UPPER VALLEY MEDICAL CENTER: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: UPPER VALLEY MEDICAL CENTER (EIN 31-0537095)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-11-12
IRS object ID: 201313169349305666
Schema version: 2012v2.1
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)
Timestamp	2013-11-12T17:24:24-06:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ERNST & YOUNG US LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	111 MONUMENT CIRCLE SUITE 2600	AddressLine1
City	INDIANAPOLIS	City
State	IN	State
ZIP Code	46204	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	310537095	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Upper Valley Medical Center	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of Name	% J MICHAEL SIMS	InCareOfName
Name Control	UPPE	NameControl
Phone	9374999942	Phone

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

Officer Officer

Field	Value	IRS element (for citing)
Name	TIMOTHY D SNIDER	Name
Title	V/P - CFO	Title
Phone	9374999942	Phone
Date Signed	2013-11-12	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Phone	3176817000	Phone

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Address Change	X	AddressChange
Name Of Principal Officer Person	Thomas Parker	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	3130 N County Line Rd 25 A	AddressLine1
City	Troy	City
State	OH	State
ZIP Code	45373	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	266285955	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.premierhealth.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1926	YearFormation
State Legal Domicile	OH	StateLegalDomicile
Activity Or Mission Description	See Schedule O.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	18	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	13	NbrIndependentVotingMembers
Total Nbr Employees	1596	TotalNbrEmployees
Total Nbr Volunteers	150	TotalNbrVolunteers
Total Gross UBI	222414	TotalGrossUBI
Contributions Grants Prior Year	63258	ContributionsGrantsPriorYear
Contributions Grants Current Year	204249	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	147412296	ProgramServiceRevenuePriorYear
Program Service Revenue CY	136222579	ProgramServiceRevenueCY
Investment Income Prior Year	2719969	InvestmentIncomePriorYear
Investment Income Current Year	5591678	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1433718	OtherRevenuePriorYear
Other Revenue Current Year	5273533	OtherRevenueCurrentYear
Total Revenue Prior Year	151629241	TotalRevenuePriorYear
Total Revenue Current Year	147292039	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	242433	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	466210	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	79119649	SalariesEtcPriorYear
Salaries Etc Current Year	82671356	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	65994730	OtherExpensePriorYear
Other Expenses Current Year	57075139	OtherExpensesCurrentYear
Total Expenses Prior Year	145356812	TotalExpensesPriorYear
Total Expenses Current Year	140212705	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	6272429	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	7079334	RevenuesLessExpensesCY
Total Assets BOY	154457885	TotalAssetsBOY
Total Assets EOY	146435432	TotalAssetsEOY
Total Liabilities BOY	117307199	TotalLiabilitiesBOY
Total Liabilities EOY	112239789	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	37150686	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	34195643	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	SEE SCHEDULE O	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	122838148	Expense
Grants	466210	Grants
Revenue	136000165	Revenue
Description	See Schedules H and O.	Description
Total Program Service Expense	122838148	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	true	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	true	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	true	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	true	TaxExemptBonds
Invest Tax Exempt Bonds	false	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	true	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	true	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	true	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	true	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	75	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	1596	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	true	UnrelatedBusinessIncome
Form990-T Filed	true	Form990-TFiled
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	18	NbrVotingGoverningBodyMembers
Number Independent Voting Members	13	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	OH	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	J MICHAEL SIMS	NamePerson
Telephone Number	9374999942	TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (37 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
Douglas R Murray
Trustee	0.5	2.5	X	0	0	0
Rowan R Nickol MD
BOARD Chair	0.5	39.5	X	0	342111	25961	X
Craig C Bundschuh
Secretary	0.5	2.5	X	0	0	0	X
Cliff R Alexander
Trustee	0.5	1.0	X	0	0	0
Ronald R Fox
Trustee	0.5	1.0	X	0	0	0
Daniel P French
Trustee	0.5	1.0	X	0	0	0
Gail Haddad RN
Trustee	0.5	1.0	X	0	0	0
William E Lukens
Trustee	0.5	2.5	X	0	0	0
Peter E Nims MD
Trustee	0.5	2.5	X	0	0	0
P Naga Maddireddy MD
Trustee	0.5	1.0	X	20512	1000	0
James R Pancoast
Premier President & CEO	0.5	1.0	X	0	0	0
Michael R Tinkler DDS
Trustee	0.5	1.0	X	0	0	0
Joel H Walker
Trustee	0.5	1.0	X	0	0	0
Mary Patricia Wampler RN
Trustee	0.5	1.0	X	0	0	0
Thomas Parker
President & CEO	32.0	8.0	X	428346	0	28901	X
Steven Staley
Trustee	0.5	1.0	X	0	0	0
Arthur R Disbrow
Vice Chair	0.5	2.5	X	0	0	0	X
Paul Weber MD
Trustee	0.5	39.5	X	0	257839	26480
Timothy Snider
Vice President/CFO	32.0	8.0		254194	0	40161	X
K Duane Martin
Recording Secretary(thru 5-12)	0.25	1.25		0	0	0	X
Jenna M Downey Esq
Recording Secretary	0.25	1.25		0	0	0	X
Michael Maiberger
SR VP-CHIEF STRATEGY (PREMIER)	8.0	32.0		0	569067	75958		X
James Hurak
Vice President - Operations	40.0	0.0		205195	0	48170		X
Rebecca Rice
Vice President - Operations	40.0	0.0		226116	0	35487		X
Mary M Clancy
VP - CIO (Premier)	8.0	32.0		0	482163	39747		X
WILLIAM E LINESCH
VP - HUMAN RESOURCES (PREMIER)	8.0	32.0		0	445854	38785		X
Dale E Creech
CLO (Premier)	8.0	32.0		0	598155	56953		X
MARK W SHAW
VP - MANAGED CARE (Premier)	8.0	32.0		0	403205	57358		X
Mark S Shaker
SR VP SRVCE INTEGRATE(PREMIER)	8.0	32.0		0	746571	33540		X
RENEE P GEORGE
VP - REVENUE CYCLE (Premier)	8.0	32.0		0	276674	34514		X
Danny Bailey DPM
Chief Medical Officer	40.0	0.0		292798	0	30066		X
Judy A Synder
Chief Nursing Officer	40.0	0.0		237082	0	36006		X
Shakil Rahman MD
Physician	40.0	0.0		340909	0	26280			X
Rafay Atiq MD
Physician	40.0	0.0		252620	0	26341			X
William Watercutter
Director of IT	40.0	0.0		145810	0	25744			X
Thomas Bigley
Director of Pharmacy	40.0	0.0		163119	0	22964			X
Tracy Moser
Director of Human Resources	40.0	0.0		178555	0	30925			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2745256	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	4122639	TotalReportableCompFrmRltdOrgs
Total Other Compensation	740341	TotalOtherCompensation
Number Individuals GT100 K	36	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Brackett Builders
185 Marybil Dr S	TROY	OH	45373	Construction	2504940
GE Medical Systems
3000 Grandview Blvd	WAUKESHA	WI	53188	Medical Services	945465
RC Pathology Consultants
1785 Fox Run	TROY	OH	45373	Pathology	986000
Cerner Corporation
2800 Rockcreek Pkwy	KANSAS CITY	MO	64117	Medical Services	876009
Community Blood Center
349 S Main St	DAYTON	OH	45402	Medical services	848332

