2014-11-13T18:07:22-06:00 2013-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE 4000 INDIANAPOLIS IN 46204 990 2013-01-01 311079309 ATRIUM MEDICAL CENTER % J MICHAEL SIMS ATRI 9374999942 110 N MAIN ST Suite 500 DAYTON OH 45402 SCOTT SHELTON CFO 9374404000 2014-11-11 true CHRISTOPHER B BOGGS P00032493 9374404000 2013 2015-11-30 17:44:51Z CAROL TURNER 110 N MAIN ST SUITE 500 DAYTON OH 45402 536395716 false X WWW.PREMIERHEALTH.COM X 1983 OH ATRIUM MEDICAL CENTER WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. 12 7 2247 303 1000546 -106967 324684 307156 234843399 208801119 5553028 5970273 2275160 14981199 242996271 230059747 287108 683894 0 0 111031138 105927099 0 0 0 123206483 113491558 234524729 220102551 8471542 9957196 377787452 383907371 255826301 244331423 121961151 139575948 X ATRIUM MEDICAL CENTER WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. false false 195254721 683894 208801119 PLEASE SEE SCHEDULE H. 195254721 true true false true false false false false false true true true false false true true false true false false true false false false false false true true true false true true false false false false false false false false true false false false false false false true true true false false true 178 0 true 2247 true true true false false false false false false false false false X 12 7 false true false false true true true true true false false true true true true true true true true true true OH X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 500 DAYTON OH 45402 X JEFFREY S ZOLLETT MD BOARD CHAIR 0.5 1.5 X X 0 0 0 FRANK B CHAPMAN BOARD VICE CHAIR -THRU 3/28/13 0.5 0.5 X X 0 0 0 DAVID A PEARCE BOARD SECRETARY / TREASURER 0.5 1.5 X X 0 0 0 BARRY ROBERTSON MD EX OFFICIO W/ VOTE 0.5 0.0 X 8530 0 0 JAMES R PANCOAST TRUSTEE / PREMIER PRES & CEO 8.0 6.0 X 0 0 0 MARJORIE K COWAN PHD TRUSTEE 0.5 0.5 X 0 0 0 DAVID A FLOERING MD TRUSTEE 0.5 0.5 X 0 0 0 THOMAS E GROSSMANN TRUSTEE 0.5 0.5 X 1498 0 0 LARRY L HOLLINGSHEAD TRUSTEE 0.5 1.0 X 0 0 0 STEPHEN M JONES TRUSTEE 0.5 0.5 X 0 0 0 JAMES B KLEINGERS TRUSTEE 0.5 1.0 X 0 0 0 PERCY D MITCHELL JR MD TRUSTEE 0.5 0.5 X 0 0 0 JOHN J VENTURELLA TRUSTEE 0.5 0.5 X 2041 0 0 CAROL J TURNER PRESIDENT & CEO 39.0 1.0 X 483558 0 33933 THOMAS J MALONEY ASST TREAS/CFO (THRU 3/24/13) 40.0 0.0 X 98031 131453 31533 DALE E CREECH ASST SECRETARY & CLO (PREMIER) 7.75 32.25 X 0 576123 53790 LISA A MARTINEZ ASST SECRTRY & DIR LEGAL SVCS 40.0 0.0 X 156944 0 7038 SCOTT A SHELTON ASST TREAS/CFO (FROM 3/25/13) 20.0 0.0 X 144937 0 12360 RENEE P GEORGE VP - REVENUE CYCLE (PREMIER) 8.0 32.0 X 0 276642 33291 WILLIAM E LINESCH VP - HUMAN RESOURCES (PREMIER) 8.0 32.0 X 0 450825 37280 MICHAEL MAIBERGER SR VP-CHIEF STRATEGY (PREMIER) 8.0 32.0 X 0 546586 75119 MARK S SHAKER SR VP SRVCE INTEGRATE(PREMIER) 8.0 32.0 X 0 725914 29963 MARK W SHAW VP - MANAGED CARE (PREMIER) 8.0 32.0 X 0 428171 54122 DONNA L BANKS VP - OPERATIONS 40.0 0.0 X 188625 0 17897 JEFFREY K HOFFMAN MD VP MEDICAL AFFAIRS/CMO 40.0 0.0 X 217062 0 8450 THOMAS A NASH VP - CHF PURCH OFFICER PREMIER 8.0 32.0 X 0 263269 21245 MARQUITA L TURNER VP - CNO 40.0 0.0 X 141584 0 30054 LISA M GOSSETT VP - CNO (THRU 08/16/2013) 40.0 0.0 X 163156 0 17896 TED C RIPPERGER DIRECTOR - HUMAN RESOURCES 40.0 0.0 X 174724 0 18974 DAVID J CAFFERTY RADIOLOGIC