GOOD SAMARITAN HOSPITAL: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: GOOD SAMARITAN HOSPITAL (EIN 31-0536981)
Tax period: 2015-01-01 to 2015-12-31
Filed: 2016-11-12
IRS object ID: 201613179349300811
Schema version: 2015v2.1
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	2016-11-12T12:15:10-06:00	ReturnTs
Tax Period End	2015-12-31	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	2015-01-01	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 SNYDER	PersonNm
Person Title	TREASURER / CFO	PersonTitleTxt
Phone	9374999942	PhoneNum
Signature	2016-11-08	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

Field	Value	IRS element (for citing)
Tax	2015	TaxYr
Build TS	2017-02-10 21:41:12Z	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	$394,232,122	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	Good Samaritan Hospital is committed to building a healthier Dayton, Ohio community through high quality, cost COMPETITVE HEALTH CARE.	ActivityOrMissionDesc
Voting Members Governing Body	7	VotingMembersGoverningBodyCnt
Voting Members Independent	4	VotingMembersIndependentCnt
Total Employee	3490	TotalEmployeeCnt
Total Volunteers	315	TotalVolunteersCnt
Total Gross UBI	$410,907	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$112,378	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,515,417	PYContributionsGrantsAmt
CY Contributions Grants	$959,031	CYContributionsGrantsAmt
PY Program Service Revenue	$319,870,778	PYProgramServiceRevenueAmt
CY Program Service Revenue	$338,862,036	CYProgramServiceRevenueAmt
PY Investment Income	$14,745,364	PYInvestmentIncomeAmt
CY Investment Income	$9,042,783	CYInvestmentIncomeAmt
PY Other Revenue	$4,004,497	PYOtherRevenueAmt
CY Other Revenue	$5,213,465	CYOtherRevenueAmt
PY Total Revenue	$340,136,056	PYTotalRevenueAmt
CY Total Revenue	$354,077,315	CYTotalRevenueAmt
PY Grants And Similar Paid	$2,812,407	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$2,363,870	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$154,067,507	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$154,536,874	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$171,815,869	PYOtherExpensesAmt
CY Other Expenses	$181,444,700	CYOtherExpensesAmt
PY Total Expenses	$328,695,783	PYTotalExpensesAmt
CY Total Expenses	$338,345,444	CYTotalExpensesAmt
PY Revenues Less Expenses	$11,440,273	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$15,731,871	CYRevenuesLessExpensesAmt
Total Assets BOY	$528,583,518	TotalAssetsBOYAmt
Total Assets EOY	$493,068,205	TotalAssetsEOYAmt
Total Liabilities BOY	$156,852,216	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$145,021,154	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$371,731,302	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$348,047,051	NetAssetsOrFundBalancesEOYAmt
Mission	GOOD SAMARITAN HOSPITAL IS COMMITTED TO BUILDING A HEALTHIER DAYTON, OHIO COMMUNITY THROUGH HIGH QUALITY, COST COMPETITVE HEALTH CARE.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$312,900,537	ExpenseAmt
Grant	$2,363,870	GrantAmt
Revenue	$338,862,036	RevenueAmt
Desc	SEE SCHEDULE H	Desc
Total Program Service Expenses	$312,900,537	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	false	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (true)	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	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	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	207	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	3490	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	7	GoverningBodyVotingMembersCnt
Independent Voting Member	4	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	Yes (true)	DelegationOfMgmtDutiesInd
Change To Org Documents	false	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
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

