2016-11-12T11:37:28-06:00 2015-12-31 ERNST & YOUNG US LLP 800 YARD ST 200 GRANDVIEW HEIGHTS OH 43212 990 2015-01-01 311079309 ATRIUM MEDICAL CENTER % J MICHAEL SIMS ATRI 9374999942 110 N MAIN ST STE 500 DAYTON OH 45402 J MICHAEL SIMS VP FINANCE 9374999942 2016-11-01 true DIANE L BEAN P00104972 6142245678 2015 2017-02-10 21:41:12Z CAROL TURNER 1 MEDICAL CENTER DR MIDDLETOWN OH 45005 277011710 false X WWW.PREMIERHEALTH.COM X 1983 OH ATRIUM MEDICAL CENTER WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. 7 2 2230 310 771347 -213437 283835 288165 227821619 241686748 4327484 2210667 2196833 2605102 234629771 246790682 615456 756602 0 0 99591635 107952704 0 0 0 125212436 122925406 225419527 231634712 9210244 15155970 391547851 382765607 258343431 253435968 133204420 129329639 ATRIUM MEDICAL CENTER WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. false false 212164728 756602 241686748 PLEASE SEE SCHEDULE H. 212164728 true true false true false false false false false true true false false true true true false true false false true false false false false false true true true false true true false false false false false false false false false false false false false false true true true true false false true 185 0 true 2230 true true true false false false false false false false false false X 7 2 false true false false true true true true true false false true true true true true true true true true true X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 500 DAYTON OH 45402 X DAVID A FLOERING MD BOARD CHAIR 0.5 0.0 X X 0 0 0 CAROL J TURNER FACHE PRESIDENT & CEO 39.0 1.0 X X 571939 0 40660 WILLIAM J ANDREW MD TRUSTEE 0.5 0.0 X 39975 863 0 P DAVID MITCHELL MD TRUSTEE 0.5 0.0 X 19980 1725 0 BARRY ROBERTSON MD TRUSTEE 0.5 0.0 X 1605 0 0 JAMES R PANCOAST PREMIER PRESIDENT & CEO 8.0 8.0 X 0 0 0 MARQUITA L TURNER TRUSTEE 40.0 0.0 X 228643 0 29386 LISA A GIBBS Treasurer & CFO 19.5 0.5 X 108810 0 10139 DONNA L BANKS VP OPERATIONS 40.0 0.0 X 193831 0 23008 DALE E CREECH SYSTEM SR VP-CLO 8.0 32.0 X 0 624758 60638 THOMAS R CURTIN SYSTEM VP REVENUE CYCLE 8.0 32.0 X 0 276277 37323 GARY G GINTER SYSTEM VP & CIO 8.0 32.0 X 0 493377 53719 BARBARA A JOHNSON SYSTEM VP-HR OPERATIONS 8.0 32.0 X 0 491255 17489 TAMMY S LUNDSTROM SYSTEM VP-CMO 8.0 32.0 X 0 656668 10493 MARILYN NOLL VP OPERATIONS 40.0 0.0 X 178883 0 16824 THOMAS R PARKER CHIEF EXPERIENCE OFFICER 8.0 32.0 X 0 481498 38310 MARK W SHAW SYSTEM VP-MANAGED CARE 8.0 32.0 X 0 393525 61180 SCOTT A SHELTON SYSTEM VP-CPO 8.0 32.0 X 0 313527 29282 SYLVAIN TREPANIER DNP RN CENP SYSTEM VP-CNO 8.0 32.0 X 0 386458 17725 CRAIG SELF CHIEF STRAT. 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FUNDS WERE ALSO GRANTED TO CITIZENS FOR SINCLAIR IN SUPPORT OF THE SINCLAIR COMMUNITY COLLEGE LEVY CAMPAIGN. PART II-B, LINE 1I: THE HOSPITAL CONTRACTS WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. 132575 3734 2650 133659 133055 5860 6340 132575 133799 4556 5300 133055 132950 4975 4126 133799 136502 2269 5 5826 132950 1.00000 false false 17862162 17862162 231140482 74050416 157090066 1201281 890386 310895 131680484 94234037 37446447 13466107 13466107 226175677 JOINT OPERATING AGREEMENT 19930000 REBATES RECEIVABLE 3654774 MISC AR 1132005 DEFERRED COMPENSATION 956699 DEPOSITS 184886 OTHER LT ASSETS 80707 OTHER INVESTMENTS 47066 25986137 0 SWAP LIABILITY 20461486 PENSION OBLIGATION & DEFERRED 7123837 SELF INSURANCE RESERVE 4412668 ACCRUED MANAGED CARE A/R LIAB 3756031 LOAN GUARANTEE & OTHER LTL 1248437 HOSPITAL FRANCHISE FEE PAYABLE 914241 DUE TO AFFILIATES 761643 OTHER 2244533 40922876 X Part V, Line 4: THE ORGANIZATIONS ENDOWMENT FUNDS ARE DESIGNATED TO SUPPORT SPECIFIC HEALTHCARE SERVICES OR CAPITAL NEEDS. PART X, LINE 2: THE FOLLOWING FOOTNOTE IS FROM THE AUDITED COMBINED FINANCIAL STATEMENTS FOR PREMIER HEALTH AND AFFILIATES. ATRIUM HEALTH SYSTEMS IS THE PARENT ORGANIZATION OF ATRIUM MEDICAL CENTER (AMC). PREMIER HEALTH (PREMIER), MEDAMERICA HEALTH SYSTEMS (MAHS), ATRIUM HEALTH SYSTEM (AHS), AND UVMC HAVE BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE TAX-EXEMPT NONPROFIT CORPORATIONS AND PUBLIC CHARITIES UNDER SECTIONS 501(C)(3) AND 509(A), RESPECTIVELY, OF THE INTERNAL REVENUE CODE. SAMARITAN HEALTH PARTNERS (SHP) IS TAX-EXEMPT UNDER SECTION 501(C)(3) AND IS A PUBLIC CHARITY BY REASON OF BEING INCLUDED IN THE GROUP RULING ISSUED TO THE U.S. CATHOLIC CHURCH. AS TAX-EXEMPT ORGANIZATIONS, THEIR INCOME IS EXEMPT FROM FEDERAL INCOME TAX EXCEPT TO THE EXTENT OF ANY UNRELATED BUSINESS ACTIVITIES. PREMIER, MAHS, SHP, AHS, AND UVMC ALSO OWN OR CONTROL CERTAIN SUBSIDIARIES, WHICH ARE FOR PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. TAXES PAYABLE AT DECEMBER 31, 2015 AND 2014, 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. 