2019-11-15T07:42:43-06:00 2018-12-31 ERNST & YOUNG US LLP 221 E 4TH STREET SUITE 2900 Cincinnati OH 45202 990 2018-01-01 020633634 Samaritan Behavioral Health Inc % J MICHAEL SIMS SAMA 9372768333 110 N MAIN ST 500 DAYTON OH 45402 TIMOTHY D SNIDER BOARD TREASURER 9374999942 2019-10-18 true JULIE L SPARKS P01268401 5136121400 108.206.163.59 31499120193195000015 2019-11-15 P 770194AAF055F9EA87E64CA02E08FE540289067F 770194AAF055F9EA87E64CA02E08FE540289067F 2018 2020-03-31 21:24:44Z BETH ESPOSITO 601 S EDWIN C MOSES BLVD DAYTON OH 45417 15032761 false 0928 X WWW.SBHIHELP.ORG X 2002 OH TO PROVIDE MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES THAT TOUCH, TEACH AND HEAL. 7 3 302 6 0 57378 3740967 4530103 10895716 10218338 41184 11760 208458 272560 14886325 15032761 0 0 0 0 12051636 12778853 0 0 0 2360588 2558687 14412224 15337540 474101 -304779 4736761 6238560 1021356 2976699 3715405 3261861 X TO PROVIDE MENTAL HEALTH AND ABUSE SERVICES THAT TOUCH, TEACH AND HEAL. false false 2442817 0 1583597 SUBSTANCE ABUSE: SAMARITAN BEHAVIORAL HEALTH'S SUBSTANCE ABUSE SERVICES OFFER THE FOLLOWING TO ANY ADULT LIVING IN MONTGOMERY COUNTY: MEDICATION ASSISTED TREATMENT (MAT) FOR OPIOID ADDICTION USING BUPRENORPHINE/NALOXONE (SUBOXONE) NALTREXONE (VIVITROL); ALL MAT SERVICES REQUIRE PARTICIPATION IN GROUP AND INDIVIDUAL COUNSELING; INDIVIDUAL, GROUP, AND FAMILY COUNSELING, AND CASE MANAGEMENT; SERVICES TO TREAT ABUSE AND ADDICTION TO ALCOHOL, COCAINE, BARBITURATES, MARIJUANA, HEROIN, AND OTHER ADDICTIVE SUBSTANCES; PROJECT DAWN - TRAINING IN THE USE AND DISTRIBUTION OF NALOXONE (NARCAN) KITS, COMBINED SUBSTANCE ABUSE AND MENTAL HEALTH COUNSELING. DURING 2018, 1,831 PATIENTS WERE SERVED. 2036153 0 956124 CRISISCARE: SAMARITAN BEHAVIORAL HEALTH'S CRISISCARE PROGRAM OFFERS THE FOLLOWING SERVICES TO ANY ADULT, ADOLESCENT OR CHILD REGARDLESS OF THEIR ABILITY TO PAY: 1) HOTLINE - 24-HOUR SUICIDE PREVENTION AND CRISIS COUNSELING TELEPHONE LINE, 2) WARMLINE - 24-HOUR SUPPORTIVE TELEPHONE COUNSELING SERVICE, 3) SCREENING & TRIAGE - EVALUATION OF CRISIS NEEDS WITH FOLLOW-UP RECOMMENDATIONS FOR SERVICE, 4) EMERGENCY WALK-INS - FACE-TO-FACE CRISIS INTERVENTION, 5) PRE-HOSPITAL SCREENING - HEALTH OFFICERS EVALUATE WHETHER A PERSON NEEDS TO BE HOSPITALIZED DUE TO LIFE THREATENING CIRCUMSTANCES, (CONTINUED IN SCHEDULE O) 1940503 0 1998349 INTEGRATED CARE SOLUTIONS: SAMARITAN BEHAVIORAL HEALTH'S YOUTH AND ADULT OUTPATIENT SERVICES OFFER THE FOLLOWING TO ADULTS, ADOLESCENTS, AND CHILDREN LIVING IN MONTGOMERY COUNTY: BEHAVIORAL HEALTH ASSESSMENTS TO DETERMINE THE NATURE AND EXTENT OF MENTAL HEALTH PROBLEMS/CONCERNS; RECOMMENDATIONS REGARDING SERVICES THAT ADDRESS PRESENTING PROBLEMS/SYMPTOMS; AN INDIVIDUALIZED SERVICE PLAN WITH THERAPEUTIC GOALS DEVELOPED IN COLLABORATION WITH THE PATIENT/FAMILY; INDIVIDUAL AND FAMILY COUNSELING; REFERRAL TO PSYCHIATRIC SERVICES IF IT APPEARS THAT MEDICATION MAY BE BENEFICIAL; ONGOING PSYCHIATRIC MEDICATION