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	59	NumberOfContractorsGT100K
Related Organizations	204249	RelatedOrganizations
Total Contributions	204249	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
NET MEDICARE / MEDICAID	621110	67817908	67817908
NET PATIENT CARE SERVICES	621110	75424875	75202461	222414
JOINT OPERATING AGREEMENT	900099	-9560000	-9560000
MEDICAL RECORDS	900099	49215	49215
FRANCHISE TAX RECOVERIES	900099	2474624	2474624

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	15957	TotalRevenueColumn
Related Or Exempt Function Income	15957	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	136222579	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	1307005	TotalRevenueColumn
Exclusion	$1,307,005	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	268780	TotalRevenueColumn
Exclusion	$268,780	ExclusionAmount

Royalties Revenue RoyaltiesRevenue

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

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	45051	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	80683	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	-35632	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	-35632	TotalRevenueColumn
Exclusion	-$35,632	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	122736383	Securities
Other	192743	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	118913233	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	3823150	Securities
Other	192743	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	4015893	TotalRevenueColumn
Exclusion	$4,015,893	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

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

Net Income From Gaming NetIncomeFromGaming

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

Net Income Or Loss NetIncomeOrLoss

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

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
CAFETERIA SALES	721110	698247	$698,247
EHR INCENTIVE	812390	2759932	$2,759,932
INTEREST RATE SWAP	523920	942788	$942,788

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	908198	TotalRevenueColumn
Exclusion	$908,198	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	5309165	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	147292039	TotalRevenueColumn
Related Or Exempt Function Income	136000165	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	222414	UnrelatedBusinessRevenue
Exclusion	$10,865,211	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	466210	Total
Program Services	466210	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	1862522	Total
Program Services	1587054	ProgramServices
Management And General	275468	ManagementAndGeneral
Fundraising	0	Fundraising

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	59778711	Total
Program Services	50937440	ProgramServices
Management And General	8841271	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	6476174	Total
Program Services	5518348	ProgramServices
Management And General	957826	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	10158435	Total
Program Services	8656002	ProgramServices
Management And General	1502433	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	4395514	Total
Program Services	3745417	ProgramServices
Management And General	650097	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	349	Total
Program Services	297	ProgramServices
Management And General	52	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	188364	Total
Program Services	160505	ProgramServices
Management And General	27859	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	64363	Total
Management And General	64363	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	17530	Total
Program Services	17530	ProgramServices

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	67082	Total
Management And General	67082	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	1006999	Total
Program Services	1006999	ProgramServices

Advertising Advertising

Field	Value	IRS element (for citing)
Total	476530	Total
Program Services	476530	ProgramServices

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1266093	Total
Program Services	1078838	ProgramServices
Management And General	187255	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	4048222	Total
Program Services	3449490	ProgramServices
Management And General	598732	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	3889252	Total
Program Services	3314032	ProgramServices
Management And General	575220	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	184150	Total
Program Services	156914	ProgramServices
Management And General	27236	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	1901	Total
Program Services	1620	ProgramServices
Management And General	281	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	2615891	Total
Program Services	2615891	ProgramServices

