2011-11-10T11:27:01-06:00 2010-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46026 990 2010-01-01 311079309 ATRIUM MEDICAL CENTER ATRI 9374999946 40 WEST 4TH STREET DAYTON OH 45402 THOMAS J MALONEY JR CFO 2011-10-27 3176817000 2010 2016-03-07 17:11:31Z CAROL TURNER 40 WEST 4TH STREET STE 2100 DAYTON OH 45402 243463326 false X WWW.PREMIERHEALTHPARTNERS.ORG X 1983 OH ATRIUM MEDICAL CENTER WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE THE COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. 11 11 2121 343 2120720 380408 90225 412286 225827140 238038850 22854514 -1786706 2240454 2040633 251012333 238705063 279150 88257 0 0 110224766 105982081 0 0 0 131552791 122531959 242056707 228602297 8955626 10102766 370321490 370736218 260313743 252466843 110007747 118269375 ATRIUM MEDICAL CENTER WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE THE COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES. false false 203254608 88257 234538173 PLEASE SEE SCHEDULE H. 203254608 true true false true false false false false true true false false true 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 false false false false false false false false true true true false false true X 162 0 true 2121 true true true false false false false false false false false false X 11 11 false false false false true true true true true false false true true true true true true true true false OH X J MICHAEL SIMS 9374999944 40 WEST 4TH STREET SUITE 2100 DAYTON OH 45402 JEFFREY S ZOLLETT MD 0.5 X 0 0 0 MARJORIE KELLY COWAN PHD 0.5 X 0 0 0 FRANK CHAPMAN 0.5 X 0 0 0 THOMAS E GROSSMANN 0.5 X 0 0 0 JERRY HAMMOND MD 0.5 X 0 0 0 LARRY HOLLINGSHEAD 0.5 X 0 0 0 STEPHEN M JONES 0.5 X 0 0 0 JAMES G KEYS JR 0.5 X 0 0 0 DAVID A PEARCE 0.5 X 0 0 0 DAVID FLOERING MD 0.5 X 0 0 0 JAMES AKERS 0.5 X 0 0 0 DOUG MCNEILL 40.0 X 1383686 0 1180467 CAROL TURNER 40.0 X 302386 0 110593 THOMAS MALONEY 40.0 X 198544 0 73231 DALE CREECH JR 40.0 X 0 379527 215755 THOMAS ARQUILLA 40.0 X 0 332530 107797 MARY CLANCY 40.0 X 0 415983 169641 RENEE GEORGE 40.0 X 0 234401 89759 J NICHOLAS LAIR 40.0 X 0 234577 120430 WILLIAM LINESCH 40.0 X 0 371715 129467 MARK SHAW 40.0 X 0 310246 114227 TED RIPPERGER 40.0 X 160908 0 42467 LISA GOSSETT 40.0 X 135872 0 68215 LENA FOGLE 40.0 X 192889 0 34647 JOANNE R MORGAN 40.0 X 150445 0 37766 DAVID CAFFERTY 40.0 X 153299 0 24486 DONNA L BANKS 40.0 X 138014 0 79161 MARK E WILLIAMS 40.0 X 177953 0 55031 2993996 2278979 2653140 42 false true false DAWSON RESOURCES 3650 OLENTANGY RIVER RD STE 450 COLUMBUS OH 43214 AGENCY STAFF 834465 MIDDLETOWN ANESTHESIA CONSULTANTS 3180 KETTERING BLVD DAYTON OH 45439 PHYSICIANS 2124790 HILLTOP OBGYN 200 MEDICAL CENTER DR STE 160 FRANKLIN OH 45005 PHYSICIANS 900000 HMP OF BUTLER COUNTY LTD 4535 DRESSLER ROAD NORTHWEST CANTON OH 44718 PHYSICIANS 1208500 PREMIER HEALTH CARE SERVICES INC 322 CONGRESS PARK DRIVE DAYTON OH 45459 PHYSICIANS 490694 20 412286 412286 NET PATIENT SERVICE REVENUE 622110 110504547 108474331 2030216 MEDICARE/MEDICAID PAYMENTS 622110 108316338 108316338 JOINT OPERATING AGREEMENT 900099 18967000 18967000 MEDICAL RECORDS 622110 78925 78925 SPORTS MEDICINE 622110 19936 19936 152104 152104 238038850 336893 336893 0 0 719324 758725 -39401 -39401 -39401 374011 2204827 292783 -1830816 -292783 -2123599 -2123599 0 0 1896758 1501928 394830 394830 CAFETERIA SALES 722210 1278019 5561 1272458 PHYSICIAN ANSWERING SERVICE 561000 109476 84943 24533 ALL OTHER REVENUE 900099 297709 297709 1685204 238705063 234538173 2120720 1633884 88257 88257 0 0 0 6882423 1720605 5161818 0 76954344 67281183 9673161 3780000 3304854 475146 12874291 11255993 1618298 5491023 4800801 690222 12163 10634 1529 434938 380266 54672 58379 58379 10467 9151 1316 0 69162 69162 10530556 10530556 588417 588417 2046847 1789558 257289 4868791 4256784 612007 0 5323770 4654572 669198 104947 91755 13192 0 77621 67864 9757 9888897 8645863 1243034 0 22419779 19601613 2818166 47218 41283 5935 OPERATING