GOOD SAMARITAN FOUNDATION-DAYTON: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN FOUNDATION-DAYTON (EIN 23-7296923)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202243189349311524
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T13:56:34-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237296923 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN FOUNDATION - DAYTON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST SUITE 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | J MICHAEL SIMS | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 9374999942 | PhoneNum |
| Signature | 2022-11-14 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | J | PersonFirstNm |
| Person Last | MICHAEL SIMS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JENNY M LEWIS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE WYOMING ST | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,421,272 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PREMIERHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | INSPIRE PHILANTHROPY TO ENHANCE THE HEALTH AND WELL-BEING OF THE GREATER DAYTON COMMUNITIES AND THE HEALTHCARE PROFESSIONALS WHO CARE FOR THEM. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 3 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $802,762 | PYContributionsGrantsAmt |
| CY Contributions Grants | $608,096 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $926,518 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,292,640 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$16,986 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $1,712,294 | PYTotalRevenueAmt |
| CY Total Revenue | $1,900,736 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $418,658 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $629,222 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $391,743 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $276,421 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $185,076 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $97,015 | PYOtherExpensesAmt |
| CY Other Expenses | $121,980 | CYOtherExpensesAmt |
| PY Total Expenses | $907,416 | PYTotalExpensesAmt |
| CY Total Expenses | $1,027,623 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $804,878 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $873,113 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,510,068 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,545,050 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $108,204 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $83,291 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $13,401,864 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,461,759 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | INSPIRE PHILANTHROPY TO ENHANCE THE HEALTH AND WELL-BEING OF THE GREATER DAYTON COMMUNITIES AND THE HEALTHCARE PROFESSIONALS WHO CARE FOR THEM. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $401,964 | ExpenseAmt |
| Grant | $401,964 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | SAMARITAN HEALTH CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER OPERATED BY FIVE RIVERS HEALTH CENTERS IN DAYTON, OHIO. SAMARITAN HEALTH CENTER PROVIDES MEDICAL, DENTAL, AND MENTAL HEALTH CARE TO MORE THAN 1,300 PATIENTS EACH YEAR. MOST PATIENTS ARE HOMELESS OR LOW-INCOME AND AT RISK OF BECOMING HOMELESS. SAMARITAN HEALTH CENTER OFFERS COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING PRIMARY CARE, PODIATRY, AND BEHAVIORAL HEALTH SERVICES, AS WELL AS ACCESS TO PATIENT EDUCATION, A DIETICIAN, AND A SOCIAL WORKER. IN 2021, THE SAMARITAN CENTER FOR WOMEN AND FAMILIES OPENED INSIDE ST. VINCENT DE PAUL'S GATEWAY HOMELESS SHELTER. THIS CLINIC PROVIDES WOMEN, CHILDREN, AND FAMILIES LIVING AT THE SHELTER WITH ACCESS TO PEDIATRIC CARE, WOMEN'S HEALTH CARE, AND PRIMARY CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $83,399 | ExpenseAmt |
