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OUTPATIENT FACILITY EYAD MAHAYRI MD

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PHYSICIAN OFFICE CLIFFORD MAXIMO MD

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PHYSICIAN OFFICE Pt I Line 7 col(f) BAD DEBTS EXCLUDED FROM COSTS 5,264,583 Pt I Line 7g NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC HAVE BEEN INCLUDED AS UNSUBSIDIZED HEALTH SERVICES Pt II COSTS ASSOCIATED WITH COMMUNITY HEALTH NEEDS PERFORMED WITH OTHER COMMUNITY BASED ORGANIZATIONS Pt I Line 7 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt III Line 2 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt III Line 3 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt III Line 4 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt III Line 8 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt III Line 9b SEE ATTACHED SUPPLEMENTAL INFORMATION Pt V Sec B 20d SEE ATTACHED SUPPLEMENTAL INFORMATION Pt V Sec B 21 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt V Sec B 22 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt VI Line 2 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt VI Line 3 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt VI Line 4 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt VI Line 5 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt VI Line 6 SEE ATTACHED SUPPLEMENTAL INFORMATION Pt VI Line 7 OHIO X X X X false false false false false false false false false EYAD MAHAYRI MD FCCP 194173 39759 5925 239857 RAYMOND M CHOREY 217592 44052 14579 2323 14579 263967 DONALD P HUELSKAMP 134121 12029 14579 2323 14579 148473 COREY A JACKSON DO 313264 19450 4404 337118 CLIFFORD B MAXIMO MD 197578 4613 202191 JOEL LINK MD 126931 32638 5925 165494 TONY STARR DO 150596 5925 156521 COREY JACKSON DO HIGHLY COMP EMP PHYSICIAN RECRUIT X 129600 34039 false true true 34039 SOUTHEASTERN OHIO PHYSICIANS INC PARTIAL OWNERSHIP BY TRUSTEE 182655 MEDICAL SERVICES false OBGYN SPECIALISTS OF SE OHIO INC PARTIAL OWNERSHIP BY FORMER TRUSTEE 200000 MEDICAL SERVICES false JAMES KELLER MD FORMER OFFICER 29878 PROFESSIONAL SERVICES false STEPHANIE R BUXTON FAMILY MEMBER OF OFFICER 44123 EMPLOYMENT false JORDI B HARDING FAMILY MEMBER OF OFFICER 46880 EMPLOYMENT false BRENDA L GRESS FAMILY MEMBER OF TRUSTEE 40272 EMPLOYMENT false AMBER E GARBER FAMILY MEMBER OF OFFICER 47281 EMPLOYMENT false Pt VI, Line 11b FORM 990 REVIEWED BY AUDIT COMMITTEE OF BOARD BEFORE FILING. PROVIDED COPY OF FORM 990 TO ALL BOARD MEMBERS BEFORE FILING Pt VI, Line 12c TRUSTEES COMPLETE ANNUAL DISCLOSURE STATEMENT DISCLOSING ALL CONFLICTS Pt VI, Line 15b EXECUTIVE COMMITTEE OF BOARD OF TRUSTEES PERFORMS COMPENSATION STUDY OF MANAGEMENT POSITIONS Pt XI NET BOOK VALUE TRANSFERRED FROM SUPERIOR MED INC 960,977 CHANGE IN PENSION LIABILITY (3,356,076) Pt XI TRANSFER TO SUPERIOR MED INC (1,290,000) Pt III, Line 2 ON JULY 24, 2012 SUPERIOR MED INC CONVERTED FROM A FOR-PROFIT Pt III, Line 2 C-CORPORATION SUBJECT TO INCOME TAX TO A SECTION 501(C)(3) Pt III, Line 2 TAX-EXEMPT ORGANIZATION KNOWN AS SUPERIOR MED LLC, WITH Pt III, Line 2 SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER INC AS ITS SOLE MEMBER. Pt III, Line 2 SUPERIOR MED LLC IS A DISREGARDED ENTITY FOR TAX PURPOSES Pt III, Line 2 AND ITS ACTIVITY IS REPORTED ON THE FORM 990 OF SOUTHEASTERN Pt III, Line 2 OHIO REGIONAL MEDICAL CENTER INC. SUPERIOR MED LLC OPERATES Pt III, Line 2 PHYSICIAN OFFICES IN THE COMMUNITY SERVED BY SOUTHEASTERN Pt III, Line 2 OHIO REGIONAL MEDICAL CENTER, INC. Pt VI, Line 15a EXECUTIVE COMMITTEE OF BOARD OF TRUSTEES PERFORMS COMPENSATION STUDY OF MANAGEMENT POSITIONS Form 990, Part IX, Line 24f LICENSES & FEES FOOD PURCHASES SUNDRY BOOKS & SUBSCRIPTIONS DUES & MEMBERSHIPS SUPERIOR MED LLC 1341 CLARK STREET CAMBRIDGE OH 43725 311311881 PHYSICIAN OFFICES OH 5048295 1989569 SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER INC GUERNSEY HEALTH SYSTEMS 1341 CLARK STREET CAMBRIDGE OH 43725 311148352 MANAGEMENT & FUND RAISING OH 501(C)3 11 TYPE II NA false SOUTHEASTERN HOME CARE LLC 1700 EDISON DRIVE MILFORD OH 45150 271219638 HOME HEALTH SERVICES OH NA RELATED 56877 348017 false false 0.33000 GUERNSEY HEALTH ENTERPRISES INC 1341 CLARK STREET CAMBRIDGE OH 43725 311191428 AMBULANCE SERVICE OH GUERNSEY HEALTH SYSTEMS C 0.00000 false UNITED AMBULANCE SERVICE OF CAMBRIDGE INC 1341 CLARK STREET CAMBRIDGE OH 43725 311086097 AMBULANCE SERVICE OH GUERNSEY HEALTH SYSTEMS C 0.00000 false SUPERIOR MED INC 1341 CLARK STREET CAMBRIDGE OH 43725 311311881 PHYSICIAN OFFICES OH GUERNSEY HEALTH SYSTEMS C 0.00000 false false true false true true false false false false true true true true true true false true false true SUPERIOR MED INC b 1290000 CASH PAID SUPERIOR MED INC s 960977 NBV OF ASSETS TRANSFERRED GUERNSEY HEALTH SYSTEMS d 102669 CASH OWED GUERNSEY HEALTH ENTERPRISES INC d 3671 CASH OWED GUERNSEY HEALTH SYSTEMS e 12785000 LOANS GUARANTEED GUERNSEY HEALTH SYSTEMS k 248961 SUPERIOR MED INC j 12670 GUERNSEY HEALTH ENTERPRISES INC l 50400 GUERNSEY HEALTH SYSTEMS m 1500000 GUERNSEY HEALTH SYSTEMS n 100000 GUERNSEY HEALTH SYSTEMS o 904043 SUPERIOR MED INC q 51083