2017-05-09T08:21:53-05:00 2016-06-30 440160260 BKD LLP 312 WALNUT STREET SUITE 3000 CINCINNATI OH 45202 990 2015-07-01 461393755 TRIHEALTH HOSPITAL INC TRIH 5135696575 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 BRIAN KRAUSE VP-FINANCE 5135695126 2017-05-09 1 P00961884 5136218300 2015 2021-01-29 14:40:06Z JOHN S PROUT 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 55810332 0 X WWW.TRIHEALTH.COM X 2012 OH TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. 12 8 261 8 0 0 0 0 53563228 55798699 44523 0 10733 11633 53618484 55810332 18412 12350 0 0 16410244 16606805 0 0 0 29293913 30358196 45722569 46977351 7895915 8832981 157397175 159093707 36473419 29336970 120923756 129756737 TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. THIS IS ACCOMPLISHED BY PROVIDING A FULL RANGE OF HEALTH RELATED SERVICES INCLUDING PREVENTION, WELLNESS AND EDUCATION. 0 0 32807848 12350 55801452 SEE SCHEDULE H 32807848 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 49 0 1 261 1 0 0 0 0 0 0 0 0 0 0 X 12 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X BRIAN KRAUSE - VP FINANCE 5135695126 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 X MICHAEL HAVERKAMP TRUSTEE 1.00 3.00 X 0 0 0 JOHN PROUT CEO (END 12/15) 5.00 55.00 X X 0 2429327 43760 PAUL EDGETT III TRUSTEE 1.00 3.00 X 0 0 0 MYRTIS POWELL TRUSTEE 1.00 3.00 X 0 0 0 SR SALLY DUFFY SECRETARY 1.00 3.00 X X 0 0 0 MICHAEL MCGRAW CHAIRMAN 1.00 3.00 X X 0 0 0 JOANN LOHR MD MED STAFF PRES (END 12/15) 1.00 10.00 X 0 45000 0 ALAN ALTMAN MD MED STAFF PRES (END 12/15) 1.00 10.00 X 0 675478 67780 CRAIG EISENTROUT MD TRUSTEE 1.00 3.00 X 0 548405 36390 WAYNE SHIRCLIFF VICE CHAIR/TREASURER 1.00 3.00 X X 0 0 0 RALPH S MICHAEL TRUSTEE 1.00 3.00 X 0 0 0 ELLEN KATZ TRUSTEE 1.00 3.00 X 0 0 0 MARK CLEMENT PRESIDENT/CEO (START 1/16) 5.00 55.00 X X 0 516747 61675 MARK DELWORTH MD MED STAFF PRES-BETHESDA 1.00 10.00 X 0 83400 0 MARGARET LEMASTERS MD MED STAFF PRES-GOOD SAM 1.00 10.00 X 0 12000 0 DONNA NIENABER ESQ SVP CORP COUNSEL/ASST SEC 5.00 55.00 X 0 490116 134995 MICHAEL CROFTON SVP CFO/ASST TREASURER 5.00 55.00 X 0 579691 145213 WILLIAM GRONEMAN EXEC VP SYSTEM DEVELOPMENT 5.00 55.00 X 0 662686 193088 GERALD OLIPHANT EXEC VP & COO (END 9/15) 5.00 55.00 X 0 704803 132198 JOHN ROBINSON MD SVP-HOSPITAL OPS (END 3/16) 10.00 50.00 X 0 416898 85959 KELVIN HANGAR EXEC DIR-TRIHEALTH EVENDALE 60.00 0.00 X 284304 0 32414 ROBERT COLLINS MD CHIEF MEDICAL OFFICER 5.00 55.00 X 0 539152 130898 SUELLEN JONES NURSING ADMIN-TRIHEALTH EV 60.00 0.00 X 183670 0 15406 JOANNE RISLEY NURSING MANAGER-TRIHEALTH 60.00 0.00 X 113767 0 7431 DEBORAH MONTGOMERY MGR-TRIHEALTH HAND SURGERY 60.00 0.00 X 103639 0 19820 GEORGES FEGHALI MD FORMER 0.00 0.00 X 0 149400 7343 685380 7853103 1114370 4 1 1 0 CLINICAL CO-MANAGEMENT LLC 8099 CORNELL ROAD CINCINNATI OH 45249 CLINICAL MANAGEMENT 1479249 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 EQUIPMENT MAINTENANCE 455856 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 EQUIPMENT/SERVICE CONTRACTS 217904 ECN MANAGEMENT LLC 3155 GLENDALE-MILFORD ROAD CINCINNATI OH 45241 CLINICAL MANAGEMENT 189200 RED CARPET SERVICES 891 W NORTH BEND ROAD CINCINNATI OH 45224 JANITORIAL 181333 7 PATIENT SERVICES 621400 55798699 55798699 55798699 8880 0 8880 8880 8880 MEDICAL RECORDS 900099 2753 2753 2753 55810332 55801452 0 8880 12350 12350 316718 316718 13302948 12238799 1064149 429820 90251 339569 1578280 1318831 259449 979039 889539 89500 1213882 1213882 787706 511502 276204 541701 450711 90990 1846860 1051595 795265 9571 5749 3822 4276 3321 955 2290379 2290379 4514949 703500 3811449 31155 31155 MEDICAL/DIETARY SUPPLY 14079055 14021755 57300 OVERHEAD ALLOCATION 3446160 3446160 OHIO HOSPITAL FEE 746244 746244 EQUIPMENT 734361 691675 42686 111897 72026 39871 46977351 32807848 14169503 0 599 599 7155524 5996948 405814 76482 9912 0 42796402 10699847 35135641 32096555 114689685 113884685 0 7038438 157397175 159093707 4012118 3023809 26863536 26005762 5597765 307399 36473419 29336970 X 120923756 129756737 120923756 129756737 157397175 159093707 8832981 0 X X 0 1 X 1 0 X 29529732 4733772 24795960 14018 2804 11214 12639138 5963271 6675867 613514 613514 32096555 ACCRUED MALPRACTICE LIABILITY 307399 307399 X PART X, LINE 2: THE FINANCIAL STATEMENTS OF TRIHEALTH HOSPITAL, INC. ARE AUDITED AS PART OF TRIHEALTH AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE AUDITED COMBINED FINANCIAL STATEMENTS OF TRIHEALTH THAT REPORTS ITS AND ITS SUBSIDIARIES AND AFFILIATES LIABILITY, IF APPLICABLE, FOR CERTAIN TAX POSITIONS UNDER ASC 740-10-25: TRIHEALTH PERFORMED AN ANALYSIS OF UNCERTAIN TAX POSITIONS AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE COMBINED FINANCIAL STATEMENTS AT EITHER DATE. 1 1 X 1 X 1 X 1 1 0 1 1 576347 0 576347 0.01230 3991182 2183300 1807882 0.03850 4567529 2183300 2384229 0.05080 4567529 2183300 2384229 0.05080 0 2850560 10003152 9705556 297596 X 1 1 1 1 TRIHEALTH EVENDALE HOSPITAL 3155 GLENDALE-MILFORD RD EVENDALE OH 45241 WWW.TRIHEALTH.COM 1482 X X TRIHEALTH EVENDALE HOSPITAL 1 0 0 1 X X X X X X X X 15 1 1 1 1 X HTTP://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/HEALTH-NEEDS-ASSESSMENT/ X 1 15 0 1 0 1 X 100.000000000000 400.000000000000 X X X X X 1 1 X 1 X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X X 1 X 0 X X X X 1 X 0 0 TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 5: PRIMARY RESEARCHCHNA COMMUNITY FOCUS GROUPS/PUBLIC MEETINGS: THE FOCUS GROUPS WERE CONDUCTED BY AN ASSIGNED FACILITATOR AND SCRIBES. THE FACILITATOR INTRODUCED THE ATTENDEES TO THE COUNTY SNAPSHOT AND THE CNI MAP. AFTER A PERIOD OF QUESTIONS AND BRAINSTORMING, EACH ATTENDEE WAS ASKED TO INDICATE WHICH ISSUES WERE MOST IMPORTANT. THE ATTENDEES INCLUDED MEMBERS OF THE COMMUNITY AND REPRESENTATIVES OF ORGANIZATIONS SERVING THE COMMUNITY, INCLUDING COMMUNITY ADVOCATES AND REPRESENTATIVES FROM FAITH-BASED ORGANIZATIONS, PUBLIC HEALTH DEPARTMENTS, AND COMMUNITY-BASED HEALTH CENTERS. THE PURPOSE OF THE MEETINGS WAS TO SOLICIT PUBLIC INPUT. THE RESULTS OF THE COMMUNITY FOCUS GROUPS WERE SUMMARIZED BY COUNTY. THIS DOCUMENT REFERS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMUNITY FOCUS GROUPS AS "COMMUNITY FOCUS GROUPS OR "FOCUS GROUPS".CHNA COMMUNITY HEALTH SURVEYS: THE SURVEY WAS CUSTOMIZED FOR THREE DIFFERENT RESPONDENTS: CONSUMERS, AGENCIES, AND HEALTH DEPARTMENTS. A SPANISH LANGUAGE SURVEY WAS ALSO CREATED WITH THE HELP OF COMMUNITY HEALTH WORKERS. THE SURVEY CONTAINED QUESTIONS ABOUT THE HEALTH ISSUES FACING THE COMMUNITY, IF HEALTH ISSUES WERE BEING ADDRESSED, AND WHAT BARRIERS THE COMMUNITY WAS EXPERIENCING. SOME PARTICIPANTS PREFERRED TO RESPOND IN-PERSON OR OVER THEPHONE, THESE RESPONSES WERE TRANSCRIBED INTO THE SURVEY TOOL. THIS DOCUMENT REFERS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMUNITY SURVEYS AS "SURVEYS".SECONDARY RESEARCHSECONDARY RESEARCH CONSISTED OF GATHERING AVAILABLE HEALTH-RELATED DATA FOR A COLLECTION OF TWENTY-THREE COUNTIES, INCLUDING BUTLER, CLERMONT, HAMILTON, AND WARREN COUNTIES. BECAUSE THE TARGETED REGION SPANNED THREE STATES, CONSISTENT DATA WERE NOT ALWAYS AVAILABLE, AND NOT ALL DATA WERE AVAILABLE FOR THE ENTIRE REGION. WHENEVER POSSIBLE, DATA WERE COLLECTED AT THE COUNTY LEVEL. SUB-COUNTY LEVEL DATA WERE NOT A FOCUS OF THIS RESEARCH. THE COUNTY HEALTH RANKINGS (CHR) FORMED THE FOUNDATION FOR DATA COLLECTION WITH ITS COUNTY-LEVEL FOCUS ON HEALTH OUTCOMES, HEALTH FACTORS, HEALTH BEHAVIORS, QUALITY OF LIFE, CLINICAL CARE, PHYSICAL ENVIRONMENT, AND SOCIOECONOMIC FACTORS. DATA WAS VERIFIED AND FORMATTED CONSISTENTLY; SUPPLEMENTAL DATA WAS ALSO IDENTIFIED AND COLLECTED. THE INTERACTIVE TOOL ON THE CNI (COMMUNITY NEED INDEX) WAS ACCESSED TO CREATE COUNTY-LEVEL MAPS AND ZIP CODE TABLES. THE CHR AND CNI WEBSITES WERE MONITORED FOR PERIODIC DATA UPDATES AND DATA WORKSHEETS WERE REVISED UNTIL SEPTEMBER 2015.STANDARDS FOR RESEARCHING AND INCLUDING THE DATA WERE ESTABLISHED AND INCLUDED THE FOLLOWING CHARACTERISTICS: COMPARABLE, COUNTY-LEVEL, FOCUSED ON HEALTH OUTCOMES, REPRODUCIBLE, REPUTABLE, AND TRENDED. THE CHR SERVED AS A STARTING POINT BUT RESOURCES WITH MORE RECENT DATA AND ADDITIONAL MEASURES WERE ALSO IDENTIFIED.INPUT FROM A BROAD RANGE OF REPRESENTATIVESINPUT WAS RECEIVED FROM INDIVIDUALS REPRESENTING UNDERSERVED POPULATIONS USING, PRIMARILY THE TWO SURVEY APPROACHES DESCRIBED ABOVE. THE COMBINATION OF THESE METHODS PROVIDED A WIDE-RANGE OF DATA COLLECTION OPPORTUNITIES ON WHICH THE CHNA COULD BE BASED.CHNA COMMUNITY FOCUS GROUPS: A TOTAL OF 156 INDIVIDUALS ATTENDED THE 11 FOCUS GROUPS, 134 OF THE ATTENDEES REPRESENTED AN ORGANIZATION. THE ORGANIZATIONS REPRESENTED BY THESE ATTENDEES SERVE THE FOLLOWING POPULATIONS: CHILDREN, ELDERLY, HOMELESS, LOW-INCOME, MEDICALLY UNDERSERVED, MINORITY, PEOPLE WITH MENTAL ILLNESS, AND VICTIMS OF DOMESTIC VIOLENCE. FIFTEEN INDIVIDUALS, ALL REPRESENTING ORGANIZATIONS, ATTENDED THE BUTLER COUNTY FOCUS GROUP ON JULY 30, 2015. THREE INDIVIDUALS ATTENDED THE CLERMONT COUNTY FOCUS GROUP ON JULY 28, 2015. APPROXIMATELY 50 INDIVIDUALS ATTENDED MEETINGS ON BEHALF OF HAMILTON COUNTY, THE MAJORITY REPRESENTED AN ORGANIZATION. ON JULY 7, 2015, SIX INDIVIDUALS ATTENDED THE WARREN COUNTY FOCUS GROUP AND REPRESENTED PREMIER HEALTH: ATRIUM MEDICAL CENTER AND PREVENTIONFIRST OR CAME ON THEIR OWN BEHALF. CHNA SURVEY: IN AGGREGATE, 329 INDIVIDUALS, 55 AGENCY REPRESENTATIVES, 52 LATINOS, AND 24 HEALTH DEPARTMENT REPRESENTATIVES COMPLETED THE CHNA SURVEY. THE CHNA TEAM, CHNA COMMITTEE, AND PARTNERS HELPED DISTRIBUTE THE SURVEY. AT COMMUNITY MEETINGS, A HANDOUT PROVIDED THE SURVEY LINK, AND THE LINKS WERE WRITTEN ON AN EASEL PAD AT THE FRONT OF THE ROOM. THROUGHOUT THE REGION, 381 INDIVIDUAL SURVEYS AND 55 AGENCY SURVEYS WERE COMPLETED, INCLUDING RESPONSES FROM AGENCIES SUCH AS BUTLER COUNTY UNITED WAY, CLERMONT COUNTY MENTAL HEALTH & RECOVERY BOARD, AND THE YMCA OF GREATER CINCINNATI. IN BUTLER, CLERMONT, HAMILTON, AND WARREN COUNTIES, RESPONDENTS INCLUDED CONTACTS FROM LOCAL HEALTH DEPARTMENTS: THE BUTLER COUNTY HEALTH DEPARTMENT, CITY OF HAMILTON HEALTH DEPARTMENT, THE MIDDLETOWN CITY HEALTH DISTRICT, THE CLERMONT COUNTY GENERAL HEALTH DISTRICT, HAMILTON COUNTY PUBLIC HEALTH, NORWOOD CITY HEALTH DISTRICT, SPRINGDALE CITY HEALTH DISTRICT, AND WARREN COUNTY COMBINED HEALTH DISTRICT. OTHER ORGANIZATIONS THAT COMPLETED THE SURVEY INCLUDED GOOD SAMARITAN FREE HEALTH CENTER, AND THE GREATER CINCINNATI FOUNDATION, ETC. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 6A: ADAMS COUNTY REGIONAL MEDICAL CENTER, ATRIUM MEDICAL CENTER, DEARBORN COUNTY HOSPITAL, LINDNER CENTER OF HOPE, MARGARET MARY COMMUNITY HOSPITAL, MCCULLOUGH-HYDE MEMORIAL HOSPITAL, MERCY HEALTH, UC HEALTH, BETHESDA NORTH HOSPITAL, BETHESDA BUTLER COUNTY, THE CHRIST HOSPITAL, CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 6B: HEALTH COLLABORATIVE, CITY OF CINCINNATI HEALTH DEPARTMENT, HAMILTON COUNTY PUBLIC HEALTH, INTERACT FOR HEALTH, XAVIER UNIVERSITY DEPARTMENT OF HEALTH SERVICES ADMINISTRATION TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 7D: AVAILABLE UPON REQUEST WITHOUT CHARGE. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 11: CHILD HEALTH/INFANT MORTALITY - TRIHEALTH EVENDALE WILL CONTINUE ITS FOCUS ON THIS HEALTH NEED THROUGH ITS HEALTH SYSTEM'S SPONSORSHIP OF MULTIPLE PROGRAMS IN ITS FOUR COUNTY SERVICE AREA IN COLLABORATION WITH OTHER EXISTING COMMUNITY SERVICE ORGANIZATIONS. TRIHEALTH EVENDALE IS AN ACTIVE PARTICIPANT IN CRADLE CINCINNATI.OBESITY - TRIHEALTH EVENDALE WILL ADDRESS THIS NEED IN THE FOUR COUNTY SERVICE AREAS. TRIHEALTH EVENDALE WILL ALSO PARTNER WITH THE COLLECTIVE IMPACT ON HEALTH (PART OF THE HEALTH COLLABORATIVE) TO MAKE THIS A REGION WIDE PRIORITY FOR HEALTH SYSTEMS AND COMMUNITY ORGANIZATIONS.SUBSTANCE ABUSE/MENTAL HEALTH - TRIHEALTH EVENDALE WILL ADDRESS THIS NEED BY ITS CONTINUED RELATIONSHIP WITH THE HOPE PROGRAM, HEALTHY MOMS AND BABES, SOJOURNERS, COMMUNITY PARTNERS (NATIONAL ALLIANCE ON MENTAL ILLNESS) AND BY EXTENDING THE BETHESDA HOSPITAL, INC. ALCOHOL AND DRUG PROGRAM OUTREACH PROGRAMS.CANCER - TRIHEALTH EVENDALE WILL ADDRESS THIS NEED BY CONTINUING TO UTILIZE THE OUTREACH MINISTRIES PROGRAM (FORMERLY NAMED PARISH NURSE PROGRAM) AT TRIHEALTH EVENDALE, WHERE THERE IS A CONCENTRATION OF THIS UNDERSERVED POPULATION. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 13B: SEE PART VI RESPONSE RELATED TO PART I, LINE 3C. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 13H: SEE PART VI RESPONSE RELATED TO PART I, LINE 3C. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 16I: TRIHEALTH EVENDALE HOSPITAL DOES NOT PROVIDE A DETAILED COPY OF ITS FINANCIAL ASSISTANCE POLICY TO PATIENTS; HOWEVER, IT DOES PROVIDE A SUMMARY OF THE POLICY.IN ADDITION, SUCH INFORMATION SHALL BE PROVIDED IN LANGUAGES CONSIDERED TO BE COMMONLY SPOKEN BY THE POPULATION TRIHEALTH EVENDALE HOSPITAL SERVES. IF TRANSLATION OR OTHER ASSISTANCE IS NEEDED TO FACILITATE COMPLETION AND/OR UNDERSTANDING OF THE FINANCIAL ASSISTANCE POLICY AND/OR APPLICATION, TRANSLATION AND OTHER REASONABLE REQUESTS FOR ASSISTANCE WILL BE PROVIDED. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 22D: TRIHEALTH EVENDALE HOSPITAL ("TEH") ISSUES A BILLING STATEMENT TO ALL FAP-ELIGIBLE INDIVIDUALS THAT STATES GROSS CHARGES FOR THE CARE RECEIVED AS THE STARTING POINT FOR APPLYING THE DISCOUNTS AND DEDUCTIONS THE FAP-ELIGIBLE INDIVIDUAL IS ENTITLED TO UNDER ITS FAP, SUCH THAT THE AMOUNT THAT A FAP-ELIGIBLE IS REQUIRED TO PAY IS (I) LESS THAN THE GROSS CHARGES FOR SUCH CARE AND (II) TYPICALLY LESS THAN THE AMOUNTS GENERALLY BILLED TO PERSONS WITH INSURANCE. CURRENTLY, AS PART OF THE TRIHEALTH SYSTEM, TEH PROVIDES FREE CARE TO PATIENTS WHOSE INCOME FALLS BELOW 100% OF THE FEDERAL POVERTY GUIDELINES. IN ADDITION, IT PROVIDES DISCOUNTED CARE ON A SLIDING SCALE TO PATIENTS WITH INCOMES ALL THE WAY UP TO 