2025-11-06T13:29:19-06:00 2024-12-31 990 2024-01-01 020633634 SAMARITAN BEHAVIORAL HEALTH INC SAMA 9374999942 110 N MAIN ST 200 DAYTON OH 45402 J MICHAEL SIMS SYSTEM VP & CORP CONTROLLER 9374999942 2025-11-06 0 2024 2025-03-06 01:10:19Z BETH ESPOSITO 601 S EDWIN C MOSES BLVD DAYTON OH 45417 12788065 0 X WWW.SBHIHELP.ORG X 2002 OH SEE PART III, LINE 1 6 2 254 2 0 0 11055518 2800772 9782441 9909243 44684 39852 22589 38198 20905232 12788065 35 0 0 0 17541065 14195560 0 0 0 5884094 2353737 23425194 16549297 -2519962 -3761232 5177883 3335615 5063043 6959823 114840 -3624208 X WE CARE. WE TEACH. WE INNOVATE. WE SERVE. 0 1 2682818 0 2074363 SAMARITAN BEHAVIORAL HEALTH'S YOUTH OUTPATIENT SERVICES OFFER THE FOLLOWING TO ADOLESCENTS AND CHILDREN LIVING IN MONTGOMERY COUNTY: BEHAVIORAL HEALTH ASSESSMENTS TO DETERMINE THE NATURE AND EXTENT OF MENTAL HEALTH PROBLEMS/CONCERNS; RECOMMENDATIONS REGARDING SERVICES THAT ADDRESS PROBLEMS/SYMPTOMS; AN INDIVIDUALIZED SERVICE PLAN WITH THERAPEUTIC GOALS DEVELOPED WITH THE PATIENT/FAMILY; INDIVIDUAL AND FAMILY COUNSELING; REFERRAL TO PSYCHIATRIC SERVICES IF IT APPEARS THAT MEDICATION MAY BE BENEFICIAL; ONGOING PSYCHIATRIC MEDICATION MANAGEMENT, CASE MANAGEMENT (COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT) SERVICES TO FURTHER SUPPORT THERAPEUTIC INTERVENTIONS AND LINK PATIENT/FAMILY TO COMMUNITY RESOURCES. 2130261 0 797799 SAMARITAN BEHAVIORAL HEALTH'S SUBSTANCE ABUSE SERVICES PROGRAM OFFER THE FOLLOWING TO ADULTS ONLY IN MONTGOMERY COUNTY: DIAGNOSTIC EVALUATIONS TO DETERMINE THE NATURE AND EXTENT OF MENTAL HEALTH PROBLEMS AND SUBSTANCE USE DISORDERS; RECOMMENDATIONS REGARDING SERVICES THAT ADDRESS PRESENTING PROBLEMS/SYMPTOMS; AN INDIVIDUALIZED SERVICE PLAN WITH THERAPEUTIC GOALS DEVELOPED WITH THE PATIENT; INDIVIDUAL AND GROUP COUNSELING; INTENSIVE OUTPATIENT TREATMENT (IOP) AND NON-INTENSIVE OUTPATIENT TREATMENT (N-IOP); REFERRAL TO MEDICATION ASSISTED TREATMENT (MAT), ONGOING MEDICATION MANAGEMENT, CASE MANAGEMENT/COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT (CPST), AND RETURN TO WORK SERVICES THROUGH THE SAMHSA REBOUND GRANT. 1733327 0 2023568 SAMARITAN BEHAVIORAL HEALTH'S SCHOOL SERVICES OFFER THE FOLLOWING TO ADOLESCENTS AND CHILDREN LIVING IN MONTGOMERY COUNTY AND MIAMI COUNTY: DIAGNOSTIC EVALUATIONS TO DETERMINE THE NATURE AND EXTENT OF MENTAL HEALTH PROBLEMS/CONCERNS; RECOMMENDATIONS REGARDING SERVICES THAT ADDRESS PROBLEMS/SYMPTOMS; AN INDIVIDUALIZED SERVICE PLAN WITH THERAPEUTIC GOALS DEVELOPED WITH THE PATIENT/FAMILY; INDIVIDUAL AND FAMILY COUNSELING; REFERRAL TO PSYCHIATRIC SERVICES IF IT APPEARS THAT MEDICATION MAY BE BENEFICIAL AT THE OUTPATIENT VISIT, OR IF AT VANDALIA, REFERRAL TO THE PSYCHIATRIC PROVIDER SPECIFIC FOR VANDALIA BUTLER SCHOOLS; ONGOING