GOOD SAMARITAN HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: GOOD SAMARITAN HOSPITAL (EIN 31-0536981)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-11-12
IRS object ID: 201343169349304934
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 O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-11-12T15:06:43-06:00	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 ST 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	310536981	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of Name	% J MICHAEL SIMS	InCareOfName
Name Control	GOOD	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	VP-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)
Name Of Principal Officer Person	Eloise Broner PresidentCEO	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	2222 PHILADELPHIA DR	AddressLine1
City	DAYTON	City
State	OH	State
ZIP Code	45406	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	404069437	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Group Exemption Number	0928	GroupExemptionNumber
Organization501c3	X	Organization501c3
Web Site	www.premierhealth.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1932	YearFormation
State Legal Domicile	OH	StateLegalDomicile
Activity Or Mission Description	GOOD SAMARITAN HOSPITAL IS COMMITTED TO BUILDING A HEALTHIER DAYTON, OHIO COMMUNITY THROUGH HIGH QUALITY, COST COMPETITVE HEALTH CARE.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	11	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	8	NbrIndependentVotingMembers
Total Nbr Employees	3304	TotalNbrEmployees
Total Nbr Volunteers	342	TotalNbrVolunteers
Total Gross UBI	1596918	TotalGrossUBI
Net Unrelated Business Txbl Income	-181300	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1806863	ContributionsGrantsPriorYear
Contributions Grants Current Year	1420927	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	371970759	ProgramServiceRevenuePriorYear
Program Service Revenue CY	361936801	ProgramServiceRevenueCY
Investment Income Prior Year	5480315	InvestmentIncomePriorYear
Investment Income Current Year	10831758	InvestmentIncomeCurrentYear
Other Revenue Prior Year	3662966	OtherRevenuePriorYear
Other Revenue Current Year	4184823	OtherRevenueCurrentYear
Total Revenue Prior Year	382920903	TotalRevenuePriorYear
Total Revenue Current Year	378374309	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	2570355	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	2406279	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	175360527	SalariesEtcPriorYear
Salaries Etc Current Year	177459287	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	185079996	OtherExpensePriorYear
Other Expenses Current Year	179144548	OtherExpensesCurrentYear
Total Expenses Prior Year	363010878	TotalExpensesPriorYear
Total Expenses Current Year	359010114	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	19910025	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	19364195	RevenuesLessExpensesCY
Total Assets BOY	491563235	TotalAssetsBOY
Total Assets EOY	495186632	TotalAssetsEOY
Total Liabilities BOY	199684274	TotalLiabilitiesBOY
Total Liabilities EOY	174297552	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	291878961	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	320889080	NetAssetsOrFundBalancesEOY
Mission Description	GOOD SAMARITAN HOSPITAL IS COMMITTED TO BUILDING A HEALTHIER DAYTON, OHIO COMMUNITY THROUGH HIGH QUALITY, COST COMPETITVE HEALTH CARE.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	321020958	Expense
Grants	2406279	Grants
Revenue	361943158	Revenue
Description	SEE SCHEDULE H	Description
Total Program Service Expense	321020958	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	false	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	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	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	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	233	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	3304	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	11	NbrVotingGoverningBodyMembers
Number Independent Voting Members	8	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	true	InvestmentInJointVenture
Written Policy Or Procedure	true	WrittenPolicyOrProcedure
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 (29 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
GEORGE BRODERICK
TRUSTEE	0.5	0.0	X	0	0	0
ELOISE P BRONER
GSH President/CEO	40.0	0.0	X	430542	0	20403	X
MARTIN FUJIMURA MD
TRUSTEE	0.5	0.0	X	0	0	0
LYNN HEPER SC
TRUSTEE	0.5	0.0	X	0	0	0
MICHAEL KERSH
TRUSTEE	0.5	0.0	X	0	0	0
MONICA ANN LUCAS SC
TRUSTEE	0.5	0.0	X	0	0	0
JAMES R PANCOAST
Premier President & CEO	0.5	0.0	X	0	0	0
LARRY TAYLOR
TRUSTEE	0.5	0.0	X	0	0	0
REV VANESSA OLIVER WARD
TRUSTEE	0.5	0.0	X	0	0	0
Jeffrey S Levine
Chair	0.5	0.0	X	0	0	0	X
Atindra Chatterji MD
Trustee and Chief of Staff	0.5	0.0	X	12285	0	0
William Kurby
Trustee (Thru 7/17/2012)	0.5	0.0	X	0	0	0
John Ayers
Trustee (thru 7/9/2012)	0.5	0.0	X	0	0	0
DALE E CREECH
Secretary	7.75	22.25		0	598155	56953	X
THOMAS R CURTIN
Treasurer & CFO	40.0	0.0		217309	0	41468	X
ANITA ADAMS
VP-OPERATIONS	40.0	0.0		232680	0	20064		X
MARY M CLANCY
VP - CIO (PREMIER)	8.0	32.0		0	482163	39747		X
MARY E GARMAN
VP-OPERATIONS/CNO of GSH/UVMC	40.0	0.0		242574	0	24486		X
RENEE P GEORGE
VP - REVENUE CYCLE (Premier)	8.0	32.0		0	276674	34514		X
WILLIAM E LINESCH
VP - HUMAN RESOURCES (PREMIER)	8.0	32.0		0	445854	38785		X
DANIEL L SCHOULTIES MD
VP-Medical Affairs	40.0	0.0		0	410725	46872		X
MARK S SHAKER
SR VP SRVCE INTEGRATE(PREMIER)	8.0	32.0		0	746571	33540		X
MARK W SHAW
VP-MANAGED CARE (Premier)	8.0	32.0		0	403205	57358		X
Michael Maiberger
V/P Strategy/Delivery Syst Dev	8.0	32.0		0	569067	75958		X
CHARLES HENDRICKS
Med Dir-Mental Health Inpt	40.0	0.0		221857	0	40394			X
JEROME SCHULTE JR
MEDICAL DIRECTOR-MENTAL HEALTH	40.0	0.0		278409	0	55901			X
CRAIG SELF
VP-BUSINESS DEVELOPMENT	40.0	0.0		243178	0	31330			X
SHARON K THORNTON
System Leader-Lab Services	40.0	0.0		196752	0	16943			X
Stacey M Lawson
Department Director-Human Rcrs	40.0	0.0		189920	0	29148			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2265506	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	3932414	TotalReportableCompFrmRltdOrgs
Total Other Compensation	663864	TotalOtherCompensation
Number Individuals GT100 K	106	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
DAWSON RESOURCES
3650 OLENTANGY RIVER RD	COLUMBUS	OH	43214	EMPLOYMENT SERVICES	1759864
ANESTHESIA ASSOC OF NW DAYTON
3180 KETTERING BVD	DAYTON	OH	45439	MEDICAL SERVICES	3114000
MEDICAL RADIOLOGISTS
1563 EAST DOROTHY SUITE 101	KETTERING	OH	45429	MEDICAL SERVICES	798149
Laboratory Corporation of America
PO Box 2140	BURLINGTON	NC	272162140	Medical Services	573426
TGC LLC
Po Box 130	HIGHLAND	MD	20777	Consulting	999785

