ATRIUM MEDICAL CENTER: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- ATRIUM MEDICAL CENTER (EIN 31-1079309)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-13
- IRS object ID
- 201403179349305535
- Schema version
- 2013v3.1
- 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 K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-13T18:07:22-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE 4000 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311079309 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATRIUM MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % J MICHAEL SIMS | InCareOfNm |
| Business Name Control | ATRI | BusinessNameControlTxt |
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST | AddressLine1 |
| Address Line2 | Suite 500 | AddressLine2 |
| City | DAYTON | City |
| State | OH | State |
| ZIP Code | 45402 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SCOTT SHELTON | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9374404000 | PhoneNum |
| Signature | 2014-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CHRISTOPHER B BOGGS | PreparerPersonNm |
| PTIN | P00032493 | PTIN |
| Phone | 9374404000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CAROL TURNER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST SUITE 500 | AddressLine1 |
| City | DAYTON | City |
| State | OH | State |
| ZIP Code | 45402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $536,395,716 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PREMIERHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | ATRIUM MEDICAL CENTER WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 2247 | TotalEmployeeCnt |
| Total Volunteers | 303 | TotalVolunteersCnt |
| Total Gross UBI | $1,000,546 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$106,967 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $324,684 | PYContributionsGrantsAmt |
| CY Contributions Grants | $307,156 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $234,843,399 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $208,801,119 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,553,028 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,970,273 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,275,160 | PYOtherRevenueAmt |
| CY Other Revenue | $14,981,199 | CYOtherRevenueAmt |
| PY Total Revenue | $242,996,271 | PYTotalRevenueAmt |
| CY Total Revenue | $230,059,747 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $287,108 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $683,894 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $111,031,138 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $105,927,099 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $123,206,483 | PYOtherExpensesAmt |
| CY Other Expenses | $113,491,558 | CYOtherExpensesAmt |
| PY Total Expenses | $234,524,729 | PYTotalExpensesAmt |
| CY Total Expenses | $220,102,551 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,471,542 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,957,196 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $377,787,452 | TotalAssetsBOYAmt |
| Total Assets EOY | $383,907,371 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $255,826,301 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $244,331,423 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $121,961,151 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $139,575,948 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ATRIUM MEDICAL CENTER WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $195,254,721 | ExpenseAmt |
| Grant | $683,894 | GrantAmt |
| Revenue | $208,801,119 | RevenueAmt |
| Desc | PLEASE SEE SCHEDULE H. | Desc |
| Total Program Service Expenses | $195,254,721 | 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 | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | 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 | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| 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 | 178 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 2247 | 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| 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 | AddressLine1 |
| City | DAYTON | City |
| State | OH | State |
| ZIP Code | 45402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (32 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 |
|---|---|---|---|---|---|---|---|---|---|
| JEFFREY S ZOLLETT MD | |||||||||
| BOARD CHAIR | 0.5 | 1.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| FRANK B CHAPMAN | |||||||||
| BOARD VICE CHAIR -THRU 3/28/13 | 0.5 | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DAVID A PEARCE | |||||||||
| BOARD SECRETARY / TREASURER | 0.5 | 1.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| BARRY ROBERTSON MD | |||||||||
| EX OFFICIO W/ VOTE | 0.5 | 0.0 | Yes (X) | $8,530 | $0 | $0 | |||
| JAMES R PANCOAST | |||||||||
| TRUSTEE / PREMIER PRES & CEO | 8.0 | 6.0 | Yes (X) | $0 | $0 | $0 | |||
| MARJORIE K COWAN PHD | |||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | |||
| DAVID A FLOERING MD | |||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | |||
| THOMAS E GROSSMANN | |||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $1,498 | $0 | $0 | |||
| LARRY L HOLLINGSHEAD | |||||||||
| TRUSTEE | 0.5 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| STEPHEN M JONES | |||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | |||
| JAMES B KLEINGERS | |||||||||
| TRUSTEE | 0.5 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| PERCY D MITCHELL JR MD | |||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | |||
| JOHN J VENTURELLA | |||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $2,041 | $0 | $0 | |||
| CAROL J TURNER | |||||||||
| PRESIDENT & CEO | 39.0 | 1.0 | Yes (X) | $483,558 | $0 | $33,933 | |||
| THOMAS J MALONEY | |||||||||
| ASST TREAS/CFO (THRU 3/24/13) | 40.0 | 0.0 | Yes (X) | $98,031 | $131,453 | $31,533 | |||
| DALE E CREECH | |||||||||
| ASST SECRETARY & CLO (PREMIER) | 7.75 | 32.25 | Yes (X) | $0 | $576,123 | $53,790 | |||
| LISA A MARTINEZ | |||||||||
| ASST SECRTRY & DIR LEGAL SVCS | 40.0 | 0.0 | Yes (X) | $156,944 | $0 | $7,038 | |||
| SCOTT A SHELTON | |||||||||
| ASST TREAS/CFO (FROM 3/25/13) | 20.0 | 0.0 | Yes (X) | $144,937 | $0 | $12,360 | |||
| RENEE P GEORGE | |||||||||
| VP - REVENUE CYCLE (PREMIER) | 8.0 | 32.0 | $0 | $276,642 | $33,291 | Yes (X) | |||
| WILLIAM E LINESCH | |||||||||
| VP - HUMAN RESOURCES (PREMIER) | 8.0 | 32.0 | $0 | $450,825 | $37,280 | Yes (X) | |||