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X X true true X X X true X WWW.PREMIERHEALTH.COM X WWW.PREMIERHEALTH.COM X WWW.PREMIERHEALTH.COM X X X X X true X false X X X X true X false false PART V, SECTION A, LINE 1: THE STATE OF OHIO DOES NOT LICENSE HOSPITALS, BUT THE OHIO DEPARTMENT OF HEALTH DOES REGISTER HOSPITALS. AS PART OF THIS REGISTRATION PROCESS, HOSPITALS IN THE STATE OF OHIO ARE REQUIRED TO COMPLETE AND SUBMIT THE ANNUAL HOSPITAL REGISTRATION AND PLANNING REPORT (AHR) EACH CALENDAR YEAR. ATRIUM MEDICAL CENTER'S REGISTRATION NUMBER IS 1116. PART V, SECTION B, LINE 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 ATRIUM MEDICAL CENTER, COMMUNITY HEALTH COLLABORATIVES FEATURING COMMUNITY, HEALTH, AND BUSINESS STAKEHOLDERS/ADVOCATES ORGANIZED BY BOTH ATRIUM MEDICAL CENTER, AND THE GREATER DAYTON AREA HOSPITAL ASSOCIATION WITH ITS MEMBER HOSPITALS. PART V, SECTION B, LINES 6A & 6B: ATRIUM MEDICAL CENTER PARTNERED WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION AND WRIGHT STATE UNIVERSITY TO PREPARE THEIR COMMUNITY HEALTH NEEDS ASSESSMENT. PART V, SECTION B, LINE 7A: THE DIRECT WEBSITE ADDRESS WHERE THE CHNA CAN BE ACCESSED IS: HTTP://WWW.ATRIUMMEDCENTER.ORG/WORKAREA/DOWNLOADASSET.ASPX?ID=76898 PART V, SECTION B, LINE 10A: THE DIRECT WEBSITE ADDRESS WHERE THE IMPLEMENTATION STRATEGY CAN BE ACCESSED IS: HTTP://WWW.PREMIERHEALTH.COM/OUR-COMMUNITY/MAKING-A-DIFFERENCE/COMMUNITY-H EALTH-IMPROVEMENT-PLAN/ATRIUM/ PART V, SECTION B, LINE 11: Premier Health was part of a collaboration in 2013 with the Greater Dayton Area Hospital Association and hospitals throughout Southwestern Ohio to conduct a regional Community Health Needs Assessment. IDENTIFIED PRIORITIES --------------------- IN THE COMMUNITY HEALTH ASSESSMENT, RESEARCHERS IDENTIFIED PRIORITY AREAS FOR COMMUNITY HEALTH IMPROVEMENT USING A VARIETY OF CRITERIA. THE PRIORITIES THAT ARE INCLUDED AND EXCLUDED IN THE PLAN ARE LISTED BELOW. PRIORITIES INCLUDED IN THE PLAN: -------------------------------- THROUGH THE COMMUNITY HEALTH RISK ASSESSMENT, THE FOLLOWING PRIORITIES WERE IDENTIFIED FOR WARREN AND BUTLER COUNTIES. THESE PRIORITIES ARE OUTLINED IN THIS PLAN. PRIMARY AND CHRONIC DISEASES 1. HYPERTENSION-HYPERTENSION SELF-REPORTED RATES ARE HIGHER IN THE SERVICE AREA THAN IN THE STATE AND NATION (33.8% VERSUS 31.7% AND 28.7%, RESPECTIVELY). IT IS THE LEADING INPATIENT DISCHARGE DIAGNOSIS AND THE 3RD LEADING ED DISCHARGE DIAGNOSIS. 2. BREAST CANCER-THE BREAST CANCER RATE IS 229 PER 100,000, AND THE RATE IS INCREASING AS OPPOSED TO OTHER HISTORICALLY PREVALENT CANCERS. 3. DIABETES-THE PREVALENCE OF DIABETES IS GREATER IN THE SERVICE AREA COMPARED TO THE STATE AND NATION ACCORDING TO SELF-REPORTS (12% VS. 10.1% AND 8.7%). IT IS THE 3RD MOST COMMON INPATIENT DISCHARGE DIAGNOSIS AND THE 6TH MOST COMMON ER DISCHARGE DIAGNOSIS. DISCHARGE DIAGNOSES RATES HAVE INCREASED FROM 2004 TO 2012. THERE IS ALSO AN INCREASE IN KIDNEY AND RENAL CANCER BOTH OF WHICH ARE ASSOCIATED TYPE 2 DIABETES. Priorities Addressed Through Collaboration ------------------------------------------ All identified priorities are important elements of improving the health of our community. In some instances priorities are already being targeted by collaborative groups of which Atrium Medical Center is a part. Additional strategies will not be developed independent of these efforts. Because of the importance of these community-wide efforts, the following identified priorities are not included in the Community Health Improvement Plan. Maternal and Infant Priorities: 1. First trimester prenatal care 2. Infant mortality rate Atrium Medical Center is involved in several state-wide initiatives addressing these issues. As part of these collaborations, Atrium Medical Center will share the goals and objectives developed by those groups