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)	$686,548	$0	$13,990
CAROL BAUER SC
TRUSTEE	39.0	1.0	Yes (X)		$0	$0	$0
GEORGE BRODERICK JR MD
TRUSTEE	0.5	1.5	Yes (X)		$0	$0	$0
JAMES R PANCOAST
PREMIER PRESIDENT & CEO	7.5	8.5	Yes (X)		$0	$0	$0
RAJESH PATEL MD
TRUSTEE/CHIEF OF STAFF	0.5	0.5	Yes (X)		$46,667	$900	$0
LASZLO TOTH MD
TRUSTEE	0.5	0.0	Yes (X)		$0	$0	$0
TIMOTHY D SNIDER
BOARD TREASURER/CFO	18.5	1.5		Yes (X)	$119,664	$0	$17,481
DALE E CREECH
BOARD SECRETARY/SYSTEM VP-CLO	7.5	8.5		Yes (X)	$0	$0	$0
ANITA ADAMS
VP - OPERATIONS	40.0	0.0			$185,216	$0	$23,163	Yes (X)
THOMAS R CURTIN
SYSTEM VP - REVENUE CYCLE	7.5	8.5			$276,277	$0	$37,323	Yes (X)
MARY E GARMAN
VP OPS & CNO	39.5	0.5			$319,501	$0	$22,611	Yes (X)
GARY G GINTER
SYSTEM VP - CIO	8.0	32.0			$0	$493,377	$53,719	Yes (X)
BARBARA A JOHNSON
SYSTEM VP- HR OPERATIONS	8.0	32.0			$0	$491,255	$17,489	Yes (X)
TAMMY S LUNDSTROM
SYSTEM VP - CMO	8.0	32.0			$0	$656,668	$10,493	Yes (X)
THOMAS R PARKER
SYSTEM VP - CHF EXPERIENCE OFF	8.0	32.0			$0	$481,498	$38,310	Yes (X)
FRANK E SAWYER
VP-HOSPITAL OPERATIONS	39.5	0.5			$226,322	$0	$34,501	Yes (X)
CRAIG SELF
VP-CHIEF STRATEGIC OFFICER	8.0	32.0			$380,470	$0	$37,955	Yes (X)
MARK W SHAW
SYSTEM VP - MANAGED CARE	8.0	32.0			$0	$393,525	$61,180	Yes (X)
SCOTT A SHELTON
SYSTEM VP - CPO	8.0	32.0			$0	$313,527	$29,282	Yes (X)
SYLVAIN TREPANIER DNP RN CENP
SYSTEM VP - CNO	8.0	32.0			$0	$386,458	$17,725	Yes (X)
DENA L HELSINGER
DEPARTMENT DIRECTOR	40.0	0.0			$212,081	$0	$25,290		Yes (X)
WANDA J KIMBROUGH
SYSTEM VP-ICM-COMP	40.0	0.0			$184,523	$0	$30,379		Yes (X)
KIM K STRAHL
SYSTEM VP STRATEGIC SOURCING	40.0	0.0			$182,275	$0	$29,838		Yes (X)
SHARON K THORNTON
SYSTEM VP - ERP OPERATIONS	40.0	0.0			$223,475	$0	$18,625		Yes (X)
DARLENE WISEMAN
VP FINANCE - SUPPORT SERVICES	40.0	0.0			$191,046	$0	$38,859		Yes (X)
RENEE P GEORGE
FORMER KEY EMPLOYEE	0.0	40.0			$0	$300,232	$21,000			Yes (X)
J NICK LAIR
FORMER KEY EMPLOYEE	0.0	40.0			$0	$294,314	$46,572			Yes (X)
DANIEL L SCHOULTIES MD
FORMER KEY EMPLOYEE	0.0	40.0			$0	$419,770	$46,591			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,234,065	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$4,231,524	TotReportableCompRltdOrgAmt
Total Other Compensation	$672,376	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	112	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
ANESTHESIA ASSOC OF NW DAYTON
3180 KETTERING BVD	DAYTON	OH	45439	MEDICAL SERVICES	$4,191,408
MEDICAL RADIOLOGISTS
1563 EAST DOROTHY SUITE 101	KETTERING	OH	45429	MEDICAL SERVICES	$2,353,076
DAWSON HEALTHCARE
3650 OLENTAGY RIVER RD STE 450	COLUMBUS	OH	43214	AGENCY STAFF	$4,560,636
KETTERING COLLEGE MEDICAL ARTS
3737 SOUTHERN BLVD	KETTERING	OH	45429	STAFFING	$1,051,599
CITYWIDE DEVELOPMENT CORP
8 N MAIN ST	DAYTON	OH	45402	COMMUNITY DVLPMNT	$818,902

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	75	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$1,479	FederatedCampaignsAmt
Related Organizations	$157,525	RelatedOrganizationsAmt
Government Grants	$799,161	GovernmentGrantsAmt
All Other Contributions	$866	AllOtherContributionsAmt
Total Contributions	$959,031	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT REVENUE	621110	$168,305,678	$167,894,771	$410,907
MEDICARE/MEDICAID	621110	$153,991,118	$153,991,118
FRANCHISE TAX RECOVERIES	423000	$10,491,970	$10,491,970
JOINT OPERATING AGREEMENT	812930	$5,963,000	$5,963,000
HEALTH EDUCATION	561499	$76,469	$76,469

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$33,801	TotalRevenueColumnAmt
Related Or Exempt Func Income	$33,801	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$338,862,036	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$4,735,579	TotalRevenueColumnAmt
Exclusion	$4,735,579	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	$4,758,146	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$2,733,383	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$2,024,763	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,024,763	TotalRevenueColumnAmt
Exclusion	$2,024,763	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$35,090,019	SecuritiesAmt
Other	$674,145	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$30,837,022	SecuritiesAmt
Other	$619,938	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$4,252,997	SecuritiesAmt
Other	$54,207	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$4,307,204	TotalRevenueColumnAmt
Exclusion	$4,307,204	ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