| Grant | $59,830 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | MOTHERS EMPOWERED PROVIDES HIGH-QUALITY, COMPREHENSIVE PRENATAL CARE AND PARENTING EDUCATION TO PREGNANT WOMEN IN GREATER DAYTON WHO ARE AT RISK OF LOSING A BABY TO INFANT MORTALITY. MOTHERS EMPOWERED IS A COLLABORATION BETWEEN LIFESTAGES CENTERS FOR WOMEN, A LOCAL OBGYN PRACTICE, AND GOOD SAMARITAN FOUNDATION-DAYTON, COMPOSED OF AN RN PROGRAM COORDINATOR, A PART TIME MEDICAL ASSISTANT, AND A CERTIFIED NURSE MIDWIFE. THESE HEALTH CARE PROFESSIONALS PROVIDE THE EVIDENCE-BASED, BEST-PRACTICE CENTERINGPREGNANCY GROUP MODEL OF PRENATAL CARE. PREGNANT MOTHERS ARE GROUPED BY DUE DATE, SO THEY GO THROUGH THE SAME STAGE OF PREGNANCY TOGETHER, LEARNING ABOUT THEIR NEW BABIES WHILE FORMING FRIENDSHIPS WITH OTHER MOMS AND BUILDING TRUSTING RELATIONSHIPS WITH THEIR MEDICAL PROVIDERS. IN 2021, 62 WOMEN WERE SERVED. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $57,090 | ExpenseAmt |
| Grant | $57,090 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE CORONAVIRUS EMERGING NEEDS FUND WAS ESTABLISHED TO PROVIDE EQUIPMENT, RESOURCES, AND SUPPORT FOR MEDICAL STAFF DURING THE COVID-19 PANDEMIC. DONATIONS ENABLED THE PURCHASE OF ESSENTIAL TESTING AND TREATMENT EQUIPMENT, MEALS TO SUPPORT FRONTLINE WORKERS, AND RESPITE SPACES FOR STAFF TO HELP EASE THE STRAIN OF LONG HOURS CARING FOR PATIENTS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $178,933 | ExpenseAmt |
| Grant | $110,338 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THIS NUMBER REPRESENTS THE BALANCE OF TOTAL EXPENDITURES OF TEMPORARILY RESTRICTED FUNDS FOR RELATED HOSPITALS NET OF PROGRAMS DESCRIBED IN SERVICE ACCOMPLISHMENTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $178,933 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $110,338 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $721,386 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 3 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | J MICHAEL SIMS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST SUITE 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| MILINDA S NIMMO ZABRAMBA MD | |||||||||
| TRUSTEE | 0.50 | 39.50 | Yes (X) | $0 | $357,804 | $30,756 | |||
| JENNY M LEWIS | |||||||||
| PRESIDENT | 13.33 | 26.67 | Yes (X) | $0 | $307,636 | $49,218 | Yes (X) | ||
| KENNETH M WATSON SR | |||||||||
| BOARD CHAIR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JO ANNE F REILING | |||||||||
| BOARD VICE-CHAIR | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| FR BENJAMIN SPEARE-HARDY III | |||||||||
| BOARD SECRETARY | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DIANE ANDERSON DO | |||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SUZANNE DONOVAN SC | |||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD T FERGUSON | |||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD A MEYER | |||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| PAMELA A PHELPS | |||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| ANN SCHUERMAN | |||||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| J MICHAEL SIMS | |||||||||
| BOARD TREASURER | 0.50 | 39.50 | $0 | $623,246 | $48,840 | Yes (X) | |||
| CHRISTINA E KNOWLES | |||||||||
| DIR-DEVELOPMENT | 40.00 | 0.00 | $104,522 | $0 | $27,714 | Yes (X) | |||
| JOHN J HALUSCHAK MD | |||||||||
| FORMER OFFICER | 0.00 | 40.00 | $0 | $220,722 | $14,360 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $104,522 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,509,408 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $170,888 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $1,472 | FederatedCampaignsAmt |
| Related Organizations | $5,000 | RelatedOrganizationsAmt |
| All Other Contributions | $601,624 | AllOtherContributionsAmt |
| Noncash Contributions | $118,857 | NoncashContributionsAmt |
| Total Contributions | $608,096 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $153,863 | TotalRevenueColumnAmt |
| Exclusion | $153,863 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $18,659,313 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $17,520,536 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,138,777 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,138,777 | TotalRevenueColumnAmt |
| Exclusion | $1,138,777 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,900,736 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,292,640 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $606,222 | TotalAmt |