MANAGEMENT, (CONTINUED IN SCHEDULE O) 6783839 0 5952828 13203312 true true false false false false false false false true true false false true false true true true false false true false false false false false false false false true false false false false false false false false false false false false false true false false false true 23 0 true 302 true true true false false false false false false false false false false false X 7 3 false true true false true true true true true false false true true true true true true true true false OH X J MICHAEL SIMS 9374999942 110 N MAIN ST 500 DAYTON OH 45402 ELOISE P BRONER BOARD CHAIR 0.5 39.5 X X 0 843163 28702 V SUE MCGATHA VICE CHAIR-PRES & CEO (TO AUG) 40.0 0.0 X X 301168 0 25336 ELISABETH ESPOSITO VICE CHAIR-PRES&CEO (FROM SEP) 40.0 0.0 X X 121338 0 28686 CAROL BAUER SC TRUSTEE 0.5 39.5 X 0 0 0 SUSAN F DAVIS-BROWN MD TRUSTEE (FROM FEB) 0.5 39.5 X 0 393903 30007 GINA MCFARLANE-EL TRUSTEE 0.5 0.0 X 0 0 0 THOMAS R PARKER TRUSTEE 0.5 39.5 X 0 600098 43008 EVANTHIA STEFFENS TRUSTEE 0.5 0.0 X 0 0 0 JENNA M DOWNEY ESQ BOARD SECRETARY 0.5 39.5 X 0 205969 20781 TIMOTHY D SNIDER BOARD TREASURER 0.5 39.5 X 0 311990 36292 ELLEN W BALLERENE MD PSYCHAITRIST 40.0 0.0 X 179672 0 34665 LUIS TELLEZ MD MED DIR - STAFF PSYCHIATRIST 40.0 0.0 X 177191 0 25482 JO ANN BROWN NP NURSE PRACTITIONER 40.0 0.0 X 114547 0 15964 WAYNE R ANABLE DO MED DIR - STAFF PSYCHIATRIST 40.0 0.0 X 106612 0 827 KAREN D GAINES CFO 40.0 0.0 X 105850 0 16722 THOMAS R CURTIN FORMER OFFICER 0.0 40.0 X 0 334595 54623 1106378 2689718 361095 9 true true false QUALIFACTS SYSTEMS INC 315 DEADERICK ST NASHVILLE TN 37238 Medical Software 197443 1 167914 4124782 237407 4530103 PROGRAM SERVICE REV 900099 10218338 10218338 10218338 11760 11760 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MISC REVENUE 900099 272560 272560 272560 15032761 10490898 11760 0 0 0 0 476528 409814 66714 0 0 10024692 8784417 1240275 295964 281003 14961 1184829 1055074 129755 796840 665326 131514 23223 5034 18189 0 16241 16241 0 0 0 455205 294682 160523 49597 4840 44757 244348 173412 70936 235720 206382 29338 0 828065 761721 66344 90477 82831 7646 0 30224 17581 12643 0 0 82556 70084 12472 95730 95730 CATHOLIC HEALTH FEES 284747 284745 2 OPERATING SUPPLIES 91170 88476 2694 REPAIRS AND MAINTENANCE 12996 10986 2010 MOVING & RELOCATION 8459 2705 5754 9929 4199 5730 15337540 13203312 2134228 0 1924154 1973887 0 0 0 0 1698262 3203351 0 0 0 0 0 0 0 0 115736 121960 877769 552440 259018 325329 0 0 0 0 0 0 0 0 739591 614033 4736761 6238560 828519 1432092 0 0 192837 1544607 0 0 0 0 0 0 0 0 0 0 0 0 1021356 2976699 X 2975814 2647829 332313 226590 407278 387442 3715405 3261861 4736761 6238560 X -304779 -44759 -104006 X false true X true true true X 3827631 2243457 2699047 3740967 4530103 17041205 8520100 10110161 10647081 10895716 10218338 50391396 0 12347731 12353618 13346128 14636683 14748441 67432601 12503242 54929359 22984 6469 -7559 41184 11760 74838 