2011-11-10T11:25:58-06:00 2010-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46026 990 2010-01-01 310537504 Miami Valley Hospital MIAM 9374999946 40 W FOURTH STREET Dayton OH 454021857 SCOTT A SHELTON CFO 2011-10-25 5136121400 2010 2016-03-07 17:11:31Z MARY H BOOSALIS 40 W FOURTH STREET DAYTON OH 454021857 799106934 false X WWW.PREMIERHEALTHPARTNERS.ORG 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. 17 10 7920 1027 0 0 2399194 1595275 665594011 713089259 13912242 24409451 13183687 16248343 695089134 755342328 6574615 2388827 0 0 351267157 342227641 0 0 0 336772147 337777496 694613919 682393964 475215 72948364 1153376911 1224144199 554170920 571966380 599205991 652177819 MIAMI VALLEY HOSPITAL WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-EFFECTIVE HEALTH CARE SERVICES. false false 615977091 2388827 713089259 PLEASE REFER TO SCHEDULE H. 615977091 true true false true false false false false false true true false false true true false true false false true false false false false false true false true false true true false false false false false false false true false false false false false false true true true true false false true 503 0 true 7920 true false false false false false false false false false false X 17 10 false false false false true true true true true false false true true true true true true true true true true OH X J MICHAEL SIMS 9374999944 40 W 4TH STREET Dayton OH 45402 X ANGELA CLEMENTS CPA 0.5 X 0 0 0 CHRISTOPHER CROOM MD 0.5 X 0 0 0 CHRISTOPHER J DANIS MD 0.5 X 0 0 0 WILLIAM L GILLISPIE 0.5 X 0 0 0 DAVID W KEY MD 0.5 X 0 0 0 ANITA J MOORE 0.5 X 0 0 0 MARY C NUTTER 0.5 X 0 0 0 JAMES M PACENTA MD 0.5 X 7500 0 0 NORM J SCHNEIDERMAN MD 0.5 X 19938 0 0 SR RABBI DAVID SOFIAN 0.5 X 0 0 0 WILLIAM C WILSON MD 0.5 X 0 0 0 GARY S COLLIER MD 40.0 X 366754 0 138563 EDWARD BLAKE 0.5 X 0 0 0 MARY H BOOSALIS 40.0 X X 4607992 0 1054203 BOBBIE L GERHART 40.0 X X 444790 0 234062 REVEREND DR BRODIE R MATHIS 0.5 X 0 0 0 JAMES J MURPHY MD 0.5 X 0 0 0 SCOTT A SHELTON 40.0 X 243965 0 95661 GEOFF WALKER 40.0 X 209167 0 93648 DALE E CREECH JR 40.0 X 379527 0 215755 THOMAS J ARQUILLA 40.0 X 332530 0 107797 WILLIAM E LINESCH 40.0 X 371715 0 129467 MARK W SHAW 40.0 X 310246 0 114227 MARY M CLANCY 40.0 X 415983 0 169641 J NICHOLAS LAIR 40.0 X 234577 0 120430 RENEE P GEORGE 40.0 X 234401 0 89759 DEBORAH A MALS 40.0 X 273511 0 105978 DIANE L PLEIMAN 40.0 X 207616 0 93529 THEODORE E WYMYSLO 40.0 X 301837 0 73011 MOLLY J HALL 40.0 X 327594 0 153771 J MICHAEL SIMS 40.0 X 281119 0 122932 THOMAS S MOSER 40.0 X 253923 0 77387 DIANE L EWING 40.0 X 251766 0 87912 10076451 0 3277733 181 false true false Compunet Clinical Labs 2308 Sandridge Drive MORAINE OH 45349 Clinical Lab 21694774 Miami Valley Emergency Specialists 35 Millard Court SPRINGBORO OH 45066 Medical Services 4553337 Anesthesiology Services Network PO Box 349 DAYTON OH 45409 Medical Services 5013075 Wright State Physicians One Wyoming Street-7000 WCHE DAYTON OH 45409 Medical Services 1919569 Radiology Physicians Inc 7707 Paragon Road CENTERVILLE OH 45459 Medical Services 2106422 66 1595275 1595275 NET PATIENT REVENUE 900099 370705044 370705044 MEDICARE/MEDICAID 900099 363364350 363364350 JOINT OPERATING AGREEMENT 900099 -22478000 -22478000 PASTORAL COUNSELING 900099 726074 726074 CLINICAL NUTRITION 900099 358827 358827 412964 412964 713089259 65707 65707 8961070 8961070 0 5097734 2147280 2950454 2950454 2950454 57000000 40343313 1274013 16656687 -1274013 15382674 15382674 0 0 993191 993191 CAFETERIA SALES 722210 5937827 5937827 PARKING GARAGE 812930 1875657 1875657 JOINT VENTURE 900099 79725 79725 4411489 4411489 12304698 755342328 713089259 0 40657794 2388827 2388827 0 0 0 11120117 8340088 2780029 0 0 265122181 231796323 33325858 14380450 12572827 1807623 