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	46	NumberOfContractorsGT100K
Related Organizations	327643	RelatedOrganizations
Government Grants	968788	GovernmentGrants
All Other Contributions	124496	AllOtherContributions
Total Contributions	1420927	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT REVENUE	621110	183538449	181947888	1590561
MEDICARE/MEDICAID	621110	166058597	166058597
CLINICAL RESEARCH	541712	65863	65863
JOINT OPERATING AGREEMENT	900099	1905000	1905000
FRANCHISE TAX RECOVERIES	900099	10224677	10224677

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	144215	TotalRevenueColumn
Related Or Exempt Function Income	144215	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	361936801	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	5115964	TotalRevenueColumn
Unrelated Business Revenue	6357	UnrelatedBusinessRevenue
Exclusion	$5,109,607	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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

Royalties Revenue RoyaltiesRevenue

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

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	4374197	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	4289806	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	84391	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	84391	TotalRevenueColumn
Exclusion	$84,391	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	23914432	Securities
Other	26750	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	18225388	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	5689044	Securities
Other	26750	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	5715794	TotalRevenueColumn
Exclusion	$5,715,794	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

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	4185964	GrossSalesOfInventory
Cost Of Goods Sold	3179934	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	1006030	TotalRevenueColumn
Exclusion	$1,006,030	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
CAFETERIA	721110	2212033	$2,212,033
PARKING GARAGE	812930	306977	$306,977
LAUNDRY	812390	52995	$52,995