PSYCHIATRIC MEDICATION MANAGEMENT, CASE MANAGEMENT (COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT) SERVICES TO FURTHER SUPPORT THERAPEUTIC INTERVENTIONS AND LINK PATIENT/FAMILY TO COMMUNITY RESOURCES. SERVICES ARE CONTRACTED THROUGH MIAMI VALLEY CAREER TECHNOLOGY CENTER, MIAMI VALLEY CAREER TECHNOLOGY CENTER ALTERNATIVE, VANDALIA BUTLER, TROTWOOD MADISON, WEST CARROLLTON IN MONTGOMERY COUNTY. IN MIAMI COUNTY, SERVICES ARE PROVIDED AT PIQUA, MILTON UNION, AND TROY CITY SCHOOLS. 7394456 0 5051711 THIS NUMBER REPRESENTS THE BALANCE OF TOTAL EXPENDITURES OF TEMPORARILY RESTRICTED FUNDS FOR SAMARITAN BEHAVIORAL HEALTH NET OF PROGRAMS DESCRIBED IN SERVICE ACCOMPLISHMENTS. 7394456 0 5051711 13940862 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 254 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 2 0 1 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 200 DAYTON OH 45402 JOANN R RINGER BOARD CHAIR 0.50 39.50 X X 0 600485 50224 ELISABETH ESPOSITO VICE-CHAIR / PRESIDENT & CEO 40.00 0.00 X X 421739 0 33972 JASON E MERRITT TRUSTEE 0.50 39.50 X 0 386947 20573 BENJAMIN W SUTHERLY TRUSTEE 0.50 39.50 X 0 213297 34240 GINA MCFARLANE-EL TRUSTEE 0.50 0.00 X 0 0 0 JONATHAN MILLER MD TRUSTEE 0.50 0.00 X 0 0 0 CHANDLER BRODERICK ESQ BOARD SECRETARY 0.50 39.50 X 0 202069 27877 ESTEE R ATZMON BOARD TREASURER 0.50 39.50 X 0 180202 28302 NANCY J SMITH DO PSYCHIATRIST 40.00 0.00 X 255204 0 20110 ELLEN W BALLERENE MD PSYCHIATRIST-SBHI 40.00 0.00 X 176649 0 41398 STEPHANIE E ACKNER DO PSYCHIATRIST-SBHI 40.00 0.00 X 177284 0 27099 DIANA L PEARSON DIR-SBHI-SUBSTANCE SVCS 40.00 0.00 X 153553 0 7908 CURTIS B EVERSON PHYSICIAN: ADDICTION MEDICINE 40.00 0.00 X 126053 0 31610 ELOISE P BRONER FORMER TRUSTEE & OFFICER 0.00 0.00 X 0 268904 4190 JENNA M DOWNEY ESQ FORMER OFFICER 0.00 40.00 X 0 416852 22416 1310482 2268756 349919 13 1 1 0 0 366857 2050204 383711 16848 2800772 PROGRAM SERVICE REVENUE 900099 9909243 9909243 9909243 39852 39852 WOMEN'S REC CENTER 900099 29064 29064 MEDICAL RECORDS 900099 9134 9134 38198 12788065 9947441 0 39852 455711 412692 43019 11349891 9828795 1521096 109645 96486 13159 1403761 1187959 215802 876552 739384 137168 272 272 18000 18000 443 443 738560 485066 253494 5334 5334 159150 122795 36355 117070 515 116555 998064 865151 132913 54097 53518 579 3420 3420 87247 87247 93448 93448 DUES AND SUBSCRIPTIONS 23893 3333 20560 TRAINING AND EDUCATION 17775 15280 2495 OPERATING SUPPLIES 15788 15788 SPECIAL EVENTS 10403 10403 10773 7696 3077 16549297 13940862 2608435 0 4772 3918 2269184 1500836 50427 81221 2012579 1079970 231513 932609 2621987 817031 5177883 3335615 1981948 842672 208457 398199 1803129 814582 1069509 4904370 5063043 6959823 X -719096 -4419081 833936 794873 114840 -3624208 5177883 3335615 -3761232 