2013-11-12T16:17:21-06:00 2012-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIR 2600 INDIANAPOLIS IN 46204 990 2012-01-01 310537504 Miami Valley Hospital % J MICHAEL SIMS MIAM 9374999942 110 N MAIN ST Suite 500 Dayton OH 45402 SCOTT A SHELTON 9374999942 2013-11-11 true 3176817000 2012 2016-02-25 16:41:14Z Bobbie Gerhart 110 N MAIN ST SUITE 500 DAYTON OH 45402 1606310949 false X WWW.PREMIERHEALTH.COM X 1890 OH MIAMI VALLEY HOSPITAL WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-EFFECTIVE HEALTH CARE SERVICES. 14 10 7622 967 0 1299919 2675858 811320920 835144825 12174810 27250377 14005077 17225886 838800726 882296946 9198113 5913883 0 0 369823871 384995078 0 0 0 406178191 419188073 785200175 810097034 53600551 72199912 1359305439 1384625214 737842571 771936176 621462868 612689038 MIAMI VALLEY HOSPITAL WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-EFFECTIVE HEALTH CARE SERVICES. false false 704537261 5913883 835144825 PLEASE REFER TO SCHEDULE H. 704537261 true true false true false false false false false false 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 true false true false false false false true true true true false false true 455 0 true 7622 true false false false false false false false false false false X 14 10 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 ANITA J MOORE 0.5 0.0 X X 0 0 0 JAMES M PACENTA MD 0.5 39.5 X 0 663331 42568 ANGELA CLEMENTS CPA 0.5 0.0 X 0 0 0 CHRISTOPHER CROOM MD 0.5 39.5 X 0 663340 35490 WILLIAM L GILLISPIE 0.5 0.0 X 0 0 0 DAVID W KEY MD 0.5 0.0 X 3000 0 0 MARY C NUTTER 0.5 0.0 X 0 0 0 SR RABBI DAVID SOFIAN 0.5 0.0 X 0 0 0 JAMES J MURPHY MD 0.5 0.0 X 0 0 0 CHRISTOPHER DANIS MD 0.5 39.5 X 0 433190 18050 MARC BELCASTRO 0.5 0.0 X 0 0 0 JACK LOHBECK 0.5 0.0 X 0 0 0 JAMES R PANCOAST 0.5 39.5 X 0 3797846 61777 BOBBIE L GERHART 40.0 0.0 X X 730837 0 44385 REV DR BRODIE MATHIS 0.5 0.0 X 0 0 0 WILLIAM C WILSON MD 0.5 0.0 X 0 0 0 GEOFFREY P WALKER 40.0 0.0 X 279662 0 48633 BARBARA A JOHNSON 40.0 0.0 X 526300 0 14763 SCOTT A SHELTON 40.0 0.0 X 300630 0 28302 MARY M CLANCY 8.0 32.0 X 482163 0 39747 DALE E CREECH 7.75 32.25 X 598155 0 56953 RENEE P GEORGE 8.0 32.0 X 276674 0 34514 WILLIAM E LINESCH 8.0 32.0 X 445854 0 38785 MARK W SHAW 8.0 32.0 X 403205 0 57358 MARK S SHAKER 8.0 32.0 X 746571 0 33540 MICHAEL MAIBERGER 8.0 32.0 X 0 569067 75958 ROBERT M BOWMAN 40.0 0.0 X 259529 0 43941 KIMBERLY A HENSLEY 40.0 0.0 X 163642 0 26039 JOANN R RINGER 40.0 0.0 X 306997 0 30537 DEBORAH A MALS 40.0 0.0 X 340340 0 45295 TAMMY S LUNDSTROM 40.0 0.0 X 432277 0 0 ANN M SCHUERMAN 40.0 0.0 X 353263 0 47920 GARY S COLLIER 40.0 0.0 X 397868 0 54859 MICHAEL A OCONNELL 40.0 0.0 X 556121 0 25757 MOLLY J HALL 40.0 0.0 X 432732 0 31067 J NICK LAIR 40.0 0.0 X 311474 0 45151 DIANE L PLEIMAN 40.0 0.0 X 263730 0 26649 8611024 6126774 1008038 222 true true false COMPUNET CLINICAL LABORATORIES 2308 SANDRIDGE DR MORAINE OH 45349 CLINICAL LAB 23822177 ANESTHESIOLOGY SERVICES NETWORK PO BOX 349 DAYTON OH 45409 Medical Services 7510120 MIAMI VALLEY EMERGENCY SPECIALISTS 35 MILLARD CT SPRINGBORO OH 45066 Medical Services 4920660 DAWSON HEALTHCARE 3650 OLENTANGY RIVER RD 450 COLUMBUS OH 43214 AGENCY STAFF 2611740 WRIGHT STATE PHYSICIANS 128 E APPLE ST DAYTON OH 45409 MEDICAL