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	$6,115,895	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$5,964,464	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$151,431	TotalRevenueColumnAmt
Exclusion	$151,431	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt
CAFETERIA	721110	$2,161,440	$2,161,440
PARKING GARAGE	812930	$277,647	$277,647
LAUNDRY	900099	$61,196	$61,196

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$536,988	TotalRevenueColumnAmt
Exclusion	$536,988	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$3,037,271	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$354,077,315	TotalRevenueColumnAmt
Related Or Exempt Func Income	$338,451,129	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$410,907	UnrelatedBusinessRevenueAmt
Exclusion	$14,256,248	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$2,363,870	TotalAmt
Program Services	$2,363,870	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	$2,427,689	TotalAmt
Program Services	$2,195,602	ProgramServicesAmt
Management And General	$232,087	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$190,775	TotalAmt
Program Services	$172,537	ProgramServicesAmt
Management And General	$18,238	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$118,507,719	TotalAmt
Program Services	$107,178,381	ProgramServicesAmt
Management And General	$11,329,338	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$5,234,460	TotalAmt
Program Services	$4,734,046	ProgramServicesAmt
Management And General	$500,414	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$19,373,507	TotalAmt
Program Services	$17,521,400	ProgramServicesAmt
Management And General	$1,852,107	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$8,802,724	TotalAmt
Program Services	$7,961,184	ProgramServicesAmt
Management And General	$841,540	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$3,836,200	TotalAmt
Program Services	$3,469,459	ProgramServicesAmt
Management And General	$366,741	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$298,663	TotalAmt
Program Services	$270,111	ProgramServicesAmt
Management And General	$28,552	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$193,607	TotalAmt
Management And General	$193,607	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$22,646	TotalAmt
Program Services	$22,646	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	$660,422	TotalAmt
Management And General	$660,422	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$27,694,519	TotalAmt
Program Services	$25,046,923	ProgramServicesAmt
Management And General	$2,647,596	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$2,881,886	TotalAmt
Program Services	$2,881,886	ProgramServicesAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,848,362	TotalAmt
Program Services	$1,671,659	ProgramServicesAmt
Management And General	$176,703	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$7,650,712	TotalAmt
Program Services	$6,919,304	ProgramServicesAmt
Management And General	$731,408	ManagementAndGeneralAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$6,493,194	TotalAmt
Program Services	$5,872,445	ProgramServicesAmt
Management And General	$620,749	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$247,954	TotalAmt
Program Services	$224,250	ProgramServicesAmt
Management And General	$23,704	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	$1,840	TotalAmt
Program Services	$1,664	ProgramServicesAmt
Management And General	$176	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$4,067,502	TotalAmt
Program Services	$4,067,502	ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$26,308,381	TotalAmt
Program Services	$23,793,300	ProgramServicesAmt
Management And General	$2,515,081	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
OPERATING SUPPLIES	$69,862,623	$69,862,623
PURCHASED SERVICES	$17,869,383	$16,161,070	$1,708,313
HOSPITAL FRANCHISE TAX	$5,658,887	$5,117,897	$540,990
EQUIPMENTAL RENTAL	$1,066,106	$1,066,106

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$4,781,813	TotalAmt
Program Services	$4,324,672	ProgramServicesAmt
Management And General	$457,141	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$338,345,444	TotalAmt
Program Services	$312,900,537	ProgramServicesAmt
Management And General	$25,444,907	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$18,140	BOYAmt
EOY	$17,640	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$21,376,399	BOYAmt
EOY	$11,697,230	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$119,677	BOYAmt
EOY	$0	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$43,065,183	BOYAmt
EOY	$54,106,496	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	$1,130,259	BOYAmt
EOY	$1,035,262	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$6,616,349	BOYAmt
EOY	$5,959,164	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$6,245,750	BOYAmt
EOY	$5,993,308	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$553,622,139	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$352,675,705	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$182,365,619	BOYAmt
EOY	$200,946,434	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$168,226,970	BOYAmt
EOY	$135,998,165	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$37,374,420	BOYAmt
EOY	$32,773,937	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	$58,668,339	BOYAmt
EOY	$41,164,156	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$528,583,518	BOYAmt
EOY	$493,068,205	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$30,818,200	BOYAmt
EOY	$24,472,947	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$1,862,472	BOYAmt
EOY	$1,408,687	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$1,017,478	BOYAmt
EOY	$1,168,573	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	$103,105,477	BOYAmt
EOY	$92,605,491	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	$20,048,589	BOYAmt
EOY	$25,365,456	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$156,852,216	BOYAmt
EOY	$145,021,154	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$371,731,302	BOYAmt
EOY	$348,047,051	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	$371,731,302	BOYAmt
EOY	$348,047,051	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$528,583,518	BOYAmt
EOY	$493,068,205	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$15,731,871	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$8,522,374	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$30,893,748	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	$62,436	GrantsOtherOrganizationsAmt
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$6,210	OtherActivitiesAmt
Total Lobbying Expenditures	$68,646	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, AND OHIO HOSPITAL ASSOCIATION. 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.	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	$7,493,563	OtherCostOrOtherBasisAmt
Book Value	$7,493,563	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$272,113,104	OtherCostOrOtherBasisAmt
Depreciation	$180,584,950	DepreciationAmt
Book Value	$91,528,154	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,268,764	OtherCostOrOtherBasisAmt
Depreciation	$3,466,521	DepreciationAmt
Book Value	$802,243	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$219,601,770	OtherCostOrOtherBasisAmt
Depreciation	$168,624,234	DepreciationAmt
Book Value	$50,977,536	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$50,144,938	OtherCostOrOtherBasisAmt
Book Value	$50,144,938	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$200,946,434	TotalBookValueLandBuildingsAmt
Financial Derivatives		FinancialDerivativesGrp
Closely Held Equity Interests		CloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp

Field	Value	IRS element (for citing)
Desc	ALTERNATIVE INVESTMENTS	Desc
Book Value	$32,773,937	BookValueAmt
Method Valuation	F	MethodValuationCd

Field	Value	IRS element (for citing)
Total Book Value Securities	$32,773,937	TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (8 entries)

DescDesc	Book ValueBookValueAmt
PENSION	$25,816,869
JOINT OPERATING AGREEMENT	$5,963,000
HCAP ACCRUAL	$3,172,426
AFFILIATES RECEIVABLE	$2,925,960
OTHER A/R	$2,555,574
SETTLEMENT - 3RD PARTY PAYORS	$481,412
DEFERRED COMPENSATION	$218,915
AFFILIATES INVESTMENT	$30,000

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$41,164,156	TotalBookValueOtherAssetsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)

DescDesc	AmtAmt
PENSION	$10,226,839
MALPRACTICE INSURANCE	$7,913,182
CONSTRUCTION RETAINAGE	$2,749,437
HOSPITAL FRANCHISE TAX PAYABLE	$1,361,799
LOAN GUARANTEE & OTHER LTL	$1,334,487
WORKERS COMPENSATION RESERVE	$1,262,252
DEFERRED COMPENSATION	$218,915
OTHER	$298,545

Field	Value	IRS element (for citing)
Total Liability	$25,365,456	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Form 990, Schedule D, Part X, Line 2:	FormAndLineReferenceDesc
Explanation	The following footnote is from the audited combined financial statements for Premier Health and affiliates. Samaritan Health Partners (SHP) is the parent organization of Good Samaritan Hospital (GSH): 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.	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	$1,967,000
East Asia and the Pacific	Investments	$8,776,000
Europe (Including Iceland and Greenland)	Investments	$21,033,000
Middle East and North Africa	Investments	$454,000
North America	Investments	$2,118,000
Russia and the Newly Independent States	Investments	$454,000
South America	Investments	$1,513,000
South Asia	Investments	$757,000
Sub-Saharan Africa	Investments	$303,000
Central America and the Caribbean	Program Services	$25,000	INSURANCE

Field	Value	IRS element (for citing)
Subtotal Spent	$37,400,000	SubtotalSpentAmt
Total Spent	$37,400,000	TotalSpentAmt
Transfer To Foreign Corp	false	TransferToForeignCorpInd
Interest In Foreign Trust	false	InterestInForeignTrustInd
Foreign Corp Ownership	false	ForeignCorpOwnershipInd
Passive Foreign Investmest Co	false	PassiveForeignInvestmestCoInd
Foreign Partnership	false	ForeignPartnershipInd
Boycott Countries	false	BoycottCountriesInd