35283466 30848334 4435132 16321427 14269824 2051603 0 177234 154956 22278 470170 470170 31511 31511 0 1034020 1034020 29909659 29909659 2762338 2762338 3901197 3410817 490380 3962623 3464521 498102 0 12673651 11080573 1593078 387059 338406 48653 0 98649 86249 12400 8740469 7641792 1098677 0 48165294 42110917 6054377 3591613 3140147 451466 OPERATING SUPPLIES 122229474 122229474 PURCHASED SERVICES 75224658 65768919 9455739 BAD DEBT EXPENSE 14363753 14363753 HOSPITAL FRANCHISE TAX 3790893 3790893 REPAIRS/MINOR EQUIPMENT 3048186 2665029 383157 3215045 2810914 404131 682393964 615977091 66416873 0 19770 21535 19087432 14090622 110873189 111988764 2854800 5863694 5664593 5933123 5124735 7156846 1051118617 462941754 511209907 588176863 328898388 330190748 90245660 92795170 21590871 22224385 57807566 45702449 1153376911 1224144199 67231634 67474568 323368942 316187261 163570344 188304551 554170920 571966380 X 599205991 652177819 599205991 652177819 1153376911 1224144199 X 72948364 -19976536 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 31511 false false 31511 false SCHEDULE C, SUPPLEMENTAL INFORMATION PART II-B, LINE 1F PAYING DUES TO GREATER DAYTON AREA HOSPITAL ASSOCIATION AND OHIO HOSPITAL ASSOCIATION. IN ADDITION, WE CONTRACT WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. 33975739 33975739 430482618 226515725 203966893 1295993 1235692 60301 346889718 230506339 116383379 238474548 4683997 233790551 588176863 ALTERNATIVE INVESTMENT 92795170 F 92795170 0 PENSION OBLIGATION 103865618 INTERCOMPANY PAYABLES 24873750 MALPRACTICE INSURANCE 21456769 LOAN GUAR & OTHER LTL 10831144 INTEREST SWAP LIABILITY 6365984 PROPERTY TAXES PAYABLE 6290309 BUILDING & CAPITAL LEASE LIAB 6106892 MEDICARE COST SETTLEMENT 3130376 BOND INTEREST 1912025 OTHER LIABILITIES 3471684 188304551 Part 990, Part IV, Line 11f Miami Valley Hospital (MVH) is a part 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, 2010 and 2009. 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 Health Specialists of Dayton, Inc. (subsidiaries of MAHS) Central America and the Caribbean Program Services Insurance 2652798 Central America and the Caribbean Investments East Asia and the Pacific Investments Europe (Including Iceland and Greenland) Investments North America Investments Russia and the Newly Independent States Investments South Asia Investments Sub-Saharan Africa Investments 2652798 2652798 false false false false false false true true X true X true X true true true false true true 42596000 15126000 27470000 0.04240 124302000 105977000 18325000 0.02830 6503000 4468000 2035000 0.00310 173401000 125571000 47830000 0.07380 968000 968000 0.00150 26581000 20315000 6266000 0.00970 29264000 5370000 23894000 0.03690 8000 8000 56821000 25685000 31136000 0.04810 230222000 151256000 78966000 0.12190 197000 197000 0.00030 1655000 1655000 0.00260 1852000 1852000 0.00290 true 3285000 132834000 136287000 -3453000 X true true 2 1 MIAMI VALLEY HOSPITAL

ONE WYOMING STREET DAYTON OH 45402

X X X X X 2 MIAMI VALLEY HOSPITAL SOUTH

2400 MIAMI VALLEY DRIVE CENTERVILLE OH 45459

X X ER & OUTPATIENT FAC. MIAMI VALLEY HOSPITAL 1 MIAMI VALLEY HOSPITAL SOUTH 2 2 Dialysis Centers of Dayton LLC

40 W 4th Street Suite 900 Dayton OH 45402

Dialysis Treatment Lincoln Park Manor

694 Isaac Prugh Way Kettering OH 45429

