2016-05-12T13:29:41-05:00 2015-06-30 440160260 BKD LLP 312 WALNUT STREET SUITE 3000 CINCINNATI OH 45202 990 2014-07-01 461393755 TRIHEALTH HOSPITAL INC TRIH 5135696575 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 BRIAN KRAUSE VP-FINANCE 5135695126 2016-05-12 1 P00961884 5136218300 2014 2016-08-17 19:52:53Z JOHN S PROUT 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 53738811 0 X WWW.TRIHEALTH.COM X 2012 OH TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. 12 8 284 8 0 0 0 0 45209117 53563228 -5952 44523 54424 10733 45257589 53618484 7500 18412 0 0 13860838 16410244 0 0 0 23495111 29293913 37363449 45722569 7894140 7895915 160116910 157397175 47185384 36473419 112931526 120923756 TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. THIS IS ACCOMPLISHED BY PROVIDING A FULL RANGE OF HEALTH RELATED SERVICES INCLUDING PREVENTION, WELLNESS AND EDUCATION. 0 0 31250130 18412 53563228 SEE SCHEDULE H 31250130 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 64 0 1 284 1 0 0 0 0 0 0 0 0 0 0 X 12 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X BRIAN KRAUSE - VP FINANCE 5135695126 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 X MICHAEL HAVERKAMP TRUSTEE 1.00 3.00 X 0 0 0 JOHN PROUT CEO 5.00 55.00 X X 0 1899621 469213 PAUL EDGETT III TRUSTEE 1.00 3.00 X 0 0 0 MYRTIS POWELL TRUSTEE 1.00 3.00 X 0 0 0 SR SALLY DUFFY TRUSTEE 1.00 3.00 X 0 0 0 MICHAEL MCGRAW CHAIRMAN 1.00 3.00 X X 0 0 0 JOANN LOHR MD MED STAFF PRES-GOOD SAM 1.00 10.00 X 0 72462 1919 ALAN ALTMAN MD MED STAFF PRES-BETHESDA 1.00 10.00 X 0 679627 92671 CRAIG EISENTROUT MD TRUSTEE 1.00 3.00 X 0 513309 48728 WAYNE SHIRCLIFF VICE CHAIRMAN/TREASURER 1.00 3.00 X X 0 0 0 RALPH S MICHAEL TRUSTEE 1.00 3.00 X 0 0 0 ELLEN KATZ TRUSTEE (START 11/14) 1.00 3.00 X 0 0 0 DONNA NIENABER ESQ SVP CORP COUNSEL/ASST SEC 5.00 55.00 X 0 559897 164078 CRAIG RUCKER SVP CFO/ASST TREASURER (END 8/14) 5.00 55.00 X 0 552575 105712 MICHAEL CROFTON SVP CFO/ASST TREASURER (START 9/14) 5.00 55.00 X 0 459900 112333 MARK CLEMENT PRESIDENT (START 5/15) 5.00 55.00 X 0 0 0 WILLIAM GRONEMAN EXEC VP SYSTEM DEVELOPMENT 5.00 55.00 X 0 655598 194358 GERALD OLIPHANT EXEC VP & COO 5.00 55.00 X 0 722085 162794 GEORGES FEGHALI MD CHIEF MEDICAL OFFICER (END 12/14) 5.00 55.00 X 0 650293 186696 JOHN ROBINSON MD SVP-HOSPITAL OPERATIONS 10.00 50.00 X 0 425790 104283 KELVIN HANGAR EXECUTIVE DIR-TRIHEALTH HOSPITAL 60.00 0.00 X 294350 0 41349 ROBERT COLLINS MD CHIEF MEDICAL OFFICER (START 1/15) 5.00 55.00 X 0 427574 109307 SUELLEN JONES NURSING ADMIN-TRIHEALTH EVENDALE 60.00 0.00 X 182798 0 25456 JOANNE RISLEY NURSING MANAGER-TRIHEALTH EVENDALE 60.00 0.00 X 112984 0 32692 DEBORAH MONTGOMERY MANAGER-TRIHEALTH HAND SURGERY CTR 60.00 0.00 X 115494 0 24362 705626 7618731 1875951 4 0 1 0 CLINICAL CO-MANAGEMENT LLC 8099 CORNELL ROAD CINCINNATI OH 45249 CLINICAL MANAGEMENT 1599008 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 EQUIPMENT MAINTENANCE 456204 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 EQUIPMENT/SERVICE CONTRACTS 257411 RECONSTRUCTIVE ORTHOPEDICS & SPORTS MED 8099 CORNELL ROAD CINCINNATI OH 45206 PHYSICAL THERAPY 201785 RED CARPET JANITORIAL SERVICE INC 891 W NORTH BEND ROAD CINCINNATI OH 45224 JANITORIAL 150105 7 PATIENT SERVICES 621400 53563228 53563228 53563228 8880 0 8880 8880 8880 164850 120327 44523 44523 44523 MEDICAL RECORDS 900099 1853 1853 1853 53618484 53563228 0 55256 18412 18412 335698 335698 13276237 12079913 1196324 435318 270350 164968 1431391 1334779 96612 931600 845669 85931 1638707 1638707 707727 379380 328347 586 586 542549 438369 104180 23609 22990 619 1811565 977886 833679 12632 8709 3923 4479 4289 190 2330446 2330446 4334654 568334 3766320 125071 125071 MEDICAL/DIETARY SUPPLY 12742775 12696452 46323 OVERHEAD ALLOCATION 3345786 3345786 EQUIPMENT 843602 789341 54261 OHIO HOSPITAL FEE 746239 746239 83486 69018 14468 45722569 31250130 14472439 0 599 8343442 7155524 405814 14868 9912 42122852 6987211 36263916 35135641 115494684 114689685 160116910 157397175 2415841 4012118 27681595 26863536 17087948 5597765 47185384 36473419 X 112931526 120923756 112931526 120923756 160116910 157397175 X 7895915 96315 X X 0 1 X 1 0 X 29521200 3372847 26148353 12457322 3614364 8842958 144330 144330 35135641 ACCRUED MALPRACTICE LIABILITY 236602 DUE TO RELATED ORGANIZATION 5361163 5597765 X PART X, LINE 2: THE FINANCIAL STATEMENTS OF TRIHEALTH HOSPITAL, INC. ARE AUDITED AS PART OF TRIHEALTH AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE AUDITED COMBINED FINANCIAL STATEMENTS OF TRIHEALTH THAT REPORTS ITS AND ITS SUBSIDIARIES AND AFFILIATES LIABILITY, IF APPLICABLE, FOR CERTAIN TAX POSITIONS UNDER ASC 740-10-25: TRIHEALTH COMPLETED AN ANALYSIS OF UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AT