for program implementation and measurement. Ohio Perinatal Quality Collaborative ------------------------------------ Atrium Medical Center is a non-charter member of this organization as a maternity hospital. The mission of the Collaborative is, "Through collaborative use of improvement science methods, reduce preterm births and improve outcomes of pre-term newborns in Ohio as quickly as possible." Projects of the collaborative include: * 39 Weeks Delivery Charter Project - To reduce elective unnecessary scheduled births before 39 weeks gestational age. (Reduce infant mortality and low birth weights.) * 39 Weeks Dissemination and Birth Registry Accuracy Project - This project was to address inaccuracies in birth certificate data within the Quality Improvement framework. * Obstetrics Antenatal Corticosteroids Project- This project focuses on increasing the use of antenatal corticosteroids to reduce mortality and morbidity among preterm infants. (Reduce infant mortality.) * Progesterone Project - This project intends to help raise awareness about the need for screening and intervention for progesterone, provide support to teams to implement screening, identification and treatment, develop the capacity and capability of skilled ultrasound technicians and remove administrative barriers to the administration of progesterone. (Reduce infant mortality and low birth weights.) Ohio Hospital Association (OHA) ------------------------------- OHA has developed a plan to reduce infant mortality (which also addresses low infant birth weight and first trimester care) in Ohio which includes: * Safe sleep (infant mortality) * Eliminating elective deliveries before 39 weeks (infant mortality) * Progesterone for high risk mothers (infant mortality) * Eliminating health disparities * Safe spacing (infant mortality and low birth weight) * Access to prenatal care (First trimester care, infant mortality and low birth weight) * Promote breast milk * These program areas also then address increasing first trimester care, improving low birth weight and decreasing infant mortality. Primary and Chronic Diseases: 3. Alcohol and drug dependence The Butler County, Ohio Alcohol and Drug Addiction Services Board coordinates services for that county. Its strategic plan shows goals to reduce the number of overdose deaths, integrate behavioral health and primary care services and using a specialized perinatal program educating high risk pregnant women about the effects of substance abuse on their baby and how to make healthier lifestyle choices. In Warren County, the Mental Health Recovery Services of Warren and Clinton counties coordinate substance abuse and mental health services for its residents. Similar to its Butler County equivalent, it assesses mental health and substance abuse needs in its community and provides funding for services that address those needs. KEY HEALTH PRIORITIES BY OBJECTIVE PRIORITY AREA 1: ---------------- Reduce the incidence and complications from adult hypertension. Blood pressure is how hard blood pushes against the walls of our arteries when our heart pumps blood. When someone has high blood pressure, which is also called hypertension, this increased pressure against the arteries causes damage. Hypertension is called the silent killer because usually those who have it do not feel anything. High blood pressure increases risk for heart disease, stroke, heart failure, kidney disease and blindness. In many cases hypertension can be prevented by maintaining a healthy weight, being active, eating healthy, not using tobacco and limiting alcohol. Most people who are diagnosed with high blood pressure can be controlled. Those with high blood pressure should take the same steps that may prevent high blood pressure. If medication is needed, it is imperative to take it every day. Self-reported rates of hypertension are higher in the service area than in the state and nation. It is the leading inpatient discharge diagnosis and the 3rd leading ED discharge diagnosis. Because of the significant health threat posed by hypertension, a community-focused, population health improvement strategy would benefit all parts of the community. PRIORITY AREA 1: REDUCE THE PROPORTION OF ADULTS WITH HYPERTENSION ------------------------------------------------------------------ OBJECTIVE 1.1: INCREASE THE PROPORTION OF ADULTS WITH HYPERTENSION WHOSE BLOOD PRESSURE IS UNDER CONTROL. Evidence-based Strategies: * COORDINATE A HYPERTENSION EDUCATION HEALTH COMMUNICATIONS CAMPAIGN THAT WILL INCLUDE COMMUNICATIONS TACTICS; FREE, COMMUNITY-BASED SCREENINGS AND FREE ONLINE EDUCATION. * PROMOTE LECTURES ABOUT HIGH BLOOD PRESSURE PREVENTION AND CONTROL IN WORKSITES, CONGREGATIONS, SENIOR CENTERS AND OTHER COMMUNITY BASED VENUES. * IDENTIFY OR DEVELOP AN EDUCATIONAL BROCHURE TARGETED TO THOSE WHO ALREADY HAVE HIGH BLOOD PRESSURE ABOUT THE IMPORTANCE OF MEDICATION ADHERENCE AND HEALTHY LIFESTYLE. MAKE COLLATERAL AVAILABLE THROUGH SYSTEM WEBSITES, FACEBOOK PAGES, AT EMPLOYER AND COMMUNITY EVENTS AND OTHER OUTLETS TO BE IDENTIFIED. THESE WILL INCLUDE HOW TO GET MORE INFORMATION BY TELEPHONE AND/OR ONLINE. Outcome Indicators ------------------ SHORT AND INTERMEDIATE TERM: * To have communications a 3 MIDDLETOWN SURGERY CENTER LLC 5950 INNOVATION DR MIDDLETOWN OH 45005 GENERAL MEDICAL & SURGICAL OUTPATIENT FACILITY SOUTHWEST OHIO AMBULATORY SURGERY CENTER 295 N BREIEL BLVD MIDDLETOWN OH 45042 GENERAL MEDICAL & SURGICAL OUTPATIENT FACILITY MASON EMERGENCY CENTER 7450 Mason Montgomery Rd MASON OH 45040 EMERGENCY CENTER PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT FOR ATRIUM MEDICAL CENTER IS PART OF THE PREMIER HEALTH REPORT. PART I, LINE 7: A COST TO CHARGE RATIO WAS USED TO CALCULATE THIS FINANCIAL ASSISTANCE AT COST. THIS CALCULATION TAKES TOTAL OPERATING EXPENSES LESS OTHER OPERATING REVENUES DIVIDED BY TOTAL GROSS REVENUES. UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENTAL PROGRAMS WERE CALCULATED USING A COST ACCOUNTING SYSTEM. THIS SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND INCLUDES FULLY LOADED COSTS. FOR THE REMAINING ITEMS THE ORGANIZATION USED SPECIFIC NUMBERS FOR EXPENSE PAID DIRECTLY FOR THESE SERVICES. PART I, LINE 7G: ATRIUM MEDICAL CENTER (AMC) PROVIDES THE FOLLOWING SUBSIDIZED SERVICE: EMERGENCY SERVICES: AMC OPERATES 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 2015, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $8,625,000. PART II, LINE 9: ATRIUM MEDICAL CENTER (AMC) PARTICIPATES IN THE FOLLOWING COMMUNITY BENEFIT ACTIVITIES: BOARD CHARITABLE CREDIT FUND: AS PART OF AMC'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 DAYTON AREA. ALSO SUGGESTED ARE ORGANIZATIONS THAT FOCUS ON SUPPORTING YOUTH, EDUCATION, UNDERSERVED GROUPS, AND SAFE NEIGHBORHOODS. THE AMOUNT OF SUPPORT PROVIDED IN 2015 WAS $110,000. IN ADDITION, ATRIUM MEDICAL CENTER OFFERS A WIDE VARIETY OF FREE HEALTH CLINICS TO THE GENERAL PUBLIC. 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 $36,429,000 AND INCURRED COST OF $52,232,000, FOR AN ADDITIONAL NET SHORTFALL OF $15,803,000 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 $44,214,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $36,429,000 TOTAL MEDICARE ASSOCIATED REVENUE $80,643,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT IN PART III, SECTION B $52,297,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $52,232,000 TOTAL MEDICARE ASSOCIATED COST $104,529,000 ALLOWABLE MEDICARE SHORTFALL IN PART III, SECTION B $8,083,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $15,803,000 TOTAL MEDICARE SHORTFALL $23,886,000 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 47% 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 HAS NOT HONORED THE TERMS OF THAT PLAN. THE FINANCIAL COUNSELORS MEET WITH INPATIENT, OUTPATIENT, SELF-PAY, AND OTHER PATIENTS UPON REQUEST WHO MAY NEED FINANCIAL ASSISTANCE. IN ADDITION TO ASSISTING PATIENTS WHO WANT TO APPLY FOR ASSISTANCE THROUGH THE MEDICAID PROGRAM, THE FINANCIAL COUNSELOR WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 2: The organization works with the community on programs that address the underlying causes of persistent health problems as part of a comprehensive strategy to improve the health status and quality of life for identified members of the community who are economically disadvantaged, disenfranchised and/or who have disproportionate unmet health needs. The organization strives to work with Premier Health, the Atrium Medical Center Board of Directors, executive management, managers, staff members, community groups, and