400% OF THE FEDERAL POVERTY GUIDELINES. ANY UNINSURED PATIENT THAT FILLS OUT A FINANCIAL ASSISTANCE FORM AUTOMATICALLY RECEIVES A 40% DISCOUNT REGARDLESS OF INCOME WHILE OTHER PATIENTS RECEIVE A 45% DISCOUNT (INCOME BETWEEN 300% AND 400% OF POVERTY GUIDELINES), 60% DISCOUNT (INCOME BETWEEN 200% AND 300% OF POVERTY GUIDELINES), OR AN 80% DISCOUNT (INCOME BETWEEN 100% AND 200% OF POVERTY GUIDELINES). THE CURRENT AVERAGE DISCOUNT WITH COMMERCIAL INSURANCE COMPANIES IS 65% SO VIRTUALLY ALL PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE WITH INCOME UP TO 300% OF THE POVERTY GUIDELINES ARE RECEIVING DISCOUNTS EQUAL TO OR GREATER THAN THE AVERAGE COMMERCIAL INSURANCE DISCOUNT. IN ADDITION, TEH BELIEVES THE TRIHEALTH FINANCIAL ASSISTANCE POLICY IS GENEROUS AS MANY HOSPITALS DO NOT OFFER ANY FINANCIAL ASSISTANCE TO PATIENTS WITH INCOME OVER 300% OF THE POVERTY GUIDELINE. HOWEVER, IT PREFERS TO EXTEND DISCOUNTS TO SUCH INDIVIDUALS RATHER THAN DENY THEM ELIGIBILITY UNDER THE POLICY SO THAT SUCH INDIVIDUALS RECEIVE SOME FINANCIAL ASSISTANCE RATHER THAN NONE. 3 1 - TRIHEALTH SURGERY CENTER WEST 3660 EDGEWOOD DRIVE CINCINNATI OH 45211 OUTPATIENT SURGERY CENTER 2 - TRIHEALTH HAND SURGERY CENTER 538 OAK STREET SUITE 200 CINCINNATI OH 45219 OUTPATIENT SURGERY CENTER 3 - TRIHEALTH ENDOSCOPY CENTER NORTH 10600 MONTGOMERY ROAD CINCINNATI OH 45242 OUTPATIENT ENDOSCOPY CENTER PART I, LINE 3C: TRIHEALTH HOSPITAL INC. UTILIZES THE FEDERAL POVERTY GUIDELINES ("FPG") IN DETERMINING CHARITY CARE ELIGIBILITY. SEE THE RESPONSES TO PART I, LINE 3A AND 3B.AN INDIVIDUAL'S INCOME UNDER FPG IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR CHARITY CARE. ADDITIONALLY, AN INDIVIDUAL'S INCOME IN RELATION TO HIS/HER MEDICAL EXPENSES IS ALSO TAKEN INTO ACCOUNT AND SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES. FINALLY, TRIHEALTH HOSPITAL, INC. PROVIDES DISCOUNTED CARE AT SELECT CLINICS. PART I, LINE 6A: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. IN 2013, TRIHEALTH ORGANIZED TRIHEALTH HOSPITAL, INC. TO SUPPORT ITS MISSION.THE COMMUNITY BENEFIT PROVIDED BY TRIHEALTH HOSPITAL, INC. IS TRACKED ON A STANDALONE BASIS; HOWEVER, ITS COMMUNITY BENEFIT IS REPORTED IN A REPORT PREPARED BY TRIHEALTH IN COMBINATION WITH ITS RELATED HOSPITALS - BETHESDA HOSPITAL, INC., THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND MCCULLOUGH-HYDE MEMORIAL HOSPITAL. PART I, LINE 7: FOR THE AMOUNTS REPORTED AT COST IN PART I, LINE 7, TRIHEALTH HOSPITAL, INC. UTILIZED WORKSHEET 2 - RATIO OF PATIENT CARE COST-TO-CHARGES, WHICH WAS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H, TO CALCULATE THE COST-TO-CHARGE RATIO. PART I, LN 7 COL(F): BAD DEBT EXPENSE IS NOT INCLUDED ON FORM 990, PART IX, LINE 25. IT IS PRESENTED ON FORM 990, PART VIII, LINE 2 AS A DEDUCTION FROM PATIENT SERVICE REVENUE WHICH CORRESPONDS TO ITS FINANCIAL STATEMENT PRESENTATION. SEE RESPONSE TO PART III, LINE 4. THEREFORE, NO ADJUSTMENT TO TOTAL EXPENSES SHOWN ON FORM 990, PART IX, LINE 25 IS NECESSARY. PART II, COMMUNITY BUILDING ACTIVITIES: TRIHEALTH HOSPITAL, INC. DID NOT ENGAGE IN ANY COMMUNITY BUILDING ACTIVITIES DURING THE TAX YEAR. PART III, LINE 4: TRIHEALTH HOSPITAL, INC.'S FINANCIAL STATEMENTS ARE AUDITED AS PART OF THE TRIHEALTH AUDIT REPORT AND AS SUCH FOLLOWING IS THAT REPORT'S FOOTNOTE.NET PATIENT ACCOUNTS RECEIVABLE (PART OF FOOTNOTE B)NET PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE HAVE BEEN ADJUSTED TO THE ESTIMATED AMOUNTS EXPECTED TO BE COLLECTED. THESE ESTIMATED AMOUNTS ARE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS. THE PROVISION FOR BAD DEBT IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY AS NECESSARY THE PROVISIONS FOR BAD DEBT AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS RECEIVABLE IN THE PERIOD OF SERVICE BASED UPON HISTORICALWRITE-OFF EXPERIENCE.AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, TRIHEALTH FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY TRIHEALTH.DUE TO THE ONGOING EXPANSION OF MEDICAID IN OHIO, TRIHEALTH HAS EXPERIENCED DECLINES IN CHARITY CARE WRITE-OFFS, ALTHOUGH IT HAS NOT CHANGED ITS CHARITY CARE POLICY SINCE JUNE 30, 2015. THE COMPANY HAS NOT EXPERIENCED SIGNIFICANT CHANGES IN THE SELF-PAY ACCOUNTS RECEIVABLE OR WRITE-OFFS OF UNCOLLECTIBLE ACCOUNTS SINCE JUNE 30, 2015. THE OVERALL ALLOWANCE PERCENTAGE FOR UNCOLLECTIBLE ACCOUNTS DECREASED FROM 36% AT JUNE 30, 2015, TO 30% AT JUNE 30, 2016, AS A RESULT OF CHANGES IN PAYOR MIX PRIMARILY DUE TO THE AFFORDABLE CARE ACT.FINANCIAL INSTRUMENTS THAT POTENTIALLY SUBJECT TRIHEALTH TO CONCENTRATIONS OF CREDIT RISK CONSIST PRIMARILY OF NONGOVERNMENTAL