22184 0 X 0 1 X 1 0 X 7753754 10350480 10105237 11055518 2800772 42065761 9889199 11809459 11067624 9805030 9947441 52518753 17642953 22159939 21172861 20860548 12748213 94584514 0 26844 68894 166739 262477 26844 68894 166739 262477 94322037 49858 73418 16201 48623 39852 227952 49858 73418 16201 48623 39852 227952 17692811 22233357 21189062 20909171 12788065 94812466 0.99480 0.99640 0.00240 0.00250 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 443 0 0 0 443 0 PART II-B, LINE 1: PAYMENTS FOR LOBBYING ACTIVITIES INCLUDE DUES PAID TO OHIO COUNCIL OF BEHAVIORAL HEALTH & FAMILY SERVICES PROVIDERS. 833936 64810 62036 165909 794873 746947 21659 81410 16080 833936 854870 410 -104443 3890 746947 770359 260 86081 1830 854870 702327 2736 81139 15842 770359 0.00000 0.69320 0.30680 0 1 1 376459 296016 80443 1487640 783954 703686 148480 148480 932609 FUNDS HELD BY GOOD SAMARITAN FOUNDATION - DAYTON 794873 DEPOSITS 22158 817031 AFFILIATES PAYABLE 4904370 4904370 X PART V, LINE 4: SAMARITAN BEHAVIORAL HEALTH, INC. (SBHI) MAKES EVERY EFFORT TO FOLLOW THE INTENT AND WISHES OF ALL ITS DONORS. THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS AND/OR EARNINGS FROM ENDOWMENT FUNDS ARE DRIVEN BY THE WISHES/RESTRICTIONS PLACED ON THE FUNDS BY THE DONOR. PERMANENT ENDOWMENTS RESULT WHEN A DONATION IS RECEIVED WITH A RESTRICTION THAT THE PRINCIPAL OR GIFT AMOUNT IS TO BE RETAINED IN PERPETUITY AND CANNOT BE SPENT. THE EARNINGS FROM THE PERMANENT ENDOWMENTS ARE THEN USED FOR THE PURPOSE SPECIFIED BY THE DONOR. TEMPORARY ENDOWMENTS ARE FUNDS IN WHICH ALL OR PART OF THE PRINCIPAL MAY BE EXPENDED ONLY AFTER THE EXPIRATION OF A STATED PERIOD OF TIME OR OCCURRENCE OF A SPECIFIED EVENT, DEPENDING ON THE DONOR'S WISHES. EARNINGS FROM TEMPORARILY RESTRICTED ENDOWMENTS CAN BE EITHER UNRESTRICTED OR RESTRICTED. SBHI USES THE TEMPORARILY RESTRICTED ENDOWMENTS FOR THE INTENDED PURPOSE SET UP BY THE DONOR, ONLY AFTER THE PERIOD OF TIME OR SPECIFIED EVENT SET BY THE DONOR HAS BEEN MET. THE "CATEGORIES" OF RESTRICTED ENDOWMENTS ARE AS FOLLOWS: SBHI PROGRAM CONSORTIUM (55%); PROGRAM OPERATING EXPENSES (24%); MENTAL HEALTH (17%); AND MISCELLANEOUS (4%). PART X, LINE 2: THE FOLLOWING FOOTNOTE IS FROM THE 2024 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF SAMARITAN BEHAVIORAL HEALTH, INC. 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 HOLDING COMPANY (PHHC) (WHOLLY OWNED SUBSIDIARY OF PHP) * MVHE, INC., (AND ITS WHOLLY OWNED SUBSIDARY EXTENDED CARE), SAMARITAN FAMILY CARE, INC., PREMIER HEALTH SPECIALISTS, INC. AND PREMIER HEALTH URGENT CARE, INC. (WHOLLY OWNED SUBSIDIARIES OF PHHC) MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS. 1 1 0 0 0 0 0 0 0 JOANN R RINGER BOARD CHAIR 0 355144 0 175969 0 69372 0 24559 0 25665 0 650709 0 0 