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	false	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,206,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,134,000	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,072,000	NetCommunityBenefitExpnsAmt
Total Expense	0.01200	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$72,547,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$52,986,000	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$19,561,000	NetCommunityBenefitExpnsAmt
Total Expense	0.05750	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$795,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$439,000	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$356,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00100	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$80,548,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$56,559,000	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$23,989,000	NetCommunityBenefitExpnsAmt
Total Expense	0.07050	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$908,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$908,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00270	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,696,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$12,337,000	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$359,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00110	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,234,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$14,234,000	NetCommunityBenefitExpnsAmt
Total Expense	0.04180	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,207,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,207,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00350	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$29,045,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$12,337,000	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$16,708,000	NetCommunityBenefitExpnsAmt
Total Expense	0.04910	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$109,593,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$68,896,000	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$40,697,000	NetCommunityBenefitExpnsAmt
Total Expense	0.11960	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$42,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$42,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$4,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$31,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$31,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$6,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$83,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$83,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$6,527,000	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$66,669,000	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$75,927,000	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$9,258,000	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	OHIO REG # 1245	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
Information Gaps	Yes (X)	InformationGapsInd
CHNA Conducted	13	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	14	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	SEE PART V, SECTION C	StrategyWebsiteURLTxt
Strategy Attached	false	StrategyAttachedInd
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 Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	www.premierhealth.com	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	www.premierhealth.com	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	www.premierhealth.com	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
FAP Notice Displayed	Yes (X)	FAPNoticeDisplayedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Other Method Used	Yes (X)	OtherMethodUsedInd
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, Question 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, community health collaboratives featuring community, health, and business stakeholders/advocates organized by both Good Samaritan Hospital, and the greater Dayton Area Hospital Association with its member hospitals. Part V, Section B, Question 6A & 6B: Good Samaritan Hospital 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, QUESTION 7A: THE DIRECT WEBSITE ADDRESS WHERE THE CHNA CAN BE ACCESSED IS: http://www.goodsamdayton.org/WorkArea/DownloadAsset.aspx?id=76900 PART V, Section B, QUESTION 10A: The direct website address where the implementation strategy can be accessed is: http://www.premierhealth.com/our-community/mking-a-difference/community-he alth-improvement-plan/gsh/ 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 outlined here. Priorities that are included in the plan are not listed in order of importance. Priorities Included in the Plan: -------------------------------- Through the Community Health Risk Assessment, the identified priorities with an improvement plan for Good Samaritan Hospital are: Primary and Chronic Diseases: 1. Hypertension-Hypertension rates 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. 2. Breast cancer-The breast cancer rate is 195.3 per 100,000, and the rate is increasing as opposed to historically prevalent cancers. 3. Diabetes- Widespread behavioral risk factors such as obesity and physical activity and the increasing rate of hospital inpatient diabetes diagnoses are cause for concern. 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 Good Samaritan Hospital 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. Low birth weight 3. Infant mortality rate Good Samaritan Hospital is involved in several state-wide initiatives addressing these issues. As part of these collaborations, Good Samaritan Hospital will share the goals and objectives developed by those groups for program implementation and measurement. Ohio Perinatal Quality Collaborative. Good Samaritan Hospital 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: 4. Alcohol and drug discharge diagnosis 5. Mental health disorders Good Samaritan Hospital is deeply involved in improving these areas. Samaritan Behavior Health (SBH), a subsidiary of the hospital, provides mental health and substance abuse services for all ages in Southwest Ohio. SBH collaborates with the National Alliance on Mental Illness of Montgomery County, Ohio. It also receives funding from the ADAMHS Board to provide Crisis Care for Montgomery County. In Montgomery County, alcohol, drug abuse and mental health services are coordinated by the ADAMHS Board (Alcohol, Drug Addiction and Mental Health Services.) The ADAMHS Board administers the planning, development, funding and evaluation of behavioral health services delivered by a network of nearly 30 community-based organizations. The ADAMHS Collaborative Coalition to Improve Alcohol and Other Drug Abuse and Addiction Services in Montgomery County, Ohio. This plan includes recommendations for: * Building infrastructure and capacity * Prevention * Building linkages * Treatment * Data sharing James Pancoast, Premier Health President and CEO is the Co-Chair of the Alcohol and Other Drug Abuse Implementation Advisory Team. 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, the 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. Hypertension rates 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 Te	ExplanationTxt

Field	Value	IRS element (for citing)
Facility	9	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 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
SAMARITAN HOMELESS CLINIC (SOLD AUG)
921 S Edwin C Moses Blvd	DAYTON	OH	45417	HOMELESS CLINIC
GSH Medical Imaging - North Main
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. 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 the following subsidized services: 1. Good Samaritan Homeless Clinic: This Clinic is the only health clinic in the surrounding area specifically for the homeless. The clinic takes an integrated approach toward primary and preventative services. With the mission of serving the total well-being of the homeless, the Clinic aims to deliver quality, compassionate care and to get our patients back on their feet. The Clinic is staffed with a full-time physician and a dedicated nursing team. The Clinic provides a number of services to the homeless, including (but not limited to) respite care, dental services, mental health and substance abuse treatment and counseling, pharmacy services, vision screenings, podiatry, case management, health education, outreach services, transportation, life skills training, cancer prevention services, diabetes services and blood pressure monitoring. The clinic was sold to a Dayton area Federal Qualified Health Clinic look-alike organization in August 2015. 2. Lifestages, LLC: This limited liability company provides healthcare to women of all ages that includes Obstetric services, gynecology services and heart, bone and breast health. Lifestages is built around the core beliefs that each woman is unique and that all women deserve the best care available. This company serves a large population of Medicaid and uninsured patients. Good Samaritan Hospital provides support through funding for Lifestages' indigent patients and medical education. The funding for 2015 was $2,264,000. 3. Emergency Services: Good Samaritan Hospital 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 amounts paid for call time and subsidies were $11,970,000. PART II, LINES 9: Good Samaritan Hospital (GSH) PARTICIPATES IN THE FOLLOWING COMMUNITY Building ACTIVITIES: (1) GSH contributed $485,000 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. GSH has recognized $631,000 from the sale and rental of these facilities. (2) 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 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 $149,000. 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 $70,240,000 AND INCURRED COST OF $98,517,000, FOR AN ADDITIONAL NET SHORTFALL OF $28,277,000 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 $66,669,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $70,240,000 TOTAL MEDICARE ASSOCIATED REVENUE $136,909,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT in PART III, SECTION B $75,927,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $98,517,000 TOTAL MEDICARE ASSOCIATED COST $174,444,000 MEDICARE SHORTFALL PER PART III, SECTION B $9,258,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $28,277,000 TOTAL MEDICARE SHORTFALL $37,535,000 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 53% 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 A PAYMENT PLAN, and HAS 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 programs 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 Good Samaritan Hospital Board of Directors, executive management, managers, staff members, community	ExplanationTxt