JUNE 30, 2015 AND 2014, AND DETERMINED NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE COMBINED FINANCIAL STATEMENTS AT EITHER DATE. 1 1 X 1 X 1 X 1 1 0 1 1 479424 0 479424 0.01050 2881112 1529548 1351564 0.02960 3360536 1529548 1830988 0.04010 3360536 1529548 1830988 0.04010 0 1244056 0 9297468 9196249 101219 X 1 1 1 1 TRIHEALTH EVENDALE HOSPITAL 3155 GLENDALE-MILFORD RD EVENDALE OH 45241 WWW.TRIHEALTH.COM 1482 X X TRIHEALTH EVENDALE HOSPITAL 1 0 0 1 X X X X X X X X 14 1 1 1 1 X HTTP://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/PRICING/ X 1 14 0 1 0 1 X 100.000000000000 400.000000000000 X X X X X 1 1 X 1 X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/ X X 1 0 X X X X 1 X 0 0 TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 5: INPUT WAS RECEIVED FROM INDIVIDUALS REPRESENTING UNDERSERVED POPULATIONS USING THE THREE SURVEY APPROACHES DESCRIBED BELOW -CHNA GROUP LEVEL ASSESSMENTS (GLAS): THE UNIVERSITY OF CINCINNATI'S ACTION RESEARCH CENTER FACILITATED LARGE GROUP COMMUNITY DISCUSSIONS (GROUP LEVEL ASSESSMENTS) WITH SERVICE PROVIDERS IN EACH OF THE COUNTIES COVERED BY THE CHNA. THE TOTAL NUMBER OF SERVICE PROVIDERS AT THE COUNTY GLAS RANGED FROM AS FEW AS NINE PEOPLE TO AS MANY AS 30 PEOPLE. OVERALL, APPROXIMATELY 200 SERVICE PROVIDERS ACROSS THE COUNTIES PARTICIPATED. THE RESULTS OF THE GLAS WERE PRESENTED BACK TO THE SERVICE PROVIDERS AND COMMUNITY AT LARGE THROUGH A SERIES OF PUBLIC PRESENTATIONS.CHNA COMMUNITY HEALTH SURVEY: THE ACTION RESEARCH CENTER ALSO SURVEYED POPULATIONS IN THE GREATER CINCINNATI REGION THAT ARE MORE OFTEN UNDERSERVED WITH A PARTICULAR FOCUS ON HEALTH CARE CONSUMERS WHO ARE UNINSURED, UNDERINSURED, LOW SOCIOECONOMIC STATUS, MINORITY, AGE 65 PLUS OR WHO HAVE BEEN DIAGNOSED WITH MENTAL ILLNESS. SURVEYS WERE ADMINISTERED TO MORE THAN 1,000 COMMUNITY RESIDENTS ACROSS THE NINE COUNTIES WITH OVERSAMPLING OF VULNERABLE GROUPS INCLUDING:MENTAL ILLNESS: RESPONDENTS WHO REPORTED BEING DIAGNOSED WITH OR HAVING EXPERIENCE WITH MENTAL ILLNESS (214 RESPONDENTS)SENIORS: THOSE 65 YEARS OF AGE OR OLDER (126 RESPONDENTS) HISPANIC/LATINOS: THOSE OF LATIN AMERICAN ORIGIN (154 RESPONDENTS)AFRICAN IMMIGRANTS: WEST AFRICAN AND CENTRAL AFRICAN IMMIGRANTS TO THE CINCINNATI AREA (48 RESPONDENTS)LOW INCOME: RESPONDENTS REPORTING COMBINED HOUSEHOLD INCOME OF $24,999 OR LESS (472 RESPONDENTS)FAMILIES AT RISK: FAMILIES WITH CHILDREN UNDER THE AGE OF 18 LIVING IN THE HOUSE REPORTING A COMBINED HOUSEHOLD INCOME OF $24,999 OR LESS (257 RESPONDENTS)THE INTERVIEW QUESTIONS WERE DRAFTED AND NARROWED TO A TOTAL OF 17 QUESTIONS IN FIVE CATEGORIES INCLUDING DEFINING HEALTH AND CONCERNS, ORGANIZATIONAL OPERATIONS PERTAINING TO COMMUNITY IMPROVEMENT, COLLABORATION AND ASSISTANCE, MEASUREMENT AND CLOSING QUESTIONS. THE SURVEYS CONTAINED QUESTIONS REGARDING BARRIERS TO HEALTH CARE, USAGE OF HEALTH CARE, HEALTH CARE NEEDS AND DEMOGRAPHIC INFORMATION.CHNA STAKEHOLDER INTERVIEWS WITH COUNTY LEADERS: FURTHER INDIVIDUAL INPUT WAS OBTAINED THROUGH ONE-ON-ONE INTERVIEWS WITH COUNTY LEADERS LASTING 45-60 MINUTES EACH. THIRTY INTERVIEWS WERE CONDUCTED IN PERSON; THREE OUT OF SIX REQUESTS TO COMPLETE THE ONLINE VERSION WERE FULFILLED; THREE INDIVIDUALS DECLINED; AND EIGHT INDIVIDUALS WERE UNABLE TO BE SCHEDULED DUE TO LACK OF RESPONSE. FOLLOWING ARE ORGANIZATIONS AND GROUPS CONSULTED WHILE CONDUCTING THE CHNA:GROUP LEVEL ASSESSMENTS REPRESENTATIONBUTLER COUNTY: BUTLER 211, BUTLER COUNTY FAMILY CHILDREN FIRST COUNCIL, BUTLER COUNTY SUCCESS, EDUCATIONAL SERVICE CENTER - SUCCESS, FAIRFIELD CITY SCHOOLS, LIFESPAN, MIDDLETOWN HEALTH DEPARTMENT, PRIMARY HEALTH SOLUTIONS, SERVE CITY, TALAWANDA SCHOOL DISTRICT BOARD, BUTLER COUNTY HEALTH DEPARTMENT AND OXFORD COLLEGE CORNER FREE CLINICCLERMONT COUNTY: AMERICAN CANCER SOCIETY, CHILD FOCUS, INC., CLERMONT COUNTY HEALTH DISTRICT, LIFEPOINT SOLUTIONS, MERCY CLERMONT, MERCY CLERMONT OUTREACH, SISTERS OF MERCY CLERMONTHAMILTON COUNTY: CENTERPOINT HEALTH, CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER, CINCINNATI HEALTH DEPARTMENT, CROSSROAD HEALTH CENTER, EVERYBODY RIDES METRO, HAMILTON COUNTY PUBLIC HEALTH, HEALTH CARE ACCESS NOW, PRO SENIORS, INC., SINCERE HOME HEALTH CARE, SINCERE HOME HEALTH CARE, TALBERT HOUSE, THE GREATER CINCINNATI FOUNDATION, THE HEALTH FOUNDATION OF GREATER CINCINNATI, THE HEALTH COLLABORATIVE, THE HEALTHCARE CONNECTION, THE HEALTHCARE CONNECTION LINCOLN HEIGHTS, UNIVERSITY OF CINCINNATI FAMILY RESIDENCYWARREN COUNTY: ABUSE RAPE CRISIS SHELTER, FAMILY & CHILDREN FIRST COUNCIL, HEALTH DISTRICT (HEALTH DEPARTMENT), OHIO STATE UNIVERSITY EXTENSION, TRIHEALTH, WARREN COUNTY CAREER CENTER, WARREN COUNTY COMMUNITY SERVICES, WARREN COUNTY UNITED