PATIENT ACCOUNTS RECEIVABLE. TRIHEALTH GRANTS CREDIT WITHOUT COLLATERAL TO ITS PATIENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS.THE PERCENTAGES OF GROSS PATIENT ACCOUNTS RECEIVABLE FROM PATIENTS AND THIRD-PARTY PAYORS AT JUNE 30 APPROXIMATED THE FOLLOWING:2016 - MEDICARE 17%, MEDICAID 3%, MANAGED CARE 32%, SELF PAY 16%, COMMERCIAL AND OTHER 32%2015 - MEDICARE 17%, MEDICAID 2%, MANAGED CARE 34%, SELF PAY 16%, COMMERCIAL AND OTHER 31%TRIHEALTH HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. THE BASIS FOR PAYMENT UNDER THESE AGREEMENTS INCLUDES PROSPECTIVELY DETERMINED RATES, COST REIMBURSEMENT, NEGOTIATED DISCOUNTS FROM ESTABLISHED RATES, AND PER DIEMPAYMENTS. PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEW AND INVESTIGATIONS. THE DIFFERENCES BETWEEN THE ESTIMATED AND ACTUAL ADJUSTMENTS ARE RECORDED AS PART OF NET PATIENT SERVICE REVENUE IN FUTURE PERIODS, AS THE AMOUNTS BECOME KNOWN, OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS. TRIHEALTH RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH IT DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBT IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS.AS FOR THE AMOUNT OF BAD DEBT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, BETHESDA HOSPITAL, INC. DOES NOT REPORT ACTUAL BAD DEBT EXPENSE AS COMMUNITY BENEFIT. IF UPON FURTHER RESEARCH, IT IS ULTIMATELY DETERMINED THAT A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER TRIHEALTH'S CHARITY CARE POLICY, THOSE COSTS WOULD BE RECLASSIFIED, AS APPROPRIATE, TO COMMUNITY BENEFIT AT THAT TIME.PLEASE NOTE THAT BAD DEBT EXPENSE IS NOT DETERMINED UNTIL AFTER ALL DISCOUNTS AND ANY ASSOCIATED PAYMENTS ARE TAKEN INTO ACCOUNT. IF ANY PAYMENTS ARE RECEIVED AFTER A PATIENT ACCOUNT IS DETERMINED TO BE BAD DEBT, THE ACCOUNT WILL BE ADJUSTED ACCORDINGLY AT THAT TIME. PART III, LINE 8: TRIHEALTH, INC. USES THE "STEPDOWN METHODOLOGY" IN DETERMINING THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT. THIS METHOD OF COST FINDING PROVIDES FOR THE ALLOCATION OF THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS WHICH UTILIZE SUCH SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. TRIHEALTH HOSPITAL,INC. DID NOT REPORT ANY MEDICARE SHORTFALL AS COMMUNITY BENEFIT IN PART III, LINE 7 OF THIS SCHEDULE. PART III, LINE 9B: AS OF THE FILING OF THIS RETURN, TRIHEALTH HOSPITAL, INC., AS PART OF TRIHEALTH, INC., MAINTAINS A WRITTEN DEBT COLLECTION POLICY. TRIHEALTH, INC., WHO PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS, WILL NOT INITIATE COLLECTION PRACTICES ON PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BEFORE COLLECTION ACTIONS ARE TAKEN, TRIHEALTH, INC. WILL MAKE REASONABLE EFFORTS, GENERALLY AS EARLY IN THE BILLING PROCESS AS POSSIBLE, TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. AFTER SUCH EFFORTS HAVE BEEN MADE AND A BALANCE REMAINS THAT IS THE RESPONSIBILITY OF THE PATIENT OR GUARANTOR, TRIHEALTH, INC. MAY PURSUE, IN ITS SOLE DISCRETION, WHATEVER ACTIONS IT MAY BE ENTITLED TO TAKE UNDER LAW. PART VI, LINE 2: IN 1995, BETHESDA HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO FORMED A PARTNERSHIP TO CREATE A LOCAL HEALTH SYSTEM: TRIHEALTH, INC. ("TRIHEALTH"). THE MISSION OF TRIHEALTH IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION.IN JANUARY 2013, TRIHEALTH ACQUIRED EVENDALE MEDICAL CENTER AND FORMED TRIHEALTH HOSPITAL, INC. THE HOSPITAL CAMPUS CONSISTS OF TEN OPERATING ROOMS, 29 INPATIENT ROOMS AND A COMPLETE IMAGING AND DIAGNOSTIC FACILITY. SERVICES RANGE FROM INPATIENT SURGERY TO ORTHOPEDICS, GYNECOLOGY AND OUTPATIENT IMAGING.TRIHEALTH PARTICIPATED IN AND WAS A FUNDER OF THE WORK OF A COLLABORATIVE, REGIONAL EFFORT, THE A.I.M. FOR BETTER HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT ("A.I.M."). IN THE AREAS ASSESSED, THOSE SURVEYED WERE MORE OFTEN UNDERSERVED, INCLUDING THE UNINSURED, THE UNDERINSURED, THOSE IN LOW SOCIOECONOMIC STATUS, MINORITIES, THOSE OVER THE AGE OF SIXTY-FIVE, OR THOSE WITH A DIAGNOSIS OF MENTAL ILLNESS. THE A.I.M., PUBLISHED IN THE SPRING OF 2012, WILL BE USED TO DEVELOP A SPECIFIC COMMUNITY HEALTH NEEDS ASSESSMENT FOR TRIHEALTH HOSPITAL, INC. PART VI, LINE 3: TRIHEALTH, INC. PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS INCLUDING TRIHEALTH HOSPITAL, INC. BROCHURES/APPLICATIONS, PROVIDED IN MULTIPLE LANGUAGES, ARE VISIBLE AND AVAILABLE IN THE REGISTRATION AND ADMITTING AREAS OF ALL TRIHEALTH AFFILIATED HOSPITALS. IN ADDITION, THE APPLICATION IS PRINTED ON THE REVERSE SIDE OF A PATIENT'S BILL WITH INSTRUCTIONS ON HOW TO COMPLETE THE APPLICATION AS WELL AS HOW TO RETURN IT. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. FINALLY, TRIHEALTH, INC.'S WEBSITE CONTAINS INFORMATION REGARDING ITS CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS WITH DIRECTIONS ON HOW TO CONTACT THE APPROPRIATE PERSONNEL TO INITIATE AN APPLICATION OR ASK QUESTIONS ABOUT THE PROCESS. PART VI, LINE 4: LOCATED IN CINCINNATI, OHIO, TRIHEALTH HOSPITAL, INC. AND THE TRIHEALTH, INC. SYSTEM SERVE HAMILTON, BUTLER, WARREN, CLINTON AND CLERMONT COUNTIES IN OHIO AS WELL AS PERSONS FROM INDIANA AND KENTUCKY. IN METROPOLITAN STATISTICAL AREAS, THE CINCINNATI-MIDDLETOWN REGION IS THE LARGEST IN OHIO. THE ESTIMATED POPULATION FOR THIS AREA IS 2,150,000. THE POPULATION WITHIN THE FIVE OHIO COUNTIES SERVED BY TRIHEALTH HOSPITAL, INC. AND TRIHEALTH, INC. IS ESTIMATED TO BE 1,663,000 AND 12.0 PERCENT OF THIS POPULATION IS UNINSURED. PART VI, LINE 5: TRIHEALTH HOSPITAL, INC. IS COMPRISED OF VARIOUS MEDICAL SERVICES INCLUDING TRIHEALTH EVENDALE HOSPITAL AND TRIHEALTH SURGERY CENTER WEST, EACH OF WHICH HAS AN OPEN MEDICAL STAFF. ITS BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES.TRIHEALTH EVENDALE HOSPITAL CONSISTS OF TEN OPERATING ROOMS, 29 INPATIENT ROOMS AND A COMPLETE IMAGING AND DIAGNOSTIC FACILITY. SERVICES RANGE FROM INPATIENT SURGERY TO ORTHOPEDICS, GYNECOLOGY AND OUTPATIENT IMAGING.TRIHEALTH SURGERY CENTER WEST CONSISTS OF FOUR OPERATING ROOMS AND TWO PROCEDURE ROOMS. PART VI, LINE 6: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH IN ORDER TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION.THROUGH FIVE (5) HOSPITALS, THREE (3) AMBULATORY LOCATIONS AND OVER 125 SITES OF CARE (EMPLOYING OVER 600 PHYSICIANS INCLUDING RESIDENTS), TRIHEALTH PROVIDES A WIDE RANGE OF CLINICAL, EDUCATIONAL, PREVENTIVE AND SOCIAL PROGRAMS. TRIHEALTH'S NON-HOSPITAL SERVICES INCLUDE PHYSICIAN PRACTICE MANAGEMENT, FITNESS CENTERS AND FITNESS CENTER MANAGEMENT, OCCUPATIONAL HEALTH CENTERS, HOME HEALTH AND HOSPICE CARE. 0 GORMAN HERITAGE FARM 10052 READING ROAD EVENDALE OH 45241 800078694 501(C)(3) 11000 GENERAL PURPOSES 1 0 1 1 0 0 0 0 0 0 0 JOHN PROUT CEO (END 12/15) 0 965035 0 369675 0 1094617 0 34500 0 9260 0 2473087 0 1038567 ALAN ALTMAN MD MED STAFF PRES (END 12/15) 0 622409 0 6275 0 46794 0 42611 0 25169 0 743258 0 0 CRAIG EISENTROUT MD TRUSTEE 0 544176 0 351 0 3878 0 9966 0 26424 0 584795 0 0 MARK CLEMENT PRESIDENT/CEO (START 1/16) 0 469331 0 40486 0 6930 0 50953 0 10722 0 578422 0 0 DONNA NIENABER ESQ SVP CORP COUNSEL/ASST SEC 0 365732 0 98337 0 26047 0 124769 0 10226 0 625111 0 0 MICHAEL CROFTON SVP CFO/ASST TREASURER 0 410902 0 134295 0 34494 0 119077 0 26136 0 724904 0 0 WILLIAM GRONEMAN EXEC VP SYSTEM DEVELOPMENT 0 443212 0 135707 0 83767 0 157191 0 35897 0 855774 0 25183 GERALD OLIPHANT EXEC VP & COO (END 9/15) 0 455494 0 171732 0 77577 0 106022 0 26176 0 837001 0 0 JOHN ROBINSON MD SVP-HOSPITAL OPS (END 3/16) 0 312225 0 89863 0 14810 0 62273 0 23686 0 502857 0 0 KELVIN HANGAR EXEC DIR-TRIHEALTH EVENDALE 228546 0 55036 0 722 0 10291 0 22123 0 316718 0 0 0 ROBERT COLLINS MD CHIEF MEDICAL OFFICER 0 394037 0 127465 0 17650 0 115738 0 15160 0 670050 0 0 SUELLEN JONES NURSING ADMIN-TRIHEALTH EV 151564 0 27293 0 4813 0 7196 0 8210 0 199076 0 0 0 GEORGES FEGHALI MD FORMER 0 9850 0 0 0 139550 0 6528 0 815 0 156743 0 0 PART I, LINE 3 TRIHEALTH, INC., A RELATED ORGANIZATION OF TRIHEALTH HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. PART I, LINES 4A-B ELIGIBLE EXECUTIVES (GENERALLY VICE PRESIDENTS AND ABOVE) PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. TRIHEALTH, INC., THE RELATED ORGANIZATION THAT PAID THE SALARIES OF THE FOLLOWING INDIVIDUALS LISTED IN SCHEDULE J, PART II, CONTRIBUTED, ON BEHALF OF THE FOLLOWING INDIVIDUALS, TO A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE AMOUNTS AS NOTED: MARK CLEMENT - $23,678 DONNA NIENABER, ESQ. - $71,617 MICHAEL CROFTON - $82,575 WILLIAM GRONEMAN - $106,849 GERALD OLIPHANT - $91,626 JOHN ROBINSON, MD - $50,617 ROBERT COLLINS, MD - $80,496 IN ADDITION, THE FOLLOWING INDIVIDUAL LISTED IN SCHEDULE J, PART II, RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH WAS TREATED AS TAXABLE COMPENSATION BY TRIHEALTH, INC.: JOHN PROUT - $1,038,567 WILLIAM GRONEMAN - $25,183 PART I, LINE 4A: THE REPORTABLE INDIVIDUALS OF TRIHEALTH HOSPITAL, INC., WITH THE EXCEPTION OF A FEW, ARE PAID BY TRIHEALTH, INC., A RELATED ORGANIZATION, RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). TRIHEALTH, INC. HAS A STANDARD EMPLOYEE SEVERANCE PACKAGE. GENERAL SEVERANCE PAY IS BASED ON LENGTH OF SERVICE. IN ADDITION, NOTICE PAY, IF APPLICABLE UNDER TRIHEALTH POLICY, MAY BE ADDED TO THE SEVERANCE PACKAGE