ELISABETH ESPOSITO VICE-CHAIR / PRESIDENT & CEO 298395 0 120465 0 2879 0 11684 0 22288 0 455711 0 0 0 JENNA M DOWNEY ESQ FORMER OFFICER 0 297195 0 119017 0 640 0 10962 0 11454 0 439268 0 0 JASON E MERRITT TRUSTEE 0 278536 0 107481 0 930 0 13276 0 7297 0 407520 0 0 NANCY J SMITH DO PSYCHIATRIST 250298 0 0 0 4906 0 8035 0 12075 0 275314 0 0 0 ELOISE P BRONER FORMER TRUSTEE & OFFICER 0 0 0 0 0 268904 0 0 0 4190 0 273094 0 0 BENJAMIN W SUTHERLY TRUSTEE 0 161764 0 51005 0 528 0 8144 0 26096 0 247537 0 0 CHANDLER BRODERICK ESQ BOARD SECRETARY 0 156506 0 45293 0 270 0 5909 0 21968 0 229946 0 0 ELLEN W BALLERENE MD PSYCHIATRIST-SBHI 175735 0 0 0 914 0 7819 0 33579 0 218047 0 0 0 ESTEE R ATZMON BOARD TREASURER 0 148680 0 31204 0 318 0 7186 0 21116 0 208504 0 0 STEPHANIE E ACKNER DO PSYCHIATRIST-SBHI 176702 0 0 0 582 0 7660 0 19439 0 204383 0 0 0 DIANA L PEARSON DIR-SBHI-SUBSTANCE SVCS 46693 0 35591 0 71269 0 3476 0 4432 0 161461 0 0 0 CURTIS B EVERSON PHYSICIAN: ADDICTION MEDICINE 111237 0 5000 0 9816 0 4609 0 27001 0 157663 0 0 0 PART I, LINE 3 COMPENSATION FOR SAMARITAN BEHAVIORAL HEALTH, INC.'S (SBHI) CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH SBHI IS AN AFFILIATE. SEE EXPLANATION ON SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINE 15. PART I, LINE 4A: THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE: ELOISE BRONER $269,909; DIANA PEARSON $70,200. 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, SAMARITAN BEHAVIORAL HEALTH, INC. (SBHI) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. SBHI SUPPLEMENTS THE AFFECTED EXECUTIVES THROUGH A PENSION RESTORATION PLAN OR 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 2024. THE INDIVIDUALS LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN RECEIVED THE ASSOCIATED PAYMENT IN 2024: JOANN RINGER $40,048. IN ADDITION, THE FOLLOWING SERP AMOUNTS WERE DEFERRED ON THE PARTICIPANTS' BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNTS ARE VESTED: JASON MERRITT $123. 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 AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES NOT TREATED AS DEFERRED COMPENSATION FOR PURPOSES OF SCHEDULE J. SUCH WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. FORM 990, PART III, LINE 3 SUBSTANCE ABUSE/115 PROGRAM: AS PART OF AN INNOVATIVE COLLABORATION TO HELP PEOPLE LIVING WITH OPIOID ADDICTION, ONEFIFTEEN ENTERED THE DAYTON MARKET IN 2019. PREMIER HEALTH AND OTHER COMMUNITY PARTNERS MADE A MULTI-YEAR COMMITMENT TO SUPPORT THE START-UP OF THE NONPROFIT ORGANIZATION AND ITS CAMPUS IN DAYTON'S CARILLON NEIGHBORHOOD, WITH SAMARITAN BEHAVIORAL HEALTH INC. (SBHI) SERVING AS ONEFIFTEEN'S OPERATING PARTNER AND PROVIDING CLINICAL CARE, INCLUDING BEHAVIORAL HEALTH SERVICES. THAT COMMUNITY SUPPORT, IN TURN, ENABLED