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	522397	TotalRevenueColumn
Exclusion	$522,397	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	3094402	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	378374309	TotalRevenueColumn
Related Or Exempt Function Income	360346240	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	1596918	UnrelatedBusinessRevenue
Exclusion	$15,010,224	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	2406279	Total
Program Services	2406279	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	1229526	Total
Program Services	1047679	ProgramServices
Management And General	181847	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	138764071	Total
Program Services	118240865	ProgramServices
Management And General	20523206	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	6923051	Total
Program Services	5899132	ProgramServices
Management And General	1023919	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	21635276	Total
Program Services	18435419	ProgramServices
Management And General	3199857	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	8907363	Total
Program Services	7589964	ProgramServices
Management And General	1317399	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	3924312	Total
Program Services	3343906	ProgramServices
Management And General	580406	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	482783	Total
Program Services	411379	ProgramServices
Management And General	71404	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	425171	Total
Management And General	425171	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	36652	Total
Program Services	36652	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	649319	Total
Management And General	649319	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	17452997	Total
Program Services	17452997	ProgramServices

Advertising Advertising

Field	Value	IRS element (for citing)
Total	2124164	Total
Program Services	2124164	ProgramServices

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	2137081	Total
Program Services	1821007	ProgramServices
Management And General	316074	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	7223566	Total
Program Services	6155201	ProgramServices
Management And General	1068365	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	7124327	Total
Program Services	6070639	ProgramServices
Management And General	1053688	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	318554	Total
Program Services	271440	ProgramServices
Management And General	47114	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	4943	Total
Program Services	4212	ProgramServices
Management And General	731	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	5708010	Total
Program Services	5708010	ProgramServices

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	28594707	Total
Program Services	24365554	ProgramServices
Management And General	4229153	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1056896	Total
Program Services	900581	ProgramServices
Management And General	156315	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
OPERATING SUPPLIES	75328619	75328619
PURCHASED SERVICES	14765390	12581588	2183802
REPAIRS & MAINTENANCE	2080890	1773126	307764
HOSPITAL FRANCHISE TAX	5286818	5286818

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	4419349	Total
Program Services	3765727	ProgramServices
Management And General	653622	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	359010114	Total
Program Services	321020958	ProgramServices
Management And General	37989156	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	9990	BOY
EOY	18590	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	13144737	BOY
EOY	9828478	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	175871	BOY
EOY	171622	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	44397297	BOY
EOY	50237537	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	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	430842	BOY
EOY	82274	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	6502407	BOY
EOY	5817766	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	2887443	BOY
EOY	4279878	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	531311157	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	326748523	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	213100298	BOY
EOY	204562634	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	157901114	BOY
EOY	165462064	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	35455171	BOY
EOY	33140110	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	5555580	BOY
EOY	3938913	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	12002485	BOY
EOY	17646766	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	491563235	BOY
EOY	495186632	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	28000633	BOY
EOY	29017159	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	5161469	BOY
EOY	4207270	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	1164185	BOY
EOY	1210978	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	7578750	BOY
EOY	5052500	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	120664104	BOY
EOY	114725651	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	37115133	BOY
EOY	20083994	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	199684274	BOY
EOY	174297552	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	291878961	BOY
EOY	320889080	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

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

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

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

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	291878961	BOY
EOY	320889080	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	491563235	BOY
EOY	495186632	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	19364195	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	12367024	ReconciliationUnrealizedInvest
Reconcilation Prior Adjustment	1027799	ReconcilationPriorAdjustment
Reconcilation Other Changes	-3748899	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	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	FederalGrantAuditPerformed

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	$29,632	GrantsOtherOrganizationsAmount
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$7,020	OtherActivitiesAmount
Total Lobbying Expenditures IIB	36652	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	PART II-B, LINE F:	Identifier
Explanation	PORTION OF DUES PAID TO GREATER DAYTON AREA HOSPITAL ASSOCIATION AND OHIO HOSPITAL ASSOCIATION. PART II-B, LINE I: WE CONTRACT WITH A LOBBYIST FOR HEALTHCARE 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	9685728	OtherCostOrOtherBasis
Book Value	9685728	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	264888214	OtherCostOrOtherBasis
Depreciation	155945024	Depreciation
Book Value	108943190	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	5755902	OtherCostOrOtherBasis
Depreciation	3568760	Depreciation
Book Value	2187142	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	240535591	OtherCostOrOtherBasis
Depreciation	167234739	Depreciation
Book Value	73300852	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	10445722	OtherCostOrOtherBasis
Book Value	10445722	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	204562634	TotalOfBookValueLandBuildings
Financial Derivatives		FinancialDerivatives
Closely Held Equity Interests		CloselyHeldEquityInterests
Total Of Book Value Securities	0	TotalOfBookValueSecurities
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (8 entries)