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	7683932	Total
Program Services	6547478	ProgramServices
Management And General	1136454	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1183142	Total
Program Services	1008155	ProgramServices
Management And General	174987	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
OPERATING SUPPLIES/EQUIP	16934090	16934090
REPAIRS & MAINTENANCE	3359850	2862928	496922
PURCHASED SERVICES	10786124	9190856	1595268
HOSPITAL FRANCHISE TAX	1977740	1977740

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	1323535	Total
Program Services	1127784	ProgramServices
Management And General	195751	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	140212705	Total
Program Services	122838148	ProgramServices
Management And General	17374557	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	3518	BOY
EOY	67341	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1340748	BOY
EOY	837638	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	16363312	BOY
EOY	19856384	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	28995	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	487223	BOY
EOY	417486	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	633671	BOY
EOY	508925	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	1891735	BOY
EOY	1692646	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	138647081	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	81425956	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	63411256	BOY
EOY	57221125	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	68986819	BOY
EOY	50184926	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	11044371	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	1310608	BOY
EOY	4604590	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	154457885	BOY
EOY	146435432	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	62253136	BOY
EOY	11868973	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	1790	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	51180950	BOY
EOY	46662667	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	696461	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	3873113	BOY
EOY	53009898	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	117307199	BOY
EOY	112239789	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	34468919	BOY
EOY	34195643	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1592465	BOY
EOY	0	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1089302	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	37150686	BOY
EOY	34195643	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	154457885	BOY
EOY	146435432	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	7079334	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	218522	ReconciliationUnrealizedInvest
Reconcilation Other Changes	-10252899	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Consolidated	X	FinancialStatementConsolidated

Field	Value	IRS element (for citing)
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	true	GrantsOtherOrganizations
Grants Other Organizations	$14,830	GrantsOtherOrganizationsAmount
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$2,700	OtherActivitiesAmount
Total Lobbying Expenditures IIB	17530	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Schedule C, Part II-B, Lines 1f & 1i:	Identifier
Explanation	Amounts include a portion of membership dues paid to Ohio Hospital Association and Greater Dayton Area Hospital Association that were used for lobbying purposes. Also includes payments to a contracted lobbyist for health care related issues.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts
Current Year Minus3 Years		CurrentYearMinus3Years
Current Year Minus4 Years		CurrentYearMinus4Years

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	409459	OtherCostOrOtherBasis
Book Value	409459	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	73116531	OtherCostOrOtherBasis
Depreciation	30391237	Depreciation
Book Value	42725294	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	78425	OtherCostOrOtherBasis
Depreciation	78425	Depreciation

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	60474063	OtherCostOrOtherBasis
Depreciation	50641883	Depreciation
Book Value	9832180	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4568603	OtherCostOrOtherBasis
Depreciation	314411	Depreciation
Book Value	4254192	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	57221125	TotalOfBookValueLandBuildings
Financial Derivatives		FinancialDerivatives
Closely Held Equity Interests		CloselyHeldEquityInterests

Other Securities OtherSecurities

Field	Value	IRS element (for citing)
Description	ALTERNATIVE INVESTMENTS	Description
Book Value	11044371	BookValue
Method Of Valuation	F	MethodOfValuation

Field	Value	IRS element (for citing)
Total Of Book Value Securities	11044371	TotalOfBookValueSecurities
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (9 entries)

DescriptionDescription	AmountAmount
PENSION OBLIGATION	$24,621,424
JOA	$9,560,000
INTER-COMPANY	$6,280,711
MALPRACTICE INSURANCE	$4,606,235
DUE TO MEDICARE / MEDICAID	$2,448,056
PHYSICIAN RELATED	$2,098,704
OTHER	$1,810,516
WORKER'S COMPENSATION	$1,063,167
FRANCHISE TAX	$521,085

Field	Value	IRS element (for citing)
Total Of Amounts	53009898	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

Field	Value	IRS element (for citing)
Identifier	Schedule D, Part X, Line 2:	Identifier
Explanation	Upper Valley Medical Center is a member, under a Joint Operating Agreement, of Premier Health (Premier), which is tax-exempt under Section 501(c)(3) of the Internal Revenue Code. As such, there is no income tax liability recorded at December 31, 2012 and 2011. In addition, Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the combined financial statements. UVMC Inc, the Parent of Upper Valley Medical Center and its respective subsidiaries are a group of corporations that are tax-exempt corporations under Section 501(c)(3) of the Internal Revenue Code except for the following subsidiaries: - UVMC Management Corporation and After Hours Family Care, Inc. (subsidiaries of UVMC) - Med-Terra, Inc. - Tax-Exempt coproration under section 501(c)(2) of the internal revenue code.	Explanation

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable (2 entries)

RegionRegion	Type Of Activities ConductedTypeOfActivitiesConducted	Total ExpendituresTotalExpenditures	Specific Services ProvidedSpecificServicesProvided
Central America and the Caribbean	Investments	13859817
Central America and the Caribbean	Program Services	9052	Insurance

Field	Value	IRS element (for citing)
Subtotal Amount Spent	13868869	SubtotalAmountSpent
Total Amount Spent	13868869	TotalAmountSpent
Transfer To Foreign Corp	false	TransferToForeignCorp
Interest In Foreign Trust	false	InterestInForeignTrust
Own Foreign Corp	false	OwnForeignCorp
Passive Foreign Invest Co	false	PassiveForeignInvestCo
Foreign Partnership	false	ForeignPartnership
Boycott Countries	false	BoycottCountries

