GOOD SAMARITAN FOUNDATION-DAYTON: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN FOUNDATION-DAYTON (EIN 23-7296923)
- Tax period
- 2018-01-01 to 2018-12-31
- Filed
- 2019-11-15
- IRS object ID
- 201923199349301937
- Schema version
- 2018v3.1
- 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 F
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-11-15T07:45:03-06:00 | ReturnTs |
| Tax Period End | 2018-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 221 E 4TH STREET SUITE 2900 | AddressLine1Txt |
| City | CINCINNATI | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-01-01 | 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 Hospital Foundation - Dayton | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % J MICHAEL SIMS | InCareOfNm |
| 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, GSHF | PersonTitleTxt |
| Phone | 9374999942 | PhoneNum |
| Signature | 2019-10-30 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JULIE L SPARKS | PreparerPersonNm |
| PTIN | P01268401 | PTIN |
| Phone | 5136121400 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 108.206.163.59 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 31499120193195000008 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2019-11-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 770194AAF055F9EA87E64CA02E08FE540289067F | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 770194AAF055F9EA87E64CA02E08FE540289067F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-04-17 16:48:07Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JENNY M LEWIS PRESIDENT | 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 | $298,546 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| 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 | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 4 | TotalEmployeeCnt |
| Total Volunteers | 33 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,119,154 | PYContributionsGrantsAmt |
| CY Contributions Grants | $557,500 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $558,595 | PYInvestmentIncomeAmt |
| CY Investment Income | $224,314 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$25,609 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $1,652,140 | PYTotalRevenueAmt |
| CY Total Revenue | $781,814 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $480,411 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $604,393 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $279,245 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $262,363 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $176,088 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $152,620 | PYOtherExpensesAmt |
| CY Other Expenses | $109,508 | CYOtherExpensesAmt |
| PY Total Expenses | $912,276 | PYTotalExpensesAmt |
| CY Total Expenses | $976,264 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $739,864 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$194,450 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,896,219 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,422,057 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $229,719 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $182,615 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,666,500 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,239,442 | 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 | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $121,393 | ExpenseAmt |
| Grant | $121,393 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Mothers Empowered (ME) provides free medical care and prenatal and parenting education to pregnant women in need. ME is a partnership of Good Samaritan Hospital Foundation and two area service organizations: Lifestages 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 75 women were served in 2018. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $284,479 | ExpenseAmt |
| Grant | $284,479 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | The foundation supports many educational programs. These include brochures and seminars for the community, 67 scholarships for employees and their children, certification programs, seminars, conferences and lectures for employees and physicians. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $18,574 | ExpenseAmt |
| Grant | $18,574 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | The patient assistance program of the Samaritan Breast Center, helped 22 patients struggling to pay for the basic necessities during their breast cancer treatment. Often, these patients find themselves worrying about how to pay a bill, rather than focus on following their treatment plan. Assistance with paying bills such as rent, utilities, food, transportation and medical fees, allows them to focus on their health. The Sharing Our Strength (SOS) Support Group, allows patients to share their stories, concerns and questions about their journey. They learn from each other and share their strength to help make the journey easier. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $266,478 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $179,947 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $690,924 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | Yes (true) | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 4 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | J MICHAEL SIMS | PersonNm |
| 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 (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| RICHARD A MEYER | |||||||