DescriptionDescription	AmountAmount
MALPRACTICE INSURANCE	$12,228,748
FICA RESIDENTS PAYABLE	$4,104,242
FRANCHISE TAX LIABILITY	$1,407,414
OTHER LIABILITIES	$777,034
INTERCOMPANY PAYABLES	$782,376
WORKERS COMPENSATION	$626,991
PHYSICIAN-RELATED	$122,429
INTEREST SWAP LIABILITY	$34,760

Field	Value	IRS element (for citing)
Total Of Amounts	20083994	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

Field	Value	IRS element (for citing)
Identifier	Form 990, Schedule D, Part X, Line 2:	Identifier
Explanation	Good Samaritan Hospital (GSH) is a member, under a joint operating agreement, of Premier Health (Premier) which is tax-Exempt under 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. GSH 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: Samaritan Family Care (subsidiary of Samaritan Health Partners (SHP) and Samaritan North Surgery Center Limited (a joint-venture partnership of which SHP is an 80% owner.)	Explanation

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable (10 entries)

RegionRegion	Type Of Activities ConductedTypeOfActivitiesConducted	Total ExpendituresTotalExpenditures	Specific Services ProvidedSpecificServicesProvided
Central America and the Caribbean	Investments	1800024
East Asia and the Pacific	Investments	11520154
Europe (Including Iceland and Greenland)	Investments	21420287
Middle East and North Africa	Investments	360005
North America	Investments	360005
Russia and the Newly Independent States	Investments	540007
South America	Investments	2160029
South Asia	Investments	540007
Sub-Saharan Africa	Investments	899837
Central America and the Caribbean	Program Services	23712	Insurance

Field	Value	IRS element (for citing)
Subtotal Amount Spent	39624067	SubtotalAmountSpent
Total Amount Spent	39624067	TotalAmountSpent
Transfer To Foreign Corp	true	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	false	ExpensesExceededBudget
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	18603000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	6340000	DirectOffsettingRevenue
Net Community Benefit Expense	12263000	NetCommunityBenefitExpense
Percent Of Total Expense	0.03380	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	55108000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	47209000	DirectOffsettingRevenue
Net Community Benefit Expense	7899000	NetCommunityBenefitExpense
Percent Of Total Expense	0.02180	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1420000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1099000	DirectOffsettingRevenue
Net Community Benefit Expense	321000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00090	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	75131000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	54648000	DirectOffsettingRevenue
Net Community Benefit Expense	20483000	NetCommunityBenefitExpense
Percent Of Total Expense	0.05650	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1822000	TotalCommunityBenefitExpense
Net Community Benefit Expense	1822000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00500	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	257000	TotalCommunityBenefitExpense
Net Community Benefit Expense	257000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00070	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	12262000	TotalCommunityBenefitExpense
Net Community Benefit Expense	12262000	NetCommunityBenefitExpense
Percent Of Total Expense	0.03380	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	70000	TotalCommunityBenefitExpense
Net Community Benefit Expense	70000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	14411000	TotalCommunityBenefitExpense
Net Community Benefit Expense	14411000	NetCommunityBenefitExpense
Percent Of Total Expense	0.03970	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	89542000	TotalCommunityBenefitExpense
Direct Offsetting Revenue	54648000	DirectOffsettingRevenue
Net Community Benefit Expense	34894000	NetCommunityBenefitExpense
Percent Of Total Expense	0.09620	PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

Field	Value	IRS element (for citing)
Total Community Building Expense	551000	TotalCommunityBuildingExpense
Net Community Building Expense	551000	NetCommunityBuildingExpense
Percent Of Total Expense	0.00150	PercentOfTotalExpense

Other Other

Field	Value	IRS element (for citing)
Total Community Building Expense	138000	TotalCommunityBuildingExpense
Net Community Building Expense	138000	NetCommunityBuildingExpense
Percent Of Total Expense	0.00040	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	689000	TotalCommunityBuildingExpense
Net Community Building Expense	689000	NetCommunityBuildingExpense
Percent Of Total Expense	0.00190	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$10,279,000	BadDebtExpenseAmount
Amount Reimbursed By Medicare	86764000	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	99967000	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-13203000	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost Accounting System	X	CostAccountingSystem

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

Field	Value	IRS element (for citing)
Business Name Line1	SAM NORTH SURG CTR	BusinessNameLine1