| MICHAEL MAIBERGER | |||||||||
| SR VP-CHIEF STRATEGY (PREMIER) | 8.0 | 32.0 | $0 | $546,586 | $75,119 | Yes (X) | |||
| MARK S SHAKER | |||||||||
| SR VP SRVCE INTEGRATE(PREMIER) | 8.0 | 32.0 | $0 | $725,914 | $29,963 | Yes (X) | |||
| MARK W SHAW | |||||||||
| VP - MANAGED CARE (PREMIER) | 8.0 | 32.0 | $0 | $428,171 | $54,122 | Yes (X) | |||
| DONNA L BANKS | |||||||||
| VP - OPERATIONS | 40.0 | 0.0 | $188,625 | $0 | $17,897 | Yes (X) | |||
| JEFFREY K HOFFMAN MD | |||||||||
| VP MEDICAL AFFAIRS/CMO | 40.0 | 0.0 | $217,062 | $0 | $8,450 | Yes (X) | |||
| THOMAS A NASH | |||||||||
| VP - CHF PURCH OFFICER PREMIER | 8.0 | 32.0 | $0 | $263,269 | $21,245 | Yes (X) | |||
| MARQUITA L TURNER | |||||||||
| VP - CNO | 40.0 | 0.0 | $141,584 | $0 | $30,054 | Yes (X) | |||
| LISA M GOSSETT | |||||||||
| VP - CNO (THRU 08/16/2013) | 40.0 | 0.0 | $163,156 | $0 | $17,896 | Yes (X) | |||
| TED C RIPPERGER | |||||||||
| DIRECTOR - HUMAN RESOURCES | 40.0 | 0.0 | $174,724 | $0 | $18,974 | Yes (X) | |||
| DAVID J CAFFERTY | |||||||||
| RADIOLOGIC ENGINEER | 40.0 | 0.0 | $149,512 | $0 | $16,308 | Yes (X) | |||
| JOANNE R MORGAN | |||||||||
| DIRECTOR PHARMACY | 40.0 | 0.0 | $164,270 | $0 | $24,545 | Yes (X) | |||
| ROBYN S MYERS | |||||||||
| DEPARTMENT DIRECTOR | 40.0 | 0.0 | $150,251 | $0 | $28,737 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,244,723 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,398,983 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $552,535 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 50 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MIDDLETOWN ANESTHESIA CONSULTANTS | |||||
| 3180 KETTERING BLVD | DAYTON | OH | 45439 | MEDICAL SERVICES | $2,603,850 |
| HMP OF BUTLER COUNTY LTD | |||||
| 4535 DRESSLER ROAD NORTHWEST | CANTON | OH | 44718 | MEDICAL SERVICES | $1,497,044 |
| DAWSON HEALTHCARE | |||||
| 3650 OLENTANGY RIVER RD | COLUMBUS | OH | 43214 | AGENCY STAFF | $1,083,139 |
| COMMUNITY BLOOD CENTER | |||||
| 349 S MAIN ST | DAYTON | OH | 45402 | LAB WORK | $984,770 |
| HILLTOP OBGYN | |||||
| 322 CONGRESS PARK DR | DAYTON | OH | 45459 | MEDICAL SERVICES | $825,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $307,156 | RelatedOrganizationsAmt |
| Total Contributions | $307,156 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 900099 | $113,671,692 | $112,720,651 | $951,041 |
| MEDICARE/MEDICAID PAYMENTS | 900099 | $94,137,617 | $94,137,617 | |
| HOSPITAL FRANCHISE TAX RECOVERIES | 900099 | $4,093,087 | $4,093,087 | |
| JOINT OPERATING AGREEMENT | 900099 | -$3,303,000 | -$3,303,000 | |
| MEDICAL RECORDS | 900099 | $95,689 | $95,689 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $106,034 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $106,034 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $208,801,119 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,196,991 | TotalRevenueColumnAmt |
| Exclusion | $1,196,991 | 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 | $796,685 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $393,632 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $403,053 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $403,053 | TotalRevenueColumnAmt |
| Exclusion | $403,053 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $309,138,174 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $304,063,680 | SecuritiesAmt |
| Other | $301,212 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,074,494 | SecuritiesAmt |
| Other | -$301,212 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,773,282 | TotalRevenueColumnAmt |
| Exclusion | $4,773,282 | 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 | $1,786,194 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,577,445 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $208,749 | TotalRevenueColumnAmt |
| Exclusion | $208,749 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| GAIN ON INTEREST SWAP ADJ | 900099 | $12,622,181 | $12,622,181 | |
| CAFETERIA SALES | 900099 | $1,337,864 | $1,329,495 | $8,369 |
| PHYSICIAN ANSWERING SERVICE | 561000 | $66,436 | $25,300 | $41,136 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $342,916 | TotalRevenueColumnAmt |
| Exclusion | $342,916 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $14,369,397 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $230,059,747 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $207,850,078 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,000,546 | UnrelatedBusinessRevenueAmt |
| Exclusion | $20,901,967 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $683,894 | TotalAmt |
| Program Services | $683,894 | 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 | $1,549,501 | TotalAmt |
| Program Services | $1,331,331 | ProgramServicesAmt |
| Management And General | $218,170 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $254,235 | TotalAmt |
| Program Services | $218,439 | ProgramServicesAmt |
| Management And General | $35,796 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,227,134 | TotalAmt |
| Program Services | $70,649,554 | ProgramServicesAmt |
| Management And General | $11,577,580 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,395,557 | TotalAmt |
| Program Services | $2,058,263 | ProgramServicesAmt |
| Management And General | $337,294 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,607,482 | TotalAmt |
| Program Services | $11,691,549 | ProgramServicesAmt |
| Management And General | $1,915,933 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,893,190 | TotalAmt |
| Program Services | $5,063,429 | ProgramServicesAmt |
| Management And General | $829,761 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,970 | TotalAmt |
| Program Services | $10,285 | ProgramServicesAmt |
| Management And General | $1,685 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $823,136 | TotalAmt |
| Program Services | $707,238 | ProgramServicesAmt |
| Management And General | $115,898 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,737 | TotalAmt |
| Management And General | $138,737 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,791 | TotalAmt |
| Program Services | $8,791 | 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 | $305,139 | TotalAmt |
| Management And General | $305,139 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,925,245 | TotalAmt |
| Program Services | $9,925,245 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $545,600 | TotalAmt |
| Program Services | $545,600 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,269,856 | TotalAmt |