WAYSTAKEHOLDER INTERVIEWS REPRESENTATIONALL COUNTIES: CHATFIELD COLLEGE, GREATER CINCINNATI FOUNDATION, HEALTHSOURCE OF OHIO, SOUTHERN STATE COMMUNITY COLLEGE, UNIVERSITY OF CINCINNATI INSTITUTE FOR POLICY RESEARCHBUTLER COUNTY: BUTLER COUNTY SUPPORTS TO ENCOURAGE LOW-INCOME FAMILIES, HAMILTON COMMUNITY FOUNDATION, MIDDLETOWN AREA UNITED WAY, MIDDLETOWN CITY HEALTH DEPARTMENT, MIDDLETOWN COMMUNITY FOUNDATIONCLERMONT COUNTY: CLERMONT COUNTY COMMUNITY SERVICES, CLERMONT COUNTY MENTAL HEALTH AND RECOVERY BOARD, UNITED WAY OF GREATER CINCINNATIHAMILTON COUNTY: CINCINNATI/HAMILTON COMMUNITY ACTION AGENCY, HAMILTON COUNTY MENTAL HEALTH AND RECOVERY SERVICES BOARD, HAMILTON COUNTY PUBLIC HEALTH, SANTA MARIA COMMUNITY SERVICES, UNITED WAY OF GREATER CINCINNATIWARREN COUNTY: MENTAL HEALTH AND RETARDATION SERVICES OF WARREN AND CLINTON COUNTIES, WARREN COUNTY COMBINED HEALTH DISTRICT, WARREN COUNTY COMMUNITY SERVICES INC. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 6A: ADAMS COUNTY REGIONAL MEDICAL CENTER, ATRIUM MEDICAL CENTER, DEARBORN COUNTY HOSPITAL, FORT HAMILTON HOSPITAL, LINDNER CENTER OF HOPE, MARGARET MARY COMMUNITY HOSPITAL, MCCULLOUGH-HYDE MEMORIAL HOSPITAL, MERCY HEALTH, UC HEALTH, BETHESDA NORTH HOSPITAL, BETHESDA BUTLER COUNTY, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 6B: GREATER CINCINNATI FOUNDATION, GREATER CINCINNATI HEALTH COUNCIL, HAMILTON COUNTY PUBLIC HEALTH, HIGHLAND COUNTY HEALTH DEPARTMENT, MIDDLETOWN HEALTH DEPARTMENT, UNITED WAY OF GREATER CINCINNATI TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 7D: AVAILABLE UPON REQUEST WITHOUT CHARGE. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 11: AS THE CHNA AND IMPLEMENTATION STRATEGY WERE ADOPTED DURING THE CURRENT TAX YEAR, TRIHEALTH EVENDALE HAS NOT HAD A MEANINGFUL OPPORTUNITY TO BEGIN ADDRESSING ANY SPECIFIC NEEDS. HOWEVER, THE FOLLOWING SIGNIFICANT HEALTH NEEDS, WHICH WERE IDENTIFIED IN THE MOST RECENTLY CONDUCTED CHNA REPORT, WILL BE ADDRESSED BY TRIHEALTH EVENDALE HOSPITAL THROUGH THE PROGRAMS AND RESOURCES IDENTIFIED:OBESITY - TRIHEALTH EVENDALE HOSPITAL WILL ASSIST IN ADDRESSING THIS HEALTH NEED THROUGH ITS FUNDING OF THE TRIHEALTH SYSTEM'S PROGRAM CALLED HEALTHY WOMEN HEALTHY LIVES, WHICH IS A SCREENING AND REFERRAL PROGRAM THAT COVERS HAMILTON COUNTY AND BUTLER COUNTY, THE SECOND MOST POPULOUS IN THE COMMUNITY SERVED. AS DESCRIBED EARLIER, TRIHEALTH EVENDALE HOSPITAL WILL ASSIST IN ADDRESSING THIS HEALTH NEED THROUGH ITS FUNDING OF THE TRIHEALTH SYSTEM'S COMMUNITY OUTREACH PROGRAM WHERE NURSES AND HEALTH WORKERS ALSO TREAT THESE PATIENTS IN THESE TWO COUNTIES.LATINO-LOW INCOME-WITH CHRONIC HEALTH CONDITIONS - TRIHEALTH EVENDALE HOSPITAL WILL ASSIST IN ADDRESSING THIS HEALTH NEED THROUGH ITS FUNDING OF THE TRIHEALTH SYSTEM'S PROGRAM CALLED HEALTHY WOMEN HEALTHY LIVES AND THE DEDICATION OF OUTREACH RESOURCES TO SERVE THE LOW INCOME AND UNDERSERVED POPULATION IN BUTLER COUNTY WHICH TEND TO BE PRIMARILY LATINO.SUBSTANCE ABUSE/MENTAL HEALTH - TRIHEALTH EVENDALE HOSPITAL WILL ADDRESS THE SUBSTANCE ABUSE NEEDS OF THE UNDERSERVED IN BUTLER COUNTY THROUGH ITS FUNDING OF THE TRIHEALTH SYSTEM'S COMMUNITY OUTREACH PROGRAM WHERE REGISTERED NURSES AND HEALTH WORKERS OPERATE IN PARTNERSHIP WITH SOJOURNER AND PRIMARY HEALTH SOLUTIONS IN THE CITY OF HAMILTON. THERE ARE PLANS TO EXPAND THIS PROGRAM INTO WARREN AND CLERMONT COUNTIES OVER TIME.BIRTH OUTCOMES - TRIHEALTH EVENDALE HOSPITAL CANNOT ADDRESS THIS NEED BY ITSELF, RATHER IT RELIES ON ITS PARTNER HOSPITALS ALSO OPERATED BY THE TRIHEALTH SYSTEM TO ADDRESS THIS NEED. TRIHEALTH EVENDALE HOSPITAL IS A SURGICAL HOSPITAL WITHOUT AN EMERGENCY ROOM AND DOES NOT, THEREFORE, HAVE THE CLINICAL COMPETENCY TO ADDRESS PRE-NATAL CARE, WHICH IMPACTS BIRTH OUTCOMES. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 13B: SEE PART VI RESPONSE RELATED TO PART I, LINE 3C. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 13H: SEE PART VI RESPONSE RELATED TO PART I, LINE 3C. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 16I: TRIHEALTH EVENDALE HOSPITAL DOES NOT PROVIDE A DETAILED COPY OF ITS FINANCIAL ASSISTANCE POLICY TO PATIENTS; HOWEVER, IT DOES PROVIDE A SUMMARY OF THE POLICY.IN ADDITION, SUCH INFORMATION SHALL BE PROVIDED IN LANGUAGES CONSIDERED TO BE COMMONLY SPOKEN BY THE POPULATION TRIHEALTH EVENDALE HOSPITAL SERVES. IF TRANSLATION OR OTHER ASSISTANCE IS NEEDED TO FACILITATE COMPLETION AND/OR UNDERSTANDING OF THE FINANCIAL ASSISTANCE POLICY AND/OR APPLICATION, TRANSLATION AND OTHER REASONABLE REQUESTS FOR ASSISTANCE WILL BE PROVIDED. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 22D: TRIHEALTH EVENDALE HOSPITAL ("TEH") ISSUES A BILLING STATEMENT TO ALL FAP-ELIGIBLE INDIVIDUALS THAT STATES GROSS CHARGES FOR THE CARE RECEIVED AS THE STARTING POINT FOR APPLYING THE DISCOUNTS AND DEDUCTIONS THE FAP-ELIGIBLE INDIVIDUAL IS ENTITLED TO UNDER ITS FAP, SUCH THAT THE AMOUNT THAT A FAP-ELIGIBLE IS REQUIRED TO PAY IS (I) LESS THAN THE GROSS CHARGES FOR SUCH CARE AND (II) TYPICALLY LESS THAN THE AMOUNTS GENERALLY BILLED TO PERSONS WITH INSURANCE. CURRENTLY, AS PART OF THE TRIHEALTH SYSTEM, TEH PROVIDES FREE CARE TO PATIENTS WHOSE INCOME FALLS BELOW 100% OF THE FEDERAL POVERTY GUIDELINES. IN ADDITION, IT PROVIDES DISCOUNTED CARE ON A SLIDING SCALE TO PATIENTS WITH INCOMES ALL THE WAY UP TO 400% OF THE FEDERAL POVERTY GUIDELINES. ANY UNINSURED PATIENT THAT FILLS OUT A FINANCIAL ASSISTANCE FORM AUTOMATICALLY RECEIVES A 40% DISCOUNT REGARDLESS OF INCOME WHILE OTHER PATIENTS RECEIVE A 45% DISCOUNT (INCOME BETWEEN 300% AND 400% OF POVERTY GUIDELINES), 60% DISCOUNT (INCOME BETWEEN 200% AND 300% OF POVERTY GUIDELINES), OR AN 80% DISCOUNT (INCOME BETWEEN 100% AND 200% OF POVERTY GUIDELINES). THE CURRENT AVERAGE DISCOUNT WITH COMMERCIAL INSURANCE COMPANIES IS 65% SO VIRTUALLY ALL PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE WITH INCOME UP TO 300% OF THE POVERTY GUIDELINES ARE RECEIVING DISCOUNTS EQUAL TO OR GREATER THAN THE AVERAGE COMMERCIAL INSURANCE DISCOUNT. IN ADDITION, TEH BELIEVES THE TRIHEALTH FINANCIAL ASSISTANCE POLICY IS GENEROUS AS MANY HOSPITALS DO NOT OFFER ANY FINANCIAL ASSISTANCE TO PATIENTS WITH INCOME OVER 300% OF THE POVERTY GUIDELINE. HOWEVER, IT PREFERS TO EXTEND DISCOUNTS TO SUCH INDIVIDUALS RATHER THAN DENY THEM ELIGIBILITY UNDER THE POLICY SO THAT SUCH INDIVIDUALS RECEIVE SOME FINANCIAL ASSISTANCE RATHER THAN NONE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/ 3 TRIHEALTH SURGERY CENTER WEST 3660 EDGEWOOD DRIVE CINCINNATI OH 45211 OUTPATIENT SURGERY CENTER TRIHEALTH HAND SURGERY CENTER 538 OAK STREET SUITE 200 CINCINNATI OH 45219 OUTPATIENT SURGERY CENTER TRIHEALTH ENDOSCOPY CENTER NORTH 10600 MONTGOMERY ROAD CINCINNATI OH 45242 OUTPATIENT ENDOSCOPY CENTER PART I, LINE 3C: TRIHEALTH HOSPITAL INC. UTILIZES THE FEDERAL POVERTY GUIDELINES ("FPG") IN DETERMINING CHARITY CARE ELIGIBILITY. SEE THE RESPONSES TO PART I, LINE 3A AND 3B.AN INDIVIDUAL'S INCOME UNDER FPG IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR CHARITY CARE. ADDITIONALLY, AN INDIVIDUAL'S INCOME IN RELATION TO HIS/HER MEDICAL EXPENSES IS ALSO TAKEN INTO ACCOUNT AND SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES. FINALLY, TRIHEALTH HOSPITAL, INC. PROVIDES DISCOUNTED CARE AT SELECT CLINICS. PART I, LINE 6A: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. IN 2013, TRIHEALTH ORGANIZED TRIHEALTH HOSPITAL, INC. TO SUPPORT ITS MISSION.THE COMMUNITY BENEFIT PROVIDED BY TRIHEALTH HOSPITAL, INC. IS TRACKED ON A STANDALONE BASIS; HOWEVER, ITS COMMUNITY BENEFIT IS REPORTED IN A REPORT PREPARED BY TRIHEALTH IN COMBINATION WITH ITS RELATED HOSPITALS - BETHESDA HOSPITAL, INC., THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND MCCULLOUGH-HYDE MEMORIAL HOSPITAL. PART I, LINE 7: FOR THE AMOUNTS REPORTED AT COST IN PART I, LINE 7, TRIHEALTH HOSPITAL, INC. UTILIZED WORKSHEET 2 - RATIO OF PATIENT CARE COST-TO-CHARGES, WHICH WAS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H, TO CALCULATE THE COST-TO-CHARGE RATIO. PART I, LN 7 COL(F): BAD DEBT EXPENSE IS NOT INCLUDED ON FORM 990, PART IX, LINE 25. IT IS PRESENTED ON FORM 990, PART VIII, LINE 2 AS A DEDUCTION FROM PATIENT SERVICE REVENUE WHICH CORRESPONDS TO ITS FINANCIAL STATEMENT PRESENTATION. SEE RESPONSE TO PART III, LINE 4. THEREFORE, NO ADJUSTMENT TO TOTAL EXPENSES SHOWN ON FORM 990, PART IX, LINE 25 IS NECESSARY. PART II, COMMUNITY BUILDING ACTIVITIES: TRIHEALTH HOSPITAL, INC. DID NOT ENGAGE IN ANY COMMUNITY BUILDING ACTIVITIES DURING THE TAX YEAR. PART III, LINE 2: SEE THE RESPONSE TO PART III, LINE 4 AS SHOWN IN PART VI - SUPPLEMENTAL INFORMATION. PART III, LINE 4: TRIHEALTH HOSPITAL, INC.'S FINANCIAL STATEMENTS ARE AUDITED AS PART OF THE TRIHEALTH AUDIT REPORT AND AS SUCH FOLLOWING IS THAT REPORT'S FOOTNOTE.NET PATIENT ACCOUNTS RECEIVABLE (PART OF FOOTNOTE B)NET PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE HAVE BEEN ADJUSTED TO THE ESTIMATED AMOUNTS EXPECTED TO BE COLLECTED. THESE ESTIMATED AMOUNTS ARE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS.THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY AS NECESSARY THE PROVISIONS FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS RECEIVABLE IN THE PERIOD OF SERVICE BASED UPON HISTORICAL WRITE-OFF EXPERIENCE.AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, TRIHEALTH FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY TRIHEALTH. DUE TO OHIO BEING A MEDICAID EXPANSION STATE, TRIHEALTH