Field	Value	IRS element (for citing)
Description Ent Primary Activity	SURGICAL SERVICES	DescriptionEntPrimaryActivity
Organization Profit Or Ownership	0.80000	OrganizationProfitOrOwnership
Physicans Profit Or Ownership	0.20000	PhysicansProfitOrOwnership

Field	Value	IRS element (for citing)
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	Good Samaritan Hospital	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	2222 Philadelphia Dr	AddressLine1
City	Dayton Ohio	City
State	OH	State
ZIP Code	45406	ZIPCode

Field	Value	IRS element (for citing)
Website Address	www.premierhealth.com	WebsiteAddress
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Teaching Hospital	X	TeachingHospital
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	Good Samaritan Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
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	4	NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
GOOD SAMARITAN NORTH HEALTH CENTER
9000 N MAIN ST	DAYTON	OH	45415	GENERAL MEDICAL AND SURGICAL
GOOD SAMARITAN NORTH SURGERY CENTER
9000 N MAIN ST	DAYTON	OH	45415	GENERAL MEDICAL AND SURGICAL
GOOD SAMARITAN HEALTH CTR-HUBER HEIGHTS
6521 GOOD SAMARITAN WAY BRANDT PIKE	HUBER HEIGHTS	OH	45424	GENERAL MEDICAL AND SURGICAL
SAMARITAN HOMELESS CLINIC
921 S Edwin C Moses Blvd	DAYTON	OH	45417	HOMELESS CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI

Field	Value	IRS element (for citing)
Identifier	Part I, Line 6a:	Identifier
Explanation	The community benefit report for Good Samaritan 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: Good Samaritan Hospital provides the following subsidized services: 1. Good Samaritan Homeless Clinic: This Clinic is the only health clinic in the surrounding area specifically for the homeless. The clinic takes an integrated approach toward primary and preventative services. With the mission of serving the total well-being of the homeless, the Clinic aims to deliver quality, compassionate care and to get our patients back on their feet. The Clinic is staffed with a full-time physician and a dedicated nursing team. The Clinic provides a number of services to the homeless, including (but not limited to) respite care, dental services, mental health and substance abuse treatment and counseling, pharmacy services, vision screenings, podiatry, case management, health education, outreach services, transportation, life skills training, cancer prevention services, diabetes services and blood pressure monitoring. 2. Lifestages, LLC: This limited liability company provides healthcare to women of all ages that includes Obstetric services, gynecology services and heart, bone and breast health. Lifestages is built around the core beliefs that each woman is unique and that all women deserve the best care available. This company serves a large population of Medicaid and uninsured patients. Good Samaritan Hospital provides support through funding for Lifestages' indigent patients and medical education. The funding for 2012 was $2,087,000. 3. Emergency Services: Good Samaritan 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. 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 amounts paid for call time and subsidies were $10,175,000. 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 $69,653,000 and incurred cost of $88,038,000, for an additional net shortfall of $18,385,000 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) 86,764,000 Medicare revenue not reported in Part III, Section B 69,653,000 Total Medicare associated revenue 156,417,000 Allowable Medicare cost per Medicare Cost Report (Part III, Section B) 99,967,000 Medicare cost not reported in Part III, Section B 88,038,000 Total Medicare associated cost 188,005,000 Medicare shortfall per Part III, Section B 13,203,000 Additional shortfall not included in Part III, Section B 18,385,000 Total Medicare shortfall 31,588,000 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 44% 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 p	Explanation