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (23 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc	Purpose Of GrantPurposeOfGrantTxt	Address Line2USAddress/AddressLine2Txt
PREMIER COMMUNITY HEALTH co FIDELITY
HEALTH 3170 Kettering Blvd	DAYTON	OH	45439	311122883	501(c)(3)	$240,714	N/A	N/A	HEALTH EDUCATION
VICTORIA THEATRE
138 N MAIN	DAYTON	OH	45402	310897638	501(c)(3)	$104,305	N/A	N/A	PERFORMING ARTS	45402
UNITED WAY
33 W First St	DAYTON	OH	45402	310536658	501(c)(3)	$7,935	N/A	N/A	COMMUNITY SUPPORT	45406
Dayton Foundation
500 Kettering Tower	Dayton	OH	45402	316027287	501(c)(3)	$1,014,968	N/A	N/A	Community Support
DayBreak
605 S Patterson Blvd	Dayton	OH	45402	310864474	501(c)(3)	$7,073	N/A	N/A	Community Support
American Heart Association
5455 N High St	Columbus	OH	43214	135613797	501(c)(3)	$64,170	N/A	N/A	Education
Good Samaritan Hospital Foundation - Dayton
110 N Main St500	Dayton	OH	45402	237296923	501(c)(3)	$14,433	N/A	N/A	Community Develop
Dayton Area Chamber of Commerce
22 E 5th	Dayton	OH	45402	310257370	501(c)(6)	$18,600	N/A	N/A	MINORITY SUPPORT
Reach Out Montgomery County
25 East Foraker St	Dayton	OH	45409	311434282	501(c)(3)	$56,908	N/A	N/A	RX ASSISTANCE FOR INDIGENT PATIENTS
AIDS Resource Center
15 West 4th St Suite 200	Dayton	OH	45402	311126780	501(c)(3)	$66,147	N/A	N/A	Community Support
Project Hope Inc
1508 North Main Street	Dayton	OH	45405	341421548	501(c)(3)	$8,050	N/A	N/A	Community Support
SINCLAIR COMMUNITY COLLEGE FOUNDATION
444 W 3RD ST	DAYTON	OH	45402	310723444	501(C)(3)	$186,070			CAPITAL RENOVATION & EXPANSION
UNIVERSITY OF DAYTON
300 COLLEGE PARK	DAYTON	OH	45469	310536715	501(C)(3)	$115,000			CYBERSECURITY & DATA INTELLIGENCE
MIAMI VALLEY HOSPITAL
110 N MAIN ST 500	DAYTON	OH	45402	310537504	501(C)(3)	$64,280			MAHOGANY CHILD & INDIGENT PATIENTS
CITIZENS FOR SINCLAIR
120 W SECOND ST 614	DAYTON	OH	45402	611529465	None	$46,000			SUPPORT
MIAMI VALLEY HOSPITAL FOUNDAITON
110 N MAIN ST 500	DAYTON	OH	45402	311040231	501(C)(3)	$23,736			SUPPORT
OMEGA COMMUNITY DEVELOPMENT
1810 HARVARD BLVD	DAYTON	OH	45406	311561713	501(C)(3)	$23,575			SUPPORT
DAYTON CONTEMPORARY DANCE COMPANY
840 GERMANTOWN STREET	DAYTON	OH	45402	237220259	501(C)(3)	$7,360			SUPPORT
ATRIUM MEDICAL CENTER FOUNDATION
110 N MAIN ST 500	DAYTON	OH	45402	311079213	501(C)(3)	$13,823			SUPPORT
MIDDLETOWN COMMUNITY FOUNDATION
300 NORTH MAIN STREET 300	MIDDLETOWN	OH	45042	310898380	501(C)(3)	$8,855			SUPPORT
UVMC FOUNDATION
110 N MAIN ST 500	DAYTON	OH	45402	311581859	501(C)(3)	$7,389			SUPPORT
OHIO HOSPITAL ASSOCIATION
155 E BROAD ST 301	COLUMBUS	OH	43215	314270340	501(C)(6)	$5,750			SUPPORT
The Heart Institute of Dayton
110 N MAIN ST 500	DAYTON	OH	45402	300502367	501(C)(3)	$297,225			HEART EDUCATION