| Program Services | $1,091,060 | ProgramServicesAmt |
| Management And General | $178,796 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,979,248 | TotalAmt |
| Program Services | $5,137,370 | ProgramServicesAmt |
| Management And General | $841,878 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,395,245 | TotalAmt |
| Program Services | $2,057,995 | ProgramServicesAmt |
| Management And General | $337,250 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,792 | TotalAmt |
| Program Services | $162,210 | ProgramServicesAmt |
| Management And General | $26,582 | 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 | $1,241 | TotalAmt |
| Program Services | $1,066 | ProgramServicesAmt |
| Management And General | $175 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,546,534 | TotalAmt |
| Program Services | $5,546,534 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,236,920 | TotalAmt |
| Program Services | $18,246,762 | ProgramServicesAmt |
| Management And General | $2,990,158 | 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 | $43,301,860 | $43,301,860 | |
| PURCHASED SERVICES | $11,131,629 | $9,564,296 | $1,567,333 |
| HOSPITAL FRANCHISE TAX | $3,802,939 | $3,802,939 | |
| LOSS ON INTEREST SWAP ADJ | $2,864,464 | $2,864,464 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,014,212 | TotalAmt |
| Program Services | $3,449,011 | ProgramServicesAmt |
| Management And General | $565,201 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,102,551 | TotalAmt |
| Program Services | $195,254,721 | ProgramServicesAmt |
| Management And General | $24,847,830 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,100 | BOYAmt |
| EOY | $10,050 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,575,827 | BOYAmt |
| EOY | $16,148,848 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,515,913 | BOYAmt |
| EOY | $34,792,840 | 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 | $663,302 | BOYAmt |
| EOY | $485,174 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,770,818 | BOYAmt |
| EOY | $1,521,614 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,974,382 | BOYAmt |
| EOY | $3,975,902 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $354,115,258 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $137,320,103 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $228,346,033 | BOYAmt |
| EOY | $216,795,155 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,296,887 | BOYAmt |
| EOY | $74,651,455 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,357,447 | BOYAmt |
| EOY | $24,295,590 | 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 | $822,091 | BOYAmt |
| EOY | $822,091 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,454,652 | BOYAmt |
| EOY | $10,408,652 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $377,787,452 | BOYAmt |
| EOY | $383,907,371 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,397,635 | BOYAmt |
| EOY | $15,774,994 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,525 | BOYAmt |
| EOY | $162,112 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,778 | BOYAmt |
| EOY | $13,651 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,500,000 | BOYAmt |
| EOY | $181,950,000 | 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 | $12,514,122 | BOYAmt |
| EOY | $15,564,980 | 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 | $41,315,241 | BOYAmt |
| EOY | $30,865,686 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $255,826,301 | BOYAmt |
| EOY | $244,331,423 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,827,352 | BOYAmt |
| EOY | $139,442,893 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,799 | BOYAmt |
| EOY | $133,055 | 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 | $121,961,151 | BOYAmt |
| EOY | $139,575,948 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $377,787,452 | BOYAmt |
| EOY | $383,907,371 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $9,957,196 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $6,464,808 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $1,192,793 | 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 | false | FederalGrantAuditRequiredInd |
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) |
|---|---|---|
| Organization Belongs Afflt Grp | Yes (X) | OrganizationBelongsAffltGrpInd |
| 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 | $3,271 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $4,320 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,591 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1F: | FormAndLineReferenceDesc |
| Explanation | PORTION OF DUES PAID TO GREATER DAYTON AREA HOSPITAL ASSOCIATION AND OHIO HOSPITAL ASSOCIATION. PART II-B, LINE 1I: WE CONTRACT 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 Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $133,799 | BeginningYearBalanceAmt |
| Contributions | $4,556 | ContributionsAmt |
| Other Expenditures | $5,300 | OtherExpendituresAmt |
| End Year Balance | $133,055 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $132,950 | BeginningYearBalanceAmt |
| Contributions | $4,975 | ContributionsAmt |
| Other Expenditures | $4,126 | OtherExpendituresAmt |
| End Year Balance | $133,799 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $136,502 | BeginningYearBalanceAmt |
| Contributions | $2,269 | ContributionsAmt |
| Investment Earnings Or Losses | $5 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $5,826 | OtherExpendituresAmt |
| End Year Balance | $132,950 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,717,698 | BeginningYearBalanceAmt |
| Other Expenditures | $1,581,196 | OtherExpendituresAmt |
| End Year Balance | $136,502 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,648,947 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $68,751 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,717,698 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,535,138 | OtherCostOrOtherBasisAmt |
| Book Value | $16,535,138 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $213,645,358 | OtherCostOrOtherBasisAmt |
| Depreciation | $59,751,418 | DepreciationAmt |
| Book Value | $153,893,940 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,817,694 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,685,086 | DepreciationAmt |
| Book Value | $1,132,608 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $118,005,470 | OtherCostOrOtherBasisAmt |
| Depreciation | $75,883,599 | DepreciationAmt |
