2023-11-14T16:23:52-06:00 2022-12-31 990 2022-01-01 311446699 PREMIER HEALTH PARTNERS PREM 9374999942 110 N MAIN ST 500 DAYTON OH 45402 J MICHAEL SIMS VP & CONTROLLER 9374999942 2023-11-14 J MICHAEL SIMS 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z PREMIER HEALTH MICHAEL C RIORDAN 110 N MAIN ST 500 DAYTON OH 45402 2435435 0 X WWW.PREMIERHEALTH.COM X 1995 OH SEE PART III, LINE 1 21 17 14 17 0 114424 127650 162430 1590021 1732342 -24219 -10190 102419 525711 1795871 2410293 158 31015 0 0 120480198 122132469 0 0 0 125944357 100930686 246424713 223094170 -244628842 -220683877 58265641 54335061 33782872 29945784 24482769 24389277 X WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH QUALITY, COST-COMPETITIVE HEALTH SERVICES. 0 0 194513943 31015 1732342 THE PRIMARY EXEMPT PURPOSE OF PREMIER HEALTH (PREMIER) IS TO ESTABLISH, MAINTAIN, SUPPORT, AND STIMULATE THE DEVELOPMENT OF A HEALTHCARE SYSTEM INCLUDING WITHOUT LIMITATION, HOSPITALS, CLINICS, AND OTHER FACILITIES THAT PROVIDE INPATIENT OR OUTPATIENT CARE OR AMBULATORY SERVICES, ACCOMMODATIONS, DIAGNOSTICS, AND TREATMENTS TO PERSONS SUFFERING FROM ILLNESS.CONTINUED IN SCHEDULE O. 1868540 0 0 PREMIER HEALTH GROUP (PHG) IS A NON-EQUITY MODEL PHYSICIAN HOSPITAL ORGANIZATION CREATED TO CLINICALLY INTEGRATE PHYSICIANS AND HOSPITALS IN THE COMMON INTEREST OF ACHIEVING THE TRIPLE AIM: IMPROVED CONSUMER EXPERIENCE WITH THE HEALTHCARE SYSTEM AND LOWERING TOTAL COST OF CARE, WHILE MAINTAINING OR IMPROVING QUALITY OUTCOMES. PHG SERVES AS THE PROVIDER NETWORK FOR AND PROVIDES CONTINUOUS QUALITY IMPROVEMENT FUNCTIONS FOR PREMIER HEALTH PLAN, PREMIER HEALTH INSURING CORPORATION AND PREMIER HEALTH ACO OF OHIO, ALL AFFILIATES OF PREMIER HEALTH. THROUGH OUR PHYSICIAN-LED ORGANIZATION, WE DEPLOY VARIOUS POPULATION HEALTH MODELS TO OUR PROVIDERS TO HELP THEM BETTER COORDINATE CARE FOR THEIR PATIENTS IN OUR EFFORTS TO SERVE PREMIER HEALTH'S MISSION OF BUILDING HEALTHIER COMMUNITIES. 196382483 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 787 0 1 14 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 21 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X J MICHAEL SIMS 9374999942 110 N MAIN ST 500 DAYTON OH 45402 X MARY H BOOSALIS PRESIDENT & CEO (TO JAN) 10.00 30.00 X X 2267077 0 24764 MICHAEL C RIORDAN PRESIDENT & CEO (FROM JAN) 10.00 30.00 X X 1280440 0 28132 BRYAN R LUDWIG MD TRUSTEE 0.50 39.50 X 0 848809 41132 DARIN J PANGALANGAN MD TRUSTEE 0.50 39.50 X 0 670193 12030 SUBODH K WADHWA MD TRUSTEE 0.50 39.50 X 0 265924 15045 KATHLEEN A CARLSON BOARD CHAIR 0.50 0.50 X X 0 0 0 STEVE BEINLICH TRUSTEE 0.50 0.50 X 0 0 0 MARVA COSBY TRUSTEE 0.50 0.00 X 0 0 0 LANCE DETRICK TRUSTEE 0.50 0.50 X 0 0 0 NICOLE ERNST TRUSTEE 0.50 1.00 X 0 0 0 GAIL P FOREST TRUSTEE 0.50 0.50 X 0 0 0 MARTIN K FUJIMURA MD TRUSTEE 0.50 0.00 X 0 0 0 JOSEPH M GERAGHTY TRUSTEE 0.50 0.00 X 0 0 0 LARRY L HOLLINGSHEAD TRUSTEE 0.50 0.50 X 0 0 0 JOHN W JACK LOHBECK TRUSTEE 0.50 0.00 X 0 0 0 JASON MAHONEY TRUSTEE 0.50 0.50 X 0 0 0 