SERVICES 2257929 69 2675858 2675858 NET PATIENT REVENUE 900099 419929434 419929434 MEDICARE/MEDICAID 900099 379936154 379936154 HOSPITAL FRANCHISE TAX RECOVERIES 900099 27863000 27863000 JOINT OPERATING AGREEMENT 900099 6605000 6605000 DENTAL CLINIC 900099 132281 132281 678956 678956 835144825 5547561 5547561 0 0 4031427 2747315 1284112 0 1284112 1284112 742529825 719581853 1245156 22947972 -1245156 21702816 21702816 0 0 3871419 439679 3431740 3431740 CAFETERIA SALES 900099 5919927 5919927 PARKING GARAGE 812930 1883543 1883543 JOINT VENTURE 900099 288959 288959 4417605 4417605 12510034 882296946 835144825 44476263 5913883 5913883 0 0 0 6403351 5456298 947053 0 0 295025546 251391268 43634278 21734034 18519570 3214464 40834098 34794735 6039363 20998049 17892438 3105611 236090 201172 34918 1353215 1153075 200140 395510 395510 48142 48142 0 1205533 1205533 37005756 37005756 3362703 3362703 4988834 4250985 737849 12999661 11077011 1922650 0 14627738 12464296 2163442 694412 591708 102704 0 10836 9233 1603 12968553 12968553 0 72890309 62109832 10780477 8511884 7252976 1258908 OPERATING SUPPLIES 139223128 139223128 PURCHASED SERVICES 59806157 50960826 8845331 LOSS ON EXTINGUISHMENT 18034384 18034384 HOSPITAL FRANCHISE TAX 10976989 10976989 19848239 16912684 2935555 810097034 704537261 105559773 0 28522 30351 34142664 19703994 0 0 113070876 139987178 0 0 0 0 9003284 7097941 6175831 6136215 8232457 9700599 1234925639 563154035 637899537 671771604 402756902 268900915 63993890 190583524 0 0 25919184 24735557 58082292 45977336 1359305439 1384625214 85784199 82730168 1592084 571795 1218263 1304271 418612767 430412394 0 0 0 0 4208750 6009302 0 0 226426508 250908246 737842571 771936176 X 621462868 612689038 0 0 0 0 621462868 612689038 1359305439 1384625214 X 72199912 11410067 -92383809 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 34912 false false true 13230 48142 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. 37033673 37033673 669334504 291408260 377926244 1981595 1303089 678506 472116091 270442686 201673405 54459776 54459776 671771604 ALTERNATE INVESTMENTS 190583524 190583524 0 PENSION OBLIGATION 176559688 MALPRACTICE INSURANCE 26524221 SWAP LIABILITY 25000094 LOAN GUARANTEE & OTHER LTL 8291299 RESIDENT FICA REFUND PAYABLE 5256490 CONTRACTOR RETAINAGE RESERVE 3331889 HOSPITAL FRANCHISE TAX PAYABLE 2921816 WORKERS COMP RESERVE 1459696 WRIGHT STATE NEUROSCIENCE 800000 OTHER 763053 250908246 X Schedule D, Part X, Line 2: Miami Valley Hospital (MVH) is a member, under a joint operating agreement, of Premier Health Partners 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. MVH 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: MVHE, Inc. and Premier Health Specialists, Inc. (subsidiaries of MedAmerica Health Systems Corp.) Central America and the Caribbean Investments 88118000 Central America and the Caribbean Program Services Insurance 45000 88163000 88163000 false false false false false false true true X true X true X true true false true true 47355000 12998000 34357000 0.04240 153709000 134430000 19279000 0.02380 6999000 5515000 1484000 0.00180 208063000 152943000 55120000 0.06800 5328000 5328000 0.00660 25024000 20590000 4434000 0.00550 15367000 15367000 0.01900 115000 115000 0.00010 45834000 20590000 25244000 0.03120 253897000 173533000 80364000 0.09920 1018000 1018000 0.00130 1018000 1018000 0.00130 true 16013000 0 142452000 164590000 -22138000 X true true 1 1 MIAMI VALLEY HOSPITAL