HAS EXPERIENCED A DECLINE IN SELF-PAY ACCOUNTS RECEIVABLE, WHICH HAS RESULTED IN A DECLINE IN WRITE-OFFS OF UNCOLLECTIBLE ACCOUNTS SINCE JUNE 30, 2013. TRIHEALTH HAS NOT EXPERIENCED SIGNIFICANT CHANGES IN WRITE-OFF TRENDS AND HAS NOT CHANGED ITS CHARITY CARE POLICY SINCE JUNE 30, 2014. THE OVERALL ALLOWANCE PERCENTAGE FOR UNCOLLECTIBLE ACCOUNTS INCREASED FROM 35% AT JUNE 30, 2014 TO 36% AT JUNE 30, 2015 AS A RESULT OF CHANGES IN PAYOR MIX PRIMARILY DUE TO THE AFFORDABLE CARE ACT.FINANCIAL INSTRUMENTS THAT POTENTIALLY SUBJECT TRIHEALTH TO CONCENTRATIONS OF CREDIT RISK CONSIST PRIMARILY OF NON-GOVERNMENTAL PATIENT ACCOUNTS RECEIVABLE. TRIHEALTH GRANTS CREDIT WITHOUT COLLATERAL TO ITS PATIENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE PERCENTAGES OF GROSS PATIENT ACCOUNTS RECEIVABLE FROM PATIENTS AND THIRD-PARTY PAYORS AT JUNE 30 APPROXIMATED THE FOLLOWING: 2015 - MEDICARE 17%, MEDICAID 2%, MANAGED CARE 34%, SELF PAY 16%, COMMERCIAL AND OTHER 31%2014 - MEDICARE 18%, MEDICAID 4%, MANAGED CARE 26%, SELF PAY 20%, COMMERCIAL AND OTHER 32%TRIHEALTH HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. THE BASIS FOR PAYMENT UNDER THESE AGREEMENTS INCLUDES PROSPECTIVELY DETERMINED RATES, COST REIMBURSEMENT, NEGOTIATED DISCOUNTS FROM ESTABLISHED RATES, AND PER DIEMPAYMENTS. PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEW AND INVESTIGATIONS. THE DIFFERENCES BETWEEN THE ESTIMATED AND ACTUAL ADJUSTMENTS ARE RECORDED AS PART OF NET PATIENT SERVICE REVENUE IN FUTURE PERIODS, AS THE AMOUNTS BECOME KNOWN, OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS. TRIHEALTH RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH IT DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBT IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS.AS FOR THE AMOUNT OF BAD DEBT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, TRIHEALTH HOSPITAL, INC. DOES NOT REPORT ACTUAL BAD DEBT EXPENSE AS COMMUNITY BENEFIT. IF UPON FURTHER RESEARCH, IT IS ULTIMATELY DETERMINED THAT A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER TRIHEALTH'S CHARITY CARE POLICY, THOSE COSTS WOULD BE RECLASSIFIED, AS APPROPRIATE, TO COMMUNITY BENEFIT AT THAT TIME. PLEASE NOTE THAT BAD DEBT EXPENSE IS NOT DETERMINED UNTIL AFTER ALL DISCOUNTS AND ANY ASSOCIATED PAYMENTS ARE TAKEN INTO ACCOUNT. IF ANY PAYMENTS ARE RECEIVED AFTER A PATIENT ACCOUNT IS DETERMINED TO BE BAD DEBT, THE ACCOUNT WILL BE ADJUSTED ACCORDINGLY AT THAT TIME. PART III, LINE 8: TRIHEALTH, INC. USES THE "STEPDOWN METHODOLOGY" IN DETERMINING THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT. THIS METHOD OF COST FINDING PROVIDES FOR THE ALLOCATION OF THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS WHICH UTILIZE SUCH SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. TRIHEALTH HOSPITAL,INC. DID NOT REPORT ANY MEDICARE SHORTFALL AS COMMUNITY BENEFIT IN PART III, LINE 7 OF THIS SCHEDULE. PART III, LINE 9B: AS OF THE FILING OF THIS RETURN, TRIHEALTH HOSPITAL, INC., AS PART OF TRIHEALTH, INC., MAINTAINS A WRITTEN DEBT COLLECTION POLICY. TRIHEALTH, INC., WHO PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS, WILL NOT INITIATE COLLECTION PRACTICES ON PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BEFORE COLLECTION ACTIONS ARE TAKEN, TRIHEALTH, INC. WILL MAKE REASONABLE EFFORTS, GENERALLY AS EARLY IN THE BILLING PROCESS AS POSSIBLE, TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. AFTER SUCH EFFORTS HAVE BEEN MADE AND A BALANCE REMAINS THAT IS THE RESPONSIBILITY OF THE PATIENT OR GUARANTOR, TRIHEALTH, INC. MAY PURSUE, IN ITS SOLE DISCRETION, WHATEVER ACTIONS IT MAY BE ENTITLED TO TAKE UNDER LAW. PART VI, LINE 2: IN 1995, BETHESDA HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO FORMED A PARTNERSHIP TO CREATE A LOCAL HEALTH SYSTEM: TRIHEALTH, INC. ("TRIHEALTH"). THE MISSION OF TRIHEALTH IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION.IN JANUARY 2013, TRIHEALTH ACQUIRED EVENDALE MEDICAL CENTER AND FORMED TRIHEALTH HOSPITAL, INC. THE HOSPITAL CAMPUS CONSISTS OF TEN OPERATING ROOMS, 29 INPATIENT ROOMS AND A COMPLETE IMAGING AND DIAGNOSTIC FACILITY. SERVICES RANGE FROM INPATIENT SURGERY TO ORTHOPEDICS, GYNECOLOGY AND OUTPATIENT IMAGING.TRIHEALTH PARTICIPATED IN AND WAS A FUNDER OF THE WORK OF A COLLABORATIVE, REGIONAL EFFORT, THE A.I.M. FOR BETTER HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT ("A.I.M."). IN THE AREAS ASSESSED, THOSE SURVEYED WERE MORE OFTEN UNDERSERVED, INCLUDING THE UNINSURED, THE UNDERINSURED, THOSE IN LOW SOCIOECONOMIC STATUS, MINORITIES, THOSE OVER THE AGE OF SIXTY-FIVE, OR THOSE WITH A DIAGNOSIS OF MENTAL ILLNESS. THE A.I.M., PUBLISHED IN THE SPRING OF 2012, WILL BE USED TO DEVELOP A SPECIFIC COMMUNITY HEALTH NEEDS ASSESSMENT FOR TRIHEALTH HOSPITAL, INC. PART VI, LINE 3: TRIHEALTH, INC. PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS INCLUDING TRIHEALTH HOSPITAL, INC. BROCHURES/APPLICATIONS, PROVIDED IN MULTIPLE LANGUAGES, ARE VISIBLE AND AVAILABLE IN THE REGISTRATION AND ADMITTING AREAS OF ALL TRIHEALTH AFFILIATED HOSPITALS. IN ADDITION, THE APPLICATION IS PRINTED ON THE REVERSE SIDE OF A PATIENT'S BILL WITH INTRUCTIONS ON HOW TO COMPLETE THE APPLICATION AS WELL AS HOW TO RETURN IT. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. FINALLY, TRIHEALTH, INC.'S WEBSITE CONTAINS INFORMATION REGARDING ITS CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS WITH DIRECTIONS ON HOW TO CONTACT THE APPROPRIATE PERSONNEL TO INITIATE AN APPLICATION OR ASK QUESTIONS ABOUT THE PROCESS. PART VI, LINE 4: LOCATED IN CINCINNATI, OHIO, TRIHEALTH HOSPITAL, INC. AND THE TRIHEALTH, INC. SYSTEM SERVE HAMILTON, BUTLER, WARREN, CLINTON AND CLERMONT COUNTIES IN OHIO AS WELL AS PERSONS FROM INDIANA AND KENTUCKY. IN METROPOLITAN STATISTICAL AREAS, THE CINCINNATI-MIDDLETOWN REGION IS THE LARGEST IN OHIO. THE ESTIMATED POPULATION FOR THIS AREA IS 2,150,000. THE POPULATION WITHIN THE FIVE OHIO COUNTIES SERVED BY TRIHEALTH HOSPITAL, INC. AND TRIHEALTH, INC. IS ESTIMATED TO BE 1,663,000 AND 12.0 PERCENT OF THIS POPULATION IS UNINSURED. PART VI, LINE 5: TRIHEALTH HOSPITAL, INC. IS COMPRISED OF VARIOUS MEDICAL SERVICES INCLUDING TRIHEALTH EVENDALE HOSPITAL AND TRIHEALTH SURGERY CENTER WEST, EACH OF WHICH HAS AN OPEN MEDICAL STAFF. ITS BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES.TRIHEALTH EVENDALE HOSPITAL CONSISTS OF TEN OPERATING ROOMS, 29 INPATIENT ROOMS AND A COMPLETE IMAGING AND DIAGNOSTIC FACILITY. SERVICES RANGE FROM INPATIENT SURGERY TO ORTHOPEDICS, GYNECOLOGY AND OUTPATIENT IMAGING.TRIHEALTH SURGERY CENTER WEST CONSISTS OF FOUR OPERATING ROOMS AND TWO PROCEDURE ROOMS. PART VI, LINE 6: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH IN ORDER TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION.THROUGH FIVE (5) HOSPITALS, THREE (3) AMBULATORY LOCATIONS AND OVER 125 SITES OF CARE (EMPLOYING OVER 600 PHYSICIANS INCLUDING RESIDENTS), TRIHEALTH PROVIDES A WIDE RANGE OF CLINICAL, EDUCATIONAL, PREVENTIVE AND SOCIAL PROGRAMS. TRIHEALTH'S NON-HOSPITAL SERVICES INCLUDE PHYSICIAN PRACTICE MANAGEMENT, FITNESS CENTERS AND FITNESS CENTER MANAGEMENT, OCCUPATIONAL HEALTH CENTERS, HOME HEALTH AND HOSPICE CARE. 0 EVENDALE CHAMBER OF COMMERCE PO BOX 62839 EVENDALE OH 45262 8600 EVENT SPONSORSHIPS 0 1 0 1 0 0 0 0 0 0 0 JOHN PROUT CEO 0 999918 0 0 0 899703 0 459406 0 9807 0 2368834 0 858502 ALAN ALTMAN MD MED STAFF PRES-BETHESDA 0 632590 0 0 0 47037 0 68008 0 24663 0 772298 0 0 CRAIG EISENTROUT MD TRUSTEE 0 509121 0 0 0 4188 0 26268 0 22460 0 562037 0 0 DONNA NIENABER ESQ SVP CORP COUNSEL/ASST SEC 0 367879 0 159406 0 32612 0 149191 0 14887 0 723975 0 0 CRAIG RUCKER SVP CFO/ASST TREASURER (END 8/14) 0 320089 0 174532 0 57954 0 96120 0 9592 0 658287 0 0 MICHAEL CROFTON SVP CFO/ASST TREASURER (START 9/14) 0 297044 0 136647 0 26209 0 87580 0 24753 0 572233 0 0 WILLIAM GRONEMAN EXEC VP SYSTEM DEVELOPMENT 0 429983 0 152937 0 72678 0 167030 0 27328 0 849956 0 22635 GERALD OLIPHANT EXEC VP & COO 0 522235 0 180186 0 19664 0 137358 0 25436 0 884879 0 0 GEORGES FEGHALI MD CHIEF MEDICAL OFFICER (END 12/14) 0 436528 0 174577 0 39188 0 164261 0 22435 0 836989 0 0 JOHN ROBINSON MD SVP-HOSPITAL OPERATIONS 0 314943 0 95378 0 15469 0 79160 0 25123 0 530073 0 0 KELVIN HANGAR EXECUTIVE DIR-TRIHEALTH HOSPITAL 233585 0 60001 0 764 0 20695 0 20654 0 335699 0 0 0 ROBERT COLLINS MD CHIEF MEDICAL OFFICER (START 1/15) 0 325380 0 81722 0 20472 0 94905 0 14402 0 536881 0 0 SUELLEN JONES NURSING ADMIN-TRIHEALTH EVENDALE 151672 0 29802 0 1324 0 17608 0 7848 0 208254 0 0 0 PART I, LINE 3 TRIHEALTH, INC., A RELATED ORGANIZATION OF TRIHEALTH HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. PART I, LINE 4B ELIGIBLE EXECUTIVES (GENERALLY VICE PRESIDENTS AND ABOVE) PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. TRIHEALTH, INC., THE RELATED ORGANIZATION THAT PAID THE SALARIES OF THE FOLLOWING INDIVIDUALS LISTED IN SCHEDULE J, PART II, CONTRIBUTED, ON BEHALF OF THE FOLLOWING INDIVIDUALS, TO A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE AMOUNTS AS NOTED: JOHN PROUT - $401,161 DONNA NIENABER, ESQ. - $84,330 CRAIG RUCKER - $55,867 MICHAEL CROFTON - $56,175 WILLIAM GRONEMAN - $102,992 GERALD OLIPHANT - $110,403 GEORGES FEGHALI, MD - $107,373 JOHN ROBINSON, MD - $52,178 ROBERT COLLINS, MD - $41,161 IN ADDITION, THE FOLLOWING INDIVIDUAL LISTED IN SCHEDULE J, PART II, RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH WAS TREATED AS TAXABLE COMPENSATION BY TRIHEALTH, INC.: JOHN