Assisted Living Schedule H Disclosure Part I, Line 6a The community benefit report for Miami Valley Hospital is part of the Premier Health Partners report. Part I, Line 7, column (f) $13,839,221 of bad debt was excluded from the denominator. Part I, Line 7g Miami Valley Hospital provides the following subsidized services: Miami Valley Hospital Medical Surgical Health Center is the largest provider of health care for the uninsured and underinsured in the Dayton area, with over 18,000 visits a year. The Center offers care for immediate medical needs, long-term care and chronic conditions. The Center also provides pharmacy vouchers in addition to diagnostic testing and wellness care. The Center provides primary care to patients as well as numerous specialty clinics. It has a dedicated social worker whose knowledge and expertise assists numerous patients in obtaining the services and healthcare they need. Miami Valley Dental Center provides dental care including sub specialist services like periodontal surgery, endodontics and oral surgery. The Dental Center has the unique ability to treat patients who might need care for conditions other than dental at the same time as their medical conditions are being monitored and controlled for the procedure. The Center services patients such as very young children with multiple dental problems, or mentally handicapped and developmentally disabled and patients who have a medical condition that must be strictly controlled during dental care. Berry Family Health Center is a separate care facility offering a full range of services associated with primary care including family practice, pediatrics, adolescents, Geriatrics, Psychology, Women's Health, Sports Medicine and minor office surgeries. The center uses a practice of evidence-based medicine in decision making. Emergency Services: Miami Valley 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 2010, the amount paid for call and subsidies was $15,755,000. Part I, Line 7: Charity Care at Cost A cost to charge ratio was used to calculate this figure. This calculation takes total operating expenses less other operating revenues and bad debt expenses divided by total gross revenues. Unreimbursed medicaid and other means-tested governmental programs was 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 III, Line 4 The organization used the same cost to charge ratio defined in Part I, Line 7 to determine bad debt expense at cost. The organization does not have a footnote in the audited financial statements which discusses this calculation. Bad debt expense is incurred when an account is taken out of Accounts Receivable and turned over to a collection agency. This is done immediately if a patient refuses payment arrangements, refuses to apply for charitable 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 charitable 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 immediately ceased and return the account back to the organization if the patient applies for charitable 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 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. The policy is as follows: After 9 months (or earlier), if the collection agency has not been able to resolve the account, the account is returned to the organization for final closeback. 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 process, the organization does not feel it has reported bad debt expense for patients eligible under the organization's charity care policy. 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 35% of net patient revenue. The organization used a cost accounting system to calculate the Medicare allowable costs. Part III, Line 9b The organization's collection policy states that no collection is to occur for patients that have applied for charitable assistance. If a patient has not applied and the account is turned over to collection and during this process they apply for assistance, then all collection efforts are immediately ceased. Part VI, line 2 The organization's community benefit plan is based on our understanding of unique communities' needs derived from collaborative needs assessments, focus groups and surveys conducted with our community partners. We rely on data provided by Greater Dayton