| Program Services | $606,222 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,000 | TotalAmt |
| Program Services | $23,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,018 | TotalAmt |
| Program Services | $59,005 | ProgramServicesAmt |
| Management And General | $59,005 | ManagementAndGeneralAmt |
| Fundraising | $118,008 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,439 | TotalAmt |
| Program Services | $6,110 | ProgramServicesAmt |
| Management And General | $6,110 | ManagementAndGeneralAmt |
| Fundraising | $12,219 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,964 | TotalAmt |
| Program Services | $3,991 | ProgramServicesAmt |
| Management And General | $3,991 | ManagementAndGeneralAmt |
| Fundraising | $7,982 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,557 | TotalAmt |
| Management And General | $27,557 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,700 | TotalAmt |
| Program Services | $14,925 | ProgramServicesAmt |
| Management And General | $14,925 | ManagementAndGeneralAmt |
| Fundraising | $29,850 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,359 | TotalAmt |
| Program Services | $1,840 | ProgramServicesAmt |
| Management And General | $1,840 | ManagementAndGeneralAmt |
| Fundraising | $3,679 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,184 | TotalAmt |
| Program Services | $6,046 | ProgramServicesAmt |
| Management And General | $6,046 | ManagementAndGeneralAmt |
| Fundraising | $12,092 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,920 | TotalAmt |
| Management And General | $1,440 | ManagementAndGeneralAmt |
| Fundraising | $480 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $274 | TotalAmt |
| Fundraising | $274 | FundraisingAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| DUES & SUBSCRIPTIONS | $599 | $150 | $150 | $299 |
| OPERATING EXPENSES | $375 | $94 | $94 | $187 |
| TRAINING AND EDUCATION | $12 | $3 | $3 | $6 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,027,623 | TotalAmt |
| Program Services | $721,386 | ProgramServicesAmt |
| Management And General | $121,161 | ManagementAndGeneralAmt |
| Fundraising | $185,076 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150 | BOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $450,777 | BOYAmt |
| EOY | $145,051 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $249,699 | BOYAmt |
| EOY | $220,857 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,826,259 | BOYAmt |
| EOY | $9,858,386 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,983,183 | BOYAmt |
| EOY | $4,245,756 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $75,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,510,068 | BOYAmt |
| EOY | $14,545,050 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,956 | BOYAmt |
| EOY | $35,855 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,248 | BOYAmt |
| EOY | $47,436 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,204 | BOYAmt |
| EOY | $83,291 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,745,344 | BOYAmt |
| EOY | $2,754,959 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,656,520 | BOYAmt |
| EOY | $11,706,800 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,401,864 | BOYAmt |
| EOY | $14,461,759 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,510,068 | BOYAmt |
| EOY | $14,545,050 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $873,113 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $208,703 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$21,921 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,119,154 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $557,500 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $615,433 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $802,762 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $609,496 | CurrentTaxYearAmt |
| Total | $3,704,345 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,119,154 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $557,500 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $615,433 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $802,762 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $609,496 | CurrentTaxYearAmt |