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (15 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance	Purpose Of GrantPurposeOfGrant	Address Line2AddressUS/AddressLine2
THE HEART INSTITUTE OF DAYTON
2200 PHILADELPHIA DR	DAYTON	OH	45406	300502367	501(c)(3)	432764	N/A	N/A	HEART EDUCATION
PREMIER COMMUNITY HEALTH
23 Jasper St	DAYTON	OH	45409	311122883	501(c)(3)	252000	N/A	N/A	HEALTH EDUCATION	45409
PHOENIX NEIGHBORHOOD DEV PROJ
8 N MAIN ST	DAYTON	OH	45402	310821189	GOVERNMENT	550580	N/A	N/A	COMMUNITY DEVELOP	45402
UNITED WAY
33 W First St	DAYTON	OH	45402	310536658	501(c)(3)	35000	N/A	N/A	COMMUNITY SUPPORT	45406
Dayton Philharmonic
109 N Main St	Dayton	OH	45402	316000101	501(c)(3)	15025	N/A	N/A	Performing Arts	Suite 200
Catholic Education Collaborative
266 Bainbridge St	Dayton	OH	45402	310536710	501(c)(3)	25000	N/A	N/A	Education
Dayton Foundation
500 Kettering Tower	Dayton	OH	45423	316027287	501(c)(3)	1223531	N/A	N/A	Community Support
American Heart Association
5455 N High St	Columbus	OH	43214	135613797	501(c)(3)	36920	N/A	N/A	Education
Good Samaritan Hospital Foundation - Dayton
110 N Main St Suite 500	Dayton	OH	454021857	237296923	501(c)(3)	23120	N/A	N/A	Community Develop
Downtown Dayton Partnership
10 W 2nd St Suite 611	Dayton	OH	45402	341722175	501(c)(3)	18000	N/A	N/A	Community Support
Lifestages Samaritan Centers for Women
9000 N Main St Suite 234	Dayton	OH	45415	311582936	501(C)(3)	13047	N/A	N/A	Women's Health
Salvation Army
615 Slaters Ln	Alexandria	VI	223141112	135562351	501(c)(3)	19500	N/A	N/A	Community Support
Dayton-Montgomery County
500 Kettering Tower	Dayton	OH	45423	311358532	501(c)(3)	13000	N/A	N/A	Scholarship
Dayton Area Chamber of Commerce
22 E 5th	Dayton	OH	45402	311113395	501(c)(3)	7200	N/A	N/A	Community Support
Dayton Opera Association
138 N Main St	Dayton	OH	45402	310643964	501(c)(3)	5200	N/A	N/A	Community Support

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	14	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	1	TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	SCHEDULE I, SUPPLEMENTAL INFORMATION:	Identifier
Explanation	1) COMMUNITY BENEFITS BUDGETED ALLOCATIONS ARE APPROVED BY GOOD SAMARITAN BOARD ANNUALLY. 2) INVOICES ARE RECEIVED IN ACCOUNTS PAYABLE UPON APPROVAL BY THE VICE PRESIDENT OF MISSIONS. 3) DISBURSEMENTS OCCUR ACCORDING TO STANDARD ACCOUNTS PAYABLE GUIDELINES.	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 (17 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
ANITA ADAMS
VP-OPERATIONS	179733	0	50994	0	1953	0	9896	0	10168	0	252744	0	0	0
ELOISE P BRONER
GSH President/CEO	313385	0	106843	0	10314	0	16982	0	3421	0	450945	0	8108	0
MARY M CLANCY
VP - CIO (PREMIER)	0	326023	0	115798	0	40342	0	25126	0	14621	0	521910	0	37243
DALE E CREECH
Secretary	0	359156	0	110992	0	128007	0	32434	0	24519	0	655108	0	123092
THOMAS R CURTIN
Treasurer & CFO	179832	0	34870	0	2607	0	16399	0	25069	0	258777	0	0	0
MARY E GARMAN
VP-OPERATIONS/CNO of GSH/UVMC	200774	0	40441	0	1359	0	9175	0	15311	0	267060	0	112	0
RENEE P GEORGE
VP - REVENUE CYCLE (Premier)	0	215265	0	60657	0	752	0	8225	0	26289	0	311188	0	0
CHARLES HENDRICKS
Med Dir-Mental Health Inpt	220594	0	0	0	1263	0	17104	0	23290	0	262251	0	0	0
WILLIAM E LINESCH
VP - HUMAN RESOURCES (PREMIER)	0	313022	0	92384	0	40448	0	31351	0	7434	0	484639	0	31031
DANIEL L SCHOULTIES MD
VP-Medical Affairs	0	335222	0	69562	0	5941	0	21509	0	25363	0	457597	0	0
JEROME SCHULTE JR
MEDICAL DIRECTOR-MENTAL HEALTH	236855	0	34686	0	6868	0	27795	0	28106	0	334310	0	199	0
CRAIG SELF
VP-BUSINESS DEVELOPMENT	194205	0	47649	0	1324	0	8292	0	23038	0	274508	0	0	0
MARK S SHAKER
SR VP SRVCE INTEGRATE(PREMIER)	0	424644	0	163966	0	157961	0	28111	0	5429	0	780111	0	153170
MARK W SHAW
VP-MANAGED CARE (Premier)	0	255582	0	87080	0	60543	0	33040	0	24318	0	460563	0	52525
SHARON K THORNTON
System Leader-Lab Services	157426	0	38713	0	613	0	8014	0	8929	0	213695	0	0	0
Michael Maiberger
V/P Strategy/Delivery Syst Dev	0	266440	0	146051	0	156576	0	45625	0	30333	0	645025	0	0
Stacey M Lawson
Department Director-Human Rcrs	162732	0	26066	0	1122	0	14333	0	14815	0	219068	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Identifier	Part I, Line 4b:	Identifier
Explanation	Due to restrictions imposed by the Internal Revenue Code, certain persons are limited in the amount of benefit that can be earned under a qualified retirement plan. Like many employers, Good Samaritan Hospital (GSH) compensates for this limitation and supplements the affected executives' qualified pension through certain nonqualified plans. GSH supplements through a Pension Restoration Plan and a Supplemental Executive Retirement Plan (SERP). The benefits under these supplemental nonqualified plans are subject to multi-year vesting and a participant can forfeit benefits earned if vesting requirements are not satisfied. Under the terms of the supplemental plans, and because of tax rules pertaining to taxation of the earned benefits upon vesting, certain individuals received a payout of the cumulative vested benefits under their supplemental plan during 2012. The individuals listed below have met the multi-year vesting requirement under the Pension Restoration Plan and received the associated payment in 2012: Mark Shaker $153,170; William Linesch $31,031; Mary Clancy $37,243; Eloise Broner $8,108; Dale Creech $123,092; Mary Garman $112; Mark Shaw $52,525 and Jerome Schulte $199. The individual listed below has met the multi-year vesting requirement under the SERP and received the associated payment in 2012: Michael Maibeberger $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 Good Samaritan 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%), Customer Satisfaction (25%), Physician Partnership (15%) 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 margin required to maintain the system 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 organizational goals or specified performance criteria (other than mere longevity of service) under the deferred compensation plan." Based on the incentive program's 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.	Explanation