Area Hospital Association to assist with the needs of the community. Miami Valley, as a member of Premier Health Partners, also participates in the Homeless Shelter Task Force and the Montgomery County Healthcare Safety Net Task Force. The Homeless Shelter Task Force offers strategic solutions to over 6,000 homeless people living in Dayton and Montgomery County. These solutions include evaluating the location of the day shelter and the Good Samaritan Homeless Clinic to ensure they are located in a place easily accessible to the Homeless. The primary goal is to provide support for the Homeless, get them into permanent housing and employed so they can be self-sufficient. The Montgomery County Healthcare Safety Net Task Force was appointed in September 2006 by the Montgomery County Commissioners. The Task Force was charged with recommending an innovative vision and achievable sets of strategies to improve and finance the healthcare safety net for vulnerable populations in Montgomery County. The Task Force, comprised of 19 members, included hospital system leadership, safety net clinical providers, the Dean of Wright State University Boonshoft School of Medicine, United Way, major insurance companies and other key stakeholders. The report from their evaluation showed that approximately 60,300 people or nearly 11% of Montgomery County residents do not have healthcare insurance. Approximately 84,082 residents or over 12% in Montgomery County were enrolled in Medicaid. Montgomery County and the surrounding region are unique as there are only four metro regions in the United States larger than Montgomery County that does not have any type of public hospital. Premier Health Partners, of which Miami Valley Hospital is a member, incurs 73.5% of uncompensated care costs. The total shortfall resulting from providing uncompensated care is more than $126 million annually. This task force recommended nine local strategies outlined as follows: 1. Strengthen and consolidate access to primary care: Currently, there are more than twenty clinics in Montgomery County that focus on providing services to the indigent populations. A collaborative effort between hospital systems and Dayton and Montgomery County Public Heath Systems that focus on providing services to the indigent populations is underway to address consolidation. Initially, three hospital-operated clinics have been consolidated into Community Health Systems of Greater Dayton, a nonprofit organization designated as a federally qualified health center. 2. Investigate implementation of a community-wide electronic linkage between healthcare providers: Premier Health Partners, of which Miami Valley Hospital is a member, implemented an electronic medical record system. This improves care coordination across hospitals and clinics to help minimize duplicative services. 3. Enhance care coordination for vulnerable populations with chronic diseases: The greatest healthcare costs can be reduced with extensive care coordination, including screenings, early detection, education, treatme STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI OH, true ALZHEIMERS ASSOCIATION 3797 SUMMIT GLEN DR G100 DAYTON OH 45449 133039601 501(C)(3) 6400 ANNUAL CONTRIBUTION AMERICAN HEART ASSOCIATION 5455 NORTH HIGH ST COLUMBUS OH 43214 135613797 501(C)(3) 24320 DAYTON START WALK AULLWOOD AUDUBON CENTER 1000 AULLWOOD RD DAYTON OH 45414 131624102 501(C)(3) 16000 FUTURE FARM INITIATION CITY OF DAYTON 101 WEST THIRD ST DAYTON OH 45402 316000175 147140 GUN VIOLENCE REDUCTION & GOOD NEIGHBOR POLICE PROGRAM. CITYWIDE DEVELOPMENT CORP 8 N MAIN ST DAYTON OH 45402 310821189 501(C)(3) 60600 GENESIS PROJECT Downtown Dayton. DAYBREAK 605 S PATTERSON BLVD DAYTON OH 45402 310864474 501(C)(3) 16000 ANNUAL PLEDGE DAYTON ART INSTITUTE 