MITCH MELFI TRUSTEE 0.50 0.00 X 0 0 0 DOUGLAS L MEYER TRUSTEE 0.50 0.50 X 0 0 0 COLLEEN RYAN TRUSTEE 0.50 0.00 X 0 0 0 LISA SHOCKLEY TRUSTEE 0.50 1.00 X 0 0 0 STEVEN STALEY TRUSTEE 0.50 1.00 X 0 0 0 JILL WILSON TRUSTEE 0.50 0.50 X 0 0 0 BARBARA A JOHNSON COO 39.00 1.00 X 1165699 0 26211 GEOFFREY P WALKER BOARD SECRETARY & CLO 10.00 30.00 X 942545 0 48436 CRAIG GANGER CFO 39.50 0.50 X 806989 0 65751 MARC R BELCASTRO DO VP MEDICAL AFFAIRS & PREMIER CMO 10.00 30.00 X 834885 0 36211 KEITH D BRICKING MD VP-CHIEF CLINICAL OFFICER (FROM OCT) 10.00 30.00 X 0 782373 67407 MARY M CLANCY CHIEF DIGITAL OFFICER 9.50 30.50 X 704534 0 52422 J MICHAEL SIMS SYS VP & CORPORATE CONTROLLER 10.00 30.00 X 677602 0 50344 MARGARET PEGGY W MARK VP NURSING/CNO/PATIENT EXP (TO APR) 10.00 30.00 X 566116 0 180268 AMANDA K ADKINS-RICCI SYSTEM VP REVENUE CYCLE 10.00 30.00 X 287332 0 22969 LISA M GOSSETT VP NURSE/CNO/PATIENT EXP (FROM JUN) 10.00 30.00 X 202745 0 12505 DIANE L PLEIMAN PRESIDENT & CEO-PHYS COMPANIES 8.00 32.00 X 851501 0 25448 JASON M BAILEY DIRECTOR-VALUE BASED SERVICES 40.00 0.00 X 204086 0 97487 MICHAEL J MAIBERGER FORMER OFFICER 0.00 0.00 X 0 822367 0 GARY G GINTER FORMER KEY EMPLOYEE 0.00 40.00 X 0 814929 49071 JENNIFER J HAULER DO FORMER KEY EMPLOYEE 0.00 40.00 X 0 765079 19428 ELAINE LAINIE M DEAN FORMER KEY EMPLOYEE 0.00 40.00 X 0 560347 25752 BILLIE L LUCENTE-BAKER FORMER KEY EMPLOYEE 0.00 40.00 X 0 319191 31843 MATTHEW S REEVES FORMER HIGHEST COMPENSATED EMPLOYEE 0.00 0.00 X 413044 0 28714 11204595 5849212 961370 14 1 1 0 BESPOKE WORKFORCE LLC 5930 CORNERSTONE CT W 300 SAN DIEGO CA 92121 MEDICAL SERVICES 110423701 ANESTHESIOLOGY SERVICES ONE WYOMING ST DAYTON OH 45409 MEDICAL SERVICES 28347590 MORRISON HEALTHCARE 400 NORTHRIDGE ROAD 600 ATLANTA GA 30350 PROFESSIONAL SERVICE 25584174 CROTHALL HEALTHCARE 1500 LIBERTY RIDGE DR 210 WAYNE PA 19087 PROFESSIONAL SERVICE 18020891 COMMONSPIRIT HEALTH 444 W LAKE ST 2500 CHICAGO IL 60606 PROFESSIONAL SERVICE 16063330 367 120643 41787 2508 162430 PATIENT INFORMATION PARTNERS 900099 1724475 1724475 HEALTH EDUCATION 900099 7867 7867 1732342 14952 25142 -10190 -10190 -10190 PURCHASE DISCOUNTS 900099 493218 493218 EMS EDUCATION 900099 31869 31869 PARKING 900099 624 624 525711 2410293 1732342 0 515521 X 31015 31015 9412881 2463845 6949036 93187786 84567916 8619870 2168174 1967618 200556 10833601 9831493 1002108 6530027 5925999 604028 763410 692795 70615 1142571 1036883 105688 32327 29337 2990 23971671 21754291 2217380 7445767 6757034 688733 2730157 2477617 252540 37454305 33989782 3464523 2702464 2452486 249978 303684 275593 28091 6961 6317 644 105 95 10 12268654 11133803 1134851 1885463 1711058 174405 ASSET IMPAIRMENT 7000000 6352500 647500 DUES & SUBSCRIPTIONS 1747260 1585638 161622 PATIENT RELATIONS 535746 486190 49556 TRAINING AND EDUCATION 493056 447448 45608 447085 405730 41355 223094170 196382483 26711687 0 2306142 2734125 115926 137762 13085821 13706327 192768820 163633646 34063529 29135174 8694223 8621673 