SUPPLIES 42329896 42329896 PURCHASED SERVICES 10605835 9272682 1333153 BAD DEBT 6908630 6908630 MINOR EQUIPMENT 524455 458531 65924 HOSPITAL FRANCHISE TAX 1573546 1573546 4107645 3591314 516331 228602297 203254608 25347689 0 8300 9000 31593260 17814129 33424016 28550459 3221743 2252831 1369465 1239609 2649238 2841704 335769239 80933512 272492428 254835727 17575934 21369190 2202784 5186310 350000 1055424 5434322 35581835 370321490 370736218 12435632 21878142 192750000 189400000 91600 63319 55036511 41125382 260313743 252466843 X 108290049 118132873 1717698 136502 110007747 118269375 370321490 370736218 X 10102766 -1841138 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 1000000 1000000 1500000 3472 3472 250000 250000 375000 0 0 false false false false false true 10927 false false false 10927 false false SCHEDULE C, SUPPLEMENTAL INFORMATION PART II-B, LINE F PAYING DUES TO GREATER DAYTON AREA HOSPITAL ASSOCIATION AND OHIO HOSPITAL ASSOCIATION. IN ADDITION, WE CONTRACT WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. 1717698 1581196 136502 1648947 0 68751 1717698 2085415 0 -436468 1648947 1.00000 false false 26379650 26379650 196982909 29972923 167009986 2817694 2152058 665636 108403556 48808531 59595025 1185430 0 1185430 254835727 JOA ALLOCATION 18967000 SELF INSURANCE TRUST ASSETS 8637072 AFFILIATE RECEIVABLES 4555926 REAL ESTATE TAXES 1543167 DEFERRED COMPENSATION 1109472 REBATES RECEIVABLE 266534 CAPITAL LEASES 119165 OTHER 383499 35581835 0 BUILDING/CAP LEASE LIABILITIES 17284347 PENSION & DEFERRED COMP 7104963 SWAP LIABILITY 5712062 SELF INSURANCE RESERVE 5613979 INTERCOMPANY PAYABLES 2131157 LOAN GUARANTEES 1316458 TAXES 1200203 BOND INTEREST 556894 OTHER 205319 41125382 Part V - Line 4 Investments to be held in perpetuity, the income from which is expendable to support health care services and capital needs. Part 990, Part IV, Line 11f Atrium Medical Center (AMC) 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. AMC 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: Middletown Surgery Center, LLC (a joint-venture partnership of which AHS is an 80.5% owner), (subsidiaries of AHS) Central America and the Caribbean Program Services Insurance 104969 Central America and the Caribbean Investments North America Investments Europe (Including Iceland and Greenland) Investments East Asia and the Pacific Investments Russia and the Newly Independent States Investments South Asia Investments Sub-Saharan Africa Investments South America Investments Middle East and North Africa Investments 104969 104969 false false false false false false true true X true X true X true true true false true true 15526000 2679000 12847000 0.05790 34773000 26157000 8616000 0.03890 612000 498000 114000 0.00050 50911000 29334000 21577000 0.09730 164000 164000 0.00070 3503000 620000 2883000 0.01300 18000 18000 0.00010 3685000 620000 3065000 0.01380 54596000 29954000 24642000 0.11110 305000 305000 0.00140 305000 305000 0.00140 true 1638000 58483000 67650000 -9167000 X true true MIDDLETOWN SURG CTR OUTPATIENT SURGERY CENTER 0.80000 0.00000 0.10000 1 1 ATRIUM MEDICAL CENTER

ONE MEDICAL CENTER DRIVE MIDDLETOWN OH 45044

X X X ATRIUM MEDICAL CENTER 1 1 MIDDLETOWN SURGERY CENTER LLC

5950 INNOVATION DRIVE FRANKLIN OH 45005

GENERAL MEDICAL & SURGICAL Supplemental Information Part I, Line 6a The community benefit report for Atrium Medical Center is part of the Premier Health Partners report. Part I, Line 7, column (f) $6,908,630 of bad debt was excluded from the denominator. Part I, Line 7g Atrium Medical Center provides the following subsidized services: Maternal Child Health Center offers comprehensive care for women and children including services for pediatric care, immunizations, prenatal care, gynecological services and routine health exams. The Center accepts medical cards, Medicaid HMOS and offers income-based discounts to patients without insurance. The Center has an on-site nutritionist that designs dietary plans specific to each patient. In addition, the Center has an on-site Social Worker that assists with discharge planning, applying for medical cards and government resources and obtaining additional family support. For 2010, the amount of support provided was $417,000. Emergency Services: Atrium Medical Center 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 $2,466,000. 