ONE WYOMING ST DAYTON OH 45409

WWW.PREMIERHEALTH.COM X X X X X 1 Miami Valley Hospital 1 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 2 Dialysis Centers of Dayton LLC

136 South Ludlow St Suite 500 Dayton OH 45402

Dialysis Treatment Lincoln Park Manor

694 Isaac Prugh Way Kettering OH 45429

Assisted Living Part I, Line 6a: The community benefit report for Miami Valley Hospital is part of the Premier Health report. 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: Miami Valley Hospital (MVH) provides the following subsidized service: Emergency Services: MVH 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 2012, the amount paid for call and subsidies was $15,367,000. 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 Medicare programs. In addition to the amounts reported on Line 5, 6, and 7, the organization received revenue of $96,912,000 and incurred cost of $134,062,000, for an additional net shortfall of $37,150,000 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) 142,452,000 Medicare revenue not reported in Part III, Section B 96,912,000 Total Medicare associated revenue 239,364,000 Allowable Medicare cost per Medicare Cost Report (Part III, Section B) 164,590,000 Medicare cost not reported in Part III, Section B 134,062,000 Total Medicare associated cost 298,652,000 Medicare shortfall per Part III, Section B 22,138,000 Additional shortfall not included in Part III, Section B 37,150,000 Total Medicare shortfall 59,288,000 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 39% 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 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 16: The hospital does not impose extraordinary collection actions such as wage garnishments, liens on primary residences, or other legal actions for any patient without first making reasonable efforts to determine whether the patient is eligible for charity care under its financial assistance policy. 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 hospital 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. PART V, SECTION B, LINE 17: No extraordinary collection actions are permitted until after first making reasonable efforts to determine whether the patient is eligible for charity care under the financial assistance policy. PART V, SECTION B, LINE 18: Before initiating collections actions, the hospital notifies self-pay patients of its financial assistance policy. Notices of the policy are publicized in the patients' bills and are also posted in the emergenc true THE DAYTON FOUNDATION 409 E Monument Ave 102 DAYTON OH 45402 310627287 501(C)(3) 3949289 VARIOUS PREMIER COMMUNITY HEALTH 23 JASPER ST DAYTON OH 45409 311122883 501(C)(3) 378000 COMMUNITY HEALTH CITY OF DAYTON 335 W THIRD ST DAYTON OH 45402 316000175 GOVERNMENT 200040 GOOD NEIGHBOR POLICE PROGRAM REACH OUT MONTGOMERY COUNTY 25 E FORAKER ST DAYTON OH 45409 311434282 501(C)(3) 180113 RX ASSISTANCE FOR INDIGENT PATIENTS UNITED WAY GREATER DAYTON AREA 33 W FIRST ST 500 DAYTON OH 45402 310536658 501(C)(3) 138215 CORPORATE