0 0 67507439 1150090 0.81368 0.80787 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 739591 -32999 92559 614033 655485 140048 41184 97126 739591 560623 121814 -8031 18921 655485 556820 5845 -603 1439 560623 543318 4141 15718 6357 556820 0.63000 0.37000 false true true 389968 213957 176011 487801 338483 149318 325329 FUNDS HELD BY GOOD SAMARITAN 614033 614033 0 0 X 14883999 -44759 -104003 -148762 15032761 15032761 15337540 15337540 15337540 PART V, LINE 4: SAMARITAN BEHAVIORAL HEALTH, INC. (SBHI) MAKES EVERY EFFORT TO FOLLOW THE INTENT AND WISHES OF ALL ITS DONORS. THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS AND/OR EARNINGS FROM ENDOWMENT FUNDS ARE DRIVEN BY THE WISHES/RESTRICTIONS PLACED ON THE FUNDS BY THE DONOR. PERMANENT ENDOWMENTS RESULT WHEN A DONATION IS RECEIVED WITH A RESTRICTION THAT THE PRINCIPAL OR GIFT AMOUNT IS TO BE RETAINED IN PERPETUITY AND CANNOT BE SPENT. THE EARNINGS FROM THE PERMANENT ENDOWMENTS ARE THEN USED FOR THE PURPOSE SPECIFIED BY THE DONOR. TEMPORARY ENDOWMENTS ARE FUNDS IN WHICH ALL OR PART OF THE PRINCIPAL MAY BE EXPENDED ONLY AFTER THE EXPIRATION OF A STATED PERIOD OF TIME OR OCCURRENCE OF A SPECIFIED EVENT, DEPENDING ON THE DONOR'S WISHES. EARNINGS FROM TEMPORARILY RESTRICTED ENDOWMENTS CAN BE EITHER UNRESTRICTED OR RESTRICTED. SBHI USES THE TEMPORARILY RESTRICTED ENDOWMENTS FOR THE INTENDED PURPOSE SET UP BY THE DONOR, ONLY AFTER THE PERIOD OF TIME OR SPECIFIED EVENT SET BY THE DONOR HAS BEEN MET. THE "CATEGORIES" OF RESTRICTED ENDOWMENTS ARE AS FOLLOWS: SBHI PROGRAM CONSORTIUM (59%); PROGRAM OPERATING EXPENSES (23%); MENTAL HEALTH (14%); AND MISCELLANEOUS (4%). 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 THE SOLE MEMBER OF SBHI. PHP has been determined by the Internal Revenue Service to be a tax-exempt nonprofit 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. 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. PART XI, LINE 2D: DISTRIBUTIONS TEMPORARILY RESTRICTED (104,003) Central America and the Caribbean Investments 12000 East Asia and the Pacific Investments 33000 Europe (Including Iceland and Greenland) Investments 90000 North America Investments 8000 Russia and the Newly Independent States Investments 2000 South America Investments 4000 South Asia Investments 2000 Sub-Saharan Africa Investments 1000 152000 152000 true false true false true false X X X X true true false false false false false false false ELOISE P BRONER BOARD CHAIR 0 453323 0 201795 0 188045 0 25345 0 3357 0 871865 0 0 V SUE MCGATHA VICE CHAIR-PRES & CEO (TO AUG) 196543 0 45492 0 59133 0 24245 0 1091 0 326504 0 0 0 ELISABETH ESPOSITO VICE CHAIR-PRES&CEO (FROM SEP) 121074 0 0 0 264 0 3933 0 24753 0 150024 0 0 0 SUSAN F DAVIS-BROWN MD TRUSTEE (FROM FEB) 0 288143 0 63065 0 42695 0 8898 0 21109 0 423910 0 0 THOMAS R PARKER TRUSTEE 0 419601 0 152940 0 27557 0 36093 0 6915 0 643106 0 0 JENNA M DOWNEY ESQ BOARD SECRETARY 0 172547 0 32552 0 870 0 7440 0 13341 0 226750 0 0 TIMOTHY