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 are 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 II Atrium Medical Center participates in the following community benefit activities: Board Charitable Credit Fund: As part of Atrium Medical Center's community partnership activity, board members of the Hospital are granted charitable credits to be donated in the name of the board member to not-for-profit, tax-exempt 501(c)(3) health and human services organizations in the area. In addition, the recipient organization must use the funds to improve the general health status of the community and the funds must be used for purposes consistent with the spirit of the Hospital's mission. The amount of support provided in 2010 was $77,000. Franklin City Schools: Atrium Medical Center donated $30,000 to the school system in 2010 Lakota Schools: Atrium Medical Center donated $48,000 to the school system in 2010. In addition, Atrium Medical Center offers a wide variety of free health clinics to the general public. 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 the account returned 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 this 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 40% 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 The Health Foundation of Greater Cincinnati to assist with the needs of the community. The Health Foundation of Greater Cincinnati conducts a survey every five years that includes telephone interviews with approximately 2,500 randomly selected adults residing within a 22 county area including Warren and Butler Counties. This survey found that 38% of area adults are below the national average for physical health status and that the percentage of area adults who report high blood pressure/hypertension and high cholesterol/triglycerides are higher than found among U.S. adults. Also, there is a higher rate of cigarette smoking and binge drinking in comparison to adults nationwide. Approximately 13% of area residents are uninsured, 14% are covered under Medicare and 7% are covered under Medicaid. The survey also indicated that around 25% of area adults do not get the care required because of cost of healthcare or no health insurance. The adults in the region are satisfied with the quality of availability of care but unsatisfied with the cost of healthcare. In order to address some of the concerns found in this survey, Atrium Medical Center offers a wide variety of health care screenings at nominal or no cost to the participant. These screenings include blood pressure, weight, total cholesterol, skin cancer, diabetes and prostate among others. The majority of theses screenings are offered in conjunction with Community Health Fairs. The Hospital also offers various seminars on how to take charge of one's health through effective goal-setting and behavior change methods. Some examples of these seminars include Stress Management, Freedom from Smoking, Wellness Lecture and Eat Well and be Well. Atrium Health Center also offers free care to indigent patients and discounted care to those below various poverty levels. The Hospital also offers payment plan arrangements to assist patients with medical bills. Part VI, Line 3 At our organization, patients are educated and informed about potential payor assistance, charity programs and other financial assistance options through a variety of contacts and media sources. Patients within our Emergency Room and Inpatients are visited by Financial Counselors who discuss various programs and assistance with the