2019-05-15T10:47:50-05:00 2018-06-30 861065772 DELOITTE TAX LLP 250 EAST FIFTH STREET SUITE 1900 CINCINNATI OH 45202 990 2017-07-01 461393755 TRIHEALTH HOSPITAL INC TRIH 5135696575 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 MICHAEL CROFTON VP-FINANCE 5135696577 2019-05-14 1 ALICIA JANISCH P00741382 5137847100 174.226.148.89 2019-05-14 21:51:19 ED P 8121CA463AABFA4EFE5158FD2073B628CA1C8F6D 5D794220C68C161820A811785299AFD302F4C684 2017 2019-02-21 02:37:17Z X MARK CLEMENT 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 65029989 0 X WWW.TRIHEALTH.COM X 2012 OH TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. 13 9 262 9 0 0 0 0 63736554 64518130 10036 0 808183 511859 64554773 65029989 14550 0 0 0 17200110 18248895 0 0 0 32302207 32288340 49516867 50537235 15037906 14492754 173649110 187632255 28854467 28344858 144794643 159287397 TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. THIS IS ACCOMPLISHED BY PROVIDING A FULL RANGE OF HEALTH RELATED SERVICES INCLUDING PREVENTION, WELLNESS AND EDUCATION. 0 0 37638047 0 65021849 SEE SCHEDULE H 37638047 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 41 0 1 262 1 0 0 0 0 0 0 0 0 0 0 X 13 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X MICHAEL CROFTON - VP FINANCE 5135696577 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 X MICHAEL HAVERKAMP TRUSTEE 1.00 3.00 X 0 0 0 PAUL EDGETT III TRUSTEE (END 7/2017) 1.00 3.00 X 0 0 0 MYRTIS POWELL TRUSTEE 1.00 3.00 X 0 0 0 SR SALLY DUFFY SECRETARY 1.00 3.00 X X 0 0 0 CRAIG EISENTROUT MD TRUSTEE 1.00 3.00 X 0 723430 48271 WAYNE SHIRCLIFF CHAIR 1.00 3.00 X X 0 0 0 RALPH S MICHAEL VICE CHAIR/TREASURER 1.00 3.00 X X 0 0 0 MARK CLEMENT PRESIDENT/CEO 5.00 55.00 X X 0 1443430 315687 MARK DELWORTH MD MED STAFF PRES-(END 12/17) 1.00 10.00 X 0 103421 0 MARGARET LEMASTERS MD MED STAFF PRES-(END 12/17) 1.00 10.00 X 0 48100 0 PHILLIP CASTELLINI TRUSTEE 1.00 3.00 X 0 0 0 LISA KNUTSON TRUSTEE 1.00 3.00 X 0 0 0 THEODORE TORBECK TRUSTEE 1.00 3.00 X 0 0 0 PHILIP FOSTER TRUSTEE 1.00 3.00 X 0 0 0 SCOTT FRIEDSTROM MD MED STAFF PRES-GOOD SAM 1.00 3.00 X 0 539051 67403 PHILLIP OBLINGER MD MED STAFF PRES-BETHESDA 1.00 3.00 X 0 57349 0 ANDREW DEVOE ASST TREASURER/CFO 5.00 55.00 X 0 804513 132225 STEVE GRACEY ASST SECRETARY/SVP LEGAL 5.00 55.00 X 0 382265 90360 WILLIAM GRONEMAN EXECUTIVE VP - (END 11/17) 5.00 55.00 X 0 774497 221077 KELVIN HANGER EXEC DIR-PERIOP OPERATIONS 60.00 0.00 X 167262 151014 43497 SUELLEN JONES NURSING ADMIN-TRIHEALTH EVENDALE 60.00 0.00 X 191656 0 25153 ROBERT COLLINS MD CMO - (END 12/2017) 5.00 55.00 X 0 600543 165747 GAIL DONOVAN EXEC VP & COO 5.00 55.00 X 0 924940 201973 DAVID COOK CHIEF HR OFFICER 5.00 55.00 X 0 461028 115687 KEVIN JOSEPH MD CMO - (START 1/2018) 5.00 55.00 X 0 578653 96075 ROB CERCEK VP-GOOD SAM REGION (END 4/18) 5.00 55.00 X 0 504445 130947 MARY IRVIN CHIEF NURSE EXECUTIVE - TRIHEALTH 15.00 45.00 X 0 407921 129405 JOANNE RISLEY NURSE MGR-TRIHEALTH EVENDALE 60.00 0.00 X 118477 0 12718 DEBORAH MONTGOMERY MGR-TRIHEALTH HAND SURGERY 60.00 0.00 X 107731 0 27732 MELISSA PAYNE PHARMACIST 60.00 0.00 X 138245 0 34163 SALLY VEATCH NURSE MGR-TRIHEALTH EVENDALE 60.00 0.00 X 114558 0 16259 VALENTINA DEDMAN NURSE MGR-TRIHEALTH EVENDALE 60.00 0.00 X 102429 0 22141 JOHN PROUT FORMER OFFICER 5.00 55.00 X 0 252304 0 DONNA NIENABER ESQ FORMER OFFICER 0.00 0.00 X 0 394836 59278 MICHAEL CROFTON FORMER OFFICER 0.00 60.00 X 0 393249 117173 940358 9544989 2072971 8 1 1 0 CLINICAL CO-MANAGEMENT LLC 8099 CORNELL ROAD CINCINNATI OH 45249 CLINICAL MANAGEMENT 1261778 SCIOTO SERVICES 3478 HAUCK RD STE D CINCINNATI OH 45241 JANITORIAL 209494 ORTHOCINCY 8099 CORNELL ROAD CINCINNATI OH 45249 PHYSICAL THERAPY STAFFING 204145 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 EQUIPMENT MAINTENANCE 151769 ARAMARK UNIFORM SERVICES 4936 MONTGOMERY RD CINCINNATI OH 45212 UNIFORMS 126613 6 PATIENT SERVICES 621400 64518130 64518130 64518130 8140 0 8140 8140 8140 EHR MEANINGFUL USE 900099 500773 500773 MISCELLANEOUS 900099 2946 2946 503719 65029989 65021849 0 8140 420186 420186 14196338 13567726 628612 665876 167304 498572 1922530 1697909 224621 1043965 971840 72125 1321778 1321778 707767 617067 90700 52159 52159 591487 494534 96953 11751 11751 2132105 1587745 544360 8407 5188 3219 1814046 1814046 4760045 1184404 3575641 MEDICAL/DIETARY SUPPLY 15176062 15170875 5187 OVERHEAD ALLOCATION 3682011 114117 3567894 EQUIPMENT 1076830 1061805 