2015-11-13T16:08:20-06:00 2014-12-31 ERNST & YOUNG US LLP 800 YARD STREET SUITE 200 GRANDVIEW HEIGHTS OH 43212 990 2014-01-01 020633634 Samaritan Behavioral Health Inc % J MICHAEL SIMS SAMA 9372768333 110 North Main Street Suite 500 Dayton OH 45402 TIMOTHY D SNIDER Treasurer 6142245678 2015-11-12 true Diane L Bean P00104972 6142245678 2014 2016-04-25 22:37:26Z SUE V MCGATHA 601 S EDWIN C MOSES BLVD DAYTON OH 45408 12539816 false 0928 X WWW.SBHIHELP.ORG X 2002 OH Mission: To Provide Mental Health and addiction services that touch, teach, and heal. Vision: Where help for life's challenges is openly sought and compassionately given. 7 4 230 4 0 3947674 3827631 7666530 8520100 43454 22984 162109 169101 11819767 12539816 0 0 0 0 9768944 9732868 0 0 0 2003836 2129165 11772780 11862033 46987 677783 3964979 4415646 1792168 1565052 2172811 2850594 X TO PROVIDE MENTAL HEALTH AND ADDICTION SERVICES THAT TOUCH, TEACH AND HEAL. VISION: WHERE HELP FOR LIFE'S CHALLENGES IS OPENLY SOUGHT AND COMPASSIONATELY GIVEN. false false 3652148 0 2155915 CRISIS-CARE: CrisisCare is an innovative, county-wide crisis and assessment service for people with mental health or drug and alcohol abuse concerns. Available 24 hours a day, seven days a week, CrisisCare services any adult or youth in Montgomery County who needs crisis services or evaluation for hospitalization. Access for Severe Mental Health and Alcohol/Drug Diagnostic Assessments is available Monday through Friday. CrisisCare served 5,084 patients and provided 7,900 services for 2014. 3904315 0 4368312 Montgomery County Mental Health Services: SBHI offers outpatient counseling and psychiatric care for children and adults experiencing mental health concerns. These services are both accessible and outcome-based, with an emphasis on brief treatment, continuity of care and client satisfaction. In 2014, over 4,600 clients were served. 1159155 0 904153 Preble County Mental Health Services: SBHI develops individual treatment plans for each client to best serve his or her needs. Staff work with the client's strengths and abilities to improve their daily functioning in the community. In addition, case managers provide ongoing support and monitoring for adults with severe mental illness. During 2014, 920 clients were served. 1331702 0 1260821 10047320 true true false false false false false false false true true false false true false true true true false false false false false false false false false false false true false false false false false false false false false false false false false true true false false false true 28 0 true 230 true false false false false false false false false false false X 7 4 false true false false true true true true true false false true true true true true true true true false OH X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 500 DAYTON OH 45402 SUE V MCGATHA PRESIDENT/CEO, VICE CHAIR 40.0 0.0 X X 208908 0 30288 CAROL BAUER SC TRUSTEE 0.5 39.5 X 0 0 0 THOMAS R CURTIN BOARD CHAIR & Treasurer 0.5 8.5 X X 0 232395 53830 ROBERT E HICKEY JR TRUSTEE 0.5 0.0 X 0 0 0 TERESA ZRYD MD TRUSTEE 0.5 0.0 X 0 5820 0 JOHN RAHE MD TRUSTEE 0.5 0.0 X 0 0 0 Frank E Sawyer Trustee (Jan 2014) 0.5 0.0 X 0 211425 32761 BRIEN DYER MD MEDICAL DIRECTOR 40.0 0.0 X 195043 0 39078 STEPHANIE ACKNER MD PSYCHIATRIST 40.0 0.0 X 117230 0 35023 ELLEN BALLERENE MD PSYCHIATRIST 40.0 0.0 X 164292 0 28437 LIESL J JACOBS MD PSYCHIATRIST 40.0 0.0 X 110529 0 5807 CARL T RATLIFF JR DO PSYCHIATRIST 40.0 0.0 X 139945 0 11732 935947 449640 236956 6 false true false Wright State Physicians 627 S Edwin C Moses Blvd DAYTON OH 45417 Psychiatric Services 142653 1 295918 3527363 4350 3827631 PROGRAM SERVICE REV 900099 8520100 8520100 8520100 22984 22984 0 0 0 0 0 0 0 0 0 MISC REVENUE 900099 169101 169101 169101 12539816 8689201 22984 0 0 0 0 239196 208908 30288 0 7553843 6758282 795561 257136 236824 20312 1068301 935708 132593 614392 498396 115996 41751 12163 29588 1000 1000 16673 16673 0 0 0 584184 460722 123462 7040 5905 1135 177597 106918 70679 193968 6488 187480 0 550586 464535 86051 60486 51532 8954 0 24000 19064 4936 0 0 118665 55265 63400 82518 82518 CATHOLIC HEALTH FEES 118900 100083 18817 BOOKS 25034 16108 8926 OPERATING SUPPLIES 95512 95512 REPAIRS AND MAINTENANCE 10355 8390 1965 20896 6517 14379 11862033 10047320 1814713 0 2608287 2874210 0 0 0 0 501237 771508 0 0 0 0 0 0 0 0 90036 35154 537337 359383 222102 177954 0 0 0 0 0 0 0 0 543317 556820 3964979 4415646 1659273 1197754 0 0 132895 367298 0 0 0 0 0 0 0 0 0 0 0 0 1792168 1565052 X 1629494 2293774 154022 165899 389295 390921 2172811 2850594 3964979 4415646 677783 X false true X true true true X 23689 4050 9757 3947674 3827631 7812801 10432209 11581281 11229707 7666530 8520100 49429827 0 10455898 11585331 11239464 11614204 12347731 57242628 0 57242628 48828 43454 22984 115266 0 0 57357894 747398 0.99799 0.99832 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 543318 4141 15718 6357 556820 536233 4728 37682 35326 543317 530903 9757 43753 48180 536233 0.70000 0.30000 true false 159261 100399 58862 378076 258984 