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent400	X	Pcent400
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	true	ExpensesExceededBudget
Unable To Provide Care	false	UnableToProvideCare
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	9885000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1268000	DirectOffsettingRevenue
Net Community Benefit Expense	8617000	NetCommunityBenefitExpense
Percent Of Total Expense	0.06140	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	19897000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	14166000	DirectOffsettingRevenue
Net Community Benefit Expense	5731000	NetCommunityBenefitExpense
Percent Of Total Expense	0.04090	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	567000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	426000	DirectOffsettingRevenue
Net Community Benefit Expense	141000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00100	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	30349000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	15860000	DirectOffsettingRevenue
Net Community Benefit Expense	14489000	NetCommunityBenefitExpense
Percent Of Total Expense	0.10330	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1217000	TotalCommunityBenefitExpense
Net Community Benefit Expense	1217000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00870	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3648000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	678000	DirectOffsettingRevenue
Net Community Benefit Expense	2970000	NetCommunityBenefitExpense
Percent Of Total Expense	0.02120	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	268000	TotalCommunityBenefitExpense
Net Community Benefit Expense	268000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00190	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	5133000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	678000	DirectOffsettingRevenue
Net Community Benefit Expense	4455000	NetCommunityBenefitExpense
Percent Of Total Expense	0.03180	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	35482000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	16538000	DirectOffsettingRevenue
Net Community Benefit Expense	18944000	NetCommunityBenefitExpense
Percent Of Total Expense	0.13510	PercentOfTotalExpense

Other Other

Field	Value	IRS element (for citing)
Total Community Building Expense	120000	TotalCommunityBuildingExpense
Net Community Building Expense	120000	NetCommunityBuildingExpense
Percent Of Total Expense	0.00090	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	120000	TotalCommunityBuildingExpense
Net Community Building Expense	120000	NetCommunityBuildingExpense
Percent Of Total Expense	0.00090	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$3,499,000	BadDebtExpenseAmount
Amount Reimbursed By Medicare	33077000	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	36959000	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-3882000	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	UPPER VALLEY MEDICAL CENTER	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	110 N MAIN ST 500	AddressLine1
City	DAYTON	City
State	OH	State
ZIP Code	45402	ZIPCode

Field	Value	IRS element (for citing)
Website Address	WWW.PREMIERHEALTH.COM	WebsiteAddress
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	UPPER VALLEY MEDICAL CENTER	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	200.	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	400.	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Other Factors	X	OtherFactors
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Attached To Invoices	X	AttachedToInvoices
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	true	ActionsOnNonpayment
Collection Activities	false	CollectionActivities
Notify Upon Admission	X	NotifyUponAdmission
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Other Actions Taken	X	OtherActionsTaken
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Average Negotiated Rates	X	AverageNegotiatedRates
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	7	NumberOfOtherFacilities

Other Facilities OtherFacilities (7 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
DIALYSIS SERVICES
3130 N COUNTY RD 25A	TROY	OH	45373	DIALYSIS
HYATT CENTER
450 HYATT ST	TIPP CITY	OH	45371	LABORATORY, IMAGING, SPORTS MEDICINE, SURGERY
OUTPATIENT CARE CENTER NORTH
280 LOONEY RD	PIQUA	OH	45356	LABORATORY, IMAGING, REHABILITATIVE THERAPY
OUTPATIENT CARE CENTER SOUTH
998 S DORSET RD	TROY	OH	45373	LABORATORY, IMAGING OCCUPATIONAL HEALTH REHABILITATIVE THERAPY
STANFIELD PLACE
31 STANFIELD RD	TROY	OH	45373	LABORATORY, IMAGING
JACOB DETTMER BUILDING
3130 N COUNTY RD 25A	TROY	OH	45373	SLEEP DISORDER
VERSAILLES CENTER
471 MARKER RD	VERSAILLES	OH	45380	LABORATORY