Field	Value	IRS element (for citing)
Total501c3 Org	20	Total501c3OrgCnt
Total Other Org	3	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	false	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 (21 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	$433,215	$0	$113,857	$0	$139,476	$0	$11,050	$0	$2,940	$0	$700,538	$0	$0	$0
ANITA ADAMS
VP - OPERATIONS	$153,836	$0	$28,823	$0	$2,557	$0	$13,388	$0	$9,775	$0	$208,379	$0	$0	$0
THOMAS R CURTIN
SYSTEM VP - REVENUE CYCLE	$217,857	$0	$55,160	$0	$3,260	$0	$8,232	$0	$29,091	$0	$313,600	$0	$0	$0
MARY E GARMAN
VP OPS & CNO	$277,596	$0	$40,351	$0	$1,554	$0	$10,480	$0	$12,131	$0	$342,112	$0	$0	$0
GARY G GINTER
SYSTEM VP - CIO	$0	$351,975	$0	$139,106	$0	$2,296	$0	$26,339	$0	$27,380	$0	$547,096	$0	$0
BARBARA A JOHNSON
SYSTEM VP- HR OPERATIONS	$0	$372,517	$0	$106,120	$0	$12,618	$0	$7,701	$0	$9,788	$0	$508,744	$0	$0
TAMMY S LUNDSTROM
SYSTEM VP - CMO	$0	$519,002	$0	$131,441	$0	$6,225	$0	$8,908	$0	$1,585	$0	$667,161	$0	$0
THOMAS R PARKER
SYSTEM VP - CHF EXPERIENCE OFF	$0	$369,184	$0	$87,253	$0	$25,061	$0	$26,354	$0	$11,956	$0	$519,808	$0	$0
FRANK E SAWYER
VP-HOSPITAL OPERATIONS	$192,254	$0	$33,469	$0	$599	$0	$9,640	$0	$24,861	$0	$260,823	$0	$0	$0
CRAIG SELF
VP-CHIEF STRATEGIC OFFICER	$314,509	$0	$64,068	$0	$1,893	$0	$11,333	$0	$26,622	$0	$418,425	$0	$0	$0
MARK W SHAW
SYSTEM VP - MANAGED CARE	$0	$282,789	$0	$65,769	$0	$44,967	$0	$35,804	$0	$25,376	$0	$454,705	$0	$0
SCOTT A SHELTON
SYSTEM VP - CPO	$0	$250,217	$0	$50,865	$0	$12,445	$0	$25,280	$0	$4,002	$0	$342,809	$0	$0
SYLVAIN TREPANIER DNP RN CENP
SYSTEM VP - CNO	$0	$329,769	$0	$55,449	$0	$1,240	$0	$7,971	$0	$9,754	$0	$404,183	$0	$0
DENA L HELSINGER
DEPARTMENT DIRECTOR	$186,856	$0	$22,668	$0	$2,557	$0	$21,248	$0	$4,042	$0	$237,371	$0	$0	$0
WANDA J KIMBROUGH
SYSTEM VP-ICM-COMP	$140,105	$0	$38,152	$0	$6,266	$0	$17,276	$0	$13,103	$0	$214,902	$0	$0	$0
KIM K STRAHL
SYSTEM VP STRATEGIC SOURCING	$150,750	$0	$29,175	$0	$2,350	$0	$20,328	$0	$9,510		$212,113	$0	$0	$0
SHARON K THORNTON
SYSTEM VP - ERP OPERATIONS	$168,219	$0	$36,858	$0	$18,398	$0	$9,448	$0	$9,177		$242,100	$0	$0	$0
DARLENE WISEMAN
VP FINANCE - SUPPORT SERVICES	$167,882	$0	$21,591	$0	$1,573	$0	$18,271	$0	$20,588	$0	$229,905	$0	$0	$0
RENEE P GEORGE
FORMER KEY EMPLOYEE	$0	$253,960	$0	$45,640	$0	$632	$0	$9,526	$0	$11,474	$0	$321,232	$0	$0
J NICK LAIR
FORMER KEY EMPLOYEE	$0	$224,436	$0	$41,191	$0	$28,687	$0	$21,914	$0	$24,658	$0	$340,886	$0	$0
DANIEL L SCHOULTIES MD
FORMER KEY EMPLOYEE	$0	$309,086	$0	$35,979	$0	$74,705	$0	$21,123	$0	$25,468	$0	$466,361	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 4B:	FormAndLineReferenceDesc
Explanation	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 SUPPLEMENTS 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 2015. The individuals listed below have met the multi-year vesting requirement under the Pension Restoration Plan and received the associated payment in 2015: Eloise Broner $118,605; BARBARA JOHNSON $5,674; Nick Lair $9,733; Mark Shaw $37,161; Scott Shelton $8,625. There were no individuals who met the multi-year vesting requirement under the SERP and received the associated payments in 2015. 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	$190,775	TransactionAmt
Transaction	Salary	TransactionDesc
Sharing Of Revenues	false	SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Form 990, Part VI, Section A, Question 3:	FormAndLineReferenceDesc
Explanation	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. 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 Question 6: Good Samaritan Hospital has two corporate members. One member is Samaritan Health Partners, the parent company of the hospital. 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, Question 7a: Samaritan Health Partners (SHP) has the sole authority to elect the Board of Trustees of Good Samaritan Hospital (GSH). SHP has the authority to remove trustees at any regular or special meeting or by written consent. Premier Health (Premier) has the right to request that SHP remove a trustee of GSH 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 SHP. 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), 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, Question 12c: PREMIER HEALTH (PREMIER), WITH 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, Question 15A and 15B: COMPENSATION TO 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, 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, Question 9: PENSION FASB 158 ADJUSTMENT $(19,626,997) EQUITY TRANSFERS $(15,010,767) PHG EQUITY TRANSFER $(460,393) MINORITY INTEREST DISTRIBUTION $(365,280) FOUNDATION ADJUSTMENT $(157,525) PSS EQUITY TRANSFER $87,630 TRANSFER FROM AFFILIATE $143,142 LIFESTAGES ACQUISITION $256,442 DIVIDENDS RECEIVED FROM SNSC $4,240,000 TOTAL $(30,893,748)	ExplanationTxt