ENGINEER 40.0 0.0 X 149512 0 16308 JOANNE R MORGAN DIRECTOR PHARMACY 40.0 0.0 X 164270 0 24545 ROBYN S MYERS DEPARTMENT DIRECTOR 40.0 0.0 X 150251 0 28737 2244723 3398983 552535 50 false true false MIDDLETOWN ANESTHESIA CONSULTANTS 3180 KETTERING BLVD DAYTON OH 45439 MEDICAL SERVICES 2603850 HMP OF BUTLER COUNTY LTD 4535 DRESSLER ROAD NORTHWEST CANTON OH 44718 MEDICAL SERVICES 1497044 DAWSON HEALTHCARE 3650 OLENTANGY RIVER RD COLUMBUS OH 43214 AGENCY STAFF 1083139 COMMUNITY BLOOD CENTER 349 S MAIN ST DAYTON OH 45402 LAB WORK 984770 HILLTOP OBGYN 322 CONGRESS PARK DR DAYTON OH 45459 MEDICAL SERVICES 825000 22 307156 307156 NET PATIENT SERVICE REVENUE 900099 113671692 112720651 951041 MEDICARE/MEDICAID PAYMENTS 900099 94137617 94137617 HOSPITAL FRANCHISE TAX RECOVERIES 900099 4093087 4093087 JOINT OPERATING AGREEMENT 900099 -3303000 -3303000 MEDICAL RECORDS 900099 95689 95689 106034 106034 208801119 1196991 1196991 0 0 796685 393632 403053 0 403053 403053 309138174 304063680 301212 5074494 -301212 4773282 4773282 0 0 1786194 1577445 208749 208749 GAIN ON INTEREST SWAP ADJ 900099 12622181 12622181 CAFETERIA SALES 900099 1337864 8369 1329495 PHYSICIAN ANSWERING SERVICE 561000 66436 41136 25300 342916 342916 14369397 230059747 207850078 1000546 20901967 683894 683894 0 0 0 1549501 1331331 218170 0 254235 218439 35796 82227134 70649554 11577580 2395557 2058263 337294 13607482 11691549 1915933 5893190 5063429 829761 11970 10285 1685 823136 707238 115898 138737 138737 8791 8791 0 305139 305139 9925245 9925245 545600 545600 1269856 1091060 178796 5979248 5137370 841878 0 2395245 2057995 337250 188792 162210 26582 0 1241 1066 175 5546534 5546534 0 21236920 18246762 2990158 0 OPERATING SUPPLIES 43301860 43301860 PURCHASED SERVICES 11131629 9564296 1567333 HOSPITAL FRANCHISE TAX 3802939 3802939 LOSS ON INTEREST SWAP ADJ 2864464 2864464 4014212 3449011 565201 220102551 195254721 24847830 0 10100 10050 4575827 16148848 0 0 36515913 34792840 0 0 0 0 663302 485174 1770818 1521614 2974382 3975902 354115258 137320103 228346033 216795155 55296887 74651455 37357447 24295590 0 0 822091 822091 9454652 10408652 377787452 383907371 17397635 15774994 87525 162112 11778 13651 184500000 181950000 0 0 0 0 12514122 15564980 0 0 41315241 30865686 255826301 244331423 X 121827352 139442893 133799 133055 0 0 121961151 139575948 377787452 383907371 X 9957196 6464808 1192793 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X false false false false false true 3271 false false true 4320 7591 false false PART II-B, LINE 1F: 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. 133799 4556 5300 133055 132950 4975 4126 133799 136502 2269 5 5826 132950 1717698 1581196 136502 1648947 0 68751 1717698 1.00000 false false 16535138 16535138 213645358 59751418 153893940 2817694 1685086 1132608 118005470 75883599 42121871 3111598 3111598 216795155 ALTERNATIVE INVESTMENTS 24295590 F 24295590 0 SWAP LIABILITY 8007752 JOINT OPERATING AGREEMENT ALLOC 6548000 BUILDING & CAPITAL LEASE LIABI 5494716 SELF INSURANCE RESERVE 5386425 ACCRUED MANAGED CARE A/R LIABILITY 1417330 HOSPITAL FRANCHISE FEE PAYABLE 931684 WORKERS COMP RESERVE 911541 OTHER 2168238 30865686 X Part V - Line 4: 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. Central America and the Caribbean Investments 18111000 Central