PLEDGE AMERICAN HEART ASSOCIATION 5211 MADISON RD CINCINNATI OH 45227 135613797 501(C)(3) 119580 SPONSORSHIP GOOD NEIGHBOR HOUSE 844 S PATERSON BLVD DAYTON OH 45402 311374154 501(C)(3) 45417 ANNUAL PLEDGE MIAMI VALLEY HOSPITAL FOUNDATION ONE WYOMING ST DAYTON OH 45409 311040231 501(C)(3) 39865 HEALTH PROMOTION SALVATION ARMY 1000 N KEOWEE ST DAYTON OH 45404 135562351 501(C)(3) 39852 SUPPORT DOWNTOWN DAYTON PARTNERSHIP 10 W SECOND ST 611 DAYTON OH 45402 341722175 501(C)(3) 32000 SUPPORT AIDS RESOURCE CENTER OHIO 15 W FOURTH ST 200 DAYTON OH 45402 311126780 501(C)(3) 26600 AFRICAN AMERICAN OUTREACH DAYTON MONTGOMERY COUNTY 500 KETTERING TOWER DAYTON OH 45423 311358532 501(C)(3) 25990 ANNUAL PLEDGE ATRIUM MEDICAL CENTER FOUNDATION 110 N MAIN ST SUITE 500 DAYTON OH 45402 311079213 501(C)(3) 25360 SUPPORT CENTRAL STATE UNIVERSITY FOUNDATION PO BOX 1004 WIBERFORCE OH 45384 310749885 501(C)(3) 25000 SPONSORSHIP DAYTON PHILHARMONIC ORCHESTRA 109 N MAIN ST 200 DAYTON OH 45402 316000101 501(C)(3) 23425 SPONSORSHIP CITYWIDE DEVELOPMENT CORP 8 N MAIN ST DAYTON OH 45402 310821189 501(C)(3) 19200 GENESIS PROJECT DOWNTOWN DAYTON GOODWILL EASTER SEALS 1511 KUNTZ RD DAYTON OH 45404 310537112 501(C)(3) 15995 CAR SEAT PROGRAM DAYTON CONTEMPORARY DANCE COMPANY 840 GERMANTOWN ST DAYTON OH 45402 237220259 501(C)(3) 11710 SPONSORSHIP HEALTH PARTNERS FREE CLINIC 1300 N CO RD 25A TROY OH 45373 311596731 501(C)(3) 10940 SUPPORT PARITY INC 907 W 5TH ST DAYTON OH 45402 311345623 501(C)(3) 10470 SUPPORT DAYTON OPERA ASSOCIATION 138 N MAIN ST DAYTON OH 45402 310643964 501(C)(3) 9800 ANNUAL PLEDGE GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON 110 N MAIN ST SUITE 500 DAYTON OH 45402 237296923 501(C)(3) 9380 SUPPORT DAYTON ART INSTITUTE 456 BELMONTE PK N DAYTON OH 45405 310537480 501(C)(3) 9189 SPONSORSHIP MARCH OF DIMES FOUNDATION 1275 MAMARONECK AVE WHITE PLAINS NY 10605 131846366 501(c)(3) 8980 PRESENTING SPONSOR DEVELOPMENT UVMC FOUNDATION 3130 NORTH COUNTY ROAD 25A TROY OH 45373 311581859 501(c)(3) 7470 SUPPORT AMERICAN RED CROSS 370 W FIRST ST DAYTON OH 45402 310537493 501(C)(3) 7420 SPONSORSHIP CITIZENS FOR GOOD LIBRARIES 266 BAINBRIDGE ST DAYTON OH 45402 311660503 7350 SUPPORT BRUKNER NATURE CENTER 5995 HORSESHOE BEND RD TROY OH 45373 310732613 501(C)(3) 6960 SUPPORT COUNTRYSIDE YMCA 1699 DEERFIELD RD LEBANON OH 45036 510181689 501(C)(3) 6890 SUPPORT UNIVERSITY OF DAYTON 300 COLLEGE PK DAYTON OH 45469 310536715 501(C)(3) 6705 SUPPORT AIR FORCE BASE MUSEUM FOUNDATION 1100 SPAATZ ST DAYTON OH 45433 310668800 501(C)(3) 6490 SUPPORT CHAMINADE-JULIENNE HIGH SCHOOL 505 S LUDLOW ST DAYTON OH 45402 310832408 501(C)(3) 6195 SUPPORT DAYBREAK 605 S PATTERSON BLVD DAYTON OH 45420 310864474 501(C)(3) 6155 ANNUAL PLEDGE HOSPICE OF DAYTON FOUNDATION 324 WILMINGTON AVE DAYTON OH 45420 310933339 501(C)(3) 6125 SUPPORT CULTURE WORKS 126 N MAIN ST 220 DAYTON OH 45402 237412338 501(C)(3) 6002 ANNUAL CAMPAIGN CITY FOLK FESTIVAL 126 N MAIN ST 220 DAYTON OH 45402 311030297 501(C)(3) 5900 SPONSORSHIP YWCA 141 W THIRD ST DAYTON OH 45402 310537168 501(C)(3) 5756 SUPPORT HOSPICE OF MIAMI COUNTY PO BOX 502 TROY OH 45373 311031277 501(C)(3) 5470 SUPPORT DAYTON BALLET ASSOCIATION 140 N MAIN ST DAYTON OH 45402 310734587 501(C)(3) 5053 SUPPORT 38 1 SCHEDULE I, part I, Line 2: 1) Community benefits budgeted allocations are approved by the Miami Valley Hospital Board annually. 