15025 OHIO HOSPITAL FEE 933623 933623 20269 20269 50537235 37638047 12899188 0 598 600 6496439 7233384 104867 148596 61270906 18534684 29683243 42736222 113079685 112274685 24284278 25238768 173649110 187632255 3533814 3825897 25106346 24163264 214307 355697 28854467 28344858 X 144794643 159287397 144794643 159287397 173649110 187632255 14492754 0 X X 0 1 X 1 0 X 29605045 7465492 22139553 14018 5607 8411 15246098 10745802 4500296 16405745 317783 16087962 42736222 DUE FROM RELATED ORGANIZATION 25162819 MISCELLANEOUS 75949 25238768 ACCRUED MALPRACTICE LIABILITY 304549 THIRD PARTY SETTLEMENTS 51148 355697 X PART X, LINE 2: THE FINANCIAL STATEMENTS OF TRIHEALTH HOSPITAL, INC. ARE AUDITED AS PART OF TRIHEALTH AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE AUDITED COMBINED FINANCIAL STATEMENTS OF TRIHEALTH THAT REPORTS ITS AND ITS SUBSIDIARIES AND AFFILIATES LIABILITY, IF APPLICABLE, FOR CERTAIN TAX POSITIONS UNDER ASC 740-10-25: TRIHEALTH PERFORMED AN ANALYSIS OF UNCERTAIN TAX POSITIONS AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE COMBINED FINANCIAL STATEMENTS AT JUNE 30, 2018 AND 2017. 1 1 X 1 X 1 X 1 1 0 1 1 558147 0 558147 0.01100 4563281 2605068 1958213 0.03870 5121428 2605068 2516360 0.04970 5121428 2605068 2516360 0.04970 0 1715486 0 11123780 9829938 1293842 X 1 1 1 1 TRIHEALTH EVENDALE HOSPITAL 3155 GLENDALE-MILFORD RD EVENDALE OH 45241 WWW.TRIHEALTH.COM 1482 X X TRIHEALTH EVENDALE HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/ X 1 15 0 1 0 1 X 150.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 5: PRIMARY RESEARCHCHNA COMMUNITY FOCUS GROUPS/PUBLIC MEETINGS: THE FOCUS GROUPS WERE CONDUCTED BY AN ASSIGNED FACILITATOR AND SCRIBES. THE FACILITATOR INTRODUCED THE ATTENDEES TO THE COUNTY SNAPSHOT AND THE CNI MAP. AFTER A PERIOD OF QUESTIONS AND BRAINSTORMING, EACH ATTENDEE WAS ASKED TO INDICATE WHICH ISSUES WERE MOST IMPORTANT. THE ATTENDEES INCLUDED MEMBERS OF THE COMMUNITY AND REPRESENTATIVES OF ORGANIZATIONS SERVING THE COMMUNITY, INCLUDING COMMUNITY ADVOCATES AND REPRESENTATIVES FROM FAITH-BASED ORGANIZATIONS, PUBLIC HEALTH DEPARTMENTS, AND COMMUNITY-BASED HEALTH CENTERS. THE PURPOSE OF THE MEETINGS WAS TO SOLICIT PUBLIC INPUT. THE RESULTS OF THE COMMUNITY FOCUS GROUPS WERE SUMMARIZED BY COUNTY. THIS DOCUMENT REFERS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMUNITY FOCUS GROUPS AS "COMMUNITY FOCUS GROUPS OR "FOCUS GROUPS".CHNA COMMUNITY HEALTH SURVEYS: THE SURVEY WAS CUSTOMIZED FOR THREE DIFFERENT RESPONDENTS: CONSUMERS, AGENCIES, AND HEALTH DEPARTMENTS. A SPANISH LANGUAGE SURVEY WAS ALSO CREATED WITH THE HELP OF COMMUNITY HEALTH WORKERS. THE SURVEY CONTAINED QUESTIONS ABOUT THE HEALTH ISSUES FACING THE COMMUNITY, IF HEALTH ISSUES WERE BEING ADDRESSED, AND WHAT BARRIERS THE COMMUNITY WAS EXPERIENCING. SOME PARTICIPANTS PREFERRED TO RESPOND IN-PERSON OR OVER THE PHONE, THESE RESPONSES WERE TRANSCRIBED INTO THE SURVEY TOOL. THIS DOCUMENT REFERS TO THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMUNITY SURVEYS AS "SURVEYS".SECONDARY RESEARCHSECONDARY RESEARCH CONSISTED OF GATHERING AVAILABLE HEALTH-RELATED DATA FOR A COLLECTION OF TWENTY-THREE COUNTIES, INCLUDING BUTLER, CLERMONT, HAMILTON, AND WARREN COUNTIES. BECAUSE THE TARGETED REGION SPANNED THREE STATES, CONSISTENT DATA WERE NOT ALWAYS AVAILABLE, AND NOT ALL DATA WERE AVAILABLE FOR THE ENTIRE REGION. WHENEVER POSSIBLE, DATA WERE COLLECTED AT THE COUNTY LEVEL. SUB-COUNTY LEVEL DATA WERE NOT A FOCUS OF THIS RESEARCH. THE COUNTY HEALTH RANKINGS (CHR) FORMED THE FOUNDATION FOR DATA COLLECTION WITH ITS COUNTY-LEVEL FOCUS ON HEALTH OUTCOMES, HEALTH FACTORS, HEALTH BEHAVIORS, QUALITY OF LIFE, CLINICAL CARE, PHYSICAL ENVIRONMENT, AND SOCIOECONOMIC FACTORS. DATA WAS VERIFIED AND FORMATTED CONSISTENTLY; SUPPLEMENTAL DATA WAS ALSO IDENTIFIED AND COLLECTED. THE INTERACTIVE TOOL ON THE CNI (COMMUNITY NEED INDEX) WAS ACCESSED TO CREATE COUNTY-LEVEL MAPS AND ZIP CODE TABLES. THE CHR AND CNI WEBSITES WERE MONITORED FOR PERIODIC DATA UPDATES AND DATA WORKSHEETS WERE REVISED UNTIL SEPTEMBER 2015.STANDARDS FOR RESEARCHING AND INCLUDING THE DATA WERE ESTABLISHED AND INCLUDED THE FOLLOWING CHARACTERISTICS: COMPARABLE, COUNTY-LEVEL, FOCUSED ON HEALTH OUTCOMES, REPRODUCIBLE, REPUTABLE, AND TRENDED. THE CHR SERVED AS A STARTING POINT BUT RESOURCES WITH MORE RECENT DATA AND ADDITIONAL MEASURES WERE ALSO IDENTIFIED.INPUT FROM A BROAD RANGE OF