FURP.ORG / PUBLIC DATA EXPLORER

UPPER VALLEY MEDICAL CENTER: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
UPPER VALLEY MEDICAL CENTER (EIN 31-0537095)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-15
IRS object ID
201823199349302027
Schema version
2017v2.3
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 ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-15T08:05:58-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11900 Scripps Center 312 Walnut StAddressLine1Txt
CityCincinnatiCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45202ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN310537095EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UPPER VALLEY MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% J MICHAEL SIMSInCareOfNm
Business Name ControlUPPEBusinessNameControlTxt
Phone9374999942PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1110 N MAIN ST 500AddressLine1Txt
CityDAYTONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45402ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTIMOTHY D SNIDERPersonNm
Person TitleVP-CFOPersonTitleTxt
Phone9374999942PhoneNum
Signature2018-11-12SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJULIE L SPARKSPreparerPersonNm
PTINP01268401PTIN
Phone5136121400PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address108.206.163.59IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id31499120183195000003FederalOriginalSubmissionId
Federal Original Submission Id2018-11-15FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id582F47EFACDD6166E52205D1FBFEA2601660FA18AtSubmissionCreationDeviceId
At Submission Filing Device Id770194AAF055F9EA87E64CA02E08FE540289067FAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2018-06-14 16:35:46ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTHOMAS R PARKERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line13130 N COUNTY RD 25 AAddressLine1Txt
CityTROYCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45373ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$158,683,386GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PREMIERHEALTH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1926FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionWE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH SERVICES.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee1600TotalEmployeeCnt
Total Volunteers132TotalVolunteersCnt
Total Gross UBI$111,160TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$39,575NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$172,769PYContributionsGrantsAmt
CY Contributions Grants$173,653CYContributionsGrantsAmt
PY Program Service Revenue$147,916,213PYProgramServiceRevenueAmt
CY Program Service Revenue$140,040,738CYProgramServiceRevenueAmt
PY Investment Income$2,070,570PYInvestmentIncomeAmt
CY Investment Income$2,809,093CYInvestmentIncomeAmt
PY Other Revenue$1,738,653PYOtherRevenueAmt
CY Other Revenue$1,539,425CYOtherRevenueAmt
PY Total Revenue$151,898,205PYTotalRevenueAmt
CY Total Revenue$144,562,909CYTotalRevenueAmt
PY Grants And Similar Paid$550,292PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$900,212CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$76,668,833PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$71,557,239CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$67,469,708PYOtherExpensesAmt
CY Other Expenses$65,415,776CYOtherExpensesAmt
PY Total Expenses$144,688,833PYTotalExpensesAmt
CY Total Expenses$137,873,227CYTotalExpensesAmt
PY Revenues Less Expenses$7,209,372PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$6,689,682CYRevenuesLessExpensesAmt
Total Assets BOY$187,350,287TotalAssetsBOYAmt
Total Assets EOY$171,626,840TotalAssetsEOYAmt
Total Liabilities BOY$105,229,559TotalLiabilitiesBOYAmt
Total Liabilities EOY$94,045,521TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$82,120,728NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$77,581,319NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionWE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH SERVICES.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$125,627,530ExpenseAmt
Grant$900,212GrantAmt
Revenue$140,248,774RevenueAmt
DescSee Schedule H and Schedule O.Desc
Total Program Service Expenses$125,627,530TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesYes (true)ForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document88IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee1600EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldOHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJ MICHAEL SIMSPersonNm
Phone9374999942PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1110 N MAIN ST SUITE 500AddressLine1Txt
CityDaytonCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45402ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (29 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
ROWAN R NICKOL MD
BOARD CHAIR0.52.5Yes (X)Yes (X)$0$0$0
REBECCA A RICE
PRESIDENT & CEO38.02.0Yes (X)Yes (X)$512,767$0$46,447
MARY H BOOSALIS
PREMIER PRESIDENT & CEO7.58.5Yes (X)Yes (X)$0$0$0
RAFAY ATIQ MD
TRUSTEE0.539.5Yes (X)$100$511,403$34,154
JENNIFER J HAULER MD
TRUSTEE / CMO (TO AUG)8.032.0Yes (X)$0$366,374$1,542
SCOTT B KANAGY DO
TRUSTEE / CMO (FROM AUG)40.00.0Yes (X)$156,270$0$8,589
PATRICK A LARREATEGUI DO
TRUSTEE0.539.5Yes (X)$0$385,805$27,018
SCOTT SWABB DO
TRUSTEE0.50.0Yes (X)$1,250$0$0
DALE E CREECH JR
BOARD SECRETARY & PREMIER CLO6.033.0Yes (X)$0$631,976$62,931
DIANE L PLEIMAN
COO39.50.5Yes (X)$298,414$0$26,871
TIMOTHY D SNIDER
BOARD TREASURER &CFO-SEE SCH O18.02.0Yes (X)$282,546$0$30,211
BENJAMIN A WATSON
RECORDING SECRETARY0.52.0Yes (X)$0$0$0
THOMAS R CURTIN
SYSTEM VP - REVENUE CYCLE8.031.0$0$306,577$58,768Yes (X)
GARY G GINTER
SYSTEM VP - CIO8.032.0$0$525,006$87,150Yes (X)
BARBARA A JOHNSON
SYSTEM VP - HR OPERATIONS8.032.0$0$508,775$38,453Yes (X)
TAMMY S LUNDSTROM MD
SYSTEM VP - CMO (TO AUG) / CCO8.032.0$0$722,423$83,950Yes (X)
MARGARET W MARK
SYSTEM VP - CNO (FROM JUN)8.032.0$0$345,867$35,411Yes (X)
THOMAS R PARKER
CHIEF EXPERIENCE OFFICER8.032.0$0$526,374$67,212Yes (X)
CRAIG SELF
SYS VP -CHIEF STRATEGY OFFICER8.032.0$0$536,933$50,456Yes (X)
MARK W SHAW
SYSTEM VP - MANAGED CARE8.032.0$0$514,343$61,788Yes (X)
SCOTT A SHELTON
SYS VP-CHF PURCHASING OFFICER8.032.0$0$380,597$29,234Yes (X)
SYLVAIN TREPANIER DNP RN CENP
SYSTEM VP - CNO (TO APR)8.031.0$0$215,751$28,526Yes (X)
TERRY R FRY
VICE PRESIDENT - CNO40.00.0$232,364$0$40,263Yes (X)
MELISSA M TALLMADGE
DIRECTOR NURSING SURG/ICU/PCU40.00.0$165,403$0$27,651Yes (X)
TERESA A GULKER
DIRECTOR NURSING MED SURG/OB40.00.0$165,064$0$13,512Yes (X)
KATHRYN M BOERGER
DIRECTOR HR40.00.0$161,597$0$3,437Yes (X)
KATHLEEN J SCARBROUGH
PRES/EXEC DIR-UVMC FOUNDATION10.030.0$109,665$45,497$28,273Yes (X)
RENEE P GEORGE
FORMER KEY EMPLOYEE0.040.0$0$396,472$28,198Yes (X)
MICHAEL J MAIBERGER
FORMER KEY EMPLOYEE0.039.5$0$1,045,111$33,228Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,085,440TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$7,965,284TotReportableCompRltdOrgAmt
Total Other Compensation$953,273TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K31IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
SKANSKA USA
1633 LITTLETON RDPARSIPPANYNJ07054CONSTRUCTION$3,825,744
VALLEY ANESTHESIA INC
3130 N CO RD 25ATROYOH45373MEDICAL SERVICES$2,020,583
CATHOLIC HEALTH INITIATIVES
3900 OLYMPIC BLVD 400ERLANGERKY41018CLINICAL ENGINEERING$1,723,387
COMPUNET CLINICAL LABORATORIES
2308 SANDRIDGE DRMORAINEOH45349LABORATORY SERVICES$1,395,146
DAWSON HEALTHCARE
1114 DUBLIN RDCOLUMBUSOH43215MEDICAL SERVICES$1,003,340
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K33CntrctRcvdGreaterThan100KCnt
Related Organizations$173,653RelatedOrganizationsAmt
Total Contributions$173,653TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT CARE REVENUE621110$67,203,034$67,103,659$99,375
MEDICARE/MEDICAID621110$70,077,646$70,077,646
HOSPITAL FRANCHISE TAX RECOVERIES900099$2,656,087$2,656,087
ATHLETIC TRAINING900099$65,684$65,684
MEDICAL RECORDS900099$36,994$36,994

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,293TotalRevenueColumnAmt
Related Or Exempt Func Income$1,293RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$140,040,738TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$689,215TotalRevenueColumnAmt
Exclusion$689,215ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$2,608,085RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$2,164,017RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$444,068RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$444,068TotalRevenueColumnAmt
Exclusion$444,068ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$13,508,188SecuritiesAmt
Other$197,450OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$11,505,496SecuritiesAmt
Other$80,264OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$2,002,692SecuritiesAmt
Other$117,186OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,119,878TotalRevenueColumnAmt
Exclusion$2,119,878ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$427,615GrossSalesOfInventoryAmt
Cost Of Goods Sold$370,700CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$56,915TotalRevenueColumnAmt
Exclusion$56,915ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
CAFETERIA SALES721210$702,840$702,840
ELECTRONIC MEDICAL RECORD MGMT SVC900099$208,036$208,036
ALL OTHER REVENUE900099$127,566$115,781$11,785
FieldValueIRS element (for citing)
Other Revenue Total$1,038,442OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$144,562,909TotalRevenueColumnAmt
Related Or Exempt Func Income$140,149,399RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$111,160UnrelatedBusinessRevenueAmt
Exclusion$4,128,697ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$900,212TotalAmt
Program Services$900,212ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,363,465TotalAmt
Program Services$1,221,665ProgramServicesAmt
Management And General$141,800ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$57,242,681TotalAmt
Program Services$51,289,442ProgramServicesAmt
Management And General$5,953,239ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,401,039TotalAmt
Program Services$1,255,331ProgramServicesAmt
Management And General$145,708ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$7,589,678TotalAmt
Program Services$6,800,351ProgramServicesAmt
Management And General$789,327ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,960,376TotalAmt
Program Services$3,548,497ProgramServicesAmt
Management And General$411,879ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$94,212TotalAmt
Program Services$84,414ProgramServicesAmt
Management And General$9,798ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$513,295TotalAmt
Program Services$459,912ProgramServicesAmt
Management And General$53,383ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$75,957TotalAmt
Management And General$75,957ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$14,286TotalAmt
Program Services$14,286ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$109,752TotalAmt
Management And General$109,752ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$8,879,282TotalAmt
Program Services$7,955,837ProgramServicesAmt
Management And General$923,445ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,311,777TotalAmt
Program Services$1,311,777ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,038,933TotalAmt
Program Services$930,884ProgramServicesAmt
Management And General$108,049ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$4,967,392TotalAmt
Program Services$4,450,783ProgramServicesAmt
Management And General$516,609ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,275,267TotalAmt
Program Services$2,038,639ProgramServicesAmt
Management And General$236,628ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$131,298TotalAmt
Program Services$117,643ProgramServicesAmt
Management And General$13,655ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,424,802TotalAmt
Program Services$1,424,802ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$12,290,326TotalAmt
Program Services$11,012,132ProgramServicesAmt
Management And General$1,278,194ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
OPERATING SUPPLIES$15,893,039$15,893,039
PURCHASED SERVICES$8,779,415$7,866,356$913,059
JOINT OPERATING AGREEMENT$3,590,000$3,216,640$373,360
HOSPITAL FRANCHISE TAX$2,181,983$2,181,983

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,844,760TotalAmt
Program Services$1,652,905ProgramServicesAmt
Management And General$191,855ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$137,873,227TotalAmt
Program Services$125,627,530ProgramServicesAmt
Management And General$12,245,697ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,860BOYAmt
EOY$3,810EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,808,655BOYAmt
EOY$5,734,097EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$21,116,723BOYAmt
EOY$19,970,158EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$134,000EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$503,818BOYAmt
EOY$558,451EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,493,024BOYAmt
EOY$1,274,017EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$204,722,183LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$117,013,417LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$91,485,593BOYAmt
EOY$87,708,766EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$48,768,299BOYAmt
EOY$39,014,538EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$14,696,404BOYAmt
EOY$11,823,680EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$5,474,911BOYAmt
EOY$5,405,323EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$187,350,287BOYAmt
EOY$171,626,840EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$10,782,754BOYAmt
EOY$9,763,541EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$279,110BOYAmt
EOY$362,618EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$51,388BOYAmt
EOY$65,844EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$63,100,490BOYAmt
EOY$60,339,258EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$350,903BOYAmt
EOY$126,785EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$30,664,914BOYAmt
EOY$23,387,475EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$105,229,559BOYAmt
EOY$94,045,521EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$82,120,728BOYAmt
EOY$77,581,319EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$82,120,728BOYAmt
EOY$77,581,319EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$187,350,287BOYAmt
EOY$171,626,840EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$6,689,682ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$4,684,950NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$15,914,041OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$11,586GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$2,700OtherActivitiesAmt
Total Lobbying Expenditures$14,286TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind
Form4720 Filed4912 TaxfalseForm4720Filed4912TaxInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1F:FormAndLineReferenceDesc
ExplanationPAYMENTS FOR LOBBYING ACTIVITIES INCLUDE DUES PAID TO GREATER DAYTON AREA HOSPITAL ASSOCIATION, DAYTON DEVELOPMENT COALITION, AMERICAN HOSPITAL ASSOCIATION, AND OHIO HOSPITAL ASSOCIATION. PART II-B, LINE 1I: THE HOSPITAL CONTRACTS WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,247,083OtherCostOrOtherBasisAmt
Book Value$1,247,083BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$128,448,464OtherCostOrOtherBasisAmt
Depreciation$67,438,676DepreciationAmt
Book Value$61,009,788BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$71,869,873OtherCostOrOtherBasisAmt
Depreciation$49,574,741DepreciationAmt
Book Value$22,295,132BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,156,763OtherCostOrOtherBasisAmt
Book Value$3,156,763BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$87,708,766TotalBookValueLandBuildingsAmt
Financial DerivativesFinancialDerivativesGrp
Closely Held Equity InterestsCloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescALTERNATIVE INVESTMENTSDesc
Book Value$11,823,680BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$11,823,680TotalBookValueSecuritiesAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)

DescDescAmtAmt
PENSION OBLIGATION$12,711,874
JOINT OPERATING AGREEMENT$3,590,000
MALPRACTICE INSURANCE$2,900,191
DEFERRED COMPENSATION$2,507,603
WORKER'S COMP RESERVE$919,294
SETTLEMENT - 3RD PARTY PAYOR$698,355
LOAN GUAR & OTHER LTL$51,565
OTHER$8,593
FieldValueIRS element (for citing)
Total Liability$23,387,475TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE FOLLOWING FOOTNOTE IS FROM THE AUDITED COMBINED FINANCIAL STATEMENTS FOR PREMIER HEALTH AND AFFILIATES. UVMC IS THE PARENT ORGANIZATION OF UPPER VALLEY MEDICAL CENTER: PREMIER HEALTH (PREMIER), MEDAMERICA HEALTH SYSTEMS (MAHS), SAMARITAN HEALTH PARTNERS (SHP), ATRIUM HEALTH SYSTEM (AHS), AND UVMC HAVE BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE TAX-EXEMPT NONPROFIT CORPORATIONS AND PUBLIC CHARITIES UNDER SECTIONS 501(C)(3) AND 509(A), RESPECTIVELY, OF THE INTERNAL REVENUE CODE. AS TAX-EXEMPT ORGANIZATIONS, THEIR INCOME IS EXEMPT FROM FEDERAL INCOME TAX EXCEPT TO THE EXTENT OF ANY UNRELATED BUSINESS ACTIVITIES. PREMIER, SHP, AND UVMC ALSO OWN OR CONTROL CERTAIN SUBSIDIARIES, WHICH ARE FOR-PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. TAXES PAYABLE AT DECEMBER 31, 2017 AND 2016, FOR SUCH UNRELATED BUSINESS ACTIVITIES ARE NOT SIGNIFICANT. 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 (3 entries)

RegionRegionTxtType Of Activities ConductedTypeOfActivitiesConductedTxtRegion Total ExpendituresRegionTotalExpendituresAmtSpecific Services ProvidedSpecificServicesProvidedTxt
Central America and the CaribbeanInvestments$5,125,000
Europe (Including Iceland and Greenland)Investments$3,736,000
Central America and the CaribbeanProgram Services$27,000INSURANCE
FieldValueIRS element (for citing)
Subtotal Spent$8,888,000SubtotalSpentAmt
Total Spent$8,888,000TotalSpentAmt
Transfer To Foreign CorpfalseTransferToForeignCorpInd
Interest In Foreign TrustfalseInterestInForeignTrustInd
Foreign Corp OwnershipfalseForeignCorpOwnershipInd
Passive Foreign Investmest CofalsePassiveForeignInvestmestCoInd
Foreign PartnershipfalseForeignPartnershipInd
Boycott CountriesfalseBoycottCountriesInd

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,628,000TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,458,000DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,170,000NetCommunityBenefitExpnsAmt
Total Expense0.02280TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$26,537,087TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,452,087DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,085,000NetCommunityBenefitExpnsAmt
Total Expense0.06530TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,171,000TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$896,000DirectOffsettingRevenueAmt
Net Community Benefit Expns$275,000NetCommunityBenefitExpnsAmt
Total Expense0.00200TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$33,336,087TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,806,087DirectOffsettingRevenueAmt
Net Community Benefit Expns$12,530,000NetCommunityBenefitExpnsAmt
Total Expense0.09010TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$444,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$444,000NetCommunityBenefitExpnsAmt
Total Expense0.00320TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,228,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,228,000NetCommunityBenefitExpnsAmt
Total Expense0.02320TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$547,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$547,000NetCommunityBenefitExpnsAmt
Total Expense0.00390TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,219,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,219,000NetCommunityBenefitExpnsAmt
Total Expense0.03030TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$37,555,087TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,806,087DirectOffsettingRevenueAmt
Net Community Benefit Expns$16,749,000NetCommunityBenefitExpnsAmt
Total Expense0.12040TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$117,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$117,000NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,000NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,450TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,450NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,000NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$121,450TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$121,450NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$3,720,619BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$29,045,000ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$32,056,000CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$3,011,000MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost Accounting SystemYes (X)CostAccountingSystemInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UPPER VALLEY MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1110 N MAIN ST 500AddressLine1Txt
CityDAYTONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45402ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.PREMIERHEALTH.COMWebsiteAddressTxt
State LicenseSEE PART V SEC CStateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1UPPER VALLEY MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSee Part V, Section COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt17ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSee Part V, Section CStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE PART V, SEC CFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE PART V, SEC CFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART V, SEC CFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr PrvtYes (X)LookBackMedicaidMedcrPrvtInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp

FieldValueIRS element (for citing)
Form And Line ReferencePART V, SECTION B, LINE 1:FormAndLineReferenceDesc
ExplanationTHE STATE OF OHIO DOES NOT LICENSE HOSPITALS, BUT THE OHIO DEPARTMENT OF HEALTH DOES REGISTER HOSPITALS. AS PART OF THIS REGISTRATION PROCESS, HOSPITALS IN THE STATE OF OHIO ARE REQUIRED TO COMPLETE AND SUBMIT THE ANNUAL HOSPITAL REGISTRATION AND PLANNING REPORT (AHR) EACH CALENDAR YEAR. UPPER VALLEY'S REGISTRATION NUMBER IS 1036. PART V, SECTION B, LINE 5: PARTNERING IN THE DATA REVIEW PROCESS AND IN THE PROCESS FOR IDENTIFYING AND PRIORITIZING COMMUNITY HEALTH NEEDS AND SERVICES WERE THE BOARD OF TRUSTEES AND EXECUTIVE LEADERSHIP OF UPPER VALLEY MEDICAL CENTER, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, MIAMI COUNTY PUBLIC HEALTH, SHELBY COUNTY HEALTH DEPARTMENT, DARKE COUNTY GENERAL HEALTH DISTRICT