individuals to provide a collaborative approach to the governance and management of community benefit activities. PART VI, LINE 3: THERE ARE SEVERAL WAYS IN WHICH OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR SERVICES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FIRST, NOTIFICATION OF SUCH AVAILABLE ASSISTANCE IS CLEARLY POSTED IN REGISTRATION AREAS, AS WELL AS MATERNITY AND EMERGENCY DEPARTMENTS. NEXT, PATIENT ADVOCATES, PATIENT ACCESS STAFF MEMBERS, AND FINANCIAL COUNSELORS IN THE INPATIENT AND EMERGENCY DEPARTMENTS MEET WITH UNINSURED AND UNDERINSURED PATIENTS, AND THOSE WITH ONLY MEDICARE COVERAGE TO DISCUSS ELIGIBILITY FOR ASSISTANCE. FINANCIAL COUNSELORS ALSO DISCUSS OPTIONS TO RESOLVE UNPAID ACCOUNT BALANCES WITH UNINSURED AND UNDERINSURED PATIENTS. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE, ALONG WITH INFORMATION ON HOW TO OBTAIN AN APPLICATION. WHEN A PATIENT RECEIVES A BILL, THE REVERSE SIDE OF THE BILL CONTAINS INFORMATION ABOUT THE STATE OF OHIO FREE CARE PROGRAM (CARE ASSURANCE) AND A FINANCIAL ASSISTANCE APPLICATION. THE BILLING STATEMENTS OFFER THE FINANCIAL ASSISTANCE OPTIONS AVAILABLE, AND THE CONTACT INFORMATION FOR ASSISTANCE. PART VI, LINE 4: THE ORGANIZATION IS LOCATED IN MIDDLETOWN, OHIO. OUR TARGET POPULATION INCLUDES CITIZENS IN THE CITY OF MIDDLETOWN, AS WELL AS SURROUNDING COMMUNITIES. A LARGE POPULATION OF OUR PATIENTS ARE INDIGENT. THE ORGANIZATION OFFERS A VARIETY OF FREE HEALTH SCREENINGS AND HEALTH EDUCATION TO MEMBERS OF THE COMMUNITY FOR PREVENTATIVE MEDICINE. THE ORGANIZATION IS ALSO COMMITTED TO CONTRIBUTING FUNDS EACH YEAR FOR THE BENEFIT OF VARIOUS COMMUNITY PROGRAMS. FOR 2015, MEDICARE PATIENTS REPRESENTED 47.9% OF GR true ATRIUM MEDICAL CENTER FOUNDATION 110 N MAIN ST STE 500 DAYTON OH 45402 311079213 501(C)(3) 49015 SUPPORT SINCLAIR COMMUNITY COLLEGE FOUNDATION 444 W 3RD STREET DAYTON OH 45402 310723444 501(C)(3) 121350 CAPITAL RENOVATION & EXPANSION UNIVERSITY OF DAYTON 300 COLLEGE PARK DAYTON OH 45469 310536715 501(C)(3) 75000 CYBERSECURITY & DATA INTELLIGENCE VICTORIA THEATRE ASSOCIATION 138 N MAIN ST DAYTON OH 45402 310897638 501(C)(3) 68025 SUPPORT AMERICAN HEART ASSOCIATION 5211 MADISON RD CINCINNATI OH 45227 135613797 501(C)(3) 56850 SUPPORT AIDS RESOURCE CENTER 15 W FOURTH ST 200 DAYTON OH 45402 311126780 501(C)(3) 43139 VARIOUS MIAMI VALLEY HOSPITAL 110 N MAIN ST STE 500 DAYTON OH 45402 310537504 501(C)(3) 41922 MAHOGANY CHILD & BRIDGE PROGRAMS REACH OUT MONTGOMERY COUNTY 25 E FORAKER ST DAYTON OH 45409 311434282 501(C)(3) 37114 RX ASSISTANCE FOR INDIGENT PATIENTS MIDDLETOWN TRANSIT SYSTEM 3045 MOSER CT HAMILTON OH 45011 316000139 GOVERNMENT 31913 SUPPORT CITIZENS FOR SINCLAIR 120 W SECOND ST 614 DAYTON OH 45402 611529465 None 30000 SUPPORT MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST STE 500 DAYTON OH 45402 311040231 501(C)(3) 15480 SUPPORT OMEGA COMMUNITY DEVELOPMENT 1800 HARVARD BLVD DAYTON OH 45406 311561713 501(C)(3) 15375 SUPPORT MIDDLETOWN COMMUNITY FOUNDATION 300 N MAIN ST 300 MIDDLETOWN OH 45042 310898380 501(C)(3) 11775 SUPPORT GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON 110 N MAIN ST STE 500 DAYTON OH 45402 237296923 501(C)(3) 9413 SUPPORT PROJECT HOPE 1510 N MAIN ST DAYTON OH 45405 341421548 501(C)(3) 5250 SUPPORT UNITED WAY OF THE GREATER DAYTON AREA 33 W THIRD ST 500 DAYTON OH 45402 310536658 501(C)(3) 5175 SUPPORT COMMUNITY FOUNDATION OF WEST CHESTER LIBERTY 5641 UNION CENTRE DR WEST CHESTER OH 45069 311661966 501(C)(3) 5150 SUPPORT 16 1 SCHEDULE I, Part I, Line 2: 1) DISBURSEMENTS ARE ANALYZED MONTHLY THROUGH VARIOUS REPORTS AND COMMITTEE MEETINGS. 2) INVOICES ARE RECEIVED IN ACCOUNTS PAYABLE AND APPROVED AND DISBURSED PER ORGANIZATIONAL POLICY. 