| BOARD CHAIR | 0.5 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| SUZANNE DONOVAN SC | |||||||
| BOARD VICE-CHAIR | 0.5 | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ANN SCHUERMAN | |||||||
| BOARD SECRETARY | 0.5 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JENNY M LEWIS | |||||||
| PRESIDENT-MVH & GSH FOUNDATION | 20.0 | 20.0 | Yes (X) | Yes (X) | $39,715 | $246,225 | $51,140 |
| ZACHARY L ALLEN | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| DIANE ANDERSON DO | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| HON PATRICK J FOLEY | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| JIM KELLEHER | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| JEAN L MAYCHACK | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| GENE REICHARD | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| JO ANNE F REILING | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| DANIEL L SCHOULTIES MD | |||||||
| TRUSTEE | 0.5 | 39.5 | Yes (X) | $0 | $100,164 | $0 | |
| FR BENJAMIN SPEARE-HARDY III | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| DOUGLAS A TALMAGE | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| KENNETH M WATSON SR | |||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| MILINDA S NIMMO ZABRAMBA MD | |||||||
| TRUSTEE | 0.5 | 39.5 | Yes (X) | $0 | $335,510 | $31,934 | |
| KATIE MCKEE | |||||||
| BOARD TREASURER (TO JUL) | 0.5 | 39.5 | Yes (X) | $0 | $82,219 | $10,212 | |
| J MICHAEL SIMS | |||||||
| BOARD TREASURER (FROM NOV) | 0.5 | 39.5 | Yes (X) | $0 | $401,849 | $53,110 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $39,715 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,165,967 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $146,396 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | none | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contractor Address | ContractorAddress |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $3,531 | FederatedCampaignsAmt |
| Related Organizations | $91,435 | RelatedOrganizationsAmt |
| All Other Contributions | $462,534 | AllOtherContributionsAmt |
| Noncash Contributions | $322 | NoncashContributionsAmt |
| Total Contributions | $557,500 | TotalContributionsAmt |
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $236,819 | TotalRevenueColumnAmt |
| Exclusion | $236,819 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$495,773 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$483,268 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$12,505 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$12,505 | TotalRevenueColumnAmt |
| Exclusion | -$12,505 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $781,814 | TotalRevenueColumnAmt |
| Exclusion | $224,314 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $301,341 | TotalAmt |
| Program Services | $301,341 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $303,052 | TotalAmt |
| Program Services | $303,052 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,817 | TotalAmt |
| Program Services | $11,704 | ProgramServicesAmt |
| Management And General | $11,704 | ManagementAndGeneralAmt |
| Fundraising | $23,409 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,098 | TotalAmt |
| Program Services | $44,775 | ProgramServicesAmt |
| Management And General | $44,775 | ManagementAndGeneralAmt |
| Fundraising | $89,548 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,450 | TotalAmt |
| Program Services | $363 | ProgramServicesAmt |
| Management And General | $363 | ManagementAndGeneralAmt |
| Fundraising | $724 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,882 | TotalAmt |
| Program Services | $5,471 | ProgramServicesAmt |
| Management And General | $5,471 | ManagementAndGeneralAmt |
| Fundraising | $10,940 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,116 | TotalAmt |
| Program Services | $3,279 | ProgramServicesAmt |
| Management And General | $3,279 | ManagementAndGeneralAmt |
| Fundraising | $6,558 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,018 | TotalAmt |
| Management And General | $21,018 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,957 | TotalAmt |
| Program Services | $489 | ProgramServicesAmt |
| Management And General | $489 | ManagementAndGeneralAmt |
| Fundraising | $979 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,328 | TotalAmt |
| Program Services | $332 | ProgramServicesAmt |
| Management And General | $332 | ManagementAndGeneralAmt |
| Fundraising | $664 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,629 | TotalAmt |
| Program Services | $3,657 | ProgramServicesAmt |
| Management And General | $3,657 | ManagementAndGeneralAmt |
| Fundraising | $7,315 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,871 | TotalAmt |
| Program Services | $1,718 | ProgramServicesAmt |
| Management And General | $1,718 | ManagementAndGeneralAmt |
| Fundraising | $3,435 | FundraisingAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,271 | TotalAmt |
| Management And General | $1,703 | ManagementAndGeneralAmt |
| Fundraising | $568 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,465 | TotalAmt |
| Fundraising | $2,465 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| PURCHASED SERVICES | $53,312 | $13,328 | $13,328 | $26,656 |
| TRAINING & EDUCATION | $2,878 | $720 | $720 | $1,438 |
| EQUIPMENT RENTAL | $1,079 | $270 | $270 | $539 |