2) Invoices are received in Accounts Payable upon appropriate approval for payment. 3) Disbursements occur according to standard Accounts Payable guidelines. X X X X true true false false false true true false false JAMES M PACENTA MD 0 656881 0 0 0 6450 0 17598 0 24970 0 705899 0 0 CHRISTOPHER CROOM MD 0 560489 0 100000 0 2851 0 14049 0 21441 0 698830 0 0 CHRISTOPHER DANIS MD 0 368190 0 65000 0 0 0 5336 0 12714 0 451240 0 0 JAMES R PANCOAST 0 896436 0 434586 0 2466824 0 32011 0 29766 0 3859623 0 0 GEOFFREY P WALKER 205906 0 66783 0 6973 0 26013 0 22620 0 328295 0 5466 0 BOBBIE L GERHART 478426 0 182353 0 70058 0 32600 0 11785 0 775222 0 60189 0 BARBARA A JOHNSON 333901 0 182425 0 9974 0 4747 0 10016 0 541063 0 5206 0 SCOTT A SHELTON 228808 0 69243 0 2579 0 24514 0 3788 0 328932 0 0 0 MARY M CLANCY 326023 0 115798 0 40342 0 25126 0 14621 0 521910 0 37243 0 DALE E CREECH 359156 0 110992 0 128007 0 32434 0 24519 0 655108 0 123092 0 RENEE P GEORGE 215265 0 60657 0 752 0 8225 0 26289 0 311188 0 0 0 WILLIAM E LINESCH 313022 0 92384 0 40448 0 31351 0 7434 0 484639 0 31031 0 MARK W SHAW 255582 0 87080 0 60543 0 33040 0 24318 0 460563 0 52525 0 MARK S SHAKER 424644 0 163966 0 157961 0 28111 0 5429 0 780111 0 153170 0 MICHAEL MAIBERGER 0 266440 0 146051 0 156576 0 45625 0 30333 0 645025 0 0 J NICK LAIR 211273 0 88664 0 11537 0 21775 0 23376 0 356625 0 10733 0 ROBERT M BOWMAN 183792 0 74486 0 1251 0 19448 0 24493 0 303470 0 0 0 KIMBERLY A HENSLEY 140529 0 22476 0 637 0 14257 0 11782 0 189681 0 0 0 TAMMY S LUNDSTROM 430210 0 0 0 2067 0 0 0 0 0 432277 0 0 0 ANN M SCHUERMAN 240548 0 70494 0 42221 0 37380 0 10540 0 401183 0 33620 0 GARY S COLLIER 277093 0 70189 0 50586 0 33324 0 21535 0 452727 0 45287 0 JOANN R RINGER 207695 0 97833 0 1469 0 27496 0 3041 0 337534 0 0 0 DEBORAH A MALS 232845 0 83763 0 23732 0 31346 0 13949 0 385635 0 17949 0 MICHAEL A OCONNELL 188796 0 183443 0 183882 0 22448 0 3309 0 581878 0 0 0 MOLLY J HALL 315008 0 111240 0 6484 0 8428 0 22639 0 463799 0 0 0 DIANE L PLEIMAN 197868 0 60041 0 5821 0 20032 0 6617 0 290379 0 4632 0 Part I, Line 4A: MICHAEL A. OCONNELL RECEIVED SEVERANCE PAYMENTS OF $182,000. 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, MIAMI VALLEY HOSPITAL (MVH), COMPENSATES FOR THIS LIMITATION AND SUPPLEMENTS THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. MVH SUPPLEMENTS THE AFFECTED EXECUTIVES 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 2012. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2012: GARY COLLIER $45,287; DALE CREECH $123,092; BARBARA JOHNSON $5,206; NICK LAIR $10,733; WILLIAM LINESCH $31,031; MARY CLANCY $37,243; DEBORAH MALS $17,949; DIANE PLEIMAN $4,632; MARK SHAKER $153,170; MARK SHAW $52,525; ANN SCHUERMAN $33,620; BOBBIE GERHART $60,189; GEOFFREY WALKER $5,466. The individuals listed below have met the multi-year vesting requirement under the SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2012: JIM PANCOAST $2,450,555; MICHAEL MAIBERGER $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. PART I, LINE 6A AND 6B: PREMIER HEALTH (PREMIER), WHICH MIAMI VALLEY HOSPITAL 