AND THE AMOUNT OF NOTICE PAY WILL BE DETERMINED BY HUMAN RESOURCES IN ACCORDANCE WITH TRIHEALTH POLICY. PAYMENTS OF SEVERANCE ARE CONDITIONED UPON SIGNING A SEPARATION AND RELEASE AGREEMENT. DURING THE 2015 CALENDAR YEAR, THE FOLLOWING REPORTABLE INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM TRIHEALTH, INC.: GERALD OLIPHANT - $56,179 FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS, DIRECTORS AND TRUSTEES OF TRIHEALTH HOSPITAL, INC. LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARDS OF BETHESDA HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, BOTH AFFILIATED ENTITIES OF TRIHEALTH HOSPITAL, INC. AS WELL AS TRIHEALTH, INC., THE SINGLE CORPORATE MEMBER OF TRIHEALTH HOSPITAL, INC. JOHN PROUT, MICHAEL CROFTON, GERALD OLIPHANT, ROBERT COLLINS, MD, MARK CLEMENT AND MYRTIS POWELL HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE MCCULLOUGH-HYDE MEMORIAL HOSPITAL, AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. WAYNE SHIRCLIFF, ELLEN KATZ, CRAIG EISENTROUT, MD, ALAN ALTMAN, MD, MARK DELWORTH, MD, MICHAEL HAVERKAMP, AND MYRTIS POWELL HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA, INC., THE SINGLE CORPORATE MEMBER OF BETHESDA HOSPITAL, INC., AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. JOHN PROUT, MARK CLEMENT AND MYRTIS POWELL HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE GOOD SAMARITAN COLLEGE OF NURSING AND HEALTH SCIENCE, AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. JOHN PROUT, MARK CLEMENT, MYRTIS POWELL AND CRAIG EISENTROUT, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA FOUNDATION, INC., A RELATED ENTITY OF BETHESDA HOSPITAL, INC., AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. JOHN PROUT, MARK CLEMENT, DONNA NIENABER, ESQ., WILLIAM GRONEMAN, GERALD OLIPHANT, CRAIG EISENTROUT, MD, ALAN ALTMAN, MD, MICHAEL CROFTON, JOHN ROBINSON, MD AND ROBERT COLLINS, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED ENTITY BOARDS OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES AS WELL AS BEING EMPLOYED BY TRIHEALTH, INC. OR ITS AFFILIATES/SUBSIDIARIES. TRIHEALTH, INC. IS THE SINGLE CORPORATE MEMBER OF TRIHEALTH HOSPITAL, INC. SR. SALLY DUFFY AND MICHAEL MCGRAW HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER VIA AN UNRELATED TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF TRIHEALTH HOSPITAL, INC. SHALL BE TRIHEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A PURSUANT TO ARTICLE II, SECTION 2.2 OF THE CODE OF REGULATIONS OF TRIHEALTH HOSPITAL, INC. ("HOSPITAL") THE SOLE MEMBER OF THE CORPORATION SHALL ELECT THE TRUSTEES OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF TRIHEALTH HOSPITAL, INC. ("HOSPITAL") HAS THE ABILITY TO APPROVE THE DECISIONS OF THE HOSPITAL'S GOVERNING BODY THAT ARE RESERVED TO IT BY OHIO LAW. FORM 990, PART VI, SECTION B, LINE 11 MEMBERS OF THE BOARD ARE PROVIDED AN ELECTRONIC COPY OF THIS FORM 990 PRIOR TO FILING. SUBSEQUENT TO PRESENTATION TO THE BOARD, THE ORGANIZATION FILES THE RETURN MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH NON-SUBSTANTIVE CHANGES ARE NOT SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE CERTAIN FINANCIAL INTERESTS AND FIDUCIARY RELATIONSHIPS. THE EXECUTIVE COMMITTEE AND CORPORATE COUNSEL REVIEW RESPONSES, CONDUCT FURTHER INVESTIGATION, IF NECESSARY, AND DETERMINE WHEN A CONFLICT EXISTS WITH RESPECT TO A CERTAIN TRANSACTION. IF A CONFLICT EXISTS, THE TRANSACTION IS NOT TO BE ENTERED INTO UNLESS ALTERNATIVES ARE FULLY INVESTIGATED AND, IN THEIR ABSENCE, THE BOARD, WITHOUT PARTICIPATION OF THE INTERESTED MEMBER(S), DETERMINES THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. PLANS TO MANAGE THE CONFLICT DURING THE RELATIONSHIP ARE IMPLEMENTED. ALL DISCUSSIONS ARE APPROPRIATELY DOCUMENTED. ALL DIRECTORS AND MANAGERS, WHICH INCLUDE OFFICERS AND KEY EMPLOYEES, ARE REQUIRED TO ANNUALLY DISCLOSE ANY CIRCUMSTANCES, INCLUDING FAMILY AND BUSINESS RELATIONSHIPS, THAT MAY CAUSE A CONFLICT OF INTEREST FOR THE ORGANIZATION. THESE RESPONSES ARE REVIEWED AND ACTED UPON BY A CONFLICT OF INTEREST COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING COMPENSATION OF TRIHEALTH HOSPITAL, INC.'S OFFICERS AND DIRECTORS, THE ANNUAL PROCESS PERFORMED BY TRIHEALTH, INC. (A RELATED ORGANIZATION WHO PAID THE INDIVIDUALS) INCLUDED: * COMPENSATION COMMITTEE; * INDEPENDENT COMPENSATION CONSULTANT; * COMPENSATION SURVEY OR STUDY; AND * APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. ADDITIONALLY, ALL DISCUSSIONS AND DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 TRIHEALTH HOSPITAL, INC.'