America and the Caribbean Program Services INSURANCE 24000 18135000 18135000 false false false false false false true true X true X true X true true false true true 17217000 3598000 13619000 0.06190 40874000 32104000 8770000 0.03980 596000 516000 80000 0.00040 58687000 36218000 22469000 0.10210 32000 32000 0.00010 6452000 6452000 0.02930 84000 84000 0.00040 6568000 6568000 0.02980 65255000 36218000 29037000 0.13190 672000 672000 0.00310 672000 672000 0.00310 true 3648525 0 50462000 58595000 -8133000 X true true 1 1 ATRIUM MEDICAL CENTER ONE MEDICAL CENTER DRIVE MIDDLETOWN OH 45044 WWW.PREMIERHEALTH.COM SEE PART V SECT C X X X ATRIUM MEDICAL CENTER 1 true X X X X X X X X X 13 true true true X SEE PART V, SECTION C X X X X X X X true false true true 200. true 400. true X X X X true true X X X X X X true false X X X X true X false false PART V, SECTION A, LINE 1: THE STATE OF OHIO DOES NOT LICENSE HOSPITALS, BUT THE OHIO DEPARTMENT OF HEALTH DOES REGISTER HOSPITALS. AS PART OF THIS REGISTRATION PROCESS, HOSPITALS IN THE STATE OF OHIO ARE REQUIRED TO COMPLETE AND SUBMIT THE ANNUAL HOSPITAL REGISTRATION AND PLANNING REPORT (AHR) EACH CALENDAR YEAR. ATRIUM MEDICAL CENTER'S REGISTRATION NUMBER IS 1116. Part V, Section B, LINE 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. 1 MIDDLETOWN SURGERY CENTER LLC 5950 INNOVATION DR MIDDLETOWN OH 45005 GENERAL MEDICAL & SURGICAL OUTPATIENT FACILITY PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT FOR ATRIUM MEDICAL CENTER IS PART OF THE PREMIER HEALTH REPORT. PART I, LINE 7: A COST TO CHARGE RATIO WAS USED TO CALCULATE 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 true ATRIUM MEDICAL CENTER FOUNDATION 110 N Main St Suite 500 DAYTON OH 45402 311079213 501(C)(3) 382620 COMMUNITY PROGRAMS VICTORIA THEATRE ASSOCIATION 138 N MAIN ST DAYTON OH 45402 310897638 501(C)(3) 72000 COMMUNITY PROGRAMS MIDDLETOWN CHRISTIAN SCHOOL FOUNDATION 3011 UNION RD FRANKLIN OH 45005 311741971 501(C)(3) 50000 COMMUNITY PROGRAMS DAYTON ART INSTITUTE 456 BELMONTE PARK N DAYTON OH 45405 310537480 501(C)(3) 24224 COMMUNITY PROGRAMS MIAMI UNIVERSITY 501 E HIGH ST OXFORD OH 45056 316402089 501(C)(3) 10000 Community Programs GOODWILL EASTER SEALS 1511 KUNTZ RD Dayton OH 45404 310537112 501(C)(3) 9200 Community Programs RONALD MCDONALD HOUSE 555 VALLEY ST DAYTON OH 45404 310964793 501(C)(3) 8300 COMMUNITY PROGRAM MIDDLETOWN COMMUNITY FOUNDATION 300 N MAIN ST 300 MIDDLETOWN OH 45042 310898380 501(C)(3) 7920 COMMUNITY PROGRAMS MIDDLETOWN FINE ARTS CENTER 130 N VERITY PKWY MIDDLETOWN OH 45042 316014837 501(C)(3) 5500 COMMUNITY PROGRAMS CULTURE WORKS 110 N MAIN ST 165 DAYTON OH 45402 237412338 501(C)(3) 5176 COMMUNITY PROGRAMS 10 0 SCHEDULE I, Part I, Line 2: 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. X X X X false true false false false true true false false CAROL J TURNER PRESIDENT & CEO 376632 0 82474 0 24452 0 10615 0 23318 0 517491 0 0 0 THOMAS J MALONEY ASST TREAS/CFO (THRU 3/24/13) 45501 130543 52195 0 335 910 2982 4075 6046 18430 107059 153958 0 0 DALE E CREECH ASST SECRETARY & CLO (PREMIER) 0 367721 0 97597 0 110805 0 30227 0 23563 0 629913 0 0 RENEE P GEORGE VP - REVENUE CYCLE (PREMIER) 0 218785 0 57230 0 627 0 7790 0 25501 0 309933 0 0 WILLIAM E LINESCH VP - HUMAN RESOURCES (PREMIER) 0 302375 0 85347 0 63103 