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 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 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. A COUNTY OF MONTGOMERY OH 316000172 613549GP3 2008-11-13 234895988 SEE PART VI - Note A false false false B COUNTY OF MONTGOMERY OH 316000172 613549GZ1 2009-02-24 126463824 SEE PART VI - Note B false false false C COUNTY OF MONTGOMERY OH 316000172 613549JL9 2011-04-12 106431124 SEE PART VI - Note C false false false D COUNTY OF MONTGOMERY OH 316000172 613549JX3 2011-04-26 85000000 SEE PART VI - Note C false false false A 137865000 0 234895988 0 3249201 0 2119000 0 0 34304034 0 347077 2010 true false true true B 115000000 0 126463824 0 5940580 0 2293824 0 0 0 0 0 2010 true false true true C 585000 0 106431124 0 1804070 0 1203000 0 0 105228124 0 0 2010 false false true true D 0 0 85000000 0 20306 0 727500 0 0 84272500 0 1 2010 false false true true A false true true true true true 0.00777 0.00000 0.00777 false false false true B false true true true true true 0.00777 0.00000 0.00777 false false false true C false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true D false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true A true true true MERRILL LYNCH true true false 0 false B false false true false false false 0 false 0 false C false false true false false true BARCLAYSWELLS FARGO 24. true false false 0 false D false false true false true true BARCLAYSWELLS FARGO 33.5 true false false 0 false A true B true C true D true Note A, PART 1, LINE A, COLUMN F: 0 REFUND MIAMI VALLEY HOSPITAL BOND SERIES 1992B, 1998A, 2003A, 2003B, & 2003C, AND TO PROVIDE FUNDS TO CONSTRUCT THE SOUTH EAST TOWER ON THE HOSPITAL'S CAMPUS. Note B, PART 1, LINE B, COLUMN F: 0 REFUND PORTION OF MIAMI VALLEY HOSPITAL SERIES 2008A AND 2008B BONDS. Note C, PART 1, LINE C & D, COLUMN F: 0 PROVIDE FUNDS TO CONSTRUCT THE SOUTH EAST TOWER ON THE HOSPITAL'S CAMPUS. A COUNTY OF MONTGOMERY OH 316000172 2012-11-20 79830687 SEE PART VI - Note D false false false B COUNTY OF MONTGOMERY OH 316000172 2012-11-20 48433796 SEE PART VI - Note D false false false A 0 0 79830687 0 226646 0 169313 0 0 0 0 0 2010 true false true true B 0 0 48433796 0 143001 0 206204 0 0 0 0 24776 2010 true false true true A false true true true true true 0.00777 0.00000 0.00777 false false false true B false true true true true true 0.00777 0.00000 0.00777 false false false true A false true false false true true PNC 27. true false false 0 false true B false true false false true true DEUTSCHE BANK AG 27. true false false 0 false true A true B true Note D, PART 1, LINE A & B, COLUMN F: 0 REFUND MIAMI VALLEY HOSPITAL SERIES 2009A BONDS. CHRISTOPHER DANIS DIRECTOR 290854 SEE SCHEDULE L PART V SCOTT SHELTON OFFICER 23822177 SEE SCHEDULE L PART V Diane Pleiman FORMER KEY EMPLOYEE 23822177 SEE SCHEDULE L PART V Schedule L - Part IV: Christopher Danis, M.D. was a 25% owner in Hand & Reconstructive Surgeons. Premier Health Specialists (PHS), which is wholly owned by MedAmerica Health Systems (MAHS) completed an asset purchase of Hand & Reconstructive Surgeons in June 2012, which included placing the physicians on PHS's payroll. Prior to the purchase, MVH contracted with Hand & Reconstructive Surgeons to provide medical services. After the asset purchase, the Hand & Reconstructive Surgeons contract was assigned to PHS. 