Form990 Schedule H Part VI Form990ScheduleHPartVI

Field	Value	IRS element (for citing)
Identifier	Part I, line 6a:	Identifier
Explanation	An annual written community benefit report is prepared by the organization directly. In addition, Upper Valley Medical Center's community benefit information is included in an annual community benefit report with Premier Health, a related organization. Both of these reports are made available to the public via publications in local newspapers, as well as on the organizations' websites. PART I, LINE 7: A cost to charge ratio was used to calculate this financial assistance at cost. This calculation takes total operating expenses less other operating revenues divided by total gross revenues. Unreimbursed Medicaid and other means-tested governmental programs were calculated using a cost accounting system. This system addresses all patient segments and includes fully loaded costs. For the remaining items the organization used specific numbers for expense paid directly for these services. Part I, line 7g: Included in subsidized health services are revenues and expenses related to an obstetrics clinic which is subsidized by both the Miami County Health Department and Upper Valley Medical Center. This clinic serves the prenatal, delivery, and postnatal medical needs of women in the hospital's Miami County service area. Also included in subsidized health services are revenues and expenses related to an outpatient behavioral health clinic which serves the mental and behavioral health needs of area residents. The clients in both of these clinics include those who either have no medical insurance or qualify for Medicaid services. The total community benefit expense for these clinics in 2012 was $1,238,000, with direct offsetting revenues of $678,000. The net community benefit expense was $560,000. Also included in subsidized health services are the expenses the hospital incurs related to the call time and physician subsidies due to the large number of indigent patients coming through the emergency room. The hospital operates a 24-hour emergency room 365 days per year. This emergency room is open to all individuals regardless of their ability to pay. For 2012, the amounts paid for call time and subsidies were $2,410,000. Part II: Other community building activities include cash donations made to other organizations throughout the Miami County area. Upper Valley Medical Center makes several direct charitable donations to other not-for-profit organizations throughout Miami County. These organizations include area schools, chambers of commerce, churches, etc. These donations are given in the spirit of aiding in the overall well-being of the community. 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 and the patient has not returned phone calls, set up a payment plan, applied for financial assistance, and there is not an insurance balance being contended. 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. These accounts are 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 the Medicare programs. In addition to the amounts reported on line 5, 6 and 7, the organization received revenue of $18,538,000 and incurred cost of $19,255,000, for an additional net shortfall of $717,000 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) 33,077,000 Medicare revenue not reported in Part III, Section B 18,538,000 Total Medicare Associated Revenue 51,615,000 Allowable Medicare Cost per Medicare Cost report (Part III, section B) 36,959,000 Medicare Cost not reported in Part III, Section B 19,255,000 Total Medicare Associated Cost 56,214,000 Medicare Shortfall per Part III, Section B 3,882,000 Additional shortfall not included in Part III, Section B 717,000 Total Medicare Shortfall 4,599,000 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 46% of net patient revenue. The organization used a cost accounting system to calculate the Medicare allowable costs. PART III, LINE 9B: The organization makes reasonable efforts to determine whether or not an individual is eligible for assistance under the state or hospital financial assistance policy before engaging in extraordinary collective actions against that individual. Patients who are known to qualify for financial assistance are offered reasonable payment plan arrangements for any remaining balances. Any third party collecting self-pay receivables on our behalf is required to make reasonable efforts to determine if the individual meets the qualifications of the state or of our hospital financial assistance programs. Reasonable efforts include: A. Validating that the patient owes the unpaid bills and that all sources of third party payment have been identified and billed by the hospital. B. Documenting that the organization has or has attempted to offer the patient the opportunity to apply for charity care under its financial assistance policy. C. Documented that the patient does not qualify for financial assistance. D. Document that the patient has been offered a payment plan, 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 V, SECTION B, LINE 12H: 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 assist	Explanation

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable (11 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant	Address Line2AddressUS/AddressLine2
AMERICAN CANCER SOCIETY
5555 FRANTZ RD	DUBLIN	OH	43017	340726080	501(C)(3)	7500	Sponsorship
EDISON FOUNDATION
1973 EDISON DR	PIQUA	OH	45356	311379781	501(C)(3)	12150	CAPITAL, EVENT SPONSORSHIP & GENERAL FUND
Health Partners Free Clinic
1300 N County Rd 25A	Troy	OH	45373	311596731	501(C)(3)	87700	Operations
AMERICAN HEART ASSOCIATION
1313 W Dorothy Ln	Kettering	OH	45409	135613797	501(c)(3)	27200	Community Support
Hospice of Miami County
PO Box 502	Troy	OH	45373	311031277	501(c)(3)	118800	Operations
Troy Development Council
405 SW Public Sq	Troy	OH	45373	310918399	501(c)(3)	15000	Sponsorship	Suite 330
Miami County Dental Clinic
1364 W Main St	Troy	OH	45373	204901192	501(c)(3)	51700	Operations
Miami Valley Hospital
110 N Main St	Dayton	OH	45402	310537504	501(c)(3)	12739	Community Support	Suite 500
Troy Foundation
216 W Franklin St	Troy	OH	45373	316018703	501(c)(3)	5600	Community Support
YMCA of Miami County
223 W High St	Piqua	OH	45356	310537179	501(c)(3)	5200	Sponsorship
UVMC Foundation
3130 N COUNTY ROAD 25A	Troy	OH	45373	311581859	501(c)(3)	10300	Community Support