PROUT - $858,502 WILLIAM GRONEMAN - $22,635 PART I, LINE 4A: THE REPORTABLE INDIVIDUALS OF TRIHEALTH HOSPITAL, INC., WITH THE EXCEPTION OF A FEW, ARE PAID BY TRIHEALTH, INC., A RELATED ORGANIZATION, RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). TRIHEALTH, INC. HAS A STANDARD EMPLOYEE SEVERANCE PACKAGE. GENERAL SEVERANCE PAY IS BASED ON LENGTH OF SERVICE. IN ADDITION, NOTICE PAY, IF APPLICABLE UNDER TRIHEALTH POLICY, MAY BE ADDED TO THE SEVERANCE PACKAGE AND THE AMOUNT OF NOTICE PAY WILL BE DETERMINED BY HUMAN RESOURCES IN ACCORDANCE WITH TRIHEALTH POLICY. PAYMENTS OF SEVERANCE ARE CONDITIONED UPON SIGNING A SEPARATION AND RELEASE AGREEMENT. NO REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE 2014 CALENDAR YEAR. FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS, DIRECTORS AND TRUSTEES OF TRIHEALTH HOSPITAL, INC. LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARDS OF BETHESDA HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, BOTH AFFILIATED ENTITIES OF TRIHEALTH HOSPITAL, INC. AS WELL AS TRIHEALTH, INC., THE SINGLE CORPORATE MEMBER OF TRIHEALTH HOSPITAL, INC. WAYNE SHIRCLIFF, ELLEN KATZ, CRAIG EISENTROUT, MD, ALAN ALTMAN, MD, MICHAEL HAVERKAMP, AND MYRTIS POWELL HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA, INC., THE SINGLE CORPORATE MEMBER OF BETHESDA HOSPITAL, INC., AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. JOHN PROUT AND MYRTIS POWELL HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE GOOD SAMARITAN COLLEGE OF NURSING AND HEALTH SCIENCE, AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. JOHN PROUT AND CRAIG EISENTROUT, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA FOUNDATION, INC., A RELATED ENTITY OF BETHESDA HOSPITAL, INC., AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. JOHN PROUT, MARK CLEMENT, DONNA NIENABER, ESQ., CRAIG RUCKER, WILLIAM GRONEMAN, GERALD OLIPHANT, GEORGES FEGHALI, MD, CRAIG EISENTROUT, MD, ALAN ALTMAN, MD, JOANN LOHR, MD, MICHAEL CROFTON, JOHN ROBINSON, MD AND ROBERT COLLINS, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED ENTITY BOARDS OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES AS WELL AS BEING EMPLOYED BY TRIHEALTH, INC. OR ITS AFFILIATES/SUBSIDIARIES. TRIHEALTH, INC. IS THE SINGLE CORPORATE MEMBER OF TRIHEALTH HOSPITAL, INC. SR. SALLY DUFFY AND MICHAEL MCGRAW HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER VIA AN UNRELATED TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF TRIHEALTH HOSPITAL, INC. SHALL BE TRIHEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A PURSUANT TO ARTICLE II, SECTION 2.2 OF THE CODE OF REGULATIONS OF TRIHEALTH HOSPITAL, INC. ("HOSPITAL") THE SOLE MEMBER OF THE CORPORATION SHALL ELECT THE TRUSTEES OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF TRIHEALTH HOSPITAL, INC. ("HOSPITAL") HAS THE ABILITY TO APPROVE THE DECISIONS OF THE HOSPITAL'S GOVERNING BODY THAT ARE RESERVED TO IT BY OHIO LAW. FORM 990, PART VI, SECTION B, LINE 11 MEMBERS OF THE BOARD ARE PROVIDED AN ELECTRONIC COPY OF THIS FORM 990 PRIOR TO FILING. SUBSEQUENT TO PRESENTATION TO THE BOARD, THE ORGANIZATION FILES THE RETURN MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH NON-SUBSTANTIVE CHANGES ARE NOT SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE CERTAIN FINANCIAL INTERESTS AND FIDUCIARY RELATIONSHIPS. THE EXECUTIVE COMMITTEE AND CORPORATE COUNSEL REVIEW RESPONSES, CONDUCT FURTHER INVESTIGATION, IF NECESSARY, AND DETERMINE WHEN A CONFLICT EXISTS WITH RESPECT TO A CERTAIN TRANSACTION. IF A CONFLICT EXISTS, THE TRANSACTION IS NOT TO BE ENTERED INTO UNLESS ALTERNATIVES ARE FULLY INVESTIGATED AND, IN THEIR ABSENCE, THE BOARD, WITHOUT PARTICIPATION OF THE INTERESTED MEMBER(S), DETERMINES THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. PLANS TO MANAGE THE CONFLICT DURING THE RELATIONSHIP ARE IMPLEMENTED. ALL DISCUSSIONS ARE APPROPRIATELY DOCUMENTED. ALL DIRECTORS AND MANAGERS, WHICH INCLUDE OFFICERS AND KEY EMPLOYEES, ARE REQUIRED TO ANNUALLY DISCLOSE ANY CIRCUMSTANCES, INCLUDING FAMILY AND BUSINESS RELATIONSHIPS, THAT MAY CAUSE A CONFLICT OF INTEREST FOR THE ORGANIZATION. THESE RESPONSES ARE REVIEWED AND ACTED UPON BY A CONFLICT OF INTEREST COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING COMPENSATION OF TRIHEALTH HOSPITAL, INC.'S OFFICERS AND DIRECTORS, THE ANNUAL PROCESS PERFORMED BY TRIHEALTH, INC. (A RELATED ORGANIZATION WHO PAID THE INDIVIDUALS) INCLUDED: * COMPENSATION COMMITTEE; * INDEPENDENT COMPENSATION CONSULTANT; * COMPENSATION SURVEY OR STUDY; AND * APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. ADDITIONALLY, ALL DISCUSSIONS AND DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 TRIHEALTH HOSPITAL, INC.'