ONEFIFTEEN TO FUND THE INCREASED OPERATIONS AT SBHI. HAVING REACHED THE NEXT PHASE, PREMIER HEALTH AND SBHI HAVE MUTUALLY AGREED WITH ONEFIFTEEN THAT SBHI WILL WIND DOWN OPERATIONS ON THE ONEFIFTEEN CAMPUS. BEGINNING IN 2024, ONEFIFTEEN WILL OPERATE THE CAMPUS AS AN INDEPENDENT PROVIDER. WHILE SBHI WILL NO LONGER SERVE AS ONEFIFTEEN'S OPERATING PARTNER, IT WILL CONTINUE TO OFFER OUTPATIENT SERVICES IN THE COMMUNITY. CRISISCARE: SAMARITAN BEHAVIORAL HEALTH'S CRISISCARE PROGRAM GRANT ENDED JUNE 2024, AND THE SERVICES WERE DISCONTINUED. FORM 990, PART VI, SECTION A, LINE 3 PREMIER HEALTH (PREMIER), AS THE OPERATOR OF SAMARITAN BEHAVIORAL HEALTH, INC. (SBHI), DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR SBHI, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. SBHI SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. SBHI SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. SBHI SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF SBHI WITH ALL THIRD-PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. SBHI MUST HAVE APPROVAL FROM PREMIER TO BORROW IN ANY FISCAL YEAR, GUARANTEE IN ANY YEAR, OR INCUR ANY LIEN OR OTHER ENCUMBRANCE ON ANY PROPERTY IN AN AMOUNT EQUAL TO OR GREATER THAN $1,000,000. SBHI MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN SBHI'S ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 6 SAMARITAN BEHAVIORAL HEALTH, INC. HAS ONE CORPORATE MEMBER: PREMIER HEALTH, AN OHIO NON-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A PREMIER HEALTH (PREMIER) HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR SAMARITAN BEHAVIORAL HEALTH, INC. PREMIER HAS THE AUTHORITY TO REMOVE SUCH TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. FORM 990, PART VI, SECTION A, LINE 7B SEE EXPLANATION FOR FORM 990, 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, OF WHICH SAMARITAN BEHAVIORAL HEALTH, INC. IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. AFTER ALL CHANGES FROM THE ABOVE PERSONS ARE MADE, 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, WITH WHICH SBHI IS AN AFFILIATE, 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 COMPENSATION FOR SBHI'S CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH SBHI IS AN AFFILIATE, ON AN ANNUAL BASIS. THE 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. PREMIER HEALTH 110 MAIN ST 200 DAYTON OH 45402 311446699 PARENT OH 501 (C) (3) 12B N/A 0 MEDAMERICA HEALTH SYSTEMS CO 110 MAIN ST 200 DAYTON OH 45402 311040228 SUPPORT ORG OH 501 (C) (3) 12B N/A 0 MIAMI VALLEY HOSPITAL 110 MAIN ST 200 DAYTON OH 45402 310537504 HOSPITAL OH 501 (C) (3) 3 PREMIER HEALTH 0 MIAMI VALLEY HOSPITAL FOUNDATION 110 MAIN ST 200 DAYTON OH 45402 311040231 FOUNDATION OH 501 (C) (3) 7 PREMIER HEALTH 0 FIDELITY HEALTH CARE INC 110 MAIN