| OPERATING SUPPLIES | $100 | $25 | $25 | $50 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,600 | TotalAmt |
| Program Services | $400 | ProgramServicesAmt |
| Management And General | $400 | ManagementAndGeneralAmt |
| Fundraising | $800 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $976,264 | TotalAmt |
| Program Services | $690,924 | ProgramServicesAmt |
| Management And General | $109,252 | ManagementAndGeneralAmt |
| Fundraising | $176,088 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150 | BOYAmt |
| EOY | $150 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $432,338 | BOYAmt |
| EOY | $99,256 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $292,289 | BOYAmt |
| EOY | $150,191 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,946,175 | BOYAmt |
| EOY | $7,523,389 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,103,972 | BOYAmt |
| EOY | $3,472,063 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,295 | BOYAmt |
| EOY | $177,008 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,896,219 | BOYAmt |
| EOY | $11,422,057 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,499 | BOYAmt |
| EOY | $57,106 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $181,220 | BOYAmt |
| EOY | $125,509 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,719 | BOYAmt |
| EOY | $182,615 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,205,154 | BOYAmt |
| EOY | $2,669,061 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,897,550 | BOYAmt |
| EOY | $5,226,262 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,563,796 | BOYAmt |
| EOY | $3,344,119 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,666,500 | BOYAmt |
| EOY | $11,239,442 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,896,219 | BOYAmt |
| EOY | $11,422,057 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$194,450 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$780,046 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$452,562 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 | $589,930 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $723,400 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $716,921 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,119,154 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $557,500 | CurrentTaxYearAmt |
| Total | $3,706,905 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $589,930 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $723,400 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $716,921 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,119,154 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $557,500 | CurrentTaxYearAmt |
| Total | $3,706,905 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $580,847 | SubstantialContributorsTotAmt |
| Public Support Total170 | $3,126,058 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $255,074 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $219,063 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $222,066 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $248,127 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $236,819 | CurrentTaxYearAmt |
| Total | $1,181,149 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $4,888,054 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $30,394 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.63953 | PublicSupportCY170Pct |
| Public Support PY170 | 0.63028 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| 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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,416,198 | BeginningYearBalanceAmt |
| Contributions | $524,734 | ContributionsAmt |
| Investment Earnings Or Losses | $155,578 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $391,043 | GrantsOrScholarshipsAmt |
| End Year Balance | $8,705,467 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,324,280 | BeginningYearBalanceAmt |
| Contributions | $537,177 | ContributionsAmt |
| Investment Earnings Or Losses | -$3,256 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $442,003 | GrantsOrScholarshipsAmt |
| End Year Balance | $8,416,198 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,122,600 | BeginningYearBalanceAmt |
| Contributions | $434,289 | ContributionsAmt |
| Investment Earnings Or Losses | $114,695 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $347,304 | GrantsOrScholarshipsAmt |
| End Year Balance | $8,324,280 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.39020 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.60980 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
| Land | LandGrp | |
| Buildings | BuildingsGrp | |
| Leasehold Improvements | LeaseholdImprovementsGrp | |
| Equipment | EquipmentGrp | |
| Other Land Buildings | OtherLandBuildingsGrp | |
| Financial Derivatives | FinancialDerivativesGrp | |
| Closely Held Equity Interests | CloselyHeldEquityInterestsGrp | |
| Total Book Value Securities | $0 | TotalBookValueSecuritiesAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED ANNUITIES | Desc |
| Amt | $125,509 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $125,509 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, Part V, Line 4: | FormAndLineReferenceDesc |