patient. There are signs informing patients of charity programs at all registration locations and every patient billing statement lists how they can apply for free care or financial assistance. Patients may also visit our cashier's office or call our customer service department to discuss payor assistance or charity eligibility. Part VI, Line 4 Atrium Medical Center is located in Middletown, Ohio. Our target population includes citizens in the City of Middletown as well as surrounding communities. A large population of our patients are indigent. As companies continue to move out of the market, we continue to see higher unemployment rates and therefore, more uninsured citizens. Unemployment rates are over 9% for Warren and Butler Cou true ATRIUM MEDICAL CENTER FOUNDATION 40 WEST 4TH STREET SUITE 2100 DAYTON OH 45402 311079213 501(C)(3) 47250 COMMUNITY PROGRAMS PREMIER COMMUNITY HEALTH 23 JASPER ST DAYTON OH 45409 311122883 501(C)(3) 10575 COMMUNITY PROGRAMS 2 SCHEDULE I, SUPPLEMENTAL INFORMATION 1) COMMUNITY BENEFITS BUDGETED ALLOCATIONS ARE APPROVED BY ATRIUM HEALTH SYSTEM 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. X X X X true true false false false true true false false DOUG MCNEILL 388464 0 95879 0 899343 0 1171916 0 8551 0 2564153 0 95879 0 CAROL TURNER 230700 0 43122 0 28564 0 89381 0 21212 0 412979 0 43122 0 THOMAS MALONEY 170164 0 27098 0 1282 0 49049 0 24182 0 271775 0 27098 0 DALE CREECH JR 0 290064 0 83578 0 5885 0 191883 0 23872 0 595282 0 83578 THOMAS ARQUILLA 0 264036 0 51072 0 17422 0 81169 0 26628 0 440327 0 51072 MARY CLANCY 0 292302 0 88969 0 34712 0 155900 0 13741 0 585624 0 88969 RENEE GEORGE 0 191717 0 42107 0 577 0 68282 0 21477 0 324160 0 42107 J NICHOLAS LAIR 0 191363 0 42563 0 651 0 100673 0 19757 0 355007 0 42563 WILLIAM LINESCH 0 287966 0 60181 0 23568 0 122429 0 7038 0 501182 0 60181 MARK SHAW 0 246858 0 58629 0 4759 0 93606 0 20621 0 424473 0 58629 TED RIPPERGER 138564 0 21997 0 347 0 34576 0 7891 0 203375 0 21997 0 LISA GOSSETT 115102 0 20213 0 557 0 56774 0 11441 0 204087 0 0 0 LENA FOGLE 159320 0 32374 0 1195 0 19932 0 14715 0 227536 0 17374 0 JOANNE R MORGAN 133017 0 15877 0 1551 0 32400 0 5366 0 188211 0 15877 0 DAVID CAFFERTY 152143 0 0 0 1156 0 15430 0 9056 0 177785 0 0 0 DONNA L BANKS 117810 0 19402 0 802 0 57896 0 21265 0 217175 0 19402 0 MARK E WILLIAMS 132683 0 45000 0 270 0 43180 0 11851 0 232984 0 0 0 SCHEDULE J, SUPPLEMENTAL INFORMATION PART I, QUESTION 4A DOUGLAS MCNEILL - $892,214 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, Atrium Medical Center (AMC), compensates for this limitation and supplements the affected executives' qualified pension through certain nonqualified plans. AMC 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; William Linesch $18,269; Thomas Arquilla $13,194; Mary Clancy $31,838; 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. PART I, QUESTIONS 6A AND 6B PREMIER HEALTH PARTNERS, OF WHICH ATRIUM MEDICAL CENTER 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 INCENTIVE PAYOUT IS COMPUTED BASED ON A PERCENTAGE OF THE EMPLOYEE'S SALARY. 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 AS A WHOLE. THIS FINANCIAL TARGET IS SET BASED ON THE MARGIN REQUIRED TO MAINTAIN THE SYSTEM AA CREDIT RATING. 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. CITY OF MIDDLETOWN OH 316000139 597146AH2 2008-11-21 111000000 REFUND SERIES 2007A & B false false false CITY OF MIDDLETOWN OH 316000139 597146AJ8 2010-11-15 86000000 REFUND SERIES 2006A false false false 7600000 0 111000000 0 0 0 560000 0 0 0 0 0 2007 true false true true 0 0 86000000 0 0 0 560000 0 0 0 0 0 2007 true false true true false true true true true 0.00050 0.00150 0.00200 true false true true true true 0.00050 0.00150 0.00200 true false true true MERRILL LYNCH 29.9 true false false false true false true false false false FORM 990, SUPPLEMENTAL INFORMATION Form 990, Part I, Question 10 Atrium Medical Center has designated its