456 BELMONTE PARK NORTH DAYTON OH 45405 310537480 501(C)(3) 69700 SPONSOR THE DAYTON FOUNDATION 500 KETTERING TOWER DAYTON OH 45423 316027287 501(C)(3) 33860 NEIGHBORHOOD PROJECT and safety. DAYTON PHILHARMONIC VOLUNTEERS 439 CLAZON GLEN COURT DAYTON OH 45429 316033500 501(C)(3) 18400 TITLE SPONSOR population. FIDELITY HEALTHCARE 3832 KETTERING BLVD DAYTON OH 45439 311075381 501(C)(3) 39673 BRIDGE PROJECT MARCH OF DIMES - MIAMI VALLEY DIVISION 3131 S DIXIE DR - 313 DAYTON OH 45439 131846366 501(C)(3) 15000 PRESENTING SPONSOR development. MARY SCOTT NURSING CENTER INC 3109 CAMPUS DR DAYTON OH 45406 316010222 501(C)(3) 41000 GRANT OMEGA COMMUNITY DEVELOPMENT 1810 HARVARD BLVD DAYTON OH 45406 311561713 501(C)(3) 6400 CONTRIBUTION REACH OUT MONTGOMERY COUNTY 25 EAST FORAKER DAYTON OH 45409 311434282 501(C)(3) 165997 RX ASSISTANCE for indigent patients. UNITED WAY GREATER DAYTON PO BOX 634625 CINCINNATI OH 45263 310536658 501(C)(3) 62500 CORPORATE PLEDGE WRIGHT STATE UNIVERSITY 3640 COLONEL GLENN HIGHWAY DAYTON OH 45435 310732831 25600 CONTRIBUTION TO NURSING INST AMERICAN CANCER SOCIETY 2808 READING ROAD CINCINNATI OH 45236 340726080 501(C)(3) 7040 CONTRIBUTION GDAHA - BRIGHTER FUTURES 2 RIVERPLACE DR STE 400 DAYTON OH 45405 311221836 501(C)(6) 90000 HOME NURSING VISITS CULTURE WORKS 126 N MAIN ST STE 210 DAYTON OH 45402 237412338 501(C)(3) 9600 ANNUAL CAMPAIGN DAYTON DEVELOPMENT COALITION 40 N MAIN ST STE 900 DAYTON OH 45423 311423890 501(C)(6) 108000 SPONSOR DAYTON OPERA ASSOCIATION 138 N MAIN ST DAYTON OH 45402 310643964 501(C)(3) 13440 ANNUAL PLEDGE COUNTY CORPORATION 130 W SECOND ST STE 1420 DAYTON OH 45402 310978908 501(C)(3) 100000 MEN'S GATEWAY SHELTER NEW YORK UNIVERSITY 726 BROADWAY 9TH FLR NEW YORK NY 10003 135562308 501(C)(3) 95413 NICHE PROGRAM - GERIATRIC CARE VICTORIA THEATRE ASSOCIATION 138 N MAIN ST DAYTON OH 45402 310897638 501(C)(3) 192000 SPONSOR AIDS RESOURCE CENTER OHIO 15 W FOURTH ST 200 DAYTON OH 45402 311256541 501(C)(3) 100000 COMMUNITY PARTNERSHIP Premier Community Health 23 Jasper Street Dayton OH 45409 311122883 501(c)(3) 417155 Community Health Miami Valley Hospital Foundation 40 W 4th Street Dayton OH 45402 311040231 501(c)(3) 92506 Health Promotion 24 3 Schedule I, Supplemental Information 1) Community benefits budgeted allocations are approved by the the Miami Valley 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 false true false false false true true false false GARY S COLLIER MD 258413 0 60364 0 47977 0 119697 0 18866 0 505317 0 103428 0 MARY H BOOSALIS 396953 0 223818 0 3987221 0 1045753 0 8450 0 5662195 0 1496787 0 BOBBIE L GERHART 315043 0 95170 0 34577 0 214589 0 19473 0 678852 0 123313 0 SCOTT A SHELTON 196141 0 45688 0 2136 0 92470 0 3191 0 339626 0 45688 0 DALE E CREECH JR 290064 0 83578 0 5885 0 191883 0 23872 0 595282 0 83578 0 THOMAS J ARQUILLA 264036 0 51072 0 17422 0 81169 0 26628 0 440327 0 64266 0 WILLIAM E LINESCH 287965 0 60181 0 23569 0 122429 0 7038 0 501182 0 78450 0 MARK W SHAW 246858 0 58629 0 4759 0 93606 0 20621 0 424473 0 58629 0 MARY M CLANCY 292302 0 88969 0 34712 0 155900 0 13741 0 585624 0 120807 0 J NICHOLAS LAIR 191363 0 42563 0 651 0 100673 0 19757 0 355007 0 42563 0 RENEE P GEORGE 191717 0 42107 0 577 0 68282 0 21477 0 324160 0 42107 0 THEODORE E WYMYSLO 258195 0 40588 0 3054 0 54023 0 18988 0 374848 0 40588 0 MOLLY J HALL 266310 0 58185 0 3099 0 133433 0 20338 0 481365 0 58185 0 J MICHAEL SIMS 212403 0 52160 0 16556 0 101352 0 21580 0 404051 0 67165 0 DEBORAH A MALS 218866 0 51567 0 3078 0 94613 0 11365 0 379489 0 51567 0 THOMAS S MOSER 204095 0 42713 0 7115 0 68767 0 8620 0 331310 0 42713 0 DIANE L PLEIMAN 164905 0 41662 0 1049 0 88568 0 4961 0 301145 0 0 DIANE L EWING 204017 0 44166 0 3583 0 78388 0 9524 0 339678 0 0 GEOFF WALKER 169284 0 38838 0 1045 0 