D SNIDER BOARD TREASURER 0 228185 0 81615 0 2190 0 20001 0 16291 0 348282 0 0 ELLEN W BALLERENE MD PSYCHAITRIST 179229 0 0 0 443 0 6796 0 27869 0 214337 0 0 0 LUIS TELLEZ MD MED DIR - STAFF PSYCHIATRIST 176279 0 0 0 912 0 6108 0 19374 0 202673 0 0 0 THOMAS R CURTIN FORMER OFFICER 0 255614 0 72332 0 6649 0 21583 0 33040 0 389218 0 0 PART I, LINE 4A: THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT IN 2018: JO ANN BROWN $19,232; V. SUE MCGATHA $53,770. PART I, LINE 4B: DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, CERTAIN PERSONS ARE LIMITED IN THE AMOUNT OF BENEFIT THAT CAN BE EARNED UNDER A QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, SAMARITAN BEHAVIORAL HEALTH (SBHI) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. SBHI SUPPLEMENTS THE AFFECTED EXECUTIVES THROUGH A PENSION RESTORATION PLAN 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 THE 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: ELOISE BRONER $164,913. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2018: SUSAN DAVIS-BROWN $1,369. IN ADDITION, THE FOLLOWING SERP AMOUNTS WERE DEFERRED ON THE PARTICIPANTS' BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNTS ARE VESTED AND PAID TO THE SERP PARTICIPANTS: THOMAS CURTIN $2,634; THOMAS PARKER $12,494; TIMOTHY SNIDER $1,028. 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. FORM 990, PART III, LINE 4B (CONTINUED): 6) MOBILE CRISIS SERVICES CRISIS INTERVENTION SERVICES PROVIDED AT RESIDENCES AND/OR IN THE COMMUNITY FOR THOSE WHO ARE AT RISK OF HARM TO THEMSELVES OR OTHERS, 7) CRISIS COUNSELING PROVIDES COUNSELING UP TO 4 SESSIONS FOR ACUTE STABILIZATION AND ON-GOING SUPPORT, 8) CRISIS DEBRIEFING - SERVICES ARE AVAILABLE FOR INDIVIDUALS OR GROUPS INVOLVED IN TRAUMATIC EVENTS. CRISISCARE SERVED 1,654 PATIENTS AND PROVIDED 6,197 UNITS OF SERVICES FOR 2018. FORM 990, PART III, LINE 4C (CONTINUED): CASE MANAGEMENT (COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT) SERVICES TO FURTHER SUPPORT THERAPEUTIC INTERVENTIONS AND LINK PATIENT/FAMILY TO COMMUNITY RESOURCES. DURING 2018, 3,355 PATIENTS WERE SERVED. FORM 990, PART III, LINE 4D: THIS NUMBER REPRESENTS THE BALANCE OF TOTAL EXPENDITURES OF TEMPORARILY RESTRICTED FUNDS FOR SAMARITAN BEHAVIORAL HEALTH (SBHI) NET OF PROGRAMS DESCRIBED IN SERVICE ACCOMPLISHMENTS. FORM 990, PART VI, SECTION A, LINE 3: PREMIER HEALTH (PREMIER) AS THE OPERATOR OF SBHI DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR SBHI, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. SBHI SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. SBHI SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. SBHI SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF SBHI WITH ALL THIRD-PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. SBHI MUST HAVE APPROVAL FROM PREMIER TO BORROW IN ANY FISCAL YEAR, GUARANTEE IN ANY YEAR, OR INCUR ANY LIEN OR OTHER ENCUMBRANCE ON ANY PROPERTY IN AN AMOUNT EQUAL TO OR GREATER THAN $1,000,000. SBHI MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN SBHI'S ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 4: THE DEFINITIVE SYSTEM REORGANIZATION AGREEMENT EFFECTIVE JANUARY 1, 2018 CHANGED THE SOLE MEMBER OF SBHI FROM SAMARITAN HEALTH PARTNERS TO PREMIER. FORM 990, PART VI, SECTION A, LINE 6: SBHI 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 SBHI. 