Investments as Trading. In accordance with the AICPA, Guide for Healthcare, all unrealized gains and losses are recognized through the Profit and Loss Statement. For 990 reporting, this activity is excluded per the instructions by the Internal Revenue Service. In 2010, Atrium Medical Center recognized unrealized gains of $509,505. Form 990, Part VI, Section A, Question 6 Atrium Medical Center has two members. One member is Atrium Health System, 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. Atrium Health System 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 Atrium Health System (AHS) has the sole authority to elect the Board of Trustees for Atrium Medical Center (AMC). AHS has the authority to remove trustees at any regular or special meeting or by written consent. In addition to removal by AHS, a trustee may be removed from office with approval by AHS, 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 AHS 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 AHS. Form 990, Part VI, Section A, Question 7b Premier Health Partners (PHP) develops and oversees the implementation of the strategic plan for Atrium Medical Center (AMC) which addresses such matters as location of clinical and administrative expenses and the consolidation of such services. AMC shall comply with and implement this plan and shall not take any action that materially departs from this plan without PHP approval. AMC develops and submits an annual capital and operating budget to PHP for approval. AMC shall adopt and implement the capital and operating budget so approved and/or revised for it by PHP. AMC periodically develops and submits a business plan to PHP for approval. AMC shall implement the business plan approved by PHP. PHP is the sole agent to negotiate all relationships with payors on behalf of AMC with all third party payors and alternative delivery systems including, but not limited to insurers. AMC 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. AMC 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 Atrium Medical Center 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. A final version of the return is sent to Ernst & Young U.S. LLP for a final review and taken to the Audit Committee of PHP. At the Audit Committee 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. The 990 tax return is also shared with the Board of Atrium Medical Center. Form 990, Part VI, Section B, Question 12c Premier Health Partners (PHP), of which Atrium Medical Center 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 Atrium Medical Center, 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, Part VII, Column B Officers work an average of 40 hours over the entities listed in Schedule R. Form 990, Part XI, Question 5 Unrealized Gain 509,505 Foundation Contribution (290,000) Equity Transfers (626,004) Pension Adjustment 3,248,717 Captive Insurance 562,424 HSD/Primary Care (3,712,005) Capital Donation (7,896) Restricted Gift (1,595,300) Other 69,421 TOTAL (1,841,138) 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. Atrium Medical Center's tax year began January 1, 2010 and it therefore has not attached the audited financial statements to its 2010 Form 990. PREMIER HEALTH PARTNERS 40 WEST 4TH STREET DAYTON OH 45402 311446699 SUPPORT. ORG. OH 501(c)(3) 11-I NA ATRIUM HEALTH SYSTEM 40 WEST 4TH STREET DAYTON OH 45402 310537492 PARENT OH 501(c)(3) 11-I NA ATRIUM MEDICAL CENTER FOUNDATION 1 MEDICAL CENTER DR MIDDLETOWN OH 45044 311079213 SUPPORT. ORG. OH 501(c)(3) 11-II ATRIUM HLTH MIDDLETOWN SURGERY CENTER LLC 5950 INNOVATION DR FRANKLIN OH 45005 205160579 SURGERY CENTE OH AHS Related -200103 6311873 true 0 false 0.80000 false false true false false false false false false false false false false false true true true false ATRIUM MEDICAL CENTER FOUNDATION C 412286 ATRIUM MEDICAL CENTER FOUNDATION O 572253 ATRIUM MEDICAL CENTER FOUNDATION P 386553 ATRIUM MEDICAL CENTER FOUNDATION Q 2392758