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
110 N Main St Suite 500	DAYTON	OH	45402	311107411	PARENT	OH	501(c)(3)	11C III FI	NA	false
PREMIER HEALTH
110 N Main St Suite 500	DAYTON	OH	45402	311446699	SUPPRTG. ORG.	OH	501(c)(3)	11A I	NA	false
Good SAMARITAN HOSPITAL FOUNDATION-Dayto
110 N Main St Suite 500	DAYTON	OH	45402	237296923	FOUNDATION	OH	501(c)(3)	7	SHP	Yes (true)
CATHOLIC HEALTH INITIATIVES
198 INVERNESS DR W SUITE 500	ENGLEWOOD	CO	80112	470617373	PARENT	CO	501(c)(3)	9	NA	false
THE HEART INSTITUTE OF DAYTON
110 N MAIN ST SUITE 500	DAYTON	OH	45402	300502367	EDUCATION	OH	501(c)(3)	9	SHP	Yes (true)
Samaritan Behavorial Health
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	$5,053,852	ShareOfTotalIncomeAmt
Share Of EOY Assets	$5,056,141	ShareOfEOYAssetsAmt
Disproportionate Allocations	false	DisproportionateAllocationsInd
UBI Code V	$0	UBICodeVAmt
General Or Managing Partner	Yes (true)	GeneralOrManagingPartnerInd
Ownership	0.80000	OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	SAMARITAN FAMILY CARE	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	110 N Main St	AddressLine1Txt
City	DAYTON	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	45402	ZIPCd

Field	Value	IRS element (for citing)
EIN	311299450	EIN
Primary Activities	PHYSICIANS	PrimaryActivitiesTxt
Legal Domicile State	OH	LegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	SHP	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Entity Type	C CORP	EntityTypeTxt
Share Of Total Income	$0	ShareOfTotalIncomeAmt
Share Of EOY Assets	$0	ShareOfEOYAssetsAmt
Ownership	0.00000	OwnershipPct
Controlled Organization	Yes (true)	ControlledOrganizationInd

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 (14 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Samaritan Behavioral Health Inc
Q	$236,928	CASH
Samaritan Family Care
A-IV	$935,976	CASH
Samaritan Family Care
P	$1,817,730	CASH
Samaritan Family Care
Q	$21,422,992	FMV
Samaritan Family Care
R	$3,521,871	FMV
Samaritan North Surgery Center
A-IV	$715,258	Cash
Samaritan North Surgery Center
C	$365,280	Cash
Samaritan North Surgery Center
F	$4,240,000	Cash
The Heart Institute of Dayton
Q	$297,225	FMV
Catholic Health Initiatives
R	$3,787,000	FMV
Premier Health
B	$460,393	Cash
Good Samaritan Hospital Foundation - Dayton
P	$52,004	Cash
Good Samaritan Hospital Foundation - Dayton
Q	$702,766	Cash
Good Samaritan Hospital Foundation - Dayton
C	$268,941	FMV