119092 177954 FUNDS HELD BY GOOD SAMARITAN 556820 556820 X 12539816 12539816 12539816 11862033 11862033 11862033 Schedule D, Part X, Line 2: 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. Taxes payable at December 31, 2014 and 2013 for such unrelated business activities are not significant. Premier, MAHS, SHP, AHS, and UVMC also own or control certain subsidiaries, which are for profit corporations subject to federal income taxes. These are: * PHIC (a wholly owned subsidiary of Premier Health) * PHPlan (a wholly owned subsidiary of PHIC) * MVHE, Inc and Premier Health Specialists, Inc. (formerly Health Specialists of Dayton, Inc.) (subsidiaries of MAHS) * Samaritan Family Care (subsidiary of SHP) and Samaritan North Surgery Center Limited (a joint-venture partnership of which GSH is an 80% owner) * Middletown Surgery Center, LLC (a joint venture partnership of which AMC is an 80.5% owner) (subsidiary of AHS) * UVMC Management Corporation and After Hours Family Care, Inc. (subsidiaries of UVMC) Management annually reviews its tax positions and has determined that there are no material uncertain tax positions. X X X X false false false false false false false false false SUE V MCGATHA PRESIDENT/CEO, VICE CHAIR 167692 0 36918 0 4298 0 20751 0 9537 0 239196 0 0 0 THOMAS R CURTIN BOARD CHAIR & Treasurer 0 184090 0 45762 0 2543 0 24688 0 29142 0 286225 0 0 BRIEN DYER MD MEDICAL DIRECTOR 192666 0 200 0 2177 0 18754 0 20324 0 234121 0 0 0 STEPHANIE ACKNER MD PSYCHIATRIST 117091 0 100 0 39 0 9763 0 25260 0 152253 0 0 0 ELLEN BALLERENE MD PSYCHIATRIST 163930 0 200 0 162 0 6789 0 21648 0 192729 0 0 0 CARL T RATLIFF JR DO PSYCHIATRIST 139817 0 0 128 0 3336 0 8396 0 151677 0 0 0 Frank E Sawyer Trustee (Jan 2014) 0 170952 0 39919 0 554 0 8221 0 24540 0 244186 0 0 Form 990 - Part VI, Section A, Question 3: Premier Health (Premier), as the operator of Samaritan Bevavioral Health, Inc.(SBHI), develops and oversees the implementation of the strategic plan for SBHI, which includes (but is not limited to) such matters as location of clinical and administrative expenses. SBHI shall comply with and implement this plan and shall not take any action that materially departs from this plan without Premier's approval. SBHI develops and submits an annual capital and operating budget to Premier for approval. SBHI shall adopt and implement the capital and operating budget so approved and/or revised for it by Premier. SBHI may periodically develop and submit a business plan to Premier for approval. SBHI shall implement any business plan approved by Premier. Premier is the sole agent to negotiate all relationships with payors on behalf of SBHI with all third party payors and alternative delivery systems including, but not limited to insurers. SBHI 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. SBHI must seek Premier's approval for any acquisitions, sale or transfer of any material asset used in Premier's activities. Form 990, Part III, Question 4d: This number represents the balance of total expenditures of temporarily restricted funds for Samaritan Behavorial Health net of programs described in service accomplishments. Form 990 - Part VI, Question 6: samaritan Behavioral Health Inc. (SBHI) has two corporate members. One member is Samaritan Health Partners, Inc. (SHP), the parent company of SBHI. The second member is Premier Health (Premier), an Ohio not-for-profit corporation formed pursuant to the joint operating agreement. 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 for Samaritan Behavioral Health, Inc. (SBHI). SHP has the authority to remove trustees at any regular or special meeting or by written consent. 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), which Samaritan Behavorial health, Inc. 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), OF WHICH Samaritan Behavioral Health, Inc. 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 OFFICER. 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 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: Premier Health (PREMIER), of which Samaritan Health Partners (The parent of Samaritan Behavioral Health Inc. (SBHI)) is an affiliate, 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 WHICH 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. Samaritan Health Partners (SHP) 110 N MAIN St SUITE 500 Dayton OH 45402 311107411 Parent OH 501(c)(3) 11-C FI NA false Good Samaritan Hospital 110 N MAIN ST SUITE 500 DAYTON OH 45402 310536981 HOSPITAL OH 501(c)(3) 3 SHP 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 2200 PHILADELPHIA DR DAYTON OH 45406 300502367 EDUCATION OH 501(C)(3) 9 SHP true SAMARITAN NORTH SURGERY CENTER 9000 N MAIN ST STE 500 DAYTON OH 45415 311618587 O/P SURGERY OH GSH RELATED 0 0 false 0 false 0.00000 SAMARITAN FAMILY CARE 110 N MAIN ST STE 500 DAYTON OH 45402 311299450 PHYSICIANS OH SHP C CORP 0 0 0.00000 true false false true false false false false false false false false false false false false true false false false Catholic Health Initiatives C 165151 Cash Catholic Health Initiatives P 118900 Cash