| Explanation | The Good Samaritan Hospital Foundation-Dayton (GSHF) 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 GSHF 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 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 ELDERCARE (12%); To benefit specific programs for a Samaritan Health Partner's affiliate (7%); and miscellaneous (31%). SCHEDULE D, Part X, Line 2: THE FOLLOWING FOOTNOTE IS FROM THE 2018 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS A MEMBER OF GSHF. PHP HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE TAX-EXEMPT NONPROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS 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. THE TAX CUTS AND JOBS ACT (THE ACT) WAS ENACTED ON DECEMBER 22, 2017. FOR TAX-EXEMPT ENTITIES, THE ACT REQUIRES ORGANIZATIONS TO CATEGORIZE CERTAIN FRINGE BENEFIT EXPENSES AS A SOURCE OF UNRELATED BUSINESS INCOME, PAY AN EXCISE TAX ON REMUNERATION ABOVE CERTAIN THRESHOLDS THAT IS PAID TO EXECUTIVES BY THE ORGANIZATION, AND REPORT INCOME OR LOSS FROM UNRELATED BUSINESS ACTIVITIES ON AN ACTIVITY-BY-ACTIVITY BASIS, AMONG OTHER PROVISIONS. CERTAIN REGULATORY GUIDANCE PROVIDES FOR A MEASUREMENT PERIOD OF UP TO ONE YEAR, DURING WHICH THE ACCOUNTING FOR THE TAX EFFECTS OF THE ACT MAY BE COMPLETED. PHP MAY RECORD FURTHER ADJUSTMENTS IN FUTURE PERIODS UPON OBTAINING, PREPARING, OR ANALYZING ADDITIONAL INFORMATION ABOUT FACTS AND CIRCUMSTANCES THAT EXISTED AS OF THE DATE OF ENACTMENT. PHP WILL CONTINUE TO REVISE AND REFINE THE CALCULATIONS AS ADDITIONAL IRS GUIDANCE IS ISSUED; HOWEVER, PHP DOES NOT ANTICIPATE ANY MATERIAL IMPACT TO THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America and the Caribbean | RegionTxt |
| Type Of Activities Conducted | Investments | TypeOfActivitiesConductedTxt |
| Region Total Expenditures | $1,057,000 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Spent | $1,057,000 | SubtotalSpentAmt |
| Total Spent | $1,057,000 | TotalSpentAmt |
| Transfer To Foreign Corp | false | TransferToForeignCorpInd |
| Interest In Foreign Trust | false | InterestInForeignTrustInd |
| Foreign Corp Ownership | false | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | false | PassiveForeignInvestmestCoInd |
| Foreign Partnership | false | ForeignPartnershipInd |
| Boycott Countries | false | BoycottCountriesInd |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|---|
| Good Samaritan Hospital | |||||||||
| 110 N Main St Suite 500 | Dayton | OH | 45402 | 310536981 | 501(c)(3) | $227,482 | N/A | N/A | Operations |
| FIVE RIVERS HEALTH CENTERS | |||||||||
| 3535 SALEM AVENUE NO 100 | DAYTON | OH | 45406 | 450914398 | 501(C)(3) | $6,816 | N/A | N/A | OPERATIONS |
| CATHOLIC SOCIAL SERVICES | |||||||||
| 922 W RIVERVIEW AVENUE | DAYTON | OH | 45402 | 310536645 | 501(C)(3) | $67,042 | N/A | N/A | OPERATIONS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| Educational Scholarships | 67 | $163,456 |
| CATASTROPHIC FINANCIAL ASSISTANCE | 22 | $18,574 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part 1, 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) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JENNY M LEWIS | ||||||||||||||
| PRESIDENT-MVH & GSH FOUNDATION | $26,478 | $164,162 | $12,911 | $80,045 | $326 | $2,018 | $3,329 | $20,638 | $3,774 | $23,399 | $46,818 | $290,262 | $0 | $0 |
| MILINDA S NIMMO ZABRAMBA MD | ||||||||||||||
| TRUSTEE | $0 | $271,241 | $0 | $54,712 | $0 | $9,557 | $0 | $8,343 | $0 | $23,591 | $0 | $367,444 | $0 | $0 |
| J MICHAEL SIMS | ||||||||||||||
| BOARD TREASURER (FROM NOV) | $0 | $288,061 | $0 | $74,913 | $0 | $38,875 | $0 | $23,763 | $0 | $29,347 | $0 | $454,959 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B: | FormAndLineReferenceDesc |
| Explanation | 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 HOSPITAL FOUNDATION-DAYTON (GSHF) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. GSHF 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 2018. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2018: J. MICHAEL SIMS $15,913. 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 ($29). 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. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Part III, LINE 4D: | FormAndLineReferenceDesc |
| Explanation | This number represents the balance of total expenditures of temporarily restricted funds for Good Samaritan Hospital net of programs described in service accomplishments. Form 990, Part VI, Section A, Line 4: THE DEFINITIVE SYSTEM REORGANIZATION AGREEMENT EFFECTIVE JANUARY 1, 2018 changed the sole MEMBER OF GOOD SAMARITAN HOSPITAL FOUNDATION-DAYTON (GSHF) from Samaritan Health Partners to Premier Health (Premier). Form 990, Part VI, Section A, Line 6: GSHF has one corporate member; PREMIER, AN OHIO NON-PROFIT CORPORATION. Form 990, Part VI, Section A, Lines 7a & 7b: PREMIER HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR GSHF. PREMIER HAS THE AUTHORITY TO REMOVE SUCH TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. 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 GSHF IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE TAX MANAGER AND 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 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 GSHF 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, lINES 15A and 15B: COMPENSATION TO GSHF CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH GSHF 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 FOR KEY EXECUTIVES, VICE PRESIDENTS, AND DIRECTOR LEVEL POSITIONS. THE INDEPENDENT COMPARABILITY DATA IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THIS COMMITTEE IS COMPRISED OF THREE MEMBERS, ALL OF 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 $(452,562) | ExplanationTxt |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Premier Health Partners (Premier) | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311446699 | Parent | OH | 501(C)(3) | 12B | NA | false |
