2021-11-08T10:18:34-06:00 2020-12-31 346565596 ERNST & YOUNG US LLP 221 E 4TH ST SUITE 2900 CINCINNATI OH 45202 990 2020-01-01 237296923 GOOD SAMARITAN FOUNDATION - DAYTON GOOD 9374999942 110 N MAIN ST SUITE 500 DAYTON OH 45402 J MICHAEL SIMS TREASURER 9374999942 2021-11-08 1 J MICHAEL SIMS 999009999 JULIE L SPARKS P01268401 5136121400 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JENNY M LEWIS ONE WYOMING ST DAYTON OH 45402 18714344 0 X WWW.PREMIERHEALTH.COM X 1973 OH INSPIRE PHILANTHROPY TO ENHANCE THE HEALTH AND WELL-BEING OF THE GREATER DAYTON COMMUNITIES AND THE HEALTHCARE PROFESSIONALS WHO CARE FOR THEM. 12 9 3 16 0 0 632538 802762 0 0 1103886 926518 -17105 -16986 1719319 1712294 424503 418658 0 0 334757 391743 0 0 228599 71695 97015 830955 907416 888364 804878 12946945 13510068 742058 108204 12204887 13401864 X INSPIRE PHILANTHROPY TO ENHANCE THE HEALTH AND WELL-BEING OF THE GREATER DAYTON COMMUNITIES AND THE HEALTHCARE PROFESSIONALS WHO CARE FOR THEM. 0 0 68305 30219 0 MOTHERS EMPOWERED (ME) PROVIDES FREE MEDICAL CARE AND PRENATAL AND PARENTING EDUCATION TO PREGNANT WOMEN IN NEED. ME IS A PARTNERSHIP OF GOOD SAMARITAN FOUNDATION AND TWO AREA SERVICE ORGANIZATIONS: LIFE STAGES CENTERS FOR WOMEN AND CATHOLIC SOCIAL SERVICES OF THE MIAMI VALLEY. THROUGH GROUP PRENATAL CARE, THE MOTHERS MEET IN SMALL GROUPS OF WOMEN WITH SIMILAR DUE DATES TO LEARN TO CARE FOR THEMSELVES AND THEIR BABY, COMPLETE REGULAR PREGNANCY CHECK-UPS, AND FORM A SUPPORT NETWORK WITH OTHER YOUNG MOTHERS. APPROXIMATELY 65 WOMEN WERE SERVED IN 2020. 88295 88295 0 SAMARITAN HEALTH CENTER IS A FEDERALLY QUALIFIED HEALTH CENTER OPERATED BY FIVE RIVERS HEALTH CENTERS IN DAYTON, OHIO. SAMARITAN HEALTH CENTER PROVIDES HEALTHCARE TO ANY INDIVIDUAL, REGARDLESS OF THEIR ABILITY TO PAY, ON A SLIDING SCALE FEE BASED ON INCOME. APPROXIMATELY 1,800 PATIENTS ARE TREATED EACH YEAR; NEARLY 100% OF PATIENTS PAY NOTHING. MOST PATIENTS ARE HOMELESS OR LOW-INCOME AND AT RISK OF BECOMING HOMELESS. SAMARITAN HEALTH CENTER OFFERS COMPREHENSIVE HEALTHCARE SERVICES INCLUDING PRIMARY CARE, PODIATRY, AND BEHAVIORAL HEALTH SERVICES, AS WELL AS ACCESS TO PATIENT EDUCATION, A DIETICIAN, AND A SOCIAL WORKER. 126254 126254 0 CORONAVIRUS EMERGING NEEDS - GIFTS PROVIDED A MUCH-NEEDED BOOST FOR OUR CLINICAL TEAMS AND SUPPORT STAFF. DONATIONS OF HOME-MADE MASKS AND PERSONAL PROTECTION GEAR, SNACKS AND DRINKS FOR THE RESPITE ROOMS, LUNCHES AND OTHER GOODIES HELPED EASE THE STRAIN ON EMPLOYEES AS THEY PUT IN LONG HOURS CARING FOR COVID-19 PATIENTS AS WELL AS PATIENTS BATTLING OTHER ILLNESSES. 249567 173890 0 THIS NUMBER REPRESENTS THE BALANCE OF TOTAL EXPENDITURES OF TEMPORARILY RESTRICTED FUNDS FOR RELATED HOSPITALS NET OF PROGRAMS DESCRIBED IN SERVICE ACCOMPLISHMENTS. 249567 173890 0 532421 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 13 0 1 3 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 9 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 SUITE 500 DAYTON OH 45402 MILINDA S NIMMO ZABRAMBA MD TRUSTEE 0.50 39.50 X 0 356032 31125 JENNY M LEWIS PRESIDENT 13.33 26.67 X X 0 280779 54187 PAMELA A PHELPS TRUSTEE (FROM SEP) 0.50 39.50 X 0 107623 16300 SUZANNE DONOVAN SC BOARD CHAIR 0.50 0.50 X X 0 0 0 KENNETH M WATSON SR BOARD VICE-CHAIR 0.50 0.00 X X 0 0 0 ANN SCHUERMAN BOARD SECRETARY 0.50 0.00 X X 0 0 0 DIANE ANDERSON DO TRUSTEE 0.50 0.00 X 0 0 0 RICHARD T FERGUSON TRUSTEE (FROM SEP) 0.50 0.00 X 0 0 0 RICHARD A MEYER TRUSTEE 0.50 0.00 X 0 0 0 GENE REICHARD