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 Hand & Reconstructive Surgeons in 2012, including the asset purchase price, was $290,854. Miami Valley Hospital contracts with Compunet for the provision of laboratory services. Scott Shelton and Diane Pleiman are board members of Compunet Clinical Lab. In addition, Scott Shelton is the Chief Financial Officer of Miami Valley Hospital, and Diane Pleiman is a FORMER key employee of Miami Valley Hospital. Compunet is owned 33% by MVHE, Inc., which is a related organization of Miami Valley Hospital. The amounts paid under this contract are competitive and the transaction is at arms-length. The total amount paid in 2012 was $23,822,177. 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 MIAMI VALLEY HOSPITAL (MVH) DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR MVH, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. MVH SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. MVH DEVELOPS AND SUBMITS AN ANNUAL CAPITAL AND OPERATING BUDGET TO PREMIER FOR APPROVAL. MVH SHALL ADOPT AND IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. MVH PERIODICALLY DEVELOPS AND SUBMITS A BUSINESS PLAN TO PREMIER FOR APPROVAL. MVH SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF MVH WITH ALL THIRD PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. MVH 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. MVH 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: MIAMI VALLEY HOSPITAL HAS TWO CORPORATE MEMBERS. ONE MEMBER IS MEDAMERICA 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. MEDAMERICA 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: MEDAMERICA HEALTH SYSTEMS (MAHS) HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR MIAMI VALLEY HOSPITAL (MVH). MAHS HAS THE AUTHORITY TO REMOVE TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. PREMIER HEALTH (PREMIER) HAS THE RIGHT TO REQUEST THAT MAHS REMOVE A TRUSTEE OF THE MAHS OR MVH 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 MAHS. 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 MIAMI VALLEY HOSPITAL 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 THE MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESS ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 TAX RETURN IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. AT THE 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 COMMITTEE. FORM 990, PART VI, SECTION B, QUESTION 12C: PREMIER HEALTH (PREMIER), OF WHICH MIAMI VALLEY HOSPITAL 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 SECTIONS CHAIRS, AND ALL EMPLOYED PHYSICIANS. IT 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 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 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, QUESTION 15A AND 15B: PREMIER HEALTH, OF WHICH MIAMI VALLEY HOSPITAL IS AN AFFILIATE, FOLLOWS A MARKET BASED COMPENSATION PHILOSOPHY DESIGNED TO ATTRACT AND RETAIN THE EXECUTIVE TALENT REQUIRED TO MEET THE HIGH PERFORMANCE STANDARDS OF OUR BOARD AND OUR COMMUNITY. PREMIER ANNUALLY REVIEWS EXECUTIVE COMPENSATION SURVEY DATA FOR A REGIONAL PEER GROUP OF SYSTEMS AND HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO PREMIER AND ITS AFFILIATES. THE DATA FOR THE SURVEY IS PROVIDED BY A THIRD PARTY CONSULTANT GROUP THAT IS INDEPENDENT OF PREMIER. THIS REPORT INCLUDES COMPARABILITY FOR KEY EXECUTIVES, VICE PRESIDENTS, AND DIRECTOR LEVEL POSITIONS. THE INDEPENDENT COMPARABILITY DATA IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THIS COMMITTEE IS COMPRISED OF THREE MEMBERS, ALL OF WHICH ARE INDEPENDENT. THIS COMMITTEE REVIEWS IN DETAIL THE COMPENSATION FOR THE PREMIER CEO, COO, CFO, CHIEF STRATEGY OFFICER, AND THE HOSPITAL CEOS. OTHER POSITIONS ARE REVIEWED AT A HIGH LEVEL FOR REASONABLENESS. ALL THE MEETING MINUTES ARE DOCUMENTED AND KEPT ON FILE ALONG WITH ANY COMPARABILITY DATA AND THE CONSULTANT REPORT. AFTER THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION ACTIONS, THE PROCESS IS AUDITED BY THE INTERNAL AUDIT DEPARTMENT. THE EXECUTIVE COMPENSATION COMMITTEE PRESENTS THE COMPENSATION ACTIONS TO THE PREMIER BOARD ANNUALLY. FORM 990, PART VI, SECTION C, QUESTION 19: THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC WHEN REQUIRED BY LAW OR FOR ACCREDITATION PURPOSES. THE CONFLICT OF INTEREST POLICY IS AVAILABLE ON THE COMPANY WEBSITE. FORM 990, PART XI, LINE 9: Pension Adjustment (41,901,354) Equity Transfers (30,990,776) Premier Plaza Transfer (18,855,137) Swap Amortization (181,708) Capital Donation 133,034 Dayton Development Adj 1,651,347 Funding from Foundation (2,239,211) Other (4) Total (92,383,809) DIALYSIS CENTERS OF DAYTON LLC 110 N MAIN ST SUITE 500 DAYTON OH 45402 311607686 DIALYSIS OH 3682488 29157440 MVH PREMIER HEALTH 110 N MAIN ST SUITE 500 DAYTON OH 45402 311446699 SUPPRTG. ORG. OH 501(C)(3) 11-1 NA false MEDAMERICA HEALTH SYSTEMS CORP (MAHS) 110 N MAIN ST SUITE 500 DAYTON OH 45402 311040228 PARENT OH 501(C)(3) 11-1 NA false MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST SUITE 500 DAYTON OH 45402 311040231 Foundation OH 501(C)(3) 7 MAHS true PREMIER COMMUNITY HEALTH 601 W RIVERVIEW AVE DAYTON OH 45406 311122883 Health Educat OH 501(C)(3) 7 MAHS true FIDELITY HEALTH CARE 3832 KETTERING BLVD DAYTON OH 45439 311075381 HOME HEALTH OH 501(C)(3) 9 MAHS true Premier Plaza LLC 110 N Main St Suite 500 Dayton OH 45402 800708185 Holding Company OH MAHS Excluded 78190 228603 false false 0.01000 MVHE INC 110 N MAIN ST SUITE 500 DAYTON OH 45402 311185270 PHYS SVCS OH MAHS CORPORATION 0 0 0.00000 true PREMIER HEALTH SPECIALISTS INC 110 N MAIN ST SUITE 500 DAYTON OH 45402 061744704 PHYS SVCS OH MAHS CORPORATION 0 0 0.00000 true true true true false false true true false true false false true false true true true true true PREMIER PLAZA LLC A-IV 833812 FMV MIAMI VALLEY HOSPITAL FOUNDATION C 2808892 CASH MIAMI VALLEY HOSPITAL FOUNDATION Q 733897 FMV Premier Health Specialists Inc G 459362 FMV Premier Health Specialists Inc H 980309 FMV Premier Health Specialists Inc J 75435 FMV Premier Health Specialists Inc M 2272703 FMV Premier Health Specialists Inc O 233016 FMV Premier Health Specialists Inc Q 6326491 FMV Premier Health Specialists Inc R 8120000 FMV MVHE INC J 55308 FMV MVHE INC M 153796 FMV MVHE INC O 257244 FMV MVHE INC Q 5449927 FMV MVHE INC R 2360699 FMV MVHE INC A-IV 30932 FMV PREMIER COMMUNITY HEALTH R 378000 FMV MEDAMERICA HEALTH SYSTEMS R 18896500 FMV