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	11	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Form 990, Schedule I, Part I, Line 2	Identifier
Explanation	UPPER VALLEY MEDICAL CENTER MONITORS THE USE OF GRANT FUNDS BY VERIFYING THAT THE ORGANIZATIONS REQUESTING ASSISTANCE ARE 501(C)(3) TAX EXEMPT ORGANIZATIONS. THE GRANTS THAT ARE GIVEN ARE USUALLY SMALL IN NATURE. LARGER ONES ARE APPROVED BY THE UVMC BOARD OF DIRECTORS. THEY ARE USUALLY GIVEN FOR A SPECIFIC PURPOSE, SUCH AS ONGOING OPERATIONS OR A CAPITAL PROJECT, AND ARE RELATED TO HEALTHCARE IN THE COMMUNITY.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	true	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	true	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	true	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (20 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Rowan R Nickol MD
BOARD Chair	0	275027	0	64033	0	3051	0	2500	0	23461	0	368072	0	0
Michael Maiberger
SR VP-CHIEF STRATEGY (PREMIER)	0	266440	0	146051	0	156576	0	45625	0	30333	0	645025	0	0
Thomas Parker
President & CEO	292333	0	112247	0	23766	0	24277	0	4624	0	457247	0	0	0
Timothy Snider
Vice President/CFO	195512	0	28761	0	29921	0	15000	0	25161	0	294355	0	0	0
James Hurak
Vice President - Operations	156528	0	29026	0	19641	0	22663	0	25507	0	253365	0	0	0
Shakil Rahman MD
Physician	289816	0	50000	0	1093	0	2500	0	23780	0	367189	0	0	0
Rafay Atiq MD
Physician	226691	0	25000	0	929	0	2500	0	23841	0	278961	0	0	0
William Watercutter
Director of IT	126751	0	12246	0	6813	0	8914	0	16830	0	171554	0	0	0
Thomas Bigley
Director of Pharmacy	141868	0	17165	0	4086	0	9940	0	13024	0	186083	0	0	0
Tracy Moser
Director of Human Resources	150488	0	16021	0	12046	0	11109	0	19816	0	209480	0	0	0
Rebecca Rice
Vice President - Operations	159967	0	40957	0	25192	0	23983	0	11504	0	261603	0	0	0
Mary M Clancy
VP - CIO (Premier)	0	326023	0	115798	0	40342	0	25126	0	14621	0	521910	0	37243
WILLIAM E LINESCH
VP - HUMAN RESOURCES (PREMIER)	0	313022	0	92384	0	40448	0	31351	0	7434	0	484639	0	31031
Dale E Creech
CLO (Premier)	0	359156	0	110992	0	128007	0	32434	0	24519	0	655108	0	123092
MARK W SHAW
VP - MANAGED CARE (Premier)	0	255582	0	87080	0	60543	0	33040	0	24318	0	460563	0	52525
Mark S Shaker
SR VP SRVCE INTEGRATE(PREMIER)	0	424644	0	163966	0	157961	0	28111	0	5429	0	780111	0	153170
RENEE P GEORGE
VP - REVENUE CYCLE (Premier)	0	215265	0	60657	0	752	0	8225	0	26289	0	311188	0	0
Paul Weber MD
Trustee	0	206185	0	49794	0	1860	0	2500	0	23980	0	284319	0	0
Danny Bailey DPM
Chief Medical Officer	246931	0	41822	0	4045	0	7500	0	22566	0	322864	0	0	0
Judy A Synder
Chief Nursing Officer	172165	0	36102	0	28815	0	25691	0	10315	0	273088	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifier

ExplanationExplanation

SCHEDULE J, 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, Upper Valley Medical Center compensates for this limitation and supplements the affected executives' qualified pension through certain nonqualified plans. Upper Valley Medical Center supplements through a Pension Restoration Plan and Supplemental Executive Retirement Plan or "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 2012. The individuals listed below have met the multi-year vesting requirement under the pension restoration plan and received the associated payment in 2012: Mary Clancy $37,243; William Linesch $31,031; Dale Creech $123,092; Mark Shaw $52,525; Mark Shaker $153,170. Michael Maiberger met the multi-year vesting requirement under the SERP and received an associated payment in 2012 of $29,210. 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.

Schedule J, Part I, Lines 6a & 6b:

PREMIER HEALTH (Premier), OF WHICH UPPER VALLEY 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 as 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 ORGANIZATIONAL EFFECTIVENESS. THE 2012 INCENTIVE PLAN AMOUNTS WERE PAID TO THE PARTICIPANTS IN 2013. THESE ARE NOT REPORTED AS DEFERRED COMPENSATION ON THE 2012 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 ORGANIZATIONAL GOALS OR SPECIFIED 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.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	County of Miami Ohio	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	316000055	IssuerEIN
CUSIP Number	593328EVS	CUSIPNumber
Date Issued	2006-06-29	DateIssued
Issue Price	57502248	IssuePrice
Description Of Purpose	See Part VI	DescriptionOfPurpose
Defeased	false	Defeased
On Behalf Of Issuer	false	OnBehalfOfIssuer
Pool Financing	false	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Amount Retired	7970000	AmountRetired
Amount Bond Defeased	0	AmountBondDefeased
Total Proceeds	61378018	TotalProceeds
Amount In Reserve Fund	5374565	AmountInReserveFund
Capitalized Interest	0	CapitalizedInterest
Refunding Escrow	0	RefundingEscrow
Issuance Costs From Proceeds	663253	IssuanceCostsFromProceeds
Credit Enhancement	0	CreditEnhancement
Working Capital Expenditures	0	WorkingCapitalExpenditures
Capital Expenditures	19589170	CapitalExpenditures
Other Spent Proceeds	35751030	OtherSpentProceeds
Amount Unspent	0	AmountUnspent
Year Of Subst Completion	2009	YearOfSubstCompletion
Current Refunding	true	CurrentRefunding
Advance Refunding	false	AdvanceRefunding
Final Allocation Made	true	FinalAllocationMade
Adequate Books And Recds Maintaind	true	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	false	OwningBondFinancedProperty
Any Lease Arrangements	true	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	true	MngmentCntrctBondFinancdPrprty
Engage Bond Counsel Contracts	true	EngageBondCounselContracts
Any Research Agreements	false	AnyResearchAgreements
Prcntge Prvt Business Use By Others	0.00050	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00220	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.00270	TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test	false	BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop	false	ChangeInUseBondFinancedProp
Remedial Action Taken	false	RemedialActionTaken
Non Qualified Bond Remed Procdrs	false	NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	false	Form8038TFiled
No Rebate Due	false	NoRebateDue
Variable Rate Issue	false	VariableRateIssue
Hedge Identified In Books And Recds	true	HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