| Total | $3,704,345 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $593,955 | SubstantialContributorsTotAmt |
| Public Support Total170 | $3,110,390 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $248,127 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $236,819 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $216,433 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $156,350 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $153,863 | CurrentTaxYearAmt |
| Total | $1,011,592 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $4,715,937 | TotalSupportAmt |
| Public Support CY170 | 0.65950 | PublicSupportCY170Pct |
| Public Support PY170 | 0.62780 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $10,656,520 | BeginningYearBalanceAmt |
| Contributions | $522,412 | ContributionsAmt |
| Investment Earnings Or Losses | $1,132,315 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $604,446 | GrantsOrScholarshipsAmt |
| End Year Balance | $11,706,800 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,446,814 | BeginningYearBalanceAmt |
| Contributions | $680,596 | ContributionsAmt |
| Investment Earnings Or Losses | $1,059,761 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $530,651 | GrantsOrScholarshipsAmt |
| End Year Balance | $10,656,520 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,570,381 | BeginningYearBalanceAmt |
| Contributions | $503,148 | ContributionsAmt |
| Investment Earnings Or Losses | $1,335,433 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $962,148 | GrantsOrScholarshipsAmt |
| End Year Balance | $9,446,814 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,461,345 | BeginningYearBalanceAmt |
| Contributions | $454,878 | ContributionsAmt |
| Investment Earnings Or Losses | -$537,350 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $808,492 | GrantsOrScholarshipsAmt |
| End Year Balance | $8,570,381 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,705,467 | BeginningYearBalanceAmt |
| Contributions | $927,231 | ContributionsAmt |
| Investment Earnings Or Losses | $292,931 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $464,284 | GrantsOrScholarshipsAmt |
| End Year Balance | $9,461,345 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.40800 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.59200 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SECURITIES | Desc |
| Book Value | $4,245,756 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $4,245,756 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| AFFILIATES PAYABLE | $34,356 |
| DEFERRED ANNUITIES | $13,080 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $47,436 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE GOOD SAMARITAN FOUNDATION-DAYTON (GSF-DAYTON) 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. A PERMANENT ENDOWMENT RESULTS 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 ENDOWMENT ARE 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. THE GSF-DAYTON USES THE TEMPORARILY RESTRICTED ENDOWMENTS FOR THE INTENDED PURPOSE SETUP BY THE DONOR, ONLY AFTER THE PERIOD OF TIME OR SPECIFIED EVENT SET BY THE DONOR HAS BEEN MET. THE CATEGORIES OF PERMANENTLY AND TEMPORARILY RESTRICTED ENDOWMENTS ARE AS FOLLOWS: TO SUPPORT THE LOCAL COMMUNITY HOMELESS CLINIC OPERATIONS (16%); TO FUND EDUCATIONAL PROGRAMS/SCHOLARSHIPS (18%); TO FUND THE FOUNDATION OPERATIONS (15%); TO SUPPORT HEART DISEASE (9%); TO SUPPORT MOTHERS EMPOWERED(ME)TO PROVIDE FREE MEDICAL CARE AND PRENATAL AND PARENTING EDUCATION TO PREGNANT WOMEN IN NEED (8%),TO SUPPORT ELDER CARE (7%); TO BENEFIT SPECIFIC PROGRAMS FOR A SAMARITAN HEALTH PARTNER'S AFFILIATE (7%); AND MISCELLANEOUS (20%). |
| PART X, LINE 2: | THE FOLLOWING FOOTNOTE IS FROM THE 2021 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF GOOD SAMARITAN FOUNDATION-DAYTON. 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) * GOOD SAMARITAN HOSPITAL AND UVMC MANAGEMENT CORPORATION (SUBSIDIARIES OF PHP) MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| FIVE RIVERS HEALTH CENTERS | ||||||||||