| Book Value | $42,121,871 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,111,598 | OtherCostOrOtherBasisAmt |
| Book Value | $3,111,598 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $216,795,155 | TotalBookValueLandBuildingsAmt |
| Financial Derivatives | FinancialDerivativesGrp | |
| Closely Held Equity Interests | CloselyHeldEquityInterestsGrp |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ALTERNATIVE INVESTMENTS | Desc |
| Book Value | $24,295,590 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $24,295,590 | TotalBookValueSecuritiesAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)
| DescDesc | AmtAmt |
|---|---|
| SWAP LIABILITY | $8,007,752 |
| JOINT OPERATING AGREEMENT ALLOC | $6,548,000 |
| BUILDING & CAPITAL LEASE LIABI | $5,494,716 |
| SELF INSURANCE RESERVE | $5,386,425 |
| ACCRUED MANAGED CARE A/R LIABILITY | $1,417,330 |
| HOSPITAL FRANCHISE FEE PAYABLE | $931,684 |
| WORKERS COMP RESERVE | $911,541 |
| OTHER | $2,168,238 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $30,865,686 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V - Line 4: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATIONS ENDOWMENT FUNDS ARE DESIGNATED TO SUPPORT SPECIFIC HEALTHCARE SERVICES OR CAPITAL NEEDS. SCHEDULE D, PART X, LINE 2: The following footnote is from the audited combined financial statements for Premier Health and affiliates. Atrium Health Systems is the parent organization of Atrium Medical Center. Premier Health (Premier), MedAmerica Health Systems (MAHS), Atrium Health System (AHS), and UVMC, Inc. (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, 2013 and 2012 for such unrelated business activities are not significant. MAHS, SHP, AHS, and UVMC also own or control certain subsidiaries, which are for profit corporations subject to federal income taxes. These are: 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. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp (2 entries)
| RegionRegionTxt | Type Of Activities ConductedTypeOfActivitiesConductedTxt | Region Total ExpendituresRegionTotalExpendituresAmt | Specific Services ProvidedSpecificServicesProvidedTxt |
|---|---|---|---|
| Central America and the Caribbean | Investments | $18,111,000 | |
| Central America and the Caribbean | Program Services | $24,000 | INSURANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Spent | $18,135,000 | SubtotalSpentAmt |
| Total Spent | $18,135,000 | 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 |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| 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 | $17,217,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,598,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,619,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06190 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,874,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $32,104,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,770,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03980 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $596,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $516,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $80,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,687,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $36,218,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $22,469,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10210 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $32,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $32,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,452,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,452,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02930 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $84,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $84,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,568,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,568,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02980 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $65,255,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $36,218,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $29,037,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13190 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $672,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $672,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00310 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $672,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $672,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00310 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,648,525 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $50,462,000 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $58,595,000 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$8,133,000 | 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 |
| 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 | ATRIUM MEDICAL CENTER | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE MEDICAL CENTER DRIVE | AddressLine1 |
| City | MIDDLETOWN | City |
| State | OH | State |
| ZIP Code | 45044 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PREMIERHEALTH.COM | WebsiteAddressTxt |
| State License | SEE PART V SECT C | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATRIUM MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 400. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Other Factors | Yes (X) | OtherFactorsInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| 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 A, 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. ATRIUM MEDICAL CENTER'S REGISTRATION NUMBER IS 1116. Part V, Section B, LINE 3: Partners in the data review process and in the process for identifying and prioritizing community health needs and services are the Board of trustees and executive leadership of Atrium Medical Center, community health collaboratives featuring community, health, and business stakeholders/advocates organized by both Atrium Medical Center, and the greater Dayton Area Hospital Association with its member hospitals. Part V, Section B, LINE 4: Atrium Medical Center partnered with member hospitals of the Greater Dayton Area Hospital Association and Wright State University to prepare their Community Health Needs Assessment. PART V, LINE 5A: THE DIRECT WEBSITE ADDRESS WHERE THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CAN BE ACCESSED IS: http://www.atriummedcenter.org/workarea/downloadasset.aspx?id=76898 PART V, SECTION B, LINE 