58265641 54335061 32539851 28943891 93785 7355 1149236 994538 33782872 29945784 X 24482769 24389277 24482769 24389277 58265641 54335061 X -220683877 220590385 X 0 1 X 1 0 X X 11 ATRIUM MEDICAL CENTER 311079309 3 1 0 0 MIAMI VALLEY HOSPITAL 310537504 3 1 0 0 UPPER VALLEY MEDICAL CENTER 310537095 3 1 0 0 MIAMI VALLEY HOSPITAL FOUNDATION 311040231 7 1 0 0 FIDELITY HEALTH CARE INC 311075381 10 1 0 0 PREMIER COMMUNITY HEALTH 311122883 10 1 0 0 GOOD SAMARITAN FOUNDATION - DAYTON 237296923 7 1 0 0 SAMARITAN BEHAVIORAL HEALTH INC 020633634 7 1 30000 0 UPPER VALLEY PROFESSIONAL CORPORATION 311400963 10 1 0 0 UVPC SPECIALISTS INC 203687536 10 1 0 0 UVMC NURSING CARE INC 311224064 10 1 0 0 11 30000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION A, LINE 1: THE JANUARY 1, 2018 DEFINITIVE SYSTEM REORGANIZATION AGREEMENT DESIGNATED PREMIER HEALTH (PREMIER) AS THE SOLE CORPORATE MEMBER OF THE THREE SYSTEM HOSPITALS (FIVE LOCATIONS) AND ALL HOSPITAL SUBSIDIARIES AND AFFILIATES UNLESS SPECIFICALLY EXCLUDED. THE HOSPITAL SUBSIDIARIES ARE NOT CALLED OUT BY NAME. PART IV, SECTION C, LINE 1: THE JANUARY 1, 2018 DEFINITIVE SYSTEM AGREEMENT GRANTS PREMIER THE ABILITY TO APPOINT AND / OR REMOVE BOARD MEMBERS OF THE SUPPORTED ORGANIZATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 10727 0 0 1 21600 32327 0 PART II-B, LINE 1F: PAYMENTS FOR LOBBYING ACTIVITIES INCLUDE DUES PAID TO OHIO BUSINESS ROUNDTABLE AND DAYTON DEVELOPMENT COALITION. PART II-B, LINE 1I: PREMIER CONTRACTS WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. 8625022 5045235 3579787 9428 5081 4347 179300524 158583330 20717194 4833846 4833846 29135174 AFFILIATES INVESTMENTS 5071489 DEPOSITS 3364684 DEFERRED COMPENSATION 185500 8621673 LICENSE FEE ACCRUAL 566720 TAX LIABILITY 206454 DEFERRED COMPENSATION 185500 OTHER 35864 994538 X PART X, LINE 2: THE FOLLOWING FOOTNOTE IS TAKEN FROM THE 2022 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE A TAX-EXEMPT NON-PROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS A TAX-EXEMPT ORGANIZATION, ITS INCOME IS EXEMPT FROM FEDERAL INCOME TAX EXCEPT TO THE EXTENT OF ANY UNRELATED BUSINESS ACTIVITIES. PHP CONSOLIDATES CERTAIN SUBSIDIARIES WHICH ARE FOR-PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. THESE ARE: * PREMIER HEALTH INSURING CO. (PHIC), AND PREMIER HEALTH HOLDING COMPANY (PHHC) (WHOLLY OWNED SUBSIDIARIES OF PHP), * PREMIER HEALTH PLAN (PHPLAN) (A WHOLLY OWNED SUBSIDIARY OF PHIC), * MVHE, INC., SAMARITAN FAMILY CARE, INC., PREMIER HEALTH SPECIALISTS, INC. AND PREMIER HEALTH URGENT CARE, INC. (SUBSIDIARIES OF PHHC), * PREMIER HEALTH ACO OF OHIO AND UVMC MANAGEMENT CORPORATION - CLOSED JUNE 2022 (SUBSIDIARIES OF PHP) MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 117168000 0 0 0 0 0 0 117168000 0 117168000 1 0 1 1 1 0 PART III ACCOUNTING METHOD: PART I, LINE 3: THE INVESTMENTS LISTED IN SCHEDULE F ARE NOT REPORTED ON PREMIER'S 990, PART X, BUT ARE INSTEAD REPORTED ON THE THREE HOSPITALS OF WHICH PREMIER IS THE MEMBER. 