REPRESENTATIVESINPUT WAS RECEIVED FROM INDIVIDUALS REPRESENTING UNDERSERVED POPULATIONS USING, PRIMARILY THE TWO SURVEY APPROACHES DESCRIBED ABOVE. THE COMBINATION OF THESE METHODS PROVIDED A WIDE-RANGE OF DATA COLLECTION OPPORTUNITIES ON WHICH THE CHNA COULD BE BASED.CHNA COMMUNITY FOCUS GROUPS: A TOTAL OF 156 INDIVIDUALS ATTENDED THE 11 FOCUS GROUPS, 134 OF THE ATTENDEES REPRESENTED AN ORGANIZATION. THE ORGANIZATIONS REPRESENTED BY THESE ATTENDEES SERVE THE FOLLOWING POPULATIONS: CHILDREN, ELDERLY, HOMELESS, LOW-INCOME, MEDICALLY UNDERSERVED, MINORITY, PEOPLE WITH MENTAL ILLNESS, AND VICTIMS OF DOMESTIC VIOLENCE. FIFTEEN INDIVIDUALS, ALL REPRESENTING ORGANIZATIONS, ATTENDED THE BUTLER COUNTY FOCUS GROUP ON JULY 30, 2015. THREE INDIVIDUALS ATTENDED THE CLERMONT COUNTY FOCUS GROUP ON JULY 28, 2015. APPROXIMATELY 50 INDIVIDUALS ATTENDED MEETINGS ON BEHALF OF HAMILTON COUNTY, THE MAJORITY REPRESENTED AN ORGANIZATION. ON JULY 7, 2015, SIX INDIVIDUALS ATTENDED THE WARREN COUNTY FOCUS GROUP AND REPRESENTED PREMIER HEALTH: ATRIUM MEDICAL CENTER AND PREVENTIONFIRST OR CAME ON THEIR OWN BEHALF. CHNA SURVEY: IN AGGREGATE, 329 INDIVIDUALS, 55 AGENCY REPRESENTATIVES, 52 LATINOS, AND 24 HEALTH DEPARTMENT REPRESENTATIVES COMPLETED THE CHNA SURVEY. THE CHNA TEAM, CHNA COMMITTEE, AND PARTNERS HELPED DISTRIBUTE THE SURVEY. AT COMMUNITY MEETINGS, A HANDOUT PROVIDED THE SURVEY LINK, AND THE LINKS WERE WRITTEN ON AN EASEL PAD AT THE FRONT OF THE ROOM. THROUGHOUT THE REGION, 381 INDIVIDUAL SURVEYS AND 55 AGENCY SURVEYS WERE COMPLETED, INCLUDING RESPONSES FROM AGENCIES SUCH AS BUTLER COUNTY UNITED WAY, CLERMONT COUNTY MENTAL HEALTH & RECOVERY BOARD, AND THE YMCA OF GREATER CINCINNATI. IN BUTLER, CLERMONT, HAMILTON, AND WARREN COUNTIES, RESPONDENTS INCLUDED CONTACTS FROM LOCAL HEALTH DEPARTMENTS: THE BUTLER COUNTY HEALTH DEPARTMENT, CITY OF HAMILTON HEALTH DEPARTMENT, THE MIDDLETOWN CITY HEALTH DISTRICT, THE CLERMONT COUNTY GENERAL HEALTH DISTRICT, HAMILTON COUNTY PUBLIC HEALTH, NORWOOD CITY HEALTH DISTRICT, SPRINGDALE CITY HEALTH DISTRICT, AND WARREN COUNTY COMBINED HEALTH DISTRICT. OTHER ORGANIZATIONS THAT COMPLETED THE SURVEY INCLUDED GOOD SAMARITAN FREE HEALTH CENTER, AND THE GREATER CINCINNATI FOUNDATION, ETC. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 6A: ADAMS COUNTY REGIONAL MEDICAL CENTER, ATRIUM MEDICAL CENTER, DEARBORN COUNTY HOSPITAL, LINDNER CENTER OF HOPE, MARGARET MARY COMMUNITY HOSPITAL, MCCULLOUGH-HYDE MEMORIAL HOSPITAL, MERCY HEALTH, UC HEALTH, BETHESDA NORTH HOSPITAL, BETHESDA BUTLER COUNTY, THE CHRIST HOSPITAL, CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 6B: HEALTH COLLABORATIVE, CITY OF CINCINNATI HEALTH DEPARTMENT, HAMILTON COUNTY PUBLIC HEALTH, INTERACT FOR HEALTH, XAVIER UNIVERSITY DEPARTMENT OF HEALTH SERVICES ADMINISTRATION TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 7D: AVAILABLE UPON REQUEST WITHOUT CHARGE. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 11: CHILD HEALTH/INFANT MORTALITY - TRIHEALTH EVENDALE WILL CONTINUE ITS FOCUS ON THIS HEALTH NEED THROUGH ITS HEALTH SYSTEM'S SPONSORSHIP OF MULTIPLE PROGRAMS IN ITS FOUR COUNTY SERVICE AREA IN COLLABORATION WITH OTHER EXISTING COMMUNITY SERVICE ORGANIZATIONS. TRIHEALTH EVENDALE IS AN ACTIVE PARTICIPANT IN CRADLE CINCINNATI.OBESITY - TRIHEALTH EVENDALE WILL ADDRESS THIS NEED IN THE FOUR COUNTY SERVICE AREAS. TRIHEALTH EVENDALE WILL ALSO PARTNER WITH THE COLLECTIVE IMPACT ON HEALTH (PART OF THE HEALTH COLLABORATIVE) TO MAKE THIS A REGION WIDE PRIORITY FOR HEALTH SYSTEMS AND COMMUNITY ORGANIZATIONS.SUBSTANCE ABUSE/MENTAL HEALTH - TRIHEALTH EVENDALE WILL ADDRESS THIS NEED BY ITS CONTINUED RELATIONSHIP WITH THE HOPE PROGRAM, HEALTHY MOMS AND BABES, SOJOURNERS, COMMUNITY PARTNERS (NATIONAL ALLIANCE ON MENTAL ILLNESS) AND BY EXTENDING THE BETHESDA HOSPITAL, INC. ALCOHOL AND DRUG PROGRAM OUTREACH PROGRAMS.CANCER - TRIHEALTH EVENDALE WILL ADDRESS THIS NEED BY CONTINUING TO UTILIZE THE OUTREACH MINISTRIES PROGRAM (FORMERLY NAMED PARISH NURSE PROGRAM) AT TRIHEALTH EVENDALE, WHERE THERE IS A CONCENTRATION OF THIS UNDERSERVED POPULATION. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 13B: SEE PART VI RESPONSE RELATED TO PART I, LINE 3C. TRIHEALTH EVENDALE HOSPITAL PART V, SECTION B, LINE 13H: SEE PART VI RESPONSE RELATED TO PART I, LINE 3C. 3 1 - TRIHEALTH SURGERY CENTER WEST 3660 EDGEWOOD DRIVE CINCINNATI OH 45211 OUTPATIENT SURGERY CENTER 2 - TRIHEALTH HAND SURGERY CENTER 538 OAK STREET SUITE 200 CINCINNATI OH 45219 OUTPATIENT SURGERY CENTER 3 - TRIHEALTH ENDOSCOPY CENTER NORTH 10600 MONTGOMERY ROAD CINCINNATI OH 45242 OUTPATIENT ENDOSCOPY CENTER PART I, LINE 3C: TRIHEALTH HOSPITAL INC. UTILIZES THE FEDERAL POVERTY GUIDELINES ("FPG") IN DETERMINING CHARITY CARE ELIGIBILITY. SEE THE RESPONSES TO PART I, LINE 3A AND 3B.AN INDIVIDUAL'S INCOME UNDER FPG IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR CHARITY CARE. ADDITIONALLY, AN INDIVIDUAL'S INCOME IN RELATION TO HIS/HER MEDICAL EXPENSES IS ALSO TAKEN INTO ACCOUNT AND SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES. FINALLY, TRIHEALTH HOSPITAL, INC. PROVIDES DISCOUNTED CARE AT SELECT CLINICS. PART I, LINE 6A: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. IN 2013, TRIHEALTH ORGANIZED TRIHEALTH HOSPITAL, INC. TO SUPPORT ITS MISSION.THE COMMUNITY BENEFIT PROVIDED BY TRIHEALTH HOSPITAL, INC. IS TRACKED ON A STANDALONE BASIS; HOWEVER, ITS COMMUNITY BENEFIT IS REPORTED IN A REPORT PREPARED BY TRIHEALTH IN COMBINATION WITH ITS RELATED HOSPITALS - BETHESDA HOSPITAL, INC., THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND MCCULLOUGH-HYDE MEMORIAL HOSPITAL. PART I, LINE 7: FOR THE AMOUNTS REPORTED AT COST IN PART I, LINE 7, TRIHEALTH HOSPITAL, INC. UTILIZED WORKSHEET 2 - RATIO OF PATIENT CARE COST-TO-CHARGES, WHICH WAS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H, TO CALCULATE THE COST-TO-CHARGE RATIO. PART I, LN 7 COL(F): BAD DEBT EXPENSE IS NOT INCLUDED ON FORM 990, PART IX, LINE 25. IT IS PRESENTED ON FORM 990, PART VIII, LINE 2 AS A DEDUCTION FROM PATIENT SERVICE REVENUE WHICH CORRESPONDS TO ITS FINANCIAL STATEMENT PRESENTATION. SEE RESPONSE TO PART III, LINE 4. THEREFORE, NO ADJUSTMENT TO TOTAL EXPENSES SHOWN ON FORM 990, PART IX, LINE 25 IS NECESSARY. PART II, COMMUNITY BUILDING ACTIVITIES: TRIHEALTH HOSPITAL, INC. DID NOT ENGAGE IN ANY COMMUNITY BUILDING ACTIVITIES DURING THE TAX YEAR. PART III, LINE 2: SEE PART VI RESPONSE TO PART III, LINE 4. PART III, LINE 3: SEE PART VI RESPONSE TO PART III, LINE 4. PART III, LINE 4: TRIHEALTH HOSPITAL INC.'S FINANCIAL STATEMENTS ARE AUDITED AS PART OF THE TRIHEALTH AUDIT REPORT.NET PATIENT ACCOUNTS RECEIVABLE (PART OF FOOTNOTE B)NET PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE HAVE BEEN ADJUSTED TO THE ESTIMATED AMOUNTS EXPECTED TO BE COLLECTED. THESE ESTIMATED AMOUNTS ARE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS. THE PROVISION FOR BAD DEBT IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY AS NECESSARY THE PROVISIONS FOR BAD DEBT AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS RECEIVABLE IN THE PERIOD OF SERVICE BASED UPON HISTORICAL WRITE-OFF EXPERIENCE.AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, TRIHEALTH FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY TRIHEALTH.THERE HAVE BEEN NO SIGNIFICANT CHANGES IN THE CURRENT YEAR TO THE UNDERLYING ASSUMPTIONS USED BY TRIHEALTH TO ESTIMATE THE ALLOWANCE FOR UNCOLLECTABLE ACCOOUNTS.FINANCIAL INSTRUMENTS THAT POTENTIALLY SUBJECT TRIHEALTH TO CONCENTRATIONS OF CREDIT RISK CONSIST PRIMARILY OF NONGOVERNMENTAL PATIENT ACCOUNTS RECEIVABLE. TRIHEALTH GRANTS CREDIT WITHOUT COLLATERAL TO ITS PATIENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS.THE PERCENTAGES OF GROSS PATIENT ACCOUNTS RECEIVABLE FROM PATIENTS AND THIRD-PARTY PAYORS AT JUNE 30 APPROXIMATED THE FOLLOWING:2018 - MEDICARE 12%, MEDICAID 1%, MANAGED MEDICARE/MEDICAID 26%, SELF PAY 24%, COMMERCIAL AND OTHER 37%2017 - MEDICARE 14%, MEDICAID 2%, MANAGED MEDICARE/MEDICAID 28%, SELF PAY 20%, COMMERCIAL AND OTHER 36%TRIHEALTH HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. THE BASIS FOR PAYMENT UNDER THESE AGREEMENTS INCLUDES PROSPECTIVELY DETERMINED RATES, COST REIMBURSEMENT, NEGOTIATED DISCOUNTS FROM ESTABLISHED RATES, AND PER DIEM PAYMENTS. PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEW AND INVESTIGATIONS. THE DIFFERENCES BETWEEN THE ESTIMATED AND ACTUAL ADJUSTMENTS ARE RECORDED AS PART OF NET PATIENT SERVICE REVENUE IN FUTURE PERIODS, AS THE AMOUNTS BECOME KNOWN, OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS. TRIHEALTH RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH IT DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBT IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS.AS FOR THE AMOUNT OF BAD DEBT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, TRIHEALTH