12I: IF THE PATIENT'S FAMILY'S INCOME FALLS WITHIN 400% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT QUALIFIES FOR ASSISTANCE UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY. ALL OR PART OF THE ACCOUNT WILL BE WRITTEN OFF TO CHARITY CARE, BASED UPON A SLIDING FEE SCHEDULE. THE AMOUNTS CHARGED TO PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT BILLED GROSS CHARGES FOR EMERGENCY OR MEDICALLY NECESSARY CARE. WE OFFER REASONABLE PAYMENT PLANS TO THOSE WHO HAVE QUALIFIED FOR CHARITY CARE. PATIENTS MAY ALSO QUALIFY FOR CHARITY CARE DISCOUNTS DUE TO A MEDICALLY-BASED CATASTROPHIC EVENT WHICH HAS OCCURRED IN THEIR LIFE. IF A PATIENT QUALIFIES FOR THIS DISCOUNT, HE/SHE WOULD ONLY BE HELD RESPONSIBLE FOR PAYMENT OF HIS/HER FAMILY'S MEDICAL EXPENSES UP TO 15% OF THEIR ANNUAL INCOME. PART V, SECTION B, LINE 14G: THE HOSPITAL WIDELY DISTRIBUTES INFORMATION ABOUT ITS FINANCIAL ASSISTANCE POLICY WITHIN THE AREA THAT IT SERVES. THIS INFORMATION INCLUDES THE METHOD OF APPLYING FOR AND ACCESSING FINANCIAL ASSISTANCE. NOTICES ARE PUBLICIZED IN PATIENTS' BILLS AND ARE POSTED IN THE EMERGENCY ROOM, ADMITTING AND REGISTRATION AREAS, AS WELL AS OTHER PUBLIC AREAS. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FINANCIAL COUNSELORS, PATIENT ADVOCATES, AND CUSTOMER SERVICE REPRESENTATIVES DISCUSS THE FINANCIAL ASSISTANCE POLICY WITH ALL UNINSURED PATIENTS, AND ANY PATIENT WHO EXPRESSES FINANCIAL HARDSHIP WITH PAYING THEIR BILL. APPLICATIONS FOR FINANCIAL ASSISTANCE POLICY ARE AVAILABLE IN BOTH ENGLISH AND SPANISH. PART V, SECTION B, LINE 18E: BEFORE INITIATING COLLECTIONS ACTIONS, THE HOSPITAL NOTIFIES SELF-PAY PATIENTS OF ITS FINANCIAL ASSISTANCE POLICY. NOTICES OF THE POLICY ARE PUBLICIZED IN PATIENT'S BILLS AND ARE ALSO POSTED IN THE EMERGENCY ROOM, ADMITTING AND REGISTRATION AREAS, AS WELL AS OTHER PUBLIC AREAS. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FINANCIAL COUNSELORS, PATIENT ADVOCATES, PATIENT REGISTRATION, AND CUSTOMER SERVICE REPRESENTATIVES DISCUSS THE FINANCIAL ASSISTANCE POLICY WITH ALL UNINSURED PATIENTS WHO ARE ADMITTED TO THE HOSPITAL. FINANCIAL COUNSELORS ALSO CONTACT UNINSURED OUTPATIENTS WHO ARE SCHEDULED TO HAVE MAJOR PROCEDURES. IN ANY INSTANCE WHERE A PATIENT CALLS THE HOSPITAL AND EXPRESSES A CONCERN ABOUT THEIR ABILITY TO PAY, THE FINANCIAL ASSISTANCE POLICY IS EXPLAINED. | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MIDDLETOWN SURGERY CENTER LLC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5950 INNOVATION DR | AddressLine1 |
| City | MIDDLETOWN | City |
| State | OH | State |
| ZIP Code | 45005 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | GENERAL MEDICAL & SURGICAL OUTPATIENT FACILITY | FacilityTxt |
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 ATRIUM MEDICAL CENTER IS PART OF THE PREMIER HEALTH REPORT. PART I, LINE 7: A COST TO CHARGE RATIO WAS USED TO CALCULATE FINANCIAL ASSISTANCE AT COST. THIS CALCULATION TAKES TOTAL OPERATING EXPENSES LESS OTHER OPERATING REVENUES DIVIDED BY TOTAL GROSS REVENUES. UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENTAL PROGRAMS WERE CALCULATED USING A COST ACCOUNTING SYSTEM. THIS SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND INCLUDES FULLY LOADED COSTS. FOR THE REMAINING ITEMS THE ORGANIZATION USED SPECIFIC NUMBERS FOR EXPENSE PAID DIRECTLY FOR THESE SERVICES. PART I, LINE 7G: ATRIUM MEDICAL CENTER (AMC) PROVIDES THE FOLLOWING SUBSIDIZED SERVICE: EMERGENCY SERVICES: AMC OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THIS EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL INCURS EXPENSES RELATED TO CALL TIME AND PHYSICIAN SUBSIDIES DUE TO THE LARGE NUMBER OF INDIGENT PATIENTS COMING THROUGH THE EMERGENCY ROOM. FOR 2013, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $6,452,000. PART II ATRIUM MEDICAL CENTER (AMC) PARTICIPATES IN THE FOLLOWING COMMUNITY BENEFIT ACTIVITIES: BOARD CHARITABLE CREDIT FUND: AS PART OF AMC'S COMMUNITY PARTNERSHIP ACTIVITY, BOARD MEMBERS OF THE HOSPITAL ARE GRANTED CHARITABLE CREDITS TO BE DONATED IN THE NAME OF THE BOARD MEMBER WITH PRIORITIES TO NOT-FOR-PROFIT, TAX-EXEMPT 501(C)(3) HEALTH AND HUMAN SERVICES ORGANIZATIONS, ARTS AND CULTURE ORGANIZATIONS, AS WELL AS OTHER COMMUNITY ACTIVITIES IN THE DAYTON AREA. ALSO SUGGESTED ARE ORGANIZATIONS THAT FOCUS ON SUPPORTING YOUTH, EDUCATION, UNDERSERVED GROUPS, AND SAFE NEIGHBORHOODS. THE AMOUNT OF SUPPORT PROVIDED IN 2013 WAS $91,000. IN ADDITION, ATRIUM MEDICAL CENTER OFFERS A WIDE VARIETY OF FREE HEALTH CLINICS TO THE GENERAL PUBLIC. PART III, LINE 2 & 3: BAD DEBT EXPENSE IS INCURRED WHEN AN ACCOUNT IS TAKEN OUT OF ACCOUNTS RECEIVABLE AND TURNED OVER TO A COLLECTION AGENCY. THIS ACTION MAY OCCUR IF A PATIENT REFUSES PAYMENT ARRANGEMENTS, REFUSES TO APPLY FOR FINANCIAL ASSISTANCE, AND THERE IS NOT AN INSURANCE BALANCE BEING CONTENDED. AN ACCOUNT IS WRITTEN OFF TO BAD DEBT AFTER 120 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 ARE 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 $34,382,000 AND INCURRED COST OF $44,401,000, FOR AN ADDITIONAL NET SHORTFALL OF $10,019,000 ASSOCIATED WITH THESE PROGRAMS. BELOW IS A RECONCILIATION OF THE AMOUNTS ASSOCIATED WITH MEDICARE PROGRAMS. ALLOWABLE MEDICARE REVENUE PER MEDICARE COST REPORT (PART III, SECTION B) 50,462,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B 34,382,000 TOTAL MEDICARE ASSOCIATED REVENUE 84,844,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT (PART III, SECTION B) 58,595,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B 44,401,000 TOTAL MEDICARE ASSOCIATED COST 102,996,000 MEDICARE SHORTFALL PER PART III, SECTION B 8,133,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B 10,770,000 TOTAL MEDICARE SHORTFALL 18,152,000 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 49% 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 COLLECTIONS 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, BUT HAS NOT HONORED THE TERMS OF THAT PLAN. THE FINANCIAL COUNSELORS MEET WITH INPATIENT, OUTPATIENT SELF-PAY, AND OTHER PATIENTS UPON REQUEST WHO MAY NEED FINANCIAL ASSISTANCE. IN ADDITION TO ASSISTING PATIENTS WHO WANT TO APPLY FOR ASSISTANCE THROUGH THE MEDICAID PROGRAM, THE FINANCIAL COUNSELOR WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 2: THE ORGANIZATION'S COMMUNITY BENEFIT PLAN IS BASED ON OUR UNDERSTANDING OF UNIQUE COMMUNITIES' NEEDS DERIVED FROM COLLABORATIVE NEEDS ASSESSMENTS, FOCUS GROUPS AND SURVEYS CONDUCTED WITH OUR COMMUNITY PARTNERS. WE RELY ON DATA PROVIDED BY THE HEALTH FOUNDATION OF GREATER CINCINNATI TO ASSIST