1 SAMARITAN BEHAVIORAL HEALTH INC 110 N MAIN ST SUITE 500 DAYTON OH 45402 020633634 501(C)(3) 30000 0 SUPPORT 1 1 X X X X 1 1 0 0 0 0 0 0 0 MARY H BOOSALIS PRESIDENT & CEO (TO JAN) 243179 0 1799215 0 224683 0 18855 0 5909 0 2291841 0 0 0 MICHAEL C RIORDAN PRESIDENT & CEO (FROM JAN) 1067901 0 0 0 212539 0 0 0 28132 0 1308572 0 0 0 BARBARA A JOHNSON COO 779540 0 297335 0 88824 0 14063 0 12148 0 1191910 0 0 0 GEOFFREY P WALKER BOARD SECRETARY & CLO 483803 0 150928 0 307814 0 18871 0 29565 0 990981 0 0 0 BRYAN R LUDWIG MD TRUSTEE 0 845835 0 0 0 2974 0 12084 0 29048 0 889941 0 0 DIANE L PLEIMAN PRESIDENT & CEO-PHYS COMPANIES 436713 0 225134 0 189654 0 16571 0 8877 0 876949 0 0 0 CRAIG GANGER CFO 573905 0 211359 0 21725 0 35804 0 29947 0 872740 0 0 0 MARC R BELCASTRO DO VP MEDICAL AFFAIRS & PREMIER CMO 598103 0 181805 0 54977 0 10475 0 25736 0 871096 0 0 0 GARY G GINTER FORMER KEY EMPLOYEE 0 450593 0 126517 0 237819 0 19235 0 29836 0 864000 0 203308 KEITH D BRICKING MD VP-CHIEF CLINICAL OFFICER (FROM OCT) 0 571733 0 199778 0 10862 0 34979 0 32428 0 849780 0 0 MICHAEL J MAIBERGER FORMER OFFICER 0 0 0 0 0 822367 0 0 0 0 0 822367 0 0 JENNIFER J HAULER DO FORMER KEY EMPLOYEE 0 557482 0 184044 0 23553 0 17044 0 2384 0 784507 0 0 MARY M CLANCY CHIEF DIGITAL OFFICER 470691 0 150789 0 83054 0 19693 0 32729 0 756956 0 0 0 MARGARET PEGGY W MARK VP NURSING/CNO/PATIENT EXP (TO APR) 127686 0 133099 0 305331 0 154451 0 25817 0 746384 0 0 0 J MICHAEL SIMS SYS VP & CORPORATE CONTROLLER 355741 0 138119 0 183742 0 19235 0 31109 0 727946 0 0 0 DARIN J PANGALANGAN MD TRUSTEE 0 523699 0 141347 0 5147 0 9946 0 2084 0 682223 0 0 ELAINE LAINIE M DEAN FORMER KEY EMPLOYEE 0 407817 0 129774 0 22756 0 11065 0 14687 0 586099 0 0 MATTHEW S REEVES FORMER HIGHEST COMPENSATED EMPLOYEE 0 0 95316 0 317728 0 6632 0 22082 0 441758 0 59080 0 BILLIE L LUCENTE-BAKER FORMER KEY EMPLOYEE 0 241999 0 76411 0 781 0 16655 0 15188 0 351034 0 0 AMANDA K ADKINS-RICCI SYSTEM VP REVENUE CYCLE 241887 0 44970 0 475 0 11512 0 11457 0 310301 0 0 0 JASON M BAILEY DIRECTOR-VALUE BASED SERVICES 143636 0 36299 0 24151 0 71140 0 26347 0 301573 0 0 0 SUBODH K WADHWA MD TRUSTEE 0 235408 0 0 0 30516 0 3638 0 11407 0 280969 0 0 LISA M GOSSETT VP NURSE/CNO/PATIENT EXP (FROM JUN) 200746 0 0 0 1999 0 2855 0 9650 0 215250 0 0 0 PART I, LINE 4A: THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT IN 2022: JASON BAILEY $23,694; MARY BOOSALIS $218,596; MARGARET MARK $273,306; MATTHEW REEVES $328,122. 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, PREMIER HEALTH (PREMIER) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. PREMIER SUPPLEMENTS THE AFFECTED EXECUTIVES THROUGH A PENSION RESTORATION PLAN AND A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE BENEFITS UNDER THESE SUPPLEMENTAL NONQUALIFIED PLANS ARE SUBJECT TO MULTI-YEAR VESTING AND A PARTICIPANT CAN FORFEIT BENEFITS EARNED IF VESTING REQUIREMENTS ARE NOT SATISFIED. UNDER THE TERMS OF THE SUPPLEMENTAL PLANS, AND BECAUSE OF TAX RULES PERTAINING TO TAXATION OF THE EARNED BENEFITS UPON VESTING, CERTAIN INDIVIDUALS RECEIVED A PAYOUT OF THE CUMULATIVE VESTED BENEFITS UNDER THEIR SUPPLEMENTAL PLAN DURING 2022. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2022: MARY CLANCY $78,305; DIANE PLEIMAN $166,819; J. MICHAEL SIMS $156,921; GEOFFREY WALKER $300,385. UNDER THE SERP AND RECEIVED THE ASSOCIATED PLAN PAYMENT IN 2022. THE INDIVIDUALS LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2022: MARC BELCASTRO, M.D. $43,756; GARY GINTER $230,909; BARBARA JOHNSON $74,090; MICHAEL MAIBERGER $392,827; MARGARET MARK $17,830. THE FOLLOWING SERP AMOUNTS WERE DEFERRED ON THE PARTICIPANTS' BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNTS ARE VESTED: KEITH BRICKING, M.D. $25,383; CRAIG GANGER $24,813; JENNIFER HAULER, D.O. $7,358; BILLIE LUCENTE-BAKER $1,828. 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. GOSSETT CONSULTING & INSIGHTS LLC OWNED BY KEY EMPLOYEE, LISA GOSSETT 153500 CONSULTING BEFORE BECOMING AN EMPLOYEE. AGREEMENT WAS COMPLETED PRIOR TO TAKING A FULL-TIME POSITION. 0 FORM 990, PART I, LINE 7B & PART VIII, COLUMN C: NET UNRELATED BUSINESS TAXABLE INCOME /(LOSS) COMPRISES AMOUNTS FROM PARTNERSHIP INVESTMENTS THAT ARE NOT RECOGNIZED FOR BOOK PURPOSES, THEREFORE NO UNRELATED BUSINESS INCOME/(LOSS) FROM PARTNERSHIP INVESTMENTS APPEARS ON PART VIII. FORM 990, PART III, LINE 4A (CONTINUED): AS SUCH, PREMIER IS RESPONSIBLE FOR OVERSIGHT OF THE THREE HOSPITAL ENTITIES AS ITS CHARITABLE GOAL, AND THE INFORMATION BELOW IS CUMULATIVE OF THEIR SEPARATE REPORTS: QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT COMMUNITY BENEFIT SUMMARY FROM RELATED HOSPITALS SCHEDULE H FOR THE YEAR ENDED DECEMBER 31, 2022. CHARITY AND MEANS-TESTED GOVERNMENT PROGRAMS AND CERTAIN OTHER COMMUNITY BENEFITS AT COST: $ 8,745,000 CHARITY CARE AT COST $178,449,000 UNREIMBURSED MEDICAID $ 11,160,000 UNREIMBURSED COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS ------------ $198,354,000 TOTAL OTHER COMMUNITY BENEFITS: $ 3,669,000 COMMUNITY HEALTH IMPROVEMENT SERVICES & COMMUNITY BENEFIT OPERATIONS $ 38,490,000 SUBSIDIZED HEALTH SERVICES $ 7,163,000 CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY GROUPS ------------ $ 49,322,000 TOTAL ------------ $247,676,000 GRAND TOTAL PROGRAM & OTHER COMMUNITY BENEFITS $ 21,613,000 UNPAID COST OF MEDICARE (ALLOWABLE COST AND REIMBURSEMENTS REPORTED ON MEDICARE COST REPORT) $158,721,000 OTHER UNPAID COST OF MEDICARE (COST AND REIMBURSEMENTS NOT REPORTED ON MEDICARE COST REPORT) ------------ $180,334,000 TOTAL UNPAID COST OF MEDICARE ------------ $428,010,000 TOTAL COMMUNITY BENEFIT INCLUDING THE UNPAID COSTS OF MEDICARE ------------ FORM 990, PART VI, SECTION A, LINE 6 PREMIER HEALTH (PREMIER) HAS FOUR CORPORATE MEMBERS: MEDAMERICA HEALTH SYSTEMS, CATHOLIC HEALTH INITIATIVES, ATRIUM HEALTH SYSTEM, AND UVMC. FORM 990, PART VI, SECTION A, LINE 7A MEDAMERICA HEALTH SYSTEMS ELECTS 8 BOARD MEMBERS, CATHOLIC HEALTH INITIATIVES