75297 0 18351 0 302815 0 0 0 SCHEDULE J SUPPLEMENTAL INFORMATION 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 through a Pension Restoration Plan and a Supplemental Employee 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 2010. The individuals listed below have met the multi-year vesting requirement under the Pension Restoration Plan and received the associated payment in 2010: Gary Collier $43,064; Bobbie Gerhart $28,143; Thomas Arquilla $13,194; William Linesch $18,269; Mary Clancy $31,838; J Michael Sims $15,005. Mary Boosalis met the multi-year vesting requirement under the SERP and received $3,980,847 for her 24 years of service as an executive with the organization. All or parts of these payments were also properly reported on prior years' filed IRS Form 990 returns disclosing compensation earned by these individuals under the plans for each such year. organization. Part I, Line 6a and 6b Premier Health Partners (PHP), which Miami Valley Hospital is a member, 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%), Financial (20%) and Major Initiatives (10%). 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. Vice Presidents and above incentive objectives are weighted 50% on organizational criteria and 50% on individual criteria. Directors are weighted 25% on organizational criteria and 75% on individual criteria. weighted according to balanced scorecard categories: Positive Work Environment (15%), Quality (30%), Customer Satisfaction (25%), Financial (20%) and Major Initiatives (10%). 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. Vice Presidents and above incentive objectives are weighted 50% on organizational criteria and 50% on individual criteria. Directors are weighted 25% on organizational criteria and 75% on individual criteria. COUNTY OF MONTGOMERY OH 316000172 613549GP3 2008-11-13 234895988 See Schedule K, Part V false false false COUNTY OF MONTGOMERY OH 316000172 613549GZ1 2009-02-24 126463824 See Schedule K, Part V false false false 130555000 234895988 2391706 2119000 34304034 437769 2010 true false true true 126463824 5277713 2293824 2010 true false true true false true true true true 0.01000 0.01000 true false true true true true 0.01000 0.01000 true true true true MERRILL LYNCH 23.8 true false false false true false false false false false true Schedule K, Supplemental Information Schedule K - Part 1 - Line A - Column f Refund Miami Valley Hospital Series 1992B, 1998A, 2003A, 2003B and 2003 Bonds and provide funds to construct the South East Tower on the Hospital's campus. Schedule K - Part 1 - Line B - Column f Refund a portion of Miami Valley Hospital Series 2008A and 2008B bonds. CHRISTOPHER CROOM DIRECTOR 342906 SEE SCHEDULE O false CHRISTOPHER DANIS DIRECTOR 216502 SEE SCHEDULE O false Scott Shelton DIRECTOR 21694774 SEE SCHEDULE O false Diane Pleiman Director 21694774 See Schedule O false FORM 990, SUPPLEMENTAL INFORMATION (1) Form 990 - Part I - Question 10 Miami Valley 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. In 2010 Miami Valley Hospital recognized unrealized gains of $16,482,358. Form 990, Part VI, Section A, Question 6 Miami Valley Hospital has two members. One member is MedAmerica Health Systems, the parent company of the hospital. The second member is Premier Health Partners, 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 Partners has the general authority to operate and manage the operations of Premier Health Partners' 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. In addition to removal by MAHS, a trustee may be removed from office with approval by MAHS, by the affirmative vote of not less than two-thirds of the entire Board of Trustees. Premier Health Partners (PHP) has the right to request that MAHS remove a trustee of the corporation if