ST 200 DAYTON OH 45402 311075381 HOME HEALTH OH 501 (C) (3) 10 PREMIER HEALTH 0 PREMIER COMMUNITY HEALTH 110 MAIN ST 200 DAYTON OH 45402 311122883 HEALTH EDUCATION OH 501 (C) (3) 10 FIDELITY HEALTH CARE 0 GOOD SAMARITAN FOUNDATION - DAYTON 110 MAIN ST 200 DAYTON OH 45402 237296923 FOUNDATION OH 501 (C) (3) 7 PREMIER HEALTH 0 ATRIUM HEALTH SYSTEM 110 MAIN ST 200 DAYTON OH 45402 310537492 SUPPORT ORG OH 501 (C) (3) 12B N/A 0 ATRIUM MEDICAL CENTER 110 MAIN ST 200 DAYTON OH 45402 311079309 HOSPITAL OH 501 (C) (3) 3 PREMIER HEALTH 0 UVMC 110 MAIN ST 200 DAYTON OH 45402 341850683 SUPPORT ORG OH 501 (C) (3) 12B N/A 0 UPPER VALLEY MEDICAL CENTER 110 MAIN ST 200 DAYTON OH 45402 310537095 HOSPITAL OH 501 (C) (3) 3 PREMIER HEALTH 0 UPPER VALLEY PROFESSIONAL CORP 110 MAIN ST 200 DAYTON OH 45402 311400963 HEALTH CARE OH 501 (C) (3) 10 PREMIER HEALTH HOLDING CO 0 UVPC SPECIALISTS 110 MAIN ST 200 DAYTON OH 45402 203687536 HEALTH CARE OH 501 (C) (3) 10 PREMIER HEALTH HOLDING CO 0 UVMC NURSING CARE INC 110 MAIN ST 200 DAYTON OH 45402 311224064 NURSING HOME OH 501 (C) (3) 10 PREMIER HEALTH 0 COMPUNET CLINICAL LABORATORIES LLC 110 MAIN ST 200 DAYTON OH 45402 311258010 LAB OH 501 (C) (3) 12B PREMIER HEALTH 0 SWEITZER STREET LLC 110 MAIN ST 200 DAYTON OH 45402 454700417 REAL ESTATE OH MVHE INC EXCLUDED 0 0 SWEITZER MOB LLC 110 MAIN ST 200 DAYTON OH 45402 474554657 REAL ESTATE OH MVHE INC EXCLUDED 0 0 MVHE INC 110 MAIN ST 200 DAYTON OH 45402 311185270 PHYSICIAN SVCS OH PREMIER HEALTH HOLDING CO C 0 PREMIER HEALTH SPECIALISTS 110 MAIN ST 200 DAYTON OH 45402 061744704 PHYSICIAN SVCS OH PREMIER HEALTH HOLDING CO C 0 SAMARITAN FAMILY CARE 110 MAIN ST 200 DAYTON OH 45402 311299450 PHYSICIAN SVCS OH PREMIER HEALTH HOLDING CO C 0 AFTER HOURS FAMILY CARE 110 MAIN ST 200 DAYTON OH 45402 311269483 HEALTH CARE OH UPPER VALLEY PROFESSIONAL CORP C 0 UVMC MANAGEMENT CORP 110 MAIN ST 200 DAYTON OH 45402 311360489 MANAGEMENT COMPANY OH PREMIER HEALTH C 0 PREMIER HEALTH URGENT CARE INC 110 MAIN ST 200 DAYTON OH 45402 822079409 URGENT CARE OH PREMIER HEALTH HOLDING CO C 0 PREMIER HEALTH PLAN INC 110 MAIN ST 200 DAYTON OH 45402 463024049 HEALTH INSURANCE OH PREMIER HEALTH INSURING CO C 0 GOOD SAMARITAN HOSPITAL 110 MAIN ST 200 DAYTON OH 45402 310536981 HOSPITAL OH PREMIER HEALTH C 0 PREMIER HEALTH INT'L INSURANCE BUTTERFIELD BANK BLDG 6TH FLR 65 HAMILTON BD HM12 980548485 INSURANCE BD PREMIER HEALTH C 0 PREMIER HEALTH ACO OF OHIO 110 MAIN ST 200 DAYTON OH 45402 474049773 MEDICARE ACO OH PREMIER HEALTH C 0 PREMIER HEALTH HOLDING CO 110 MAIN ST 200 DAYTON OH 45402 812419110 HOLDING CO OH PREMIER HEALTH C 0 PREMIER HEALTH INSURING CO 110 MAIN ST 200 DAYTON OH 45402 464766841 HEALTH INSURANCE OH PREMIER HEALTH C 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1