Field	Value	IRS element (for citing)
Business Name Line1	BOAML	BusinessNameLine1

Field	Value	IRS element (for citing)
Term Of Hedge	12.67	TermOfHedge
Superintegrated Hedge	false	SuperintegratedHedge
Hedge Terminated	false	HedgeTerminated
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

Field	Value	IRS element (for citing)
Business Name Line1	0	BusinessNameLine1

Field	Value	IRS element (for citing)
Gross Proceeds Invested	true	GrossProceedsInvested
Written Proc To Monitor Reqs	true	WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Proc To Undertk Corrective Action	false	ProcToUndertkCorrectiveAction

Form990 Schedule K Part VI Form990ScheduleKPartVI

Field	Value	IRS element (for citing)
Identifier	Footnotes	Identifier
Return Reference	Schedule K	ReturnReference
Explanation	Schedule K, part I, Line A, Column F Purpose of Bond-The Bond issue of 6/29/2006 was used to currently refund the 1996A, 1996B and 1996C series bonds and to provide capital for hospital improvements and equipment purchases. Schedule K, Part II, Line 3 Total proceeds of Issue-Includes sale proceeds of $57,502,248 plus $1,742,629 earnings on Debt Service Reserve Fund and $2,133,141 earnings on Project Fund. Schedule K, Part II, Line 11 Other Spent Proceeds includes $34,109,391 sale proceeds used to currently refund the 1996A, 1996B and 1996C bonds and $1,641,639 of earnings on the Debt Service Fund used to pay debt service on the 2006 series bonds. Schedule K, Part IV, Line 1 An arbitrage rebate calculation and yield restriction calculation were performed by a rebate analyst and it was determined that no arbitrage rebate or yield restriction liability were owed. Therefore, Form 8038-T was not required to be filed. Schedule K, Part IV, Line 5 Gross Proceeds Invested Beyond an Available Temporary Period. A portion of the proceeds received from the sale of the 2006 series bonds, and the earnings thereon, which were held in the Project Fund were not expended prior to June 29, 2009, the end of the 3 year temporary period described in Treas. Req. 1.148-2(e)(2). Those amounts were fully spent as of December 24, 2009. A yield restriction calculation waS performed by a rebate analyst on the five-year anniversary date of the issuance of the 2006 series bonds and it was determined that no yield reduction payments were owed. Schedule K, Part V While the organization does not have written procedures, the organization does have procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under application regulations.	Explanation

Schedule L IRS990ScheduleL

Field	Value	IRS element (for citing)
Total Balance Due	0	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	Digestive Specialty CareInc	NamePerson