PHP has determined that such trustee is frustrating the goals and purposes of Premier Health Partner's network. Such removal shall not be unreasonably refused by MAHS. Form 990, Part VI, Section A, Question 7b Premier Health Partners (PHP) develops and oversees the implementation of the strategic plan for Miami Valley Hospital (MVH), which addresses 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 PHP approval. MVH develops and submits an annual capital and operating budget to PHP for approval. MVH shall adopt and implement the capital and operating budget so approved and/or revised for it by PHP. MVH periodically develops and submits a business plan to PHP for approval. MVH shall implement the business plan approved by PHP. PHP 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 PHP 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 $500,000. MVH must seek PHP approval for any acquisitions, sale or transfer of any material asset used in PHP 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 Financial Accounting department of Premier Health Partners (PHP), of which Miami Valley Hospital is a member. It is reviewed by the Supervisor, Manager and Director of the Financial Accounting department of PHP and subsequently sent to Ernst & Young U.S. LLP for their review. After all changes from the above group are made, the return is reviewed by the Vice President/Controller of PHP 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 Directors for review. The Board of Directors is provided an electronic copy at least one week prior to the board meeting. At the meeting, the Director of Financial Accounting of PHP shares detailed information on compensation and community benefits, as well as address any other questions from the Board of Directors, pending their review. The 990 tax return is also shared with the Audit Committee of PHP. The information is mailed out to them at least one week prior to the meeting. At the meeting, the Vice President/Controller of PHP shares detailed information on compensation and community benefits, as well as addresses any other questions from the committee. Form 990, Part VI, Section B, Question 12c Premier Health Partners (PHP), of which Miami Valley Hospital is a member, requires all board members, officers, executives and management personnel to annually review the PHP 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 Conflicts of Interest Policy. This is accomplished with a memo sent out annually from the Chairman of the Board and Chief Executive Officer of PHP to all board members, executive directors, vice presidents, directors, purchasing department staff and authorized purchasers. 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. Last, 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 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, any Board or Board Committee meeting where the subject of conflicts of interest is discussed, the normally taken 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 does 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 PHP Conflicts 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 conflicts of interest questionnaires are summarized by person in a word document and sent electronically to the Finance department for any necessary disclosures required on the 990 tax return. Form 990, Part VI, Section B, Question 15A and 15B Premier Health Partners, of which Miami Valley Hospital, is a member, 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. PHP annually reviews executive compensation survey data for a regional peer group of systems and hospitals that are similar in size and complexity to PHP and its subsidiaries. The data for the survey is provided by a third party consultant group that is independent of PHP. 