TRUSTEE 0.50 0.00 X 0 0 0 JO ANNE F REILING TRUSTEE 0.50 0.00 X 0 0 0 FR BENJAMIN SPEARE-HARDY III TRUSTEE 0.50 0.00 X 0 0 0 J MICHAEL SIMS BOARD TREASURER 0.50 39.50 X 0 505791 52141 0 1250225 153753 0 0 1 0 0 855 35450 10250 756207 125849 802762 156350 156350 17755232 16985064 770168 770168 770168 0 35450 16986 -16986 -16986 1712294 0 0 909532 383006 383006 35652 35652 336263 84066 84066 168131 40996 10249 10249 20498 14484 3621 3621 7242 31194 31194 1816 454 454 908 11683 2921 2921 5841 7867 1967 1967 3933 1920 1440 480 598 598 PURCHASED SERVICES 40771 10193 10193 20385 DUES & SUBSCRIPTIONS 873 219 218 436 OPERATING EXPENSES 293 73 73 147 907416 532421 146396 228599 150 150 91677 450777 220032 249699 8546165 8826259 3967626 3983183 121295 0 12946945 13510068 64503 44956 677555 63248 742058 108204 X 2758073 2745344 9446814 10656520 12204887 13401864 12946945 13510068 X 804878 515552 16995 -140448 X 0 1 X 1 0 X 716921 1119154 557500 615433 802762 3811770 716921 1119154 557500 615433 802762 3811770 740873 3070897 222066 248127 236819 216433 156350 1079795 4891565 0.62780 0.62740 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9446814 680596 1059761 530651 10656520 8570381 503148 1335433 962148 9446814 9461345 454878 -537350 808492 8570381 8705467 927231 292931 464284 9461345 8416198 524734 155578 391043 8705467 0.40600 0.59400 0 0 0 SECURITIES 3983183 F 3983183 AFFILIATES PAYABLE 51083 DEFERRED ANNUITIES 12165 63248 X 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 (18%); TO FUND EDUCATIONAL PROGRAMS/SCHOLARSHIPS (17%); 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 (18%). PART X, LINE 2: THE FOLLOWING FOOTNOTE IS FROM THE 2020 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 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, UVMC MANAGEMENT CORPORATION (SUBSIDIARIES OF PHP) AND AFTER-HOURS FAMILY CARE, INC. (SUBSIDIARY OF UVPC). MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS. ROH BREAKFAST 35450 35450 16986 35450 35450 16986 16986 -16986 1 FIVE RIVERS HEALTH CENTERS 2261 PHILADELPHIA DRIVE SUITE 200 DAYTON OH 45406 450914398 501(C)(3) 88295 N/A N/A OPERATIONS PREMIER HEALTH PARTNERS 110 N MAIN ST SUITE 500 DAYTON OH 45402 311446699 501(C)(3) 59140 N/A N/A OPERATIONS CATHOLIC SOCIAL SERVICES 922 W RIVERVIEW AVENUE DAYTON OH 45402 310536645 501(C)(3) 30219 N/A N/A OPERATIONS MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST SUITE 500 DAYTON OH 45402 311040231 501(C)(3) 21203 N/A N/A OPERATIONS MIAMI VALLEY HOSPITAL 110 N MAIN ST SUITE 500 DAYTON OH 45402 310537504 501(C)(3) 20310 115310 FMV PERSONAL PROTECTION EQUIPMENT & ARTWORK OPERATIONS 5 EDUCATIONAL SCHOLARSHIPS 20 35652 PART I, LINE 2: 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. 0 1 0 0 0 0 0 0 0 J MICHAEL SIMS BOARD TREASURER 0 311052 0 106785 0 87954 0 23220 0 28921 0 557932 0 0 MILINDA S NIMMO ZABRAMBA MD TRUSTEE 0 327891 0 27073 0 1068 0 7886 0 23239 0 387157 0 0 JENNY M LEWIS PRESIDENT 0 191983 0 86466 0 2330 0 27563 0 26624 0 334966 0 0 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 2020. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2020: J. MICHAEL SIMS $83,220. THE FOLLOWING SERP AMOUNT WAS DEFERRED ON A PARTICIPANT'S BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNT IS VESTED AND PAID TO THE SERP PARTICIPANT: JENNY LEWIS $3,113. 