ELECTS 7 BOARD MEMBERS, ATRIUM HEALTH SYSTEM ELECTS 3 BOARD MEMBERS AND UVMC ELECTS 3 BOARD MEMBERS. THE MEMBERS MUST APPROVE ANY DISSOLUTION OF ASSETS AND ANY CHANGES IN THE CODE OF REGULATIONS OR ARTICLES OF INCORPORATION. THE MEMBERS DO NOT APPROVE ANY OPERATIONAL DECISIONS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B SEE EXPLANATION FOR PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION B, LINE 11B THIS 990 FILING AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE TAX DEPARTMENT OF PREMIER. THE RETURN IS REVIEWED BY THE MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. NEXT, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER. A FINAL VERSION OF THE RETURN IS THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT A BOARD OF TRUSTEES 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 BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 FILING IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, LINE 12C PREMIER REQUIRES ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, MEDICAL DIRECTORS, SUPPLY CHAIN DIVISION MEMBERS, AUTHORIZED SIGNERS, DIRECTORS, EXECUTIVES, MEDICAL EXECUTIVE COMMITTEE MEMBERS, MEDICAL DEPARTMENT AND SECTION CHAIRS, PHYSICIAN PARTNERSHIP COMMITTEE MEMBERS, PHYSICIAN GUIDANCE GROUP MEMBERS, AND ALL EMPLOYED PHYSICIANS 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 EITHER BY WAY OF AN ELECTRONIC COMMUNICATION SENT OUT DIRECTLY BY THE CORPORATE COMPLIANCE DEPARTMENT OR BY WAY OF A MEMO SENT OUT FROM THE CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER OF PREMIER. IT ALSO 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 CORRESPONDENCE 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 DEPARTMENT. 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 CHIEF COMPLIANCE AND ENTERPRISE RISK 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 DOCUMENT AND SENT ELECTRONICALLY TO THE FINANCE DEPARTMENT FOR ANY NECESSARY DISCLOSURES REQUIRED ON THE 990 FILING. FORM 990, PART VI, SECTION B, LINE 15 THE ANNUAL REVIEW PROCESS PERFORMED BY PREMIER 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 AND NATIONAL 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 DATA 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 CONTAINS THREE MEMBERS, ALL OF WHOM ARE INDEPENDENT. THIS COMMITTEE REVIEWS IN DETAIL THE COMPENSATION FOR THE PREMIER CEO, COO, CFO, CCO AND OTHER TOP EXECUTIVES. 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, LINE 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 UPON REQUEST. FORM 990, PART VII, SECTION A, SYSTEM KEY EMPLOYEES: THE SYSTEM KEY EMPLOYEES' TOTAL COMPENSATION AMOUNT IS ACCURATELY REPORTED ON THE VARIOUS ENTITIES THEY SERVE. THE KEY EMPLOYEES' COMPENSATION IS BEING REPORTED AS PAID BY PREMIER AS THE PAYMASTER OF THEIR APPLICABLE AFFILIATED ORGANIZATION IN ORDER TO MORE CLEARLY REFLECT THEIR RESPONSIBILITIES ACROSS THE PREMIER SYSTEM. COMPENSATION AND RELATED PAYROLL REPORTING REQUIREMENTS FOR SYSTEM KEY EMPLOYEES ARE PROCESSED AND FILED BY AFFILIATES OF PREMIER. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 10,383,851. MANAGEMENT AND GENERAL EXPENSES 1,058,410. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,442,261. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 4,333,341. MANAGEMENT AND GENERAL EXPENSES 441,690. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,775,031. COLLECTION COSTS: PROGRAM SERVICE EXPENSES 1,816,788. MANAGEMENT AND GENERAL EXPENSES 185,182. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,001,970. PURCHASED LABOR: PROGRAM SERVICE EXPENSES 1,656,810. MANAGEMENT AND GENERAL EXPENSES 168,876. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,825,686. CREDIT CARD FEES: PROGRAM SERVICE EXPENSES 1,542,508. MANAGEMENT AND GENERAL EXPENSES 157,225. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,699,733. CONSULTING FEES: PROGRAM SERVICE EXPENSES 431,913. MANAGEMENT AND GENERAL EXPENSES 44,024. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 475,937. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 358,967. MANAGEMENT AND GENERAL EXPENSES 36,589. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 395,556. RECORD RETENTION: PROGRAM SERVICE EXPENSES 302,294. MANAGEMENT AND GENERAL EXPENSES 30,812. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 333,106. TRANSPORTATION SERVICES: PROGRAM SERVICE EXPENSES 276,513. MANAGEMENT AND GENERAL EXPENSES 28,185. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 304,698. RECRUITING FEES: PROGRAM SERVICE EXPENSES 192,567. MANAGEMENT AND GENERAL EXPENSES 19,628. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 212,195. BANK FEES: PROGRAM SERVICE EXPENSES 168,673. MANAGEMENT AND GENERAL EXPENSES 17,193. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 185,866. MATERIAL STERILE PROCESSING: PROGRAM SERVICE EXPENSES 77,886. MANAGEMENT AND GENERAL EXPENSES 7,939. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 85,825. OTHER FEES: PROGRAM SERVICE EXPENSES 212,180. MANAGEMENT AND GENERAL EXPENSES 21,627. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 233,807. FORM 990, PART XI, LINE 9: EQUITY TRANSFER 220,590,385. PREMIER HEALTH GROUP LLC 110 N MAIN ST 500 DAYTON OH 45402 461428664 DR NETWORK OH 0 4471 PREMIER HEALTH MEDAMERICA HEALTH SYSTEMS CO 110 N MAIN STREET 500 DAYTON OH 45402 311040228 SUPPORT ORG OH 501(C)(3) 12B N/A 0 MIAMI VALLEY HOSPITAL 110 N MAIN STREET 500 DAYTON OH 45402 310537504 HOSPITAL OH 501(C)(3) 3 PREMIER HEALTH 1 MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN STREET 500 DAYTON OH 45402 311040231 FOUNDATION OH 501(C)(3) 7 PREMIER HEALTH 1 FIDELITY HEALTH CARE INC 110 N MAIN STREET 500 DAYTON OH 45402 311075381 HOME HEALTH OH 501(C)(3) 10 PREMIER HEALTH 1 PREMIER COMMUNITY HEALTH 110 N MAIN STREET 500 DAYTON OH 45402 311122883 HEALTH EDUCATION OH 501(C)(3) 10 FIDELITY HEALTH CARE 1 GOOD SAMARITAN FOUNDATION - DAYTON 110 N MAIN STREET 500 DAYTON OH 45402 237296923 FOUNDATION OH 501(C)(3) 7 PREMIER HEALTH 1 ATRIUM HEALTH