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 PHP CEO, PHP CFO 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 PHP board annually. Form 990, Part VI, Section C, Question 19 The governing documents, conflicts of interest policy and financial statements are made available to the public when required by law or for accreditation purposes. FORM 990, SUPPLEMENTAL INFORMATION (CONTINUED) Form 990, Part VII, Section A, Question 1a, Column B Officers work an average of 40 hours spread over the entities listed in schedule R. Schedule L - Part IV Christopher Croom is a 33% owner in Perinatal Partners. Miami Valley Hospital contracts with Perinatal Partners to provide medical services. This contract is audited by our compliance department to ensure we are paying at fair market value and do not have any Stark violations. The amounts paid under this contract are competitive and the transaction is at arms-length. The total amount paid in 2010 was $342,906. Christopher Danis is a 33% owner in Hand Reconstructive Surgeons. Miami Valley Hospital contracts with Hand Reconstructive Surgeons to provide medical services. This contract is audited by our compliance department to ensure we are paying at fair market value and do not have any Stark violations. The amounts paid under this contract are competitive and the transaction is at arms-length. The total amount paid in 2010 was $216,502. Miami Valley Hospital contracts with Compunet for the provision of laboratory services. Scott Shelton is a board member of Compunet Clinical Lab. In addition, he is the Chief Financial Officer of Miami Valley Hospital. Compunet is owned 50% 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 2010 was $21,694,774. Miami Valley Hospital contracts with Compunet for the provision of laboratory services. Diane Pleiman is a board member of Compunet Clinical Lab. In addition, she is a key employee of Miami Valley Hospital. Compunet is owned 50% 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 2010 was $21,694,774. Form 990, Part XI, Question 5 Unrealized Gain 16,482,358 Equity Transfers (28,531,862) Pension Adjustment (7,655,763) Swap Amortization (191,074) Capital Donation 588,278 Other (668,473) Total (19,976,536) Part IV, Line 20b Attaching a copy of the audited financial statements is only required under the tax law for tax years beginning after March 23, 2010. Miami Valley Hospital's tax year began January 1, 2010 and it therefore has not attached the audited financial statements to its 2010 Form 990. DIALYSIS CENTERS OF DAYTON LLC 40 W FOURTH STREET DAYTON OH 45402 311607686 DIALYSIS OH 2603215 35160409 MVH PREMIER HEALTH PARTNERS 40 W FOURTH STREET DAYTON OH 45402 311446699 SUPPRTG. ORG. OH 501(c)(3) 11-1 NA MEDAMERICA HEALTH SYSTEMS CORP 40 W FOURTH STREET DAYTON OH 45402 311040228 PARENT OH 501(c)(3) 11-1 NA MIAMI VALLEY HOSPITAL FOUNDATION 40 W FOURTH STREET DAYTON OH 45402 311040231 SUPPRTG. ORG. OH 501(c)(3) 7 MAHS PREMIER COMMUNITY HEALTH 601 W RIVERVIEW AVENUE DAYTON OH 45406 311122883 SUPPRTG. ORG. OH 501(c)(3) 7 MAHS MVHE INC 40 W FOURTH STREET DAYTON OH 45402 311185270 PHYS SVCS OH MAHS CORPORATION -10842250 28529282 1.00000 HSD INC 40 W FOURTH STREET DAYTON OH 45402 061744704 PHYS SVCS OH MAHS CORPORATION -10918382 13001797 1.00000 false true true false false false false false false false false false false true true true true true MIAMI VALLEY HOSPITAL FOUNDATION B 35950 MIAMI VALLEY HOSPITAL FOUNDATION C 504936 MIAMI VALLEY HOSPITAL FOUNDATION N 1319434 MIAMI VALLEY HOSPITAL FOUNDATION P 225464 MIAMI VALLEY HOSPITAL FOUNDATION R 1550000 HSD INC N 71040 HSD INC O 524237 HSD INC Q 11635001 MVHE INC N 37220 MVHE INC O 67188 MVHE INC Q 14228062 PREMIER COMMUNITY HEALTH B 175000 PREMIER COMMUNITY HEALTH Q 500791 Miami Valley Hospital Foundation Q 297380