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. ANY PAYMENTS MADE AFTER THE 2-1/2 MONTHS WERE PROPERLY REPORTED ON PRIOR YEARS' FILED IRS FORM 990 RETURNS, DISCLOSING COMPENSATION EARNED BY THESE INDIVIDUALS UNDER THE PLANS FOR EACH SUCH YEAR. X 1 1800 FMV X COVID-19 PPE 68 124049 FMV 0 0 1 0 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 TAX MANAGER AND THE DIRECTOR OF TAX COMPLIANCE OF PREMIER. THE RETURN IS CONCURRENTLY SENT TO ERNST & YOUNG U.S. LLP FOR THEIR REVIEW. AFTER ALL CHANGES FROM THE ABOVE GROUPS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER AND THE CHIEF FINANCIAL OFFICER OF THIS ENTITY. A FINAL VERSION OF THE RETURN IS SENT TO ERNST & YOUNG U.S. LLP FOR A FINAL REVIEW AND THEN PROVIDED TO THE BOARD OF 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 -132,396. PLEDGE RESERVE -8,052. 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 PREMIER HEALTH 0 MIAMI VALLEY HOSPITAL FOUNDATION 110 MAIN STREET SUITE 500 DAYTON OH 45402 311040231 FOUNDATION OH 501 (C) (3) 7 PREMIER HEALTH 0 FIDELITY HEALTH CARE INC 110 MAIN STREET SUITE 500 DAYTON OH 45402 311075381 HOME HEALTH OH 501 (C) (3) 10 PREMIER HEALTH 0 PREMIER COMMUNITY HEALTH 110 MAIN STREET SUITE 500 DAYTON OH 45402 311122883 HEALTH EDUCATION OH 501 (C) (3) 10 FIDELITY HEALTH CARE 0 SAMARITAN HEALTH PARTNERS 110 MAIN STREET SUITE 500 DAYTON OH 45402 311107411 SUPPORT ORG OH 501 (C) (3) 12B PREMIER HEALTH 0 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 PREMIER HEALTH 0 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 PREMIER HEALTH 0 UPPER VALLEY PROFESSIONAL CORP 110 MAIN STREET SUITE 500 DAYTON OH 45402 311400963 HEALTH CARE OH 501 (C) (3) 10 PREMIER HEALTH 0 UVPC SPECIALISTS 110 MAIN STREET SUITE 500 DAYTON OH 45402 203687536 HEALTH CARE OH 501 (C) (3) 10 UPPER VALLEY PROFESSIONAL CORP 0 UVMC NURSING CARE INC 110 MAIN STREET SUITE 500 DAYTON OH 45402 311224064 NURSING HOME OH 501 (C) (3) 10 PREMIER HEALTH 0 COMPUNET CLINICAL LABORATORIES LLC 110 MAIN STREET SUITE 500 DAYTON OH 45402 311258010 LAB OH 501 (C) (3) 12B PREMIER HEALTH 0 SAMARITAN BEHAVIORAL HEALTH INC 110 MAIN STREET SUITE 500 DAYTON OH 45402 020633634 BEHAVIORAL HEALTH OH 501 (C) (3) 7 PREMIER HEALTH 0 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 MVHE INC 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 311185270 PHYSICIAN SVCS OH PREMIER HOLDING C 0 PREMIER HEALTH SPECIALISTS 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 061744704 PHYSICIAN SVCS OH PREMIER HOLDING C 0 SAMARITAN FAMILY CARE 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 311299450 PHYSICIAN SVCS OH PREMIER HOLDING C 0 AFTER HOURS FAMILY CARE 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 311269483 HEALTH CARE OH UVPC C 0 UVMC MANAGEMENT CORP 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 311360489 MANAGEMENT COMPANY OH PREMIER C 0 PREMIER HEALTH URGENT CARE INC 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 822079409 URGENT CARE OH PREMIER HOLDING C 0 PREMIER HEALTH PLAN INC 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 463024049 HEALTH INSURANCE OH PHIC C 0 GOOD SAMARITAN HOSPITAL 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 310536981 HOSPITAL OH PREMIER C 0 PREMIER HEALTH ACO OF OHIO 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 474049773 MEDICARE ACO OH PREMIER C 0 PREMIER HEALTH HOLDING 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 812419110 HOLDING CO OH PREMIER C 0 PREMIER HEALTH INSURING CO 110 NORTH MAIN STREET SUITE 500 DAYTON OH 45402 464766841 HEALTH INSURANCE OH PREMIER C 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0