | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 311107411 | PARENT | OH | 501(c)(3) | 12C III FI | NA | false |
| PREMIER HEALTH | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 311446699 | SUPPRTG. ORG. | OH | 501(c)(3) | 12A I | NA | false |
| GOOD SAMARITAN HOSPITAL FOUNDATION-DAYTO | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 237296923 | FOUNDATION | OH | 501(c)(3) | 7 | SHP | Yes (true) |
| CATHOLIC HEALTH INITIATIVES | ||||||||||
| 198 INVERNESS DR W 500 | ENGLEWOOD | CO | 80112 | 470617373 | PARENT | CO | 501(c)(3) | 10 | NA | false |
| THE HEART INSTITUTE OF DAYTON | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 300502367 | EDUCATION | OH | 501(c)(3) | 10 | SHP | Yes (true) |
| SAMARITAN BEHAVORIAL HEALTH INC | ||||||||||
| 601 EDWIN C MOSES BLVD | DAYTON | OH | 45417 | 020633634 | Behavorial He | OH | 501(c)(3) | 7 | SHP | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN NORTH SURGERY CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9000 N MAIN ST | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45415 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311618587 | EIN |
| Primary Activities | O/P SURGERY | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GSH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $5,028,964 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $4,104,602 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| UBI Code V | $0 | UBICodeVAmt |
| General Or Managing Partner | Yes (true) | GeneralOrManagingPartnerInd |
| Ownership | 0.80000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (true) | 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 | Yes (true) | 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 | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | 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 | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (9 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON | ||
| C | $366,328 | CASH |
| GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON | ||
| Q | $613,176 | CASH |
| SAMARITAN BEHAVIORAL HEALTH INC | ||
| Q | $198,479 | CASH |
| CATHOLIC HEALTH INITIATIVES | ||
| R | $3,701,000 | FMV |
| PREMIER HEALTH | ||
| B | $277,210 | FMV |
| SAMARITAN NORTH SURGERY CENTER | ||
| A-IV | $1,045,555 | Cash |
| SAMARITAN NORTH SURGERY CENTER | ||
| F | $5,080,000 | Cash |
| SAMARITAN NORTH SURGERY CENTER | ||
| B | $487,040 | Cash |
| THE HEART INSTITUTE OF DAYTON | ||
| Q | $1,021,527 | CASH |