SYSTEM 110 N MAIN STREET 500 DAYTON OH 45402 310537492 SUPPORT ORG OH 501(C)(3) 12B N/A 0 ATRIUM MEDICAL CENTER 110 N MAIN STREET 500 DAYTON OH 45402 311079309 HOSPITAL OH 501(C)(3) 3 PREMIER HEALTH 1 UVMC 110 N MAIN STREET 500 DAYTON OH 45402 341850683 SUPPORT ORG OH 501(C)(3) 12B N/A 0 UPPER VALLEY MEDICAL CENTER 110 N MAIN STREET 500 DAYTON OH 45402 310537095 HOSPITAL OH 501(C)(3) 3 PREMIER HEALTH 1 UPPER VALLEY PROFESSIONAL CORP 110 N MAIN STREET 500 DAYTON OH 45402 311400963 HEALTH CARE OH 501(C)(3) 10 PREMIER HEALTH HOLDING CO 1 UVPC SPECIALISTS 110 N MAIN STREET 500 DAYTON OH 45402 203687536 HEALTH CARE OH 501(C)(3) 10 PREMIER HEALTH HOLDING CO 1 UVMC NURSING CARE INC 110 N MAIN STREET 500 DAYTON OH 45402 311224064 NURSING HOME OH 501(C)(3) 10 PREMIER HEALTH 1 COMPUNET CLINICAL LABORATORIES LLC (MAR 09 TO DEC 31) 110 N MAIN STREET 500 DAYTON OH 45402 311258010 LAB OH 501(C)(3) 12B PREMIER HEALTH 1 SAMARITAN BEHAVIORAL HEALTH INC 110 N MAIN STREET 500 DAYTON OH 45402 020633634 BEHAVIORAL HEALTH OH 501(C)(3) 7 PREMIER HEALTH 1 SWEITZER STREET LLC 110 N MAIN STREET 500 DAYTON OH 45402 454700417 REAL ESTATE OH MVHE INC EXCLUDED 0 0 SWEITZER MOB LLC 110 N MAIN STREET 500 DAYTON OH 45402 474554657 REAL ESTATE OH MVHE INC EXCLUDED 0 0 MVHE INC 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 311185270 PHYSICIAN SVCS OH PREMIER HEALTH HOLDING CO C 0 PREMIER HEALTH SPECIALISTS 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 061744704 PHYSICIAN SVCS OH PREMIER HEALTH HOLDING CO C 0 SAMARITAN FAMILY CARE 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 311299450 PHYSICIAN SVCS OH PREMIER HEALTH HOLDING CO C 0 AFTER HOURS FAMILY CARE 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 311269483 HEALTH CARE OH UPPER VALLEY PROFESSIONAL CORP C 0 UVMC MANAGEMENT CORP 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 311360489 MANAGEMENT COMPANY OH PREMIER HEALTH C 0 PREMIER HEALTH URGENT CARE INC 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 822079409 URGENT CARE OH PREMIER HEALTH HOLDING CO C 0 PREMIER HEALTH PLAN INC 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 463024049 HEALTH INSURANCE OH PREMIER HEALTH INSURING CO C 0 GOOD SAMARITAN HOSPITAL 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 310536981 HOSPITAL OH PREMIER HEALTH C 361306 8644041 1.00000 0 PREMIER HEALTH INT'L INSURANCE BUTTERFIELD BANK BLDG 6TH FLR 65 HAMILTON BD HM12 980548485 INSURANCE BD PREMIER HEALTH C 1.00000 0 PREMIER HEALTH ACO OF OHIO 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 474049773 MEDICARE ACO OH PREMIER HEALTH C 1.00000 0 PREMIER HEALTH HOLDING CO 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 812419110 HOLDING CO OH PREMIER HEALTH C -140194516 152375466 1.00000 0 PREMIER HEALTH INSURING CO 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 464766841 HEALTH INSURANCE OH PREMIER HEALTH C -206851 1.00000 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 MIAMI VALLEY HOSPITAL FOUNDATION C 75786 FMV