3) GRANT SPENDING IS MONITORED AGAINST BUDGETED AMOUNTS ON AN ONGOING BASIS. X X X X false true false false false false false false false CAROL J TURNER FACHE PRESIDENT & CEO 391553 0 121292 0 59094 0 12923 0 27737 0 612599 0 0 0 MARQUITA L TURNER TRUSTEE 188467 0 39101 0 1075 0 9064 0 20322 0 258029 0 0 0 DONNA L BANKS VP OPERATIONS 163684 0 28446 0 1701 0 5760 0 17248 0 216839 0 0 0 DALE E CREECH SYSTEM SR VP-CLO 0 395325 0 127297 0 102136 0 34542 0 26096 0 685396 0 0 THOMAS R CURTIN SYSTEM VP REVENUE CYCLE 0 217857 0 55160 0 3260 0 8232 0 29091 0 313600 0 0 GARY G GINTER SYSTEM VP & CIO 0 351975 0 139106 0 2296 0 26339 0 27380 0 547096 0 0 BARBARA A JOHNSON SYSTEM VP-HR OPERATIONS 0 372517 0 106120 0 12618 0 7701 0 9788 0 508744 0 0 TAMMY S LUNDSTROM SYSTEM VP-CMO 0 519002 0 131441 0 6225 0 8908 0 1585 0 667161 0 0 MARILYN NOLL VP OPERATIONS 150758 0 25842 0 2283 0 7729 0 9095 0 195707 0 0 0 THOMAS R PARKER CHIEF EXPERIENCE OFFICER 0 369184 0 87253 0 25061 0 26354 0 11956 0 519808 0 0 MARK W SHAW SYSTEM VP-MANAGED CARE 0 282789 0 65769 0 44967 0 35804 0 25376 0 454705 0 0 SCOTT A SHELTON SYSTEM VP-CPO 0 250217 0 50865 0 12445 0 25280 0 4002 0 342809 0 0 SYLVAIN TREPANIER DNP RN CENP SYSTEM VP-CNO 0 329769 0 55449 0 1240 0 7971 0 9754 0 404183 0 0 LINDA L BECKER CLINCIAL NURSE-CN 188563 0 937 0 2112 0 4196 0 13739 0 209547 0 0 0 JEFFREY K HOFFMAN MD VP MEDICAL AFFAIRS/CMO 329834 0 42472 0 11271 0 4431 0 1537 0 389545 0 0 0 TAMARA L LAINE VP-MARKET/BUSINESS DEV 166263 0 39370 0 2777 0 4422 0 24023 0 236855 0 0 0 JOANNE R MORGAN DIR-PHARMACY 178222 0 22786 0 3810 0 8841 0 15812 0 229471 0 0 0 TED C RIPPERGER DIR HUMAN RESOURCES 140430 0 22396 0 18560 0 6821 0 26233 0 214440 0 0 0 CRAIG SELF CHIEF STRAT. OFFICER/DEV. OFF. 0 314509 0 64068 0 1893 0 11333 0 26622 0 418425 0 0 RENEE P GEORGE FORMER KEY EMPLOYEE 0 253960 0 45640 0 632 0 9526 0 11474 0 321232 0 0 J NICK LAIR FORMER KEY EMPLOYEE 0 224436 0 41191 0 28687 0 21914 0 24658 0 340886 0 0 PART I, LINE 4B: DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, CERTAIN PERSONS ARE LIMITED IN THE AMOUNT OF BENEFIT THAT CAN BE EARNED UNDER A QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, ATRIUM MEDICAL CENTER (AMC) AND ITS AFFILIATED ORGANIZATIONS COMPENSATES FOR THIS LIMITATION AND SUPPLEMENTS THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. AMC SUPPLEMENTS THE AFFECTED EXECUTIVES THROUGH A PENSION RESTORATION PLAN AND A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE BENEFITS UNDER THESE SUPPLEMENTAL NONQUALIFIED PLANS ARE SUBJECT TO MULTI-YEAR VESTING AND A PARTICIPANT CAN FORFEIT BENEFITS EARNED IF VESTING REQUIREMENTS ARE NOT SATISFIED. UNDER THE TERMS OF THE SUPPLEMENTAL PLANS, AND BECAUSE OF TAX RULES PERTAINING TO TAXATION OF THE EARNED BENEFITS UPON VESTING, CERTAIN INDIVIDUALS RECEIVED A PAYOUT OF THE CUMULATIVE VESTED BENEFITS UNDER THEIR SUPPLEMENTAL PLAN DURING 2015. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2015: DALE E. CREECH $94,589; JEFFREY HOFFMAN, M.D. $5,054; BARBARA JOHNSON $5,674; J. NICK LAIR $9,733; MARK SHAW $31,161; SCOTT A. SHELTON $8,625. The individual listed below met the multi-year vesting requirement under the SERP and received the associated plan payment in 2015: Carol J. Turner $27,012 . BASED ON THE GUIDANCE PROVIDED IN THE INSTRUCTIONS TO THE FORM 990, ANY PAYMENTS TO THE PARTICIPANTS RELATED TO THESE PLANS THAT WERE MADE WITHIN 2-1/2 MONTHS AFTER THE END OF THE ORGANIZATION'S TAX YEAR ARE NOT TREATED AS DEFERRED COMPENSATION FOR PURPOSES OF SCHEDULE J. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. ANY PAYMENTS MADE AFTER THE 2-1/2 MONTHS WERE PROPERLY REPORTED ON PRIOR YEARS' FILED IRS FORM 990 RETURNS, DISCLOSING COMPENSATION EARNED BY THESE INDIVIDUALS UNDER THE PLANS FOR EACH SUCH YEAR. A CITY OF MIDDLETOWN OH 316000139 597146AH2 2008-11-21 111000000 REFUND SERIES 2007 A & B false false false B CITY OF MIDDLETOWN OH 316000139 597146AJB 2010-11-15 86000000 REFUND SERIES 2006 A false false false A 20325000 0 111000000 0 0 0 1513169 0 0 0 109486831 0 2008 true false true true B 0 0 86000000 0 0 0 560000 0 0 0 85440000 0 2010 true false true true A false true true true true true 0.00098 0.00937 0.01035 false false false true B false true true true true true 0.00098 0.00937 0.01035 false false false true A false false false true true true MERRILL LYNCH 23.9 true false false 0 false true B false false false true true false 0 false 0 false true A true B true PART IV, ARBITRAGE, LINE 2C, BOND A: COMPUTATION DATE WAS NOVEMBER 13, 2013 for the series 2008 a & B COMPUTATION DATE WAS NOVEMBER 15, 2015 for the series 2010 0 0 FORM 990, PART VI, SECTION A, QUESTION 3: PREMIER HEALTH (PREMIER) AS THE OPERATOR OF ATRIUM MEDICAL CENTER (AMC) DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR AMC, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. AMC SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. AMC SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. AMC SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF AMC WITH ALL THIRD PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. AMC MUST HAVE APPROVAL FROM PREMIER TO BORROW IN ANY FISCAL YEAR, GUARANTEE IN ANY YEAR, OR INCUR ANY LIEN OR OTHER ENCUMBRANCE ON ANY PROPERTY IN AN AMOUNT EQUAL TO OR GREATER THAN $1,000,000. AMC MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN PREMIER'S ACTIVITIES. FORM 990, PART VI, SECTION A, QUESTION 6: ATRIUM MEDICAL CENTER HAS TWO CORPORATE MEMBERS. ONE MEMBER IS ATRIUM HEALTH SYSTEMS, THE PARENT COMPANY OF THE HOSPITAL. THE SECOND MEMBER IS PREMIER HEALTH, AN OHIO NON-PROFIT CORPORATION FORMED PURSUANT TO THE JOINT OPERATING AGREEMENT. ATRIUM HEALTH SYSTEMS HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES OF THE CORPORATION. PREMIER HEALTH HAS THE GENERAL AUTHORITY TO OPERATE AND MANAGE THE OPERATIONAL ACTIVITIES OF THE CORPORATION. FORM 990, PART VI, SECTION A, QUESTION 7A: ATRIUM HEALTH SYSTEMS (AHS) HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR ATRIUM MEDICAL CENTER (AMC). FROM AMONG THOSE RECOMMENDED BY THE NOMINATING COMMITTEE SET FORTH IN THE JOINT OPERATING AGREEMENT. AHS HAS THE AUTHORITY TO REMOVE TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. PREMIER HEALTH HAS THE RIGHT TO REQUEST THAT AHS REMOVE A TRUSTEE OF AMC IF PREMIER HAS DETERMINED THAT SUCH TRUSTEE IS FRUSTRATING THE GOALS AND PURPOSES OF PREMIER'S NETWORK. SUCH REMOVAL SHALL NOT BE UNREASONABLY REFUSED BY AHS. FORM 990, PART VI, SECTION A, QUESTION 7B: SEE THE RESPONSE ABOVE FOR FORM 990, PART VI, SECTION A, QUESTION 3. FORM 990, PART VI, SECTION B, QUESTION 11B: THIS 990 TAX RETURN AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE TAX DEPARTMENT OF PREMIER HEALTH (PREMIER), OF WHICH ATRIUM MEDICAL CENTER IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE TAX MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. THE RETURN IS CONCURRENTLY SENT TO ERNST & YOUNG U.S. LLP FOR THEIR REVIEW. AFTER ALL CHANGES FROM THE ABOVE GROUPS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER AND THE CHIEF FINANCIAL OFFICER OF THIS ENTITY. A FINAL VERSION OF THE RETURN IS SENT TO ERNST & YOUNG U.S. LLP FOR A FINAL REVIEW AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT A BOARD OF TRUSTEES MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESSES ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 TAX RETURN IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, QUESTION 12C: PREMIER HEALTH (PREMIER), OF WHICH ATRIUM MEDICAL CENTER IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, OFFICERS, EXECUTIVE DIRECTORS, VICE PRESIDENTS, DIRECTORS, PURCHASING DEPARTMENT STAFF, AUTHORIZED PURCHASERS, MEDICAL DIRECTORS, DEPARTMENT AND SECTIONS CHAIRS, AND ALL EMPLOYED PHYSICIANS TO ANNUALLY REVIEW THE PREMIER COMPREHENSIVE CONFLICT OF INTEREST STATEMENT, AN EXPLANATORY MEMORANDUM, THE ANTITRUST COMPLIANCE POLICY, AND COMPLETE AN INDIVIDUAL QUESTIONNAIRE DISCLOSING ANY POTENTIAL CONFLICTS AS DEFINED IN THE CONFLICT OF INTEREST POLICY. THIS IS ACCOMPLISHED EITHER BY WAY OF AN ELECTRONIC COMMUNICATION SENT OUT DIRECTLY BY THE CORPORATE COMPLIANCE DEPARTMENT OR BY WAY OF A MEMO SENT OUT FROM THE CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER OF PREMIER. IT ALSO INCLUDES AN EXPLANATORY MEMORANDUM OF SPECIFIC ACTIVITIES THAT MIGHT GIVE CAUSE TO A CONFLICT AND AN INDIVIDUAL QUESTIONNAIRE TO DISCLOSE ALL SUCH ACTIVITIES. THIS QUESTIONNAIRE MUST BE COMPLETED AND SIGNED BY THE INDIVIDUAL. THIS CORRESPONDENCE INCLUDES A COPY OF THE ANTITRUST COMPLIANCE POLICY THAT MUST BE SIGNED BY THE INDIVIDUAL. ALL OF THESE DOCUMENTS ARE SENT TO THE CORPORATE COMPLIANCE DEPARTMENT. THE CORPORATE COMPLIANCE DEPARTMENT ENSURES ALL FORMS ARE RETURNED AND RETAINS THE DOCUMENTS FOR FIVE YEARS. IN ADDITION, AT EACH MEETING OF THE BOARD OR ANY BOARD COMMITTEE, FOLLOWING APPROVAL OF THE PREVIOUS MEETING'S MINUTES, THE BOARD OR COMMITTEE CHAIR SHALL REQUEST ANY BOARD MEMBER WHO PERCEIVES A POTENTIAL CONFLICT OF INTEREST ON ANY OF THE MEETING'S AGENDA ITEMS TO DISCLOSE THE POTENTIAL CONFLICT. ADDITIONALLY, AT ANY BOARD OR BOARD COMMITTEE MEETING WHERE THE SUBJECT OF CONFLICT OF INTEREST IS DISCUSSED, THE MINUTES SHALL CONTAIN THE NAME OF THE PARTY DISCUSSING A POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE POTENTIAL CONFLICT OF INTEREST AND WHETHER A CONFLICT OF INTEREST WAS FOUND TO EXIST. IF A CONFLICT OF INTEREST IS DETERMINED BY THE BOARD TO EXIST, THE MEMBER WILL BE EXCUSED FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON THE PARTICULAR AGENDA ITEM. THE CHIEF COMPLIANCE AND ENTERPRISE RISK OFFICER REPORTS THE RESULTS OF THE PREMIER CONFLICT OF INTEREST QUESTIONNAIRES NO LESS THAN ANNUALLY TO THE BOARD OF TRUSTEES BY WAY OF THE COMPLIANCE AND AUDIT COMMITTEE. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE MEETING. PERIODICALLY, THE INTERNAL AUDIT DEPARTMENT WILL REVIEW A SAMPLE OF COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND REPORT THE RESULTS TO THE COMPLIANCE AND AUDIT COMMITTEE. THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE INDIVIDUALLY SUMMARIZED IN A DOCUMENT AND SENT ELECTRONICALLY TO THE FINANCE DEPARTMENT FOR ANY NECESSARY DISCLOSURES REQUIRED ON THE 990 TAX RETURN. FORM 990, PART VI, SECTION B, QUESTION 15A AND 15B: COMPENSATION TO ATRIUM MEDICAL CENTERS (AMC) CEO IS REVIEWED AND APPROVED BY PREMIER HEALTH (PREMIER), OF WHICH AMC IS AN AFFILIATE, ON AN ANNUAL BASIS. THE REVIEW PROCESS PERFORMED BY PREMIER FOLLOWS A MARKET BASED COMPENSATION PHILOSOPHY DESIGNED TO ATTRACT AND RETAIN THE EXECUTIVE TALENT REQUIRED TO MEET THE HIGH PERFORMANCE STANDARDS OF OUR BOARD AND OUR COMMUNITY. PREMIER ANNUALLY REVIEWS EXECUTIVE COMPENSATION SURVEY DATA FOR A REGIONAL PEER GROUP OF SYSTEMS AND HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO PREMIER AND ITS AFFILIATES. THE DATA FOR THE SURVEY IS PROVIDED BY A THIRD PARTY CONSULTANT GROUP THAT IS INDEPENDENT OF PREMIER. THIS REPORT INCLUDES COMPARABILITY FOR KEY EXECUTIVES, VICE PRESIDENTS, AND DIRECTOR LEVEL POSITIONS. THE INDEPENDENT COMPARABILITY DATA IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THIS COMMITTEE IS COMPRISED OF THREE MEMBERS, ALL OF WHOM ARE INDEPENDENT. THIS COMMITTEE REVIEWS IN DETAIL THE COMPENSATION FOR THE PREMIER CEO, COO, CFO, CHIEF STRATEGY OFFICER, AND THE HOSPITAL CEOS. OTHER POSITIONS ARE REVIEWED AT A HIGH LEVEL FOR REASONABLENESS. ALL THE MEETING MINUTES ARE DOCUMENTED AND KEPT ON FILE ALONG WITH ANY COMPARABILITY DATA AND THE CONSULTANT REPORT. AFTER THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION ACTIONS, THE PROCESS IS AUDITED BY THE INTERNAL AUDIT DEPARTMENT. THE EXECUTIVE COMPENSATION COMMITTEE PRESENTS THE COMPENSATION ACTIONS TO THE PREMIER BOARD ANNUALLY. FORM 990, PART VI, SECTION C, QUESTION 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. Part VII, Section A, System Key Employees: The System Key Employees' total compensation amount is accurately reported on the various entities they serve. If the System Key Employee's compensation is paid by an unrelated organization, their compensation is being reported as related compensation to avoid the erroneous perception that these individuals are being paid identical amounts by multiple parties. FORM 990, PART XI, LINE 9: PREMIER HEALTH SYSTEM/PRIMARY CARE (11,881,097) PENSION FASB 158 ADJUSTMENT (3,109,276) EQUITY TRANSFERS (660,000) PHG EQUITY TRANSFER (300,256) FOUNDATION ADJUSTMENT (288,165) DISTRIBUTIONS / LIQUIDATIONS (44,617) INVESTMENT RETURN 1,084 TRANSFER FROM AFFILIATE 295,335 BIDWELL ACQUISITION 590,886 TOTAL (15,396,106) MIDDLETOWN SURGERY CENTER (AUG-DEC) 5950 INNOVATION DR FRANKLIN OH 45005 205160579 O/P SURGERY OH 1999913 6886578 AMC PREMIER HEALTH PARTNERS 110 N Main St Suite 500 DAYTON OH 45402 311446699 SUPPORT. ORG. OH 501(C)(3) 11A I NA false ATRIUM HEALTH SYSTEM (AHS) 110 N Main St Suite 500 DAYTON OH 45402 310537492 PARENT OH 501(C)(3) 11C III FI NA false ATRIUM MEDICAL CENTER FOUNDATION 110 N MAIN ST SUITE 500 DAYTON OH 45402 311079213 Foundation OH 501(C)(3) 7 AHS true MIDDLETOWN SRGRY CTR (TO AUG) 5950 INNOVATION DR FRANKLIN OH 45005 205160579 O/P SURGERY OH AMC RELATED 448892 5271583 false true 0.80500 false true true false false false false false false true false false false false false true true true false ATRIUM MEDICAL CENTER FOUNDATION C 583500 FMV ATRIUM MEDICAL CENTER FOUNDATION Q 1036079 CASH ATRIUM MEDICAL CENTER FOUNDATION B 709015 FMV & CASH Premier Health B 300256 FMV