WITH THE NEEDS OF THE COMMUNITY. THE HEALTH FOUNDATION OF GREATER CINCINNATI CONDUCTS A SURVEY EVERY FIVE YEARS THAT INCLUDES TELEPHONE INTERVIEWS WITH APPROXIMATELY 2,500 RANDOMLY SELECTED ADULTS RESIDING WITHIN A 22 COUNTY AREA INCLUDING WARREN AND BUTLER COUNTIES. THIS SURVEY FOUND THAT 38% OF AREA ADULTS ARE BELOW THE NATIONAL AVERAGE FOR PHYSICAL HEALTH STATUS AND THAT THE PERCENTAGE OF AREA ADULTS WHO REPORT HIGH BLOOD PRESSURE/HYPERTENSION AND HIGH CHOLESTEROL/TRIGLYCERIDES ARE HIGHER THAN FOUND AMONG U.S. ADULTS. ALSO, THERE IS A HIGHER RATE OF CIGARETTE SMOKING AND BINGE DRINKING IN COMPARISON TO ADULTS NATIONWIDE. APPROXIMATELY 13% OF AREA RESIDENTS ARE UNINSURED, 14% ARE COVERED UNDER MEDICARE AND 7% ARE COVERED UNDER MEDICAID. THE SURVEY ALSO INDICATED THAT AROUND 25% OF AREA ADULTS DO NOT GET THE CARE REQUIRED BECAUSE OF COST OF HEALTHCARE OR NO HEALTH INSURANCE. THE ADULTS IN THE REGION ARE SATISFIED WITH THE QUALITY AND AVAILABILITY OF CARE BUT UNSATISFIED WITH THE COST OF HEALTHCARE. IN ORDER TO ADDRESS SOME OF THE CONCERNS FOUND IN THIS SURVEY, ATRIUM MEDICAL CENTER OFFERS A WIDE VARIETY OF HEALTH CARE SCREENINGS AT NOMINAL OR NO COST TO THE PARTICIPANT. THESE SCREENINGS INCLUDE BLOOD PRESSURE, WEIGHT, TOTAL CHOLESTEROL, SKIN CANCER, DIABETES AND PROSTATE AMONG OTHERS. THE MAJORITY OF THESE SCREENINGS ARE OFFERED IN CONJUNCTION WITH COMMUNITY HEALTH FAIRS. THE HOSPITAL ALSO OFFERS VARIOUS SEMINARS ON HOW TO TAKE CHARGE OF ONE'S HEALTH THROUGH EFFECTIVE GOAL-SETTING AND BEHAVIOR CHANGE METHODS. SOME EXAMPLES OF THESE SEMINARS INCLUDE STRESS MANAGEMENT, FREEDOM FROM SMOKING, WELLNESS LECTURE AND EAT WELL AND BE WELL. ATRIUM HEALTH CENTER ALSO OFFERS FREE CARE TO INDIGENT PATIENTS AND DISCOUNTED CARE TO THOSE BELOW VARIOUS POVERTY LEVELS. THE HOSPITAL ALSO OFFERS PAYMENT PLAN ARRANGEMENTS TO ASSIST PATIENTS WITH MEDICAL BILLS. PART VI, LINE 3: THERE ARE SEVERAL WAYS IN WHICH OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR SERVICES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S FINANCIAL | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (10 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| ATRIUM MEDICAL CENTER FOUNDATION | |||||||
| 110 N Main St Suite 500 | DAYTON | OH | 45402 | 311079213 | 501(C)(3) | $382,620 | COMMUNITY PROGRAMS |
| VICTORIA THEATRE ASSOCIATION | |||||||
| 138 N MAIN ST | DAYTON | OH | 45402 | 310897638 | 501(C)(3) | $72,000 | COMMUNITY PROGRAMS |
| MIDDLETOWN CHRISTIAN SCHOOL FOUNDATION | |||||||
| 3011 UNION RD | FRANKLIN | OH | 45005 | 311741971 | 501(C)(3) | $50,000 | COMMUNITY PROGRAMS |
| DAYTON ART INSTITUTE | |||||||
| 456 BELMONTE PARK N | DAYTON | OH | 45405 | 310537480 | 501(C)(3) | $24,224 | COMMUNITY PROGRAMS |
| MIAMI UNIVERSITY | |||||||
| 501 E HIGH ST | OXFORD | OH | 45056 | 316402089 | 501(C)(3) | $10,000 | Community Programs |
| GOODWILL EASTER SEALS | |||||||
| 1511 KUNTZ RD | Dayton | OH | 45404 | 310537112 | 501(C)(3) | $9,200 | Community Programs |
| RONALD MCDONALD HOUSE | |||||||
| 555 VALLEY ST | DAYTON | OH | 45404 | 310964793 | 501(C)(3) | $8,300 | COMMUNITY PROGRAM |
| MIDDLETOWN COMMUNITY FOUNDATION | |||||||
| 300 N MAIN ST 300 | MIDDLETOWN | OH | 45042 | 310898380 | 501(C)(3) | $7,920 | COMMUNITY PROGRAMS |
| MIDDLETOWN FINE ARTS CENTER | |||||||
| 130 N VERITY PKWY | MIDDLETOWN | OH | 45042 | 316014837 | 501(C)(3) | $5,500 | COMMUNITY PROGRAMS |
| CULTURE WORKS | |||||||
| 110 N MAIN ST 165 | DAYTON | OH | 45402 | 237412338 | 501(C)(3) | $5,176 | COMMUNITY PROGRAMS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 10 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | 1) COMMUNITY BENEFITS BUDGETED ALLOCATIONS ARE APPROVED BY THE ATRIUM HEALTH SYSTEM BOARD ANNUALLY. 2) INVOICES ARE RECEIVED IN ACCOUNTS PAYABLE AFTER APPROVAL BY THE APPROPRIATE INDIVIDUAL. 3) DISBURSEMENTS OCCUR ACCORDING TO STANDARD ACCOUNTS PAYABLE GUIDELINES. | 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 | Yes (true) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (true) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CAROL J TURNER | ||||||||||||||
| PRESIDENT & CEO | $376,632 | $0 | $82,474 | $0 | $24,452 | $0 | $10,615 | $0 | $23,318 | $0 | $517,491 | $0 | $0 | $0 |
| THOMAS J MALONEY | ||||||||||||||
| ASST TREAS/CFO (THRU 3/24/13) | $45,501 | $130,543 | $52,195 | $0 | $335 | $910 | $2,982 | $4,075 | $6,046 | $18,430 | $107,059 | $153,958 | $0 | $0 |
| DALE E CREECH | ||||||||||||||
| ASST SECRETARY & CLO (PREMIER) | $0 | $367,721 | $0 | $97,597 | $0 | $110,805 | $0 | $30,227 | $0 | $23,563 | $0 | $629,913 | $0 | $0 |
| RENEE P GEORGE | ||||||||||||||
| VP - REVENUE CYCLE (PREMIER) | $0 | $218,785 | $0 | $57,230 | $0 | $627 | $0 | $7,790 | $0 | $25,501 | $0 | $309,933 | $0 | $0 |
| WILLIAM E LINESCH | ||||||||||||||
| VP - HUMAN RESOURCES (PREMIER) | $0 | $302,375 | $0 | $85,347 | $0 | $63,103 | $0 | $29,823 | $0 | $7,457 | $0 | $488,105 | $0 | $0 |
| MICHAEL MAIBERGER | ||||||||||||||
| SR VP-CHIEF STRATEGY (PREMIER) | $0 | $311,209 | $0 | $108,151 | $0 | $127,226 | $0 | $48,688 | $0 | $26,431 | $0 | $621,705 | $0 | $36,422 |
| MARK S SHAKER | ||||||||||||||
| SR VP SRVCE INTEGRATE(PREMIER) | $0 | $416,041 | $0 | $119,115 | $0 | $190,758 | $0 | $25,000 | $0 | $4,963 | $0 | $755,877 | $0 | $0 |
| MARK W SHAW | ||||||||||||||
| VP - MANAGED CARE (PREMIER) | $0 | $259,238 | $0 | $77,695 | $0 | $91,238 | $0 | $31,273 | $0 | $22,849 | $0 | $482,293 | $0 | $0 |
| DONNA L BANKS | ||||||||||||||
| VP - OPERATIONS | $152,023 | $0 | $35,681 | $0 | $921 | $0 | $4,693 | $0 | $13,204 | $0 | $206,522 | $0 | $0 | $0 |
| LISA M GOSSETT | ||||||||||||||
| VP - CNO (THRU 08/16/2013) | $119,059 | $0 | $43,308 | $0 | $789 | $0 | $2,312 | $0 | $15,584 | $0 | $181,052 | $0 | $0 | $0 |
| TED C RIPPERGER | ||||||||||||||
| DIRECTOR - HUMAN RESOURCES | $136,477 | $0 | $20,185 | $0 | $18,062 | $0 | $6,439 | $0 | $12,535 | $0 | $193,698 | $0 | $0 | $0 |
| DAVID J CAFFERTY | ||||||||||||||
| RADIOLOGIC ENGINEER | $148,355 | $0 | $0 | $0 | $1,157 | $0 | $6,593 | $0 | $9,715 | $0 | $165,820 | $0 | $0 | $0 |
| LISA A MARTINEZ | ||||||||||||||
| ASST SECRTRY & DIR LEGAL SVCS | $135,503 | $0 | $17,501 | $0 | $3,940 | $0 | $6,039 | $0 | $999 | $0 | $163,982 | $0 | $0 | $0 |
| JOANNE R MORGAN | ||||||||||||||
| DIRECTOR PHARMACY | $141,250 | $0 | $21,298 | $0 | $1,722 | $0 | $7,108 | $0 | $17,437 | $0 | $188,815 | $0 | $0 | $0 |
| ROBYN S MYERS | ||||||||||||||
| DEPARTMENT DIRECTOR | $130,372 | $0 | $16,217 | $0 | $3,662 | $0 | $3,418 | $0 | $25,319 | $0 | $178,988 | $0 | $0 | $0 |