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A - AVERAGE HOURS PER WEEK THE OFFICERS AND DIRECTORS FOR TRIHEALTH HOSPITAL, INC. THAT SHOW AT LEAST 60 HOURS PER WEEK PROVIDE SERVICES TO TRIHEALTH, INC. (A RELATED ORGANIZATION WHO PAID THE INDIVIDUALS) AND ITS SUBSIDIARIES/AFFILIATES ("TRIHEALTH") AS AN ENTIRE SYSTEM. HOURS WORKED, INCLUDING THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION, ARE NOT TRACKED ON AN ENTITY BY ENTITY BASIS, THUS THE AVERAGE HOURS PER WEEK DISCLOSED ARE ESTIMATES TO SHOW THAT THE TIME SPENT BY THESE INDIVIDUALS RELATE TO THEM FULFILLING THEIR DUTIES AS FULL-TIME, 60 HOURS-PER-WEEK EMPLOYEES OF TRIHEALTH VERSUS THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION. IN ADDITION, THE COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS IN FULFILLMENT OF THEIR DUTIES AS EMPLOYEES OF TRIHEALTH. DIRECTORS (AS NOTED WITH A "MED STAFF PRES" REFERENCE) FOR BETHESDA HOSPITAL, INC. SERVE ON THE BOARD IN THEIR CAPACITY AS MEDICAL STAFF PRESIDENT FOR EITHER BETHESDA HOSPITAL, INC. OR THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. IN ADDITION, THESE INDIVIDUALS PROVIDE SERVICES AS EMPLOYEES OF VARIOUS RELATED ENTITIES FOR WHICH THEY RECEIVE COMPENSATION. NONE OF THE COMPENSATION SHOWN IS FOR SERVING AS A DIRECTOR. FORM 990, PART XI, LINE 9: GAIN ON UNCONSOLIDATED ORGANIZATION 96,315. FORM 990, PART XII, LINE 2C THE FINANCIAL STATEMENTS OF TRIHEALTH HOSPITAL, INC. ARE AUDITED AS PART OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). TRIHEALTH HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF BOTH ITS AND ITS SUBSIDIARIES AND AFFILIATES FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF THE INDEPENDENT AUDITOR. DURING THE TAX YEAR, THERE WAS NOT A CHANGE IN THE PROCESS OF AUDIT OVERSIGHT AND/OR SELECTION OF AN INDEPENDENT AUDITOR BY TRIHEALTH. TRIHEALTH INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311438846 SUPPORT TO AFFILIATED HOSPITALS OH SECTION 501(C)(3) SCHEDULE A, LINE 11B N/A 0 GOOD SAMARITAN HOSPITAL FREE CLINIC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 273893817 HEALTHCARE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 7 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN ENTERPRISE CORP 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311383365 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 9 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN INSTITUTE 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311074519 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 9 TRIHEALTH INC 1 BETHESDA HOSPITAL INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 310537122 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 0 BETHESDA HEALTHCARE INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311027660 HEALTHCARE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 11B BETHESDA INC 1 BETHESDA FAMILY PRACTICE CENTER 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311242442 HEALTHCARE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 11A BETHESDA HOSPITAL INC 1 BETHESDA PROPERTIES INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311352694 PROPERTY MANAGEMENT OH SECTION 501(C)(2) BETHESDA HOSPITAL INC 1 HOSPICE OF CINCINNATI INCORPORATED 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 310917155 HOSPICE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 9 BETHESDA HOSPITAL INC 1 FERNSIDE INC A CENTER FOR GRIEVING CHILDREN 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311179234 COUNSELING TO GRIEVING CHILDREN OH SECTION 501(C)(3) SCHEDULE A, LINE 7 HOSPICE OF CINCINNATI INCORPORATED 1 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 310537486 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 0 GOOD SAMARITAN COLLEGE OF NURSING AND HEALTH SCIENCE 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311778403 EDUCATION OH SECTION 501(C)(3) SCHEDULE A, LINE 2 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 1 COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 237419853 DIALYSIS OH SECTION 501(C)(2) THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 1 MCCULLOUGH HYDE MEMORIAL HOSPITAL INC 110 N POPLAR STREET OXFORD OH 45056 310650283 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 1 TRIHEALTH PHYSICIANS OF INDIANA INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 461125130 PHYSICIAN PRACTICES OH N/A C 1 TRIHEALTH PHYSICIAN SOLUTIONS INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 311444353 CLAIMS ADMINISTRATION OH N/A C 1 TRIHEALTH CIPHO INC 619 OAK STREET-ACCOUNTING 3 WEST CINCINNATI OH 45206 463294306 PHYSICIAN HEALTH ORGANIZATION OH N/A C 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 BETHESDA PROPERTIES INC K 216277 FMV TRIHEALTH INC M 3345786 COST TRIHEALTH INC P 29171318 COST