HOSPITAL, INC. DOES NOT REPORT ACTUAL BAD DEBT EXPENSE AS COMMUNITY BENEFIT. IF UPON FURTHER RESEARCH, IT IS ULTIMATELY DETERMINED THAT A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER TRIHEALTH'S CHARITY CARE POLICY, THOSE COSTS WOULD BE RECLASSIFIED, AS APPROPRIATE, TO COMMUNITY BENEFIT AT THAT TIME.PLEASE NOTE THAT BAD DEBT EXPENSE IS NOT DETERMINED UNTIL AFTER ALL DISCOUNTS AND ANY ASSOCIATED PAYMENTS ARE TAKEN INTO ACCOUNT. IF ANY PAYMENTS ARE RECEIVED AFTER A PATIENT ACCOUNT IS DETERMINED TO BE BAD DEBT, THE ACCOUNT WILL BE ADJUSTED ACCORDINGLY AT THAT TIME. PART III, LINE 8: TRIHEALTH, INC. USES THE "STEPDOWN METHODOLOGY" IN DETERMINING THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT. THIS METHOD OF COST FINDING PROVIDES FOR THE ALLOCATION OF THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS WHICH UTILIZE SUCH SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. TRIHEALTH HOSPITAL,INC. DID NOT REPORT ANY MEDICARE SHORTFALL AS COMMUNITY BENEFIT IN PART III, LINE 7 OF THIS SCHEDULE. PART III, LINE 9B: AS OF THE FILING OF THIS RETURN, TRIHEALTH HOSPITAL, INC., AS PART OF TRIHEALTH, INC., MAINTAINS A WRITTEN DEBT COLLECTION POLICY. TRIHEALTH, INC., WHO PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS, WILL NOT INITIATE COLLECTION PRACTICES ON PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BEFORE COLLECTION ACTIONS ARE TAKEN, TRIHEALTH, INC. WILL MAKE REASONABLE EFFORTS, GENERALLY AS EARLY IN THE BILLING PROCESS AS POSSIBLE, TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. AFTER SUCH EFFORTS HAVE BEEN MADE AND A BALANCE REMAINS THAT IS THE RESPONSIBILITY OF THE PATIENT OR GUARANTOR, TRIHEALTH, INC. MAY PURSUE, IN ITS SOLE DISCRETION, WHATEVER ACTIONS IT MAY BE ENTITLED TO TAKE UNDER LAW. PART VI, LINE 2: IN 1995, BETHESDA HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO FORMED A PARTNERSHIP TO CREATE A LOCAL HEALTH SYSTEM: TRIHEALTH, INC. ("TRIHEALTH"). THE MISSION OF TRIHEALTH IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION.IN JANUARY 2013, TRIHEALTH ACQUIRED EVENDALE MEDICAL CENTER AND FORMED TRIHEALTH HOSPITAL, INC. THE HOSPITAL CAMPUS CONSISTS OF TEN OPERATING ROOMS, 29 INPATIENT ROOMS AND A COMPLETE IMAGING AND DIAGNOSTIC FACILITY. SERVICES RANGE FROM INPATIENT SURGERY TO ORTHOPEDICS, GYNECOLOGY AND OUTPATIENT IMAGING.TRIHEALTH PARTICIPATED IN AND WAS A FUNDER OF THE WORK OF A COLLABORATIVE, REGIONAL EFFORT, THE A.I.M. FOR BETTER HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT ("A.I.M."). IN THE AREAS ASSESSED, THOSE SURVEYED WERE MORE OFTEN UNDERSERVED, INCLUDING THE UNINSURED, THE UNDERINSURED, THOSE IN LOW SOCIOECONOMIC STATUS, MINORITIES, THOSE OVER THE AGE OF SIXTY-FIVE, OR THOSE WITH A DIAGNOSIS OF MENTAL ILLNESS. THE A.I.M., PUBLISHED IN THE SPRING OF 2012, WILL BE USED TO DEVELOP A SPECIFIC COMMUNITY HEALTH NEEDS ASSESSMENT FOR TRIHEALTH HOSPITAL, INC. PART VI, LINE 3: TRIHEALTH, INC. PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS INCLUDING TRIHEALTH HOSPITAL, INC. BROCHURES/APPLICATIONS, PROVIDED IN MULTIPLE LANGUAGES, ARE VISIBLE AND AVAILABLE IN THE REGISTRATION AND ADMITTING AREAS OF ALL TRIHEALTH AFFILIATED HOSPITALS. IN ADDITION, THE APPLICATION IS PRINTED ON THE REVERSE SIDE OF A PATIENT'S BILL WITH INSTRUCTIONS ON HOW TO COMPLETE THE APPLICATION AS WELL AS HOW TO RETURN IT. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. FINALLY, TRIHEALTH, INC.'S WEBSITE CONTAINS INFORMATION REGARDING ITS CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS WITH DIRECTIONS ON HOW TO CONTACT THE APPROPRIATE PERSONNEL TO INITIATE AN APPLICATION OR ASK QUESTIONS ABOUT THE PROCESS. PART VI, LINE 4: LOCATED IN CINCINNATI, OHIO, TRIHEALTH HOSPITAL, INC. AND THE TRIHEALTH, INC. SYSTEM SERVE HAMILTON, BUTLER, WARREN, CLINTON AND CLERMONT COUNTIES IN OHIO AS WELL AS PERSONS FROM INDIANA AND KENTUCKY. IN METROPOLITAN STATISTICAL AREAS, THE CINCINNATI-MIDDLETOWN REGION IS THE LARGEST IN OHIO. THE ESTIMATED POPULATION FOR THIS AREA IS 2,150,000. THE POPULATION WITHIN THE FIVE OHIO COUNTIES SERVED BY TRIHEALTH HOSPITAL, INC. AND TRIHEALTH, INC. IS ESTIMATED TO BE 1,663,000 AND 12.0 PERCENT OF THIS POPULATION IS UNINSURED. PART VI, LINE 5: TRIHEALTH HOSPITAL, INC. IS COMPRISED OF VARIOUS MEDICAL SERVICES AT VARIOUS LOCATIONS INCLUDING TRIHEALTH EVENDALE HOSPITAL AND TRIHEALTH SURGERY CENTER WEST, EACH OF WHICH HAS AN OPEN MEDICAL STAFF. ITS BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES.TRIHEALTH EVENDALE HOSPITAL CONSISTS OF TEN OPERATING ROOMS, 29 INPATIENT ROOMS AND A COMPLETE IMAGING AND DIAGNOSTIC FACILITY. SERVICES RANGE FROM INPATIENT SURGERY TO ORTHOPEDICS, GYNECOLOGY AND OUTPATIENT IMAGING.TRIHEALTH SURGERY CENTER WEST CONSISTS OF FOUR OPERATING ROOMS AND TWO PROCEDURE ROOMS.TRIHEALTH HAND SURGERY CENTER IS A SPACIOUS, STATE-OF-THE-ART, OUTPATIENT SURGICAL FACILITY, EQUIPPED TO PERFORM SOPHISTICATED HAND SURGERY PROCEDURES.TRIHEALTH ENDOSCOPY CENTER NORTH PROVIDES COMPETENT, SAFE, HIGH QUALITY, COST EFFECTIVE AND ACCESSIBLE CARE. THE CENTER PROVIDES SERVICE TO INDIVIDUALS THAT RANGE IN AGE FROM ADOLESCENCE (14-17 WEIGHING GREATER THAN 100 POUNDS) THROUGH THE ELDERLY ADULT (80 YEARS PLUS). TRIHEALTH SURGERY CENTER ANDERSON OFFERS THE LATEST TECHNOLOGIES AND MINIMALLY INVASIVE PROCEDURES PROVEN TO ENHANCE CLINICAL OUTCOMES. IT WILL FEATURE FOUR OPERATING ROOMS, ONE ENDOSCOPY ROOM AND A LABORATORY. THE CENTER WILL FOCUS ON PATIENT/FAMILY-CENTERED CARE INCLUDING PEDIATRICS. PART VI, LINE 6: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH IN ORDER TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION.THROUGH FIVE (5) HOSPITALS, THREE (3) AMBULATORY LOCATIONS AND OVER 125 SITES OF CARE (EMPLOYING OVER 600 PHYSICIANS INCLUDING RESIDENTS), TRIHEALTH PROVIDES A WIDE RANGE OF CLINICAL, EDUCATIONAL, PREVENTIVE AND SOCIAL PROGRAMS. TRIHEALTH'S NON-HOSPITAL SERVICES INCLUDE PHYSICIAN PRACTICE MANAGEMENT, FITNESS CENTERS AND FITNESS CENTER MANAGEMENT, OCCUPATIONAL HEALTH CENTERS, HOME HEALTH AND HOSPICE CARE. 1 1 0 0 0 0 0 0 0 CRAIG EISENTROUT MD TRUSTEE 0 706605 0 10000 0 6825 0 24338 0 23933 0 771701 0 0 MARK CLEMENT PRESIDENT/CEO 0 1064319 0 361237 0 17874 0 297460 0 18227 0 1759117 0 0 SCOTT FRIEDSTROM MD MED STAFF PRES-GOOD SAM 0 488294 0 31795 0 18962 0 37414 0 29989 0 606454 0 0 ANDREW DEVOE ASST TREASURER/CFO 0 406729 0 184778 0 213006 0 109621 0 22604 0 936738 0 0 STEVE GRACEY ASST SECRETARY/SVP LEGAL 0 278422 0 76895 0 26948 0 63155 0 27205 0 472625 0 0 WILLIAM GRONEMAN EXECUTIVE VP - (END 11/17) 0 531685 0 159221 0 83591 0 191245 0 29832 0 995574 0 31401 KELVIN HANGER EXEC DIR-PERIOP OPERATIONS 156815 90038 0 60521 10447 455 20532 0 15584 7381 203378 158395 0 0 SUELLEN JONES NURSING ADMIN-TRIHEALTH EVENDALE 156297 0 32320 0 3039 0 16556 0 8597 0 216809 0 0 0 ROBERT COLLINS MD CMO - (END 12/2017) 0 442689 0 132072 0 25782 0 148839 0 16908 0 766290 0 0 GAIL DONOVAN EXEC VP & COO 0 692100 0 215255 0 17585 0 192834 0 9139 0 1126913 0 0 DAVID COOK CHIEF HR OFFICER 0 355022 0 92932 0 13074 0 93645 0 22042 0 576715 0 0 KEVIN JOSEPH MD CMO - (START 1/2018) 0 398878 0 166718 0 13057 0 69998 0 26077 0 674728 0 0 ROB CERCEK VP-GOOD SAM REGION (END 4/18) 0 395675 0 91458 0 17312 0 105691 0 25256 0 635392 0 0 MARY IRVIN CHIEF NURSE EXECUTIVE - TRIHEALTH 0 311686 0 81251 0 14984 0 110157 0 19248 0 537326 0 0 MELISSA PAYNE PHARMACIST 137966 0 0 0 279 0 10345 0 23818 0 172408 0 0 0 JOHN PROUT FORMER OFFICER 0 0 0 0 0 252304 0 0 0 0 0 252304 0 12304 DONNA NIENABER ESQ FORMER OFFICER 0 188415 0 0 0 206421 0 53218 0 6060 0 454114 0 0 MICHAEL CROFTON FORMER OFFICER 0 302565 0 64965 0 25719 0 88719 0 28454 0 510422 0 0 PART I, LINE 3 TRIHEALTH, INC., A RELATED ORGANIZATION OF TRIHEALTH HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. PART I, LINES 4A-B ELIGIBLE EXECUTIVES (GENERALLY VICE PRESIDENTS AND ABOVE) PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FOLLOWING INDIVIDUAL LISTED IN SCHEDULE J, PART II, RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH WAS TREATED AS TAXABLE COMPENSATION BY TRIHEALTH, INC.: JOHN PROUT - $12,304 WILLIAM GRONEMAN - $31,401 PART I, LINE 4A: THE REPORTABLE INDIVIDUALS OF TRIHEALTH HOSPITAL, INC., WITH THE EXCEPTION OF A FEW, ARE PAID BY TRIHEALTH, INC., A RELATED ORGANIZATION, RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). TRIHEALTH, INC. HAS A STANDARD EMPLOYEE SEVERANCE PACKAGE. GENERAL SEVERANCE PAY IS BASED ON LENGTH OF SERVICE. IN ADDITION, NOTICE PAY, IF APPLICABLE UNDER TRIHEALTH POLICY, MAY BE ADDED TO THE SEVERANCE PACKAGE AND THE AMOUNT OF NOTICE PAY WILL BE DETERMINED BY HUMAN RESOURCES IN ACCORDANCE WITH TRIHEALTH POLICY. PAYMENTS OF SEVERANCE ARE CONDITIONED UPON SIGNING A SEPARATION AND RELEASE AGREEMENT. DURING THE 2017 CALENDAR YEAR, THE FOLLOWING REPORTABLE INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM TRIHEALTH, INC.: DONNA NIENABER - $190,434 FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS, DIRECTORS AND TRUSTEES OF TRIHEALTH HOSPITAL, INC. LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARDS OF BETHESDA HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, BOTH AFFILIATED ENTITIES OF TRIHEALTH HOSPITAL, INC. AS WELL AS TRIHEALTH, INC., THE SINGLE CORPORATE MEMBER OF TRIHEALTH HOSPITAL, INC. GAIL DONOVAN, ROBERT COLLINS, MD, MARK CLEMENT AND MYRTIS POWELL HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE MCCULLOUGH-HYDE MEMORIAL HOSPITAL, AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. WAYNE SHIRCLIFF, LISA KNUTSON, CRAIG EISENTROUT, MD, MARK DELWORTH, MD, MICHAEL HAVERKAMP, AND MYRTIS POWELL HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA, INC., THE SINGLE CORPORATE MEMBER OF BETHESDA HOSPITAL, INC., AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. MARK CLEMENT AND MYRTIS POWELL HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE GOOD SAMARITAN COLLEGE OF NURSING AND HEALTH SCIENCE, AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. MARK CLEMENT, MYRTIS POWELL AND CRAIG EISENTROUT, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA FOUNDATION, INC., A RELATED ENTITY OF BETHESDA HOSPITAL, INC., AN AFFILIATED ENTITY OF TRIHEALTH HOSPITAL, INC. MARK CLEMENT, ROB CERCEK, KELVIN HANGAR, SUELLEN JONES, ANDREW DEVOE, DAVID COOK, WILLIAM GRONEMAN, GAIL DONOVAN, CRAIG EISENTROUT, MD, STEVE GRACEY, MARY IRVIN, KEVIN JOSEPH, MD, PHILLIP OBLINGER, MD, SCOTT FRIEDSTROM, MD AND ROBERT COLLINS, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED ENTITY BOARDS OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES AS WELL AS BEING EMPLOYED BY TRIHEALTH, INC. OR ITS AFFILIATES/SUBSIDIARIES. TRIHEALTH, INC. IS THE SINGLE CORPORATE MEMBER OF TRIHEALTH HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF TRIHEALTH HOSPITAL, INC. SHALL BE TRIHEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A PURSUANT TO ARTICLE II, SECTION 2.2 OF THE CODE OF REGULATIONS OF TRIHEALTH HOSPITAL, INC. ("HOSPITAL") THE SOLE MEMBER OF THE CORPORATION SHALL ELECT THE TRUSTEES OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF TRIHEALTH HOSPITAL, INC. ("HOSPITAL") HAS THE ABILITY TO APPROVE THE DECISIONS OF THE HOSPITAL'S GOVERNING BODY THAT ARE RESERVED TO IT BY OHIO LAW. FORM 990, PART VI, SECTION B, LINE 11B MEMBERS OF THE BOARD ARE PROVIDED AN ELECTRONIC COPY OF THIS FORM 990 PRIOR TO FILING AFTER REVIEW BY THE FINANCE AND AUDIT COMMITTEE OF THE BOARD, ALONG WITH THE COMMITTEE'S SUMMARY OF THE FORM 990. SUBSEQUENT TO PRESENTATION TO THE BOARD, THE ORGANIZATION FILES THE RETURN MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH NON-SUBSTANTIVE CHANGES ARE NOT SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE CERTAIN FINANCIAL INTERESTS AND FIDUCIARY RELATIONSHIPS. THE EXECUTIVE COMMITTEE AND CORPORATE COUNSEL REVIEW RESPONSES, CONDUCT FURTHER INVESTIGATION, IF NECESSARY, AND DETERMINE WHEN A CONFLICT EXISTS WITH RESPECT TO A CERTAIN TRANSACTION. IF A CONFLICT EXISTS, THE TRANSACTION IS NOT TO BE ENTERED INTO UNLESS ALTERNATIVES ARE FULLY INVESTIGATED AND, IN THEIR ABSENCE, THE BOARD, WITHOUT PARTICIPATION OF THE INTERESTED MEMBER(S), DETERMINES THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. PLANS TO MANAGE THE CONFLICT DURING THE RELATIONSHIP ARE IMPLEMENTED. ALL DISCUSSIONS ARE APPROPRIATELY DOCUMENTED. ALL DIRECTORS AND MANAGERS, WHICH INCLUDE OFFICERS AND KEY EMPLOYEES, ARE REQUIRED TO ANNUALLY DISCLOSE ANY CIRCUMSTANCES, INCLUDING FAMILY AND BUSINESS RELATIONSHIPS, THAT MAY CAUSE A CONFLICT OF INTEREST FOR THE ORGANIZATION. THESE RESPONSES ARE REVIEWED AND ACTED UPON BY A CONFLICT OF INTEREST COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 TRIHEALTH HOSPITAL, INC.'