| SCOTT A SHELTON | ||||||||||||||
| ASST TREAS/CFO (FROM 3/25/13) | $115,021 | $0 | $28,635 | $0 | $1,281 | $0 | $10,621 | $0 | $1,739 | $0 | $157,297 | $0 | $0 | $0 |
| JEFFREY K HOFFMAN MD | ||||||||||||||
| VP MEDICAL AFFAIRS/CMO | $214,126 | $0 | $0 | $0 | $2,936 | $0 | $0 | $0 | $8,450 | $0 | $225,512 | $0 | $0 | $0 |
| THOMAS A NASH | ||||||||||||||
| VP - CHF PURCH OFFICER PREMIER | $0 | $185,778 | $0 | $20,000 | $0 | $57,491 | $0 | $0 | $0 | $21,245 | $0 | $284,514 | $0 | $0 |
| MARQUITA L TURNER | ||||||||||||||
| VP - CNO | $122,943 | $0 | $18,206 | $0 | $435 | $0 | $5,615 | $0 | $24,439 | $0 | $171,638 | $0 | $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, ATRIUM MEDICAL CENTER (AMC), COMPENSATES FOR THIS LIMITATION AND SUPPLEMENTS THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. AMC 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 2013. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2013; WILLIAM LINESCH $36,185; MARK SHAKER $168,642; MARK SHAW $83,410; DALE CREECH $106,150; MIKE MAIBERGER MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED $36,422. 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. PART I, QUESTIONS 6A AND 6B: PREMIER HEALTH, OF WHICH ATRIUM MEDICAL CENTER IS AN AFFILIATE, HAS AN INCENTIVE COMPONENT FOR ALL EXECUTIVE AND DIRECTOR LEVEL EMPLOYEES THAT TIES A PORTION OF THEIR TOTAL COMPENSATION TO ORGANIZATIONAL AND INDIVIDUAL OBJECTIVES AND OUTCOMES. THE ORGANIZATIONAL CRITERION IS WEIGHTED ACCORDING TO BALANCED SCORECARD CATEGORIES: POSITIVE WORK ENVIRONMENT (15%), QUALITY (30%), PATIENT SATISFACTION (15%), PHYSICIAN PARTNERSHIP (15%), AND FINANCIAL (25%). THE FINANCIAL CATEGORY OF THE SCORECARD IS BASED ON NET EARNINGS OF THE INDIVIDUAL HOSPITAL AND THE NET EARNINGS OF THE SYSTEM OF A WHOLE. THIS FINANCIAL TARGET IS SET BASED ON THE OPERATING AND CASH FLOW MARGINS REQUIRED TO MAINTAIN THE SYSTEM'S AA CREDIT RATINGS. INCENTIVE OBJECTIVES FOR DIRECTORS AND ABOVE ARE WEIGHTED 45% ON ORGANIZATIONAL CRITERIA, 45% ON INDIVIDUAL CRITERIA, AND 10% ON OPERATIONAL EFFECTIVENESS. THE 2013 INCENTIVE PLAN AMOUNTS WERE PAID TO THE PARTICIPANTS IN 2014. THESE ARE NOT REPORTED AS DEFERRED COMPENSATION ON THE 2013 FORM 990 BASED ON THE DEFINITION OF DEFERRED COMPENSATION CONTAINED IN THE FORM 990 INSTRUCTIONS. PER THE INSTRUCTIONS, "DEFERRED COMPENSATION IS GENERALLY TREATED AS EARNED OR ACCRUED IN THE YEAR THAT SERVICES ARE RENDERED, EXCEPT WHEN ENTITLEMENT TO PAYMENT IS CONTINGENT ON SATISFACTION OF SPECIFIED ORGANIZATIONAL GOALS OR PERFORMANCE CRITERIA (OTHER THAN MERE LONGEVITY OF SERVICE) UNDER THE DEFERRED COMPENSATION PLAN." BASED ON THE INCENTIVE PROGRAM CRITERIA OUTLINED ABOVE, WE BELIEVE THE INCENTIVE PAYMENTS MEET THE EXCEPTION NOTED IN THE INSTRUCTIONS. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. PART II, LINE 16: Scott Shelton is also the CFO of Miami Valley Hospital, which is a Premier Health affiliated hospital. Mr. Shelton also receives compensation from Miami Valley Hospital related to this position. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| CITY OF MIDDLETOWN OH | ||||||||
| A | 316000139 | 597146AH2 | 2008-11-21 | $111,000,000 | REFUND SERIES 2007 A & B | false | false | false |
| CITY OF MIDDLETOWN OH | ||||||||
| B | 316000139 | 597146AJ8 | 2010-11-15 | $86,000,000 | REFUND SERIES 2006 A | false | false | false |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Bond DefeasedBondDefeasedAmt | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Capitalized InterestCapitalizedInterestAmt | Refunding EscrowRefundingEscrowAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Working Capital ExpendituresWorkingCapitalExpendituresAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | UnspentUnspentAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $15,050,000 | $0 | $111,000,000 | $0 | $0 | $0 | $1,513,169 | $0 | $0 | $0 | $0 | $0 | 2007 | Yes (true) | false | Yes (true) | Yes (true) |
| B | $0 | $0 | $86,000,000 | $0 | $0 | $0 | $560,000 | $0 | $0 | $0 | $0 | $0 | 2007 | Yes (true) | false | Yes (true) | Yes (true) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Engage Bond Counsel ContractsEngageBondCounselContractsInd | Any Research AgreementsAnyResearchAgreementsInd | Engage Bond Counsel ResearchEngageBondCounselResearchInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Remedial Action TakenRemedialActionTakenInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | false | Yes (true) | Yes (true) | Yes (true) | Yes (true) | Yes (true) | 0.00053 | 0.01295 | 0.01348 | false | false | false | Yes (true) |
| B | false | Yes (true) | Yes (true) | Yes (true) | Yes (true) | Yes (true) | 0.00053 | 0.01295 | 0.01348 | false | false | false | Yes (true) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Business Name Line1GICProviderName/BusinessNameLine1 | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MERRIL LYNCH | |||||||||||||
| A | false | false | false | Yes (true) | Yes (true) | Yes (true) | 25.9 | Yes (true) | false | false | 0 | false | Yes (true) |
| 0 | |||||||||||||
| B | false | Yes (true) | false | false | Yes (true) | false | false | 0 | false | Yes (true) | |||
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (true) |
| B | Yes (true) |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, ARBITRAGE, LINE 2C, BOND A: | FormAndLineReferenceDesc |
| Explanation | COMPUTATION DATE WAS NOVEMBER 13, 2013 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Saundra Pearce | |||
| Sister-in-Law of D Pearce | $112,058 | Director of Nursing Salary | false |
| Michael Kleingers | |||
| Son of James Kleingers | $111,000 | Pharmacist Salary | false |
| Sheridan Zollett | |||
| Wife of Jeffrey Zollett | $31,177 | RN SALARY | false |
| David A Floering MD | |||
| Trustee | $715,143 | See Schedule L, Part V | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule L - Part IV: | FormAndLineReferenceDesc |
| Explanation | DAVID A. FLOERING, M.D. IS A GREATER THAN 5% OWNER OF MIDDLETOWN DIAGNOSTIC SERVICES, WITH WHICH ATRIUM MEDICAL CENTER HAS A CONTRACT. THIS CONTRACT WAS AUDITED BY OUR COMPLIANCE DEPARTMENT TO ENSURE WE WERE PAYING FAIR MARKET VALUE AND DID NOT HAVE ANY STARK VIOLATIONS. THE AMOUNTS PAID UNDER THIS CONTRACT ARE COMPETITIVE AND THE TRANSACTION IS AT ARMS-LENGTH. THE TOTAL AMOUNT PAID TO MIDDLETOWN DIAGNOSTIC SERVICES IN 2013 WAS $715,143. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990 - PART I - QUESTION 10: | FormAndLineReferenceDesc |