| Atrium Health System (AHS) | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 310537492 | Support Org | OH | 501(C)(3) | 12B | NA | false |
| Atrium Medical Center | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311079309 | Hospital | OH | 501(C)(3) | 3 | PREMIER | false |
| MedAmerica Health Systems Co (MAHS) | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311040228 | Support Org | OH | 501(C)(3) | 12B | NA | false |
| Miami Valley Hospital | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 310537504 | Hospital | OH | 501(C)(3) | 3 | Premier | false |
| Miami Valley Hospital Foundation | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311040231 | Foundation | OH | 501(C)(3) | 7 | Premier | false |
| Fidelity Health Care Inc (FHC) | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311075381 | Home Health | OH | 501(C)(3) | 10 | PREMIER | false |
| Premier Community Health | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311122883 | Health Educat | OH | 501(C)(3) | 10 | FHC | false |
| Samaritan Health Partners (SHP) | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311107411 | Support Org | OH | 501(C)(3) | 12B | PREMIER | false |
| Good Samaritan Hospital (GSH) | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 310536981 | Hospital | OH | 501(C)(3) | 3 | Premier | false |
| Heart Institute of Dayton | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 300502367 | Education | OH | 501(C)(3) | 10 | Premier | false |
| Samaritan Behavioral Health Inc | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 020633634 | Behavioral He | OH | 501(C)(3) | 7 | PREMIER | false |
| UVMC | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 341850683 | Support Org | OH | 501(C)(3) | 12B | NA | false |
| Upper Valley Medical Center | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 310537095 | Hospital | OH | 501(C)(3) | 3 | PREMIER | false |
| Upper Valley Professional Corp (UVPC) | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311400963 | Health Care | OH | 501(C)(3) | 10 | PREMIER | false |
| UVPC Specialists Inc | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 203687536 | Health Care | OH | 501(C)(3) | 10 | UVPC | false |
| UVMC Nursing Care Inc | ||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311224064 | Nursing Home | OH | 501(C)(3) | 10 | PREMIER | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Premier Plaza LLC | |||||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 800708185 | Holding Company | OH | MAHS | Excluded | $0 | $0 | false | false | 0.00000 |
| SW Ohio Neonatal Collaborative LLC | |||||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 463231330 | Neonatology | OH | MVH | Related | $0 | $0 | false | false | 0.00000 |
| Samaritan North Surgery Center | |||||||||||||
| 9000 N Main St | DAYTON | OH | 45415 | 311618587 | O/P Surgery | OH | GSH | Related | $0 | $0 | false | false | 0.00000 |
| Compunet Clinical Laboratories LLC | |||||||||||||
| 2308 Sandridge Dr | MORAINE | OH | 45439 | 311258010 | Medical Labs | OH | MVHE Inc | Related | $0 | $0 | false | false | 0.00000 |
| Sweitzer Street LLC | |||||||||||||
| 110 N Main St 1250 | DAYTON | OH | 45402 | 454700417 | Real Estate | OH | MVHE Inc | Excluded | $0 | $0 | false | false | 0.00000 |
| Sweitzer MOB LLC | |||||||||||||
| 110 N Main St 1250 | DAYTON | OH | 45402 | 474554657 | Real Estate | OH | MVHE Inc | Excluded | $0 | $0 | false | false | 0.00000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MVHE INC | ||||||||||||
| 110 N Main St 400 | DAYTON | OH | 45402 | 311185270 | Physician SVCS | OH | Premier Holding | C Corp | $0 | $0 | 0.00000 | false |
| Premier Health Specialists | ||||||||||||
| 110 N Main St 400 | DAYTON | OH | 45402 | 061744704 | Physician SVCS | OH | Premier Holding | C Corp | $0 | $0 | 0.00000 | false |
| Samaritan Family Care | ||||||||||||
| 110 N Main St 400 | DAYTON | OH | 45402 | 311299450 | Physician SVCS | OH | Premier Holding | C Corp | $0 | $0 | 0.00000 | false |
| After Hours Family Care | ||||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311269483 | Health Care | OH | UVPC | C Corp | $0 | $0 | 0.00000 | false |
| UVMC Management Corp | ||||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 311360489 | Management Co | OH | Premier | C Corp | $0 | $0 | 0.00000 | false |
| Premier Health Urgent Care Inc | ||||||||||||
| 110 N Main St 900 | DAYTON | OH | 45402 | 822079409 | Urgent Care | OH | Premier Holding | C Corp | $0 | $0 | 0.00000 | false |
| Premier Health Plan Inc | ||||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 463024049 | Health Insurance | OH | PHIC | C Corp | $0 | $0 | 0.00000 | false |
| Premier Health ACO of Ohio | ||||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 474049773 | Medicare ACO | OH | Premier | C Corp | $0 | $0 | 0.00000 | false |
| Premier Health Holding Co | ||||||||||||
| 110 N Main St 400 | DAYTON | OH | 45402 | 812419110 | Holding Co | OH | Premier | C Corp | $0 | $0 | 0.00000 | false |
| Premier Health Insuring Co (PHIC) | ||||||||||||
| 110 N Main St 500 | DAYTON | OH | 45402 | 464766841 | HEALTH INSURANCE | OH | Premier | C Corp | $0 | $0 | 0.00000 | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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