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A - AVERAGE HOURS PER WEEK THE OFFICERS AND DIRECTORS FOR TRIHEALTH HOSPITAL, INC. THAT SHOW AT LEAST 60 HOURS PER WEEK PROVIDE SERVICES TO TRIHEALTH, INC. (A RELATED ORGANIZATION WHO PAID THE INDIVIDUALS) AND ITS SUBSIDIARIES/AFFILIATES ("TRIHEALTH") AS AN ENTIRE SYSTEM. HOURS WORKED, INCLUDING THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION, ARE NOT TRACKED ON AN ENTITY BY ENTITY BASIS, THUS THE AVERAGE HOURS PER WEEK DISCLOSED ARE ESTIMATES TO SHOW THAT THE TIME SPENT BY THESE INDIVIDUALS RELATE TO THEM FULFILLING THEIR DUTIES AS FULL-TIME, 60 HOURS-PER-WEEK EMPLOYEES OF TRIHEALTH VERSUS THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION. IN ADDITION, THE COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS IN FULFILLMENT OF THEIR DUTIES AS EMPLOYEES OF TRIHEALTH. DIRECTORS (AS NOTED WITH A "MED STAFF PRES" REFERENCE) FOR BETHESDA HOSPITAL, INC. SERVE ON THE BOARD IN THEIR CAPACITY AS MEDICAL STAFF PRESIDENT FOR EITHER BETHESDA HOSPITAL, INC. OR THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. IN ADDITION, THESE INDIVIDUALS PROVIDE SERVICES AS EMPLOYEES OF VARIOUS RELATED ENTITIES FOR WHICH THEY RECEIVE COMPENSATION. NONE OF THE COMPENSATION SHOWN IS FOR SERVING AS A DIRECTOR. FORM 990, PART XII, LINE 2C THE FINANCIAL STATEMENTS OF TRIHEALTH HOSPITAL, INC. ARE AUDITED AS PART OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). TRIHEALTH HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF BOTH ITS AND ITS SUBSIDIARIES AND AFFILIATES FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF THE INDEPENDENT AUDITOR. DURING THE TAX YEAR, THERE WAS NOT A CHANGE IN THE PROCESS OF AUDIT OVERSIGHT AND/OR SELECTION OF AN INDEPENDENT AUDITOR BY TRIHEALTH. TRIHEALTH INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311438846 SUPPORT TO AFFILIATED HOSPITALS OH SECTION 501(C)(3) SCHEDULE A, LINE 12B N/A 0 GOOD SAMARITAN HOSPITAL FREE CLINIC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 273893817 HEALTHCARE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 7 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN ENTERPRISE CORP 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311383365 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 10 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN INSTITUTE 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311074519 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 10 TRIHEALTH INC 1 BETHESDA HOSPITAL INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 310537122 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 0 BETHESDA HEALTHCARE INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311027660 HEALTHCARE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 12B BETHESDA INC 1 BETHESDA FAMILY PRACTICE CENTER 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311242442 HEALTHCARE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 12A BETHESDA HOSPITAL INC 1 BETHESDA PROPERTIES INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311352694 PROPERTY MANAGEMENT OH SECTION 501(C)(2) BETHESDA HOSPITAL INC 1 HOSPICE OF CINCINNATI INCORPORATED 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 310917155 HOSPICE SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 10 BETHESDA HOSPITAL INC 1 FERNSIDE INC A CENTER FOR GRIEVING CHILDREN 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311179234 COUNSELING TO GRIEVING CHILDREN OH SECTION 501(C)(3) SCHEDULE A, LINE 7 HOSPICE OF CINCINNATI INCORPORATED 1 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 310537486 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 0 GOOD SAMARITAN COLLEGE OF NURSING AND HEALTH SCIENCE 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311778403 EDUCATION OH SECTION 501(C)(3) SCHEDULE A, LINE 2 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 1 COMMUNITY LIMITED CARE DIALYSIS CENTER 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 237419853 DIALYSIS OH SECTION 501(C)(2) THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 1 MCCULLOUGH HYDE MEMORIAL HOSPITAL INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 310650283 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 1 HEALTHCARE SOLUTIONS NETWORK LLC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 472103334 PHYSICIAN HOSPITAL ORGANIZATION OH N/A TRIHEALTH PHYSICIANS OF INDIANA INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 461125130 PHYSICIAN PRACTICES OH N/A C 1 TRIHEALTH PHYSICIAN SOLUTIONS INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311444353 CLAIMS ADMINISTRATION OH N/A C 1 TRIHEALTH CIPHO INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 463294306 PHYSICIAN HEALTH ORGANIZATION OH N/A C 1 PREMIERE MEDICAL ASSOCIATION 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 141913019 CONDO ASSOCIATION OH N/A C 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 BETHESDA PROPERTIES INC K 249694 FMV TRIHEALTH INC K 282674 FMV TRIHEALTH INC P 32288341 COST