| Explanation | THIS ORGANIZATION HAS DESIGNATED ITS INVESTMENTS AS TRADING. IN ACCORDANCE WITH THE AICPA GUIDE FOR HEALTHCARE, ALL UNREALIZED GAINS AND LOSSES ARE RECOGNIZED THROUGH THE PROFIT AND LOSS STATEMENT. FOR 990 REPORTING, THIS ACTIVITY IS EXCLUDED PER THE INSTRUCTIONS BY THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION A, QUESTION 3: PREMIER HEALTH (PREMIER) AS THE OPERATOR OF ATRIUM MEDICAL CENTER (AMC) DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR AMC, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. AMC SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. AMC SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. AMC SHALL IMPLEMENT ANY BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF AMC WITH ALL THIRD PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. AMC MUST HAVE APPROVAL FROM PREMIER TO BORROW IN ANY FISCAL YEAR, GUARANTEE IN ANY YEAR, OR INCUR ANY LIEN OR OTHER ENCUMBRANCE ON ANY PROPERTY IN AN AMOUNT EQUAL TO OR GREATER THAN $1,000,000. AMC MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN PREMIER'S ACTIVITIES. FORM 990, PART VI, SECTION A, QUESTION 6: ATRIUM MEDICAL CENTER HAS TWO CORPORATE MEMBERS. ONE MEMBER IS ATRIUM HEALTH SYSTEMS, THE PARENT COMPANY OF THE HOSPITAL. THE SECOND MEMBER IS PREMIER HEALTH, AN OHIO NON-PROFIT CORPORATION FORMED PURSUANT TO THE JOINT OPERATING AGREEMENT. ATRIUM HEALTH SYSTEMS HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES OF THE CORPORATION. PREMIER HEALTH HAS THE GENERAL AUTHORITY TO OPERATE AND MANAGE THE OPERATIONAL ACTIVITIES OF THE CORPORATION. FORM 990, PART VI, SECTION A, QUESTION 7A: ATRIUM HEALTH SYSTEMS (AHS) HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR ATRIUM MEDICAL CENTER (AMC). AHS HAS THE AUTHORITY TO REMOVE TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. PREMIER HEALTH HAS THE RIGHT TO REQUEST THAT AHS REMOVE A TRUSTEE OF AMC IF PREMIER HAS DETERMINED THAT SUCH TRUSTEE IS FRUSTRATING THE GOALS AND PURPOSES OF PREMIER'S NETWORK. SUCH REMOVAL SHALL NOT BE UNREASONABLY REFUSED BY AHS. FORM 990, PART VI, SECTION A, QUESTION 7B: SEE THE RESPONSE ABOVE FOR FORM 990, PART VI, SECTION A, QUESTION 3. FORM 990, PART VI, SECTION B, QUESTION 11B: THIS 990 TAX RETURN AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE TAX DEPARTMENT OF PREMIER HEALTH (PREMIER), OF WHICH ATRIUM MEDICAL CENTER IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE TAX MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. THE RETURN IS CONCURRENTLY SENT TO ERNST & YOUNG U.S. LLP FOR THEIR REVIEW. AFTER ALL CHANGES FROM THE ABOVE GROUPS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER AND THE CHIEF FINANCIAL OFFICER OF THIS ENTITY. A FINAL VERSION OF THE RETURN IS SENT TO ERNST & YOUNG U.S. LLP FOR A FINAL REVIEW AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT A BOARD OF TRUSTEES MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESSES ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 TAX RETURN IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, QUESTION 12C: PREMIER HEALTH (PREMIER), OF WHICH ATRIUM MEDICAL CENTER IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, OFFICERS, EXECUTIVE DIRECTORS, VICE PRESIDENTS, DIRECTORS, PURCHASING DEPARTMENT STAFF, AUTHORIZED PURCHASERS, MEDICAL DIRECTORS, DEPARTMENT AND SECTIONS CHAIRS, AND ALL EMPLOYED PHYSICIANS TO ANNUALLY REVIEW THE PREMIER COMPREHENSIVE CONFLICT OF INTEREST STATEMENT, AN EXPLANATORY MEMORANDUM, THE ANTITRUST COMPLIANCE POLICY, AND COMPLETE AN INDIVIDUAL QUESTIONNAIRE DISCLOSING ANY POTENTIAL CONFLICTS AS DEFINED IN THE CONFLICT OF INTEREST POLICY. THIS IS ACCOMPLISHED EITHER BY WAY OF AN ELECTRONIC COMMUNICATION SENT OUT DIRECTLY BY THE CORPORATE COMPLIANCE DEPARTMENT OR BY WAY OF A MEMO SENT OUT FROM THE CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER OF PREMIER. IT ALSO INCLUDES AN EXPLANATORY MEMORANDUM OF SPECIFIC ACTIVITIES THAT MIGHT GIVE CAUSE TO A CONFLICT AND AN INDIVIDUAL QUESTIONNAIRE TO DISCLOSE ALL SUCH ACTIVITIES. THIS QUESTIONNAIRE MUST BE COMPLETED AND SIGNED BY THE INDIVIDUAL. THIS CORRESPONDENCE INCLUDES A COPY OF THE ANTITRUST COMPLIANCE POLICY THAT MUST BE SIGNED BY THE INDIVIDUAL. ALL OF THESE DOCUMENTS ARE SENT TO THE CORPORATE COMPLIANCE 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 CORPORATE COMPLIANCE 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 ATRIUM MEDICAL CENTER 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 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 THE COMPANY WEBSITE. FORM 990, PART XI, LINE 9: Premier Health System/PRIMARY CARE (7,708,675) Premier Health Group Reclass (1,172,116) Equity Transfers (598,200) PHO Equity Infusion (400,000) Funding from Foundation (266,578) Capital Donations 94,715 Allocation - Dialysis Ops / Sale 1,932,676 Pension Adjustment 9,307,387 Other 3,584 Total 1,192,793 | ExplanationTxt |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| PREMIER HEALTH | ||||||||||
| 110 N Main St Suite 500 | DAYTON | OH | 45402 | 311446699 | SUPPORT. ORG. | OH | 501(C)(3) | 11-I | NA | false |
| ATRIUM HEALTH SYSTEM (AHS) | ||||||||||
| 110 N Main St Suite 500 | DAYTON | OH | 45402 | 310537492 | PARENT | OH | 501(C)(3) | 11-I | NA | false |
| ATRIUM MEDICAL CENTER FOUNDATION | ||||||||||
| 110 N MAIN ST SUITE 500 | DAYTON | OH | 45402 | 311079213 | Foundation | OH | 501(C)(3) | 11-I | AHS | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MIDDLETOWN SURGERY CENTER LLC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5950 INNOVATION DR | AddressLine1 |
| City | MIDDLETOWN | City |
| State | OH | State |
| ZIP Code | 45005 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205160579 | 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 | AMC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $24,749 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $5,448,988 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| UBI Code V | $0 | UBICodeVAmt |
| General Or Managing Partner | Yes (true) | GeneralOrManagingPartnerInd |
| Ownership | 0.80500 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | 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 |
| 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 | false | 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 (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ATRIUM MEDICAL CENTER FOUNDATION | ||
| C | $401,871 | Cash |
| ATRIUM MEDICAL CENTER FOUNDATION | ||
| Q | $378,288 | FMV |
| ATRIUM MEDICAL CENTER FOUNDATION | ||
| R | $598,200 | FMV |
| ATRIUM MEDICAL CENTER FOUNDATION | ||
| B | $387,620 | Cash |
| PREMIER HEALTH | ||
| B | $1,172,116 | FMV |