Field	Value	IRS element (for citing)
Relationship	>35% Owner- Fayez Abboud	Relationship
Amount Of Transaction	333853	AmountOfTransaction
Description Of Transaction	GASTROENTEROLOGY SERVICES	DescriptionOfTransaction
Sharing Of Revenues	false	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifier	ExplanationExplanation
Form 990, Part I, Line 1 and PART III, LINE 1:	Upper Valley Medical Center, as a subsidiary of UVMC, serves as an integral part in achieving UVMC's mission: UVMC will strive to provide quality care that upholds the dignity of all individuals. Care will be given in a holistic manner without regard to race, religion, creed, national origin, or social status. Our health care delivery system is structured to optimize the delivery of safe, efficient, and cost-effective health care.
FORM 990, PART I, QUESTION 10:	UPPER VALLEY MEDICAL CENTER 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 III, LINE 4A: The primary exempt purpose of Upper Valley Medical Center is to provide comprehensive inpatient, outpatient, and emergency health care services to the residents of Miami and the surrounding counties. The hospital furthers its tax-exempt purpose by promoting the health of the community in many ways. See Schedule H for more information.
Form 990, PART VI, section A, QUESTION 6:	Upper Valley Medical Center has two corporate members. One member is UVMC, the parent company of the hospital. The second member is Premier Health (Premier), an Ohio nonprofit corporation, formed pursuant to the Joint Operating Agreement. UVMC has the sole authority to elect the Board of Trustees of the corporation. Premier has the general authority to operate and manage the operations of the Premier's activities of the corporation.
Form 990, PART VI, Section A,QUESTION 7A:	UVMC has the sole authority to elect the board of trustees of Upper Valley Medical Center. UVMC has the authority to remove trustees at any regular or special board meeting or by written consent. Premier Health (Premier) has the right to request that UVMC remove a trustee of UVMC or Upper Valley Medical Center if Premier has determined that such trustee is frustrating the goals and purposes of Premier Health's network. Such request shall not be unreasonably refused by UVMC.
Form 990, PART VI, Section A, QUESTION 7B:	Premier Health (Premier) as the operator of Upper Valley Medical Center (Upper Valley) develops and oversees the implementation of the strategic plan for Upper Valley, which includes (but is not limited to) such matters as location of clinical and administrative services and the consolidation of such services. UPPER VALLEY shall comply with and implement this plan and shall not take any action that materially departs from this plan without Premier's approval. UPPER VALLEY develops and submits an annual capital and operating budget to Premier for approval. UPPER VALLEY shall adopt and implement the capital and operating budget so approved and/or revised for it by Premier. UPPER VALLEY may periodically develop and submit a business plan to Premier for approval. UPPER VALLEY shall implement any business plan approved by Premier. Premier is the sole agent to negotiate all relationships with payors on behalf of UPPER VALLEY with all third party payors and alternative delivery systems including, but not limited to insurers. UPPER VALLEY 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. UPPER VALLEY 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 B, LINE 11B:	This 990 tax return and attached schedules (the return) are prepared by staff member in the Premier Health (Premier) tax department, of which Upper Valley 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 Treasurer and President of this entity. A final version of the return is sent to Ernst & Young U.S. LLP for a final review AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. At the meeting, the Vice President/Controller (or designee) of Premier shares detailed information on compensation and other key areas, as well as addresses any questions from the board of trustees, PENDING THEIR REVIEW. The 990 tax return is also shared with the Audit Committee of Premier. At the meeting, the Vice-President/Controller (or designee) of Premier shares detailed information on compensation and other key areas, as well as addresses any other questions from the committee.
Form 990, PART VI, Section B, LINE 12C:	Premier Health (Premier), of which Upper Valley Medical Center is an affiliate, requires all board members, officers, executives, and management personnel 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 with a memo sent out annually from the Chairman of the Board and Chief Executive Officer of Premier to all board members, executive directors, vice presidents, directors, purchasing department staff, authorized purchasers, medical directors, department and section chairs, and all employeed physicians. 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 memo 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 such 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 board 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 summarized by person in a word document and sent electronically to the Finance department for any necessary disclosures required on the 990 tax return.
Form 990, PART VI, SECTION B, LINE 15A & 15B:	Premier Health (Premier), of which Upper Valley 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. The report includes comparability for key executives, vice presidents, and director level positions. The independent comparability data is reviewed by the executive compensation committee on an annual basis. This committee is comprised of three members, all of which are independent. This committee reviews in detail the compensation for the Premier CEO, COO, CFO, Chief Strategy Officer, and the hospital CEOs. Other positions are reviewed at a high level for reasonableness. All the meeting minutes are documented and kept on file along with any comparability data and the consultant report. After the compensation committee reviews and approves the compensation actions, the process is audited by the internal audit department. The executive compensation committee presents the compensation actions to the Premier board annually.
Form 990, PART VI, Section C, LINE 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:	Reversal of Foundation's Net Assets included on prior year's Balance Sheet (11,136,286) Pension Adjustment 7,897,843 Equity Transfers (6,800,000) Capital Donations 150,464 Unrealized Gain/(Loss) on Investments (87,195) Change in Auxilliary Cash position (73,476) UVMC Foundation Contribution (204,249) Total (10,252,899)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
UVMC
110 N Main St Suite 500	DAYTON	OH	45402	341850683	PARENT	OH	501(c)(3)	11, I	NA	false
UVMC Foundation
3130 N COUNTY ROAD 25A	Troy	OH	45373	311581859	Foundation	OH	501(c)(3)	11, III-O	NA	false
Med-Terra Inc
110 N MAIN ST Suite 500	DAYTON	OH	45402	311232074	HOLDING CO	OH	501(c)(2)	N/A	UVMC	true
Premier Health
110 N Main St Suite 500	Dayton	OH	45402	311446699	JOA Parent	OH	501(c)(3)	11, I	NA	false
Upper Valley Professional Corp (UVPC)
110 N Main St Suite 500	DAYTON	OH	45402	311400963	Health Care	OH	501(c)(3)	9	UVMC	true
UVPC Specialists Inc
110 N Main St Suite 500	DAYTON	OH	45402	203687536	Health Care	OH	501(c)(3)	9	UVPC	true
UVMC NURSING CARE INC
110 N Main St Suite 500	DAYTON	OH	45402	311224064	NURSING HOME	OH	501(c)(3)	9	UVMC	true

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership	Controlled OrgControlledOrg
UVMC MANAGEMENT CORPORATION
110 N Main St Suite 500	DAYTON	OH	45402	311360489	MGT COMPANY	OH	UVMC	C CORP	0	0	0.00000	true
After Hours Family Care Inc
31 Stanfield Rd	Troy	OH	45373	311269483	Health Care	OH	UVPC	C Corp	0	0	0.00000	true

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	true	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	false	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	true	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	true	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	false	DividendsRelatedOrganization
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	true	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	true	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	true	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	true	SharingOfPaidEmployees
Reimbursement Paid To Other Org	true	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	true	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	true	OtherTransferToOtherOrg
Other Transfer From Other Org	true	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (18 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
Upper Valley Professional Corporation
R	2640385	Cash
Med-Terra Inc
R	7798886	Cash
UVMC
S	244000	Cash
UVMC Nursing Care Inc
S	4000000	Cash
UVMC Foundation
C	204249	Cash
Upper Valley Professional Corporation
A(IV)	24000	CASH
Upper Valley Professional Corporation
E	3000000	CASH
Upper Valley Professional Corporation
O	172604	FMV
Upper Valley Professional Corporation
Q	1926276	FMV
UVPC SPECIALISTS INC
M	104000	FMV
UVPC SPECIALISTS INC
Q	132794	FMV
Med-Terra Inc
E	3000000	FMV
Med-Terra Inc
K	1040310	FMV
Med-Terra Inc
Q	4496218	FMV
UVMC Nursing Care Inc
Q	54226	FMV
UVMC MANAGEMENT CORPORATION
M	740648	FMV
UVPC SPECIALISTS INC
R	2400000	Cash
AFTER HOURS FAMILY CARE INC
R	160000	Cash