0 29823 0 7457 0 488105 0 0 MICHAEL MAIBERGER SR VP-CHIEF STRATEGY (PREMIER) 0 311209 0 108151 0 127226 0 48688 0 26431 0 621705 0 36422 MARK S SHAKER SR VP SRVCE INTEGRATE(PREMIER) 0 416041 0 119115 0 190758 0 25000 0 4963 0 755877 0 0 MARK W SHAW VP - MANAGED CARE (PREMIER) 0 259238 0 77695 0 91238 0 31273 0 22849 0 482293 0 0 DONNA L BANKS VP - OPERATIONS 152023 0 35681 0 921 0 4693 0 13204 0 206522 0 0 0 LISA M GOSSETT VP - CNO (THRU 08/16/2013) 119059 0 43308 0 789 0 2312 0 15584 0 181052 0 0 0 TED C RIPPERGER DIRECTOR - HUMAN RESOURCES 136477 0 20185 0 18062 0 6439 0 12535 0 193698 0 0 0 DAVID J CAFFERTY RADIOLOGIC ENGINEER 148355 0 0 0 1157 0 6593 0 9715 0 165820 0 0 0 LISA A MARTINEZ ASST SECRTRY & DIR LEGAL SVCS 135503 0 17501 0 3940 0 6039 0 999 0 163982 0 0 0 JOANNE R MORGAN DIRECTOR PHARMACY 141250 0 21298 0 1722 0 7108 0 17437 0 188815 0 0 0 ROBYN S MYERS DEPARTMENT DIRECTOR 130372 0 16217 0 3662 0 3418 0 25319 0 178988 0 0 0 SCOTT A SHELTON ASST TREAS/CFO (FROM 3/25/13) 115021 0 28635 0 1281 0 10621 0 1739 0 157297 0 0 0 JEFFREY K HOFFMAN MD VP MEDICAL AFFAIRS/CMO 214126 0 0 0 2936 0 0 0 8450 0 225512 0 0 0 THOMAS A NASH VP - CHF PURCH OFFICER PREMIER 0 185778 0 20000 0 57491 0 0 0 21245 0 284514 0 0 MARQUITA L TURNER VP - CNO 122943 0 18206 0 435 0 5615 0 24439 0 171638 0 0 0 PART I, LINE 4B: DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, CERTAIN PERSONS ARE LIMITED IN THE AMOUNT OF BENEFIT THAT CAN BE EARNED UNDER A QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, ATRIUM MEDICAL CENTER (AMC), 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. A CITY OF MIDDLETOWN OH 316000139 597146AH2 2008-11-21 111000000 REFUND SERIES 2007 A & B false false false B CITY OF MIDDLETOWN OH 316000139 597146AJ8 2010-11-15 86000000 REFUND SERIES 2006 A false false false A 15050000 0 111000000 0 0 0 1513169 0 0 0 0 0 2007 true false true true B 0 0 86000000 0 0 0 560000 0 0 0 0 0 2007 true false true true A false true true true true true 0.00053 0.01295 0.01348 false false false true B false true true true true true 0.00053 0.01295 0.01348 false false false true A false false false true true true MERRIL LYNCH 25.9 true false false 0 false true B false true false false true false 0 false 0 false true A true B true PART IV, ARBITRAGE, LINE 2C, BOND A: COMPUTATION DATE WAS NOVEMBER 13, 2013 Saundra Pearce Sister-in-Law of D Pearce 112058 Director of Nursing Salary false Michael Kleingers Son of James Kleingers 111000 Pharmacist Salary false Sheridan Zollett Wife of Jeffrey Zollett 31177 RN SALARY false David A Floering MD Trustee 715143 See Schedule L, Part V false Schedule L - Part IV: 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. FORM 990 - PART I - QUESTION 10: 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 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 true MIDDLETOWN SURGERY CENTER LLC 5950 INNOVATION DR MIDDLETOWN OH 45005 205160579 O/P Surgery OH AMC RELATED 24749 5448988 false 0 true 0.80500 false true true false false false false false false false false false false false false true true false ATRIUM MEDICAL CENTER FOUNDATION C 401871 Cash ATRIUM MEDICAL CENTER FOUNDATION Q 378288 FMV ATRIUM MEDICAL CENTER FOUNDATION R 598200 FMV ATRIUM MEDICAL CENTER FOUNDATION B 387620 Cash PREMIER HEALTH B 1172116 FMV