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 MONTGOMERY OHIO	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	316000172	IssuerEIN
Date Issued	2010-12-09	DateIssued
Issue Price	10105000	IssuePrice
Description Of Purpose	REFINANCE TAXABLE LOANS & LEASES	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	5052500	AmountRetired
Amount Bond Defeased	0	AmountBondDefeased
Total Proceeds	10105000	TotalProceeds
Amount In Reserve Fund	0	AmountInReserveFund
Capitalized Interest	0	CapitalizedInterest
Refunding Escrow	0	RefundingEscrow
Issuance Costs From Proceeds	143150	IssuanceCostsFromProceeds
Credit Enhancement	0	CreditEnhancement
Working Capital Expenditures	0	WorkingCapitalExpenditures
Capital Expenditures	0	CapitalExpenditures
Other Spent Proceeds	0	OtherSpentProceeds
Amount Unspent	0	AmountUnspent
Year Of Subst Completion	2010	YearOfSubstCompletion
Current Refunding	false	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	false	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	false	MngmentCntrctBondFinancdPrprty
Any Research Agreements	false	AnyResearchAgreements
Prcntge Prvt Business Use By Others	0.01000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00000	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.01000	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	true	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	true	VariableRateIssue
Hedge Identified In Books And Recds	true	HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

Field	Value	IRS element (for citing)
Business Name Line1	FIFTH THIRD BANK	BusinessNameLine1

Field	Value	IRS element (for citing)
Term Of Hedge	2.1	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	false	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	true	ProcToUndertkCorrectiveAction

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

IdentifierIdentifier

ExplanationExplanation

FORM 990 - PART I - QUESTION 10:

GOOD SAMARITAN HOSPITAL 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 6: Good Samaritan Hospital has two corporate members. One member is Samaritan Health Partners, the parent company of the hospital. The second member is Premier Health (Premier), an Ohio non-profit corporation formed pursuant to the joint operating agreement. Samaritan Health Partners has the sole authority to elect the Board of Trustees of the corporation. Premier has the general authority to operate and manage the operational activities of the corporation. Form 990, Part VI, Section A, Question 7a: Samaritan Health Partners (SHP) has the sole authority to elect the Board of Trustees of Good Samaritan Hospital (GSH). SHP 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 SHP remove a trustee of SHP or GSH 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 SHP. Form 990, Part VI, Section A, Question 7b: Premier Health (Premier), as the operator of Good Samaritan Hospital (GSH), develops and oversees the implementation of the strategic plan for GSH, which includes (but is not limited to) such matters as location of clinical and administrative expenses. GSH shall comply with and implement this plan and shall not take any action that materially departs from this plan without Premier's approval. GSH develops and submits an annual capital and operating budget to Premier for approval. GSH shall adopt and implement the capital and operating budget so approved and/or revised for it by Premier. GSH may periodically develop and submit a business plan to Premier for approval. GSH shall implement any business plan approved by Premier. Premier is the sole agent to negotiate all relationships with payors on behalf of GSH with all third party payors and alternative delivery systems including, but not limited to insurers. GSH 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. GSH 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, 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), which Good Samaritan Hospital is an affiliate. The return is reviewed by the Tax Manager and the 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), which Good Samaritan 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 section 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 or 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 (Premier), which Good Samaritan 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, CFO, COO, 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 VII, Column B: Atindra Chatterji M.D. serves as a Trustee on the Good Samaritan Hospital (GSH) Board where he averages 0.5 hours per week in this capacity. The compensation listed was a Stipend provided for GSH's Chief of Staff. Form 990, Part XI, Question 9: Equity transfers $(18,262,740) Pension Adjustment 10,627,392 Dividends received from SNSC 6,920,000 CHI non-Liquidative Distribution (2,110,000) Investment in SNSC (953,840) Capital Donations from GSHF 358,022 GSHF contribution (327,643) Other (90) Total $(3,748,899)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 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
SAMARITAN HEALTH PARTNERS (SHP)
110 N Main St Suite 500	DAYTON	OH	45402	311107411	PARENT	OH	501(c)(3)	11-I	NA	false
PREMIER HEALTH
110 N Main St Suite 500	DAYTON	OH	45402	311446699	SUPPRTG. ORG.	OH	501(c)(3)	11-I	NA	false
Good SAMARITAN HOSPITAL FOUNDATION-Dayto
110 N Main St Suite 500	DAYTON	OH	45402	237296923	FOUNDATION	OH	501(c)(3)	7	SHP	true
CATHOLIC HEALTH INITIATIVES
198 INVERNESS DR W SUITE 500	ENGLEWOOD	CO	80112	470617373	PARENT	CO	501(c)(3)	9	NA	false
THE HEART INSTITUTE OF DAYTON
2200 PHILADELPHIA DR	DAYTON	OH	45406	300502367	EDUCATION	OH	501(c)(3)	9	SHP	true
Samaritan Behavorial Health
601 Edwin C Moses Blvd	Dayton	OH	45417	020633634	Behavorial He	OH	501(c)(3)	7	SHP	true

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	SAMARITAN NORTH SURGERY CENTER	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	9000 N MAIN ST	AddressLine1
City	DAYTON	City
State	OH	State
ZIP Code	45415	ZIPCode

Field	Value	IRS element (for citing)
EIN	311618587	EIN
Primary Activity	O/P SURGERY	PrimaryActivity
Legal Domicile State	OH	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

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

Field	Value	IRS element (for citing)
Predominant Income Type	Related	PredominantIncomeType
Share Of Total Income	6252321	ShareOfTotalIncome
Share Of EOY Assets	4213462	ShareOfEOYAssets
Disproportionate Allocations	false	DisproportionateAllocations
Code V	$0	CodeVAmount
General Or Managing Partner	true	GeneralOrManagingPartner
Percentage Ownership	0.80000	PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	SAMARITAN FAMILY CARE	BusinessNameLine1

Address US AddressUS

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

Field	Value	IRS element (for citing)
EIN	311299450	EIN
Primary Activity	PHYSICIANS	PrimaryActivity
Legal Domicile State	OH	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

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

Field	Value	IRS element (for citing)
Type Of Entity	C CORP	TypeOfEntity
Controlled Org	true	ControlledOrg

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	true	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	false	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	true	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	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	false	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	false	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (12 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
Good Samaritan Hospital Foundation - Dayton
C	685665	Cash
Good Samaritan Hospital Foundation - Dayton
Q	430946	FMV
Samaritan Family Care
P	443056	Cash
Samaritan Family Care
Q	213752	FMV
Samaritan Family Care
R	6201262	Cash
Samaritan North Surgery Center
Q	1603115	FMV
Samaritan North Surgery Center
Q	483293	FMV
Samaritan North Surgery Center
F	6920000	Cash
Samaritan North Surgery Center
B	953840	Cash
The Heart Institute of Dayton
Q	432764	FMV
Samaritan Health Partners
B	175129	FMV
Catholic Health Initiatives
R	5862000	Cash