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 SBHI 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 SBHI IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, MEDICAL DIRECTORS, SUPPLY CHAIN DIVISION MEMBERS, AUTHORIZED SIGNERS, DIRECTORS, EXECUTIVES, MEDICAL EXECUTIVE COMMITTEE MEMBERS, MEDICAL DEPARTMENT AND SECTION CHAIRS, PHYSICIAN PARTNERSHIP COMMITTEE MEMBERS, PHYSICIAN GUIDANCE GROUP MEMBERS, AND ALL EMPLOYED PHYSICIANS TO ANNUALLY REVIEW THE PREMIER COMPREHENSIVE CONFLICT OF INTEREST STATEMENT, AN EXPLANATORY MEMORANDUM, THE ANTITRUST COMPLIANCE POLICY, AND COMPLETE AN INDIVIDUAL QUESTIONNAIRE DISCLOSING ANY POTENTIAL CONFLICTS AS DEFINED IN THE CONFLICT OF INTEREST POLICY. THIS IS ACCOMPLISHED EITHER BY WAY OF AN ELECTRONIC COMMUNICATION SENT OUT DIRECTLY BY THE CORPORATE COMPLIANCE DEPARTMENT OR BY WAY OF A MEMO SENT OUT FROM THE CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER OF PREMIER. IT ALSO INCLUDES AN EXPLANATORY MEMORANDUM OF SPECIFIC ACTIVITIES THAT MIGHT GIVE CAUSE TO A CONFLICT AND AN INDIVIDUAL QUESTIONNAIRE TO DISCLOSE ALL SUCH ACTIVITIES. THIS QUESTIONNAIRE MUST BE COMPLETED AND SIGNED BY THE INDIVIDUAL. THIS CORRESPONDENCE INCLUDES A COPY OF THE ANTITRUST COMPLIANCE POLICY THAT MUST BE SIGNED BY THE INDIVIDUAL. ALL OF THESE DOCUMENTS ARE SENT TO THE CORPORATE COMPLIANCE DEPARTMENT. THE CORPORATE COMPLIANCE DEPARTMENT ENSURES ALL FORMS ARE RETURNED AND RETAINS THE DOCUMENTS FOR FIVE YEARS. IN ADDITION, AT EACH MEETING OF THE BOARD OR ANY BOARD COMMITTEE, FOLLOWING APPROVAL OF THE PREVIOUS MEETING'S MINUTES, THE BOARD OR COMMITTEE CHAIR SHALL REQUEST ANY BOARD MEMBER WHO PERCEIVES A POTENTIAL CONFLICT OF INTEREST ON ANY OF THE MEETING'S AGENDA ITEMS TO DISCLOSE THE POTENTIAL CONFLICT. ADDITIONALLY, AT ANY BOARD OR BOARD COMMITTEE MEETING WHERE THE SUBJECT OF CONFLICT OF INTEREST IS DISCUSSED, THE MINUTES SHALL CONTAIN THE NAME OF THE PARTY DISCUSSING A POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE POTENTIAL CONFLICT OF INTEREST AND WHETHER A CONFLICT OF INTEREST WAS FOUND TO EXIST. IF A CONFLICT OF INTEREST IS DETERMINED BY THE BOARD TO EXIST, THE MEMBER WILL BE EXCUSED FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON THE PARTICULAR AGENDA ITEM. THE CHIEF COMPLIANCE AND ENTERPRISE RISK OFFICER REPORTS THE RESULTS OF THE PREMIER CONFLICT OF INTEREST QUESTIONNAIRES NO LESS THAN ANNUALLY TO THE BOARD OF TRUSTEES BY WAY OF THE COMPLIANCE AND AUDIT COMMITTEE. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE MEETING. PERIODICALLY, THE INTERNAL AUDIT DEPARTMENT WILL REVIEW A SAMPLE OF COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND REPORT THE RESULTS TO THE COMPLIANCE AND AUDIT COMMITTEE. THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE INDIVIDUALLY SUMMARIZED IN A DOCUMENT AND SENT ELECTRONICALLY TO THE FINANCE DEPARTMENT FOR ANY NECESSARY DISCLOSURES REQUIRED ON THE 990 FILING. FORM 990, PART VI, SECTION B, LINES 15A AND 15B: COMPENSATION FOR SBHIS CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH SBHI IS AN AFFILIATE, ON AN ANNUAL BASIS. THE REVIEW PROCESS PERFORMED BY PREMIER FOLLOWS A MARKET BASED COMPENSATION PHILOSOPHY DESIGNED TO ATTRACT AND RETAIN THE EXECUTIVE TALENT REQUIRED TO MEET THE HIGH-PERFORMANCE STANDARDS OF OUR BOARD AND OUR COMMUNITY. PREMIER ANNUALLY REVIEWS EXECUTIVE COMPENSATION SURVEY DATA FOR A REGIONAL 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 INTEGRATION OFFICER, CHIEF STRATEGY 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: DISTRIBUTIONS TEMPORARILY RESTRICTED (104,003) OTHER CHANGES (3) -------- TOTAL (104,006) PREMIER HEALTH (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) 10 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 EDU 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 GOOD SAMARITAN HOSPITAL FOUNDATION - DAY 110 N MAIN ST 500 DAYTON OH 45402 237296923 FOUNDATION OH 501(C)(3) 7 PREMIER false HEART INSTITUTE OF DAYTON 110 N MAIN ST 500 DAYTON OH 45402 300502367 EDUCATION OH 501(C)(3) 10 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 PREMIER PLAZA LLC 110 N MAIN ST 500 DAYTON OH 45402 800708185 HOLDING COMPANY OH MAHS EXCLUDED 0 0 false 0 false 0.00000 SOUTHWEST OHIO NEONATAL COLLABORATIVE 110 N MAIN ST 500 DAYTON OH 45402 463231330 NEONATOLOGY OH MVH RELATED 0 0 false 0 false 0.00000 SAMARITAN NORTH SURGERY CENTER 9000 N MAIN ST DAYTON OH 45402 311618587 O/P SURGERY OH GSH RELATED 0 0 false 0 false 0.00000 COMPUNET CLINICAL LABORATORIES LLC 2308 SANDRIDGE DR MORAINE OH 45439 311258010 MEDICAL LABS OH MVHE INC RELATED 0 0 false 0 false 0.00000 SWEITZER STREET LLC 110 N MAIN ST 1250 DAYTON OH 45402 454700417 REAL ESTATE OH MVHE INC EXCLUDED 0 0 false 0 false 0.00000 SWEITZER MOB LLC 110 N MAIN ST 1250 DAYTON OH 45402 474554657 REAL ESTATE OH MVHE INC EXCLUDED 0 0 false 0 false 0.00000 MVHE INC 110 N MAIN ST 400 DAYTON OH 45402 311185270 PHYSICIAN SERVICE OH PREMIER HOLDING C CORP 0 0 0.00000 false PREMIER HEALTH SPECIALISTS 110 N MAIN ST 400 DAYTON OH 45402 311185270 PHYSICIAN SERVICE OH PREMIER HOLDING C CORP 0 0 0.00000 false SAMARITAN FAMILY CARE 110 N MAIN ST 400 DAYTON OH 45402 311299450 PHYSICIAN SERVICE 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 110 N MAIN ST 900 DATYTON 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 PREMEIR 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 (PREMIER HOLDING) 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 false false false false false false false false false false false false false false false true false false true