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A - AVERAGE HOURS PER WEEK THE OFFICERS AND DIRECTORS FOR TRIHEALTH HOSPITAL, INC. THAT SHOW AT LEAST 60 HOURS PER WEEK PROVIDE SERVICES TO TRIHEALTH, INC. (A RELATED ORGANIZATION WHO PAID THE INDIVIDUALS) AND ITS SUBSIDIARIES/AFFILIATES ("TRIHEALTH") AS AN ENTIRE SYSTEM. HOURS WORKED, INCLUDING THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION, ARE NOT TRACKED ON AN ENTITY BY ENTITY BASIS, THUS THE AVERAGE HOURS PER WEEK DISCLOSED ARE ESTIMATES TO SHOW THAT THE TIME SPENT BY THESE INDIVIDUALS RELATE TO THEM FULFILLING THEIR DUTIES AS FULL-TIME, 60 HOURS-PER-WEEK EMPLOYEES OF TRIHEALTH VERSUS THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION. IN ADDITION, THE COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS IN FULFILLMENT OF THEIR DUTIES AS EMPLOYEES OF TRIHEALTH. DIRECTORS (AS NOTED WITH A "MED STAFF PRES" REFERENCE) FOR BETHESDA HOSPITAL, INC. SERVE ON THE BOARD IN THEIR CAPACITY AS MEDICAL STAFF PRESIDENT FOR EITHER BETHESDA HOSPITAL, INC. OR THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. IN ADDITION, THESE INDIVIDUALS PROVIDE SERVICES AS EMPLOYEES OF VARIOUS RELATED ENTITIES FOR WHICH THEY RECEIVE COMPENSATION. NONE OF THE COMPENSATION SHOWN IS FOR SERVING AS A DIRECTOR. FORM 990, PART XII, LINE 2C THE FINANCIAL STATEMENTS OF TRIHEALTH HOSPITAL, INC. ARE AUDITED AS PART OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). TRIHEALTH HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF BOTH ITS AND ITS SUBSIDIARIES AND AFFILIATES FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF THE INDEPENDENT AUDITOR. DURING THE TAX YEAR, THERE WAS NOT A CHANGE IN THE PROCESS OF AUDIT OVERSIGHT AND/OR SELECTION OF AN INDEPENDENT AUDITOR BY TRIHEALTH. TRIHEALTH INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311438846 SUPPORT TO AFFILIATED HOSPITALS OH SECTION 501(C)(3) SCHEDULE A, LINE 11B N/A 0 GOOD SAMARITAN HOSPITAL FREE CLINIC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 273893817 HEALTHCARE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 7 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN ENTERPRISE CORP 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311383365 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 9 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN INSTITUTE 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311074519 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 9 TRIHEALTH INC 1 BETHESDA HOSPITAL INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 310537122 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 0 BETHESDA HEALTHCARE INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311027660 HEALTHCARE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 11B BETHESDA INC 1 BETHESDA FAMILY PRACTICE CENTER 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311242442 HEALTHCARE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 11A BETHESDA HOSPITAL INC 1 BETHESDA PROPERTIES INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311352694 PROPERTY MANAGEMENT OH SECTION 501(C)(2) BETHESDA HOSPITAL INC 1 HOSPICE OF CINCINNATI INCORPORATED 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 310917155 HOSPICE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 9 BETHESDA HOSPITAL INC 1 FERNSIDE INC A CENTER FOR GRIEVING CHILDREN 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311179234 COUNSELING TO GRIEVING CHILDREN OH SECTION 501(C)(3) SCHEDULE A, LINE 7 HOSPICE OF CINCINNATI INCORPORATED 1 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 310537486 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 0 GOOD SAMARITAN COLLEGE OF NURSING AND HEALTH SCIENCE 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311778403 EDUCATION OH SECTION 501(C)(3) SCHEDULE A, LINE 2 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 1 COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 237419853 DIALYSIS OH SECTION 501(C)(2) THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 1 MCCULLOUGH HYDE MEMORIAL HOSPITAL INC 110 N POPLAR STREET OXFORD OH 45056 310650283 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 1 TRIHEALTH PHYSICIANS OF INDIANA INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 461125130 PHYSICIAN PRACTICES OH N/A C 1 TRIHEALTH PHYSICIAN SOLUTIONS INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311444353 CLAIMS ADMINISTRATION OH N/A C 1 TRIHEALTH CIPHO INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 463294306 PHYSICIAN HEALTH ORGANIZATION OH N/A C 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 BETHESDA PROPERTIES INC K 241188 FMV TRIHEALTH INC M 3446160 COST TRIHEALTH INC P 30322069 COST