| 2261 PHILADELPHIA DRIVE SUITE 200 | DAYTON | OH | 45406 | 450914398 | 501(C)(3) | $401,964 | $0 | N/A | N/A | OPERATIONS |
| PREMIER HEALTH PARTNERS | ||||||||||
| 110 N MAIN ST SUITE 500 | DAYTON | OH | 45402 | 311446699 | 501(C)(3) | $65,405 | $0 | N/A | N/A | OPERATIONS |
| CATHOLIC SOCIAL SERVICES | ||||||||||
| 922 W RIVERVIEW AVENUE | DAYTON | OH | 45402 | 310536645 | 501(C)(3) | $59,830 | $0 | N/A | N/A | OPERATIONS |
| MIAMI VALLEY HOSPITAL | ||||||||||
| 110 N MAIN ST SUITE 500 | DAYTON | OH | 45402 | 310537504 | 501(C)(3) | $26,584 | $47,309 | FMV | PERSONAL PROTECTION EQUIPMENT AND FOOD | OPERATIONS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | EDUCATIONAL SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 18 | RecipientCnt |
| Cash Grant | $23,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ALL DISTRIBUTIONS (GRANTS PAID) FOLLOW THE ENTITY'S DISBURSEMENT POLICY, INCLUDING: (A) ASSUMING FUNDS AVAILABILITY, HOSPITAL DEPARTMENT PERSONNEL COMPLETE A FOUNDATION REQUEST FORM. FOR AMOUNTS IN EXCESS OF $1,000, DIRECTOR'S & VICE-PRESIDENT'S SIGNATURES ARE REQUIRED TO REQUEST FOUNDATION FUNDING. (B) FOR A REQUEST GREATER THAN $5,000, THE FOUNDATION'S DISTRIBUTION COMMITTEE REVIEWS AND APPROVES THE REQUEST. THE CHECK ALSO REQUIRES A SECOND SIGNATURE. (C) REPORTING FOR GRANTS IS THE RESPONSIBILITY OF THE OPERATIONAL UNIT. (D) BEFORE DISBURSING FUNDS, EACH REQUEST IS VERIFIED/MATCHED FOR ITS INTENDED PURPOSE. FOR EXAMPLE, SCHOLARSHIP REQUIREMENTS INCLUDE: A) GPA REQUIREMENTS; B) LENGTH OF SERVICE; C) SPECIFIC FIELDS OF STUDY. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| J MICHAEL SIMS | ||||||||||||||
| BOARD TREASURER | $0 | $350,568 | $0 | $129,225 | $0 | $143,453 | $0 | $20,415 | $0 | $28,425 | $0 | $672,086 | $0 | $0 |
| MILINDA S NIMMO ZABRAMBA MD | ||||||||||||||
| TRUSTEE | $0 | $327,584 | $0 | $28,600 | $0 | $1,620 | $0 | $8,293 | $0 | $22,463 | $0 | $388,560 | $0 | $0 |
| JENNY M LEWIS | ||||||||||||||
| PRESIDENT | $0 | $238,913 | $0 | $65,320 | $0 | $3,403 | $0 | $23,151 | $0 | $26,067 | $0 | $356,854 | $0 | $0 |
| JOHN J HALUSCHAK MD | ||||||||||||||
| FORMER OFFICER | $0 | $190,867 | $0 | $0 | $0 | $29,855 | $0 | $0 | $0 | $14,360 | $0 | $235,082 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | COMPENSATION FOR THE GSF-DAYTON CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH GSF-DAYTON IS AN AFFILIATE. SEE EXPLANATION ON SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINE 15. |
| 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, GOOD SAMARITAN FOUNDATION-DAYTON (GSF-DAYTON) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. GSF-DAYTON 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 2021. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2021: J. MICHAEL SIMS $117,016. THE FOLLOWING SERP AMOUNT WAS DEFERRED ON A PARTICIPANT'S BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNT IS VESTED: JENNY LEWIS $2,550. 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. |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $75,000 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (3 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | EMPLOYEE FOOD | 8 | $34,834 | FMV |
| Yes (X) | COVID-19 PPE | 2 | $4,773 | FMV |
| Yes (X) | SUPPLIES/PRIZES | 11 | $4,250 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE GOOD SAMARITAN FOUNDATION (GSF-DAYTON) HAS ONE CORPORATE MEMBER: PREMIER HEALTH (PREMIER), AN OHIO NON-PROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | PREMIER HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR GSF-DAYTON. 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 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, WITH WHICH GSF-DAYTON 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 PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT THE BOARD OF TRUSTEES' MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESS ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 FILING IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. |
| FORM 990, PART VI, SECTION B, LINE 12C | PREMIER, WITH WHICH GSF-DAYTON 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 THE GSF-DAYTON CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH GSF-DAYTON 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 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, CHIEF STRATEGY OFFICER, CHIEF INTEGRATION OFFICER AND THE HOSPITAL CEOS. OTHER POSITIONS ARE REVIEWED AT A HIGH LEVEL FOR REASONABLENESS. ALL THE MEETING MINUTES ARE DOCUMENTED AND KEPT ON FILE ALONG WITH ANY COMPARABILITY DATA AND THE CONSULTANT REPORT. AFTER THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION ACTIONS, THE PROCESS IS AUDITED BY THE INTERNAL AUDIT DEPARTMENT. THE EXECUTIVE COMPENSATION COMMITTEE PRESENTS THE COMPENSATION ACTIONS TO THE PREMIER BOARD ANNUALLY. |
| FORM 990, PART VI, SECTION C, 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 XI, LINE 9: | TRANSFER TO AFFILIATE -19,545. PLEDGE RESERVE -2,376. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PREMIER HEALTH | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311446699 | PARENT | OH | 501 (C) (3) | 12B | N/A | 0 | |
| MEDAMERICA HEALTH SYSTEMS CO | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311040228 | SUPPORT ORG | OH | 501 (C) (3) | 12B | N/A | 0 | |
| MIAMI VALLEY HOSPITAL | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 310537504 | HOSPITAL | OH | 501 (C) (3) | 3 | 0 | PREMIER HEALTH | |
| MIAMI VALLEY HOSPITAL FOUNDATION | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311040231 | FOUNDATION | OH | 501 (C) (3) | 7 | 0 | PREMIER HEALTH | |
| FIDELITY HEALTH CARE INC | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311075381 | HOME HEALTH | OH | 501 (C) (3) | 10 | 0 | PREMIER HEALTH | |
| PREMIER COMMUNITY HEALTH | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311122883 | HEALTH EDUCATION | OH | 501 (C) (3) | 10 | 0 | FIDELITY HEALTH CARE | |
| ATRIUM HEALTH SYSTEM | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 310537492 | SUPPORT ORG | OH | 501 (C) (3) | 12B | N/A | 0 | |
| ATRIUM MEDICAL CENTER | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311079309 | HOSPITAL | OH | 501 (C) (3) | 3 | 0 | PREMIER HEALTH | |
| UVMC | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 341850683 | SUPPORT ORG | OH | 501 (C) (3) | 12B | N/A | 0 | |
| UPPER VALLEY MEDICAL CENTER | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 310537095 | HOSPITAL | OH | 501 (C) (3) | 3 | 0 | PREMIER HEALTH | |
| UPPER VALLEY PROFESSIONAL CORP | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311400963 | HEALTH CARE | OH | 501 (C) (3) | 10 | 0 | PREMIER HEALTH HOLDING CO | |
| UVPC SPECIALISTS | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 203687536 | HEALTH CARE | OH | 501 (C) (3) | 10 | 0 | PREMIER HEALTH HOLDING CO | |
| UVMC NURSING CARE INC | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311224064 | NURSING HOME | OH | 501 (C) (3) | 10 | 0 | PREMIER HEALTH | |
| COMPUNET CLINICAL LABORATORIES LLC | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 311258010 | LAB | OH | 501 (C) (3) | 12B | 0 | PREMIER HEALTH | |
| SAMARITAN BEHAVIORAL HEALTH INC | |||||||||||
| 110 MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 020633634 | BEHAVIORAL HEALTH | OH | 501 (C) (3) | 7 | 0 | PREMIER HEALTH | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SWEITZER STREET LLC | ||||||||||
| 110 N MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 454700417 | REAL ESTATE | OH | MVHE INC | EXCLUDED | 0 | 0 |
| SWEITZER MOB LLC | ||||||||||
| 110 N MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 474554657 | REAL ESTATE | OH | MVHE INC | EXCLUDED | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 HOLDING CO HOLDING CO | 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 HOLDING CO HOLDING CO | C | 0 |
| PREMIER HEALTH ACO OF OHIO | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 474049773 | MEDICARE ACO | OH | PREMIER HEALTH HOLDING CO HOLDING CO | C | 0 |
| PREMIER HEALTH HOLDING CO | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 812419110 | HOLDING CO | OH | PREMIER HEALTH HOLDING CO HOLDING CO | C | 0 |
| PREMIER HEALTH INSURING CO | |||||||||
| 110 NORTH MAIN STREET SUITE 500 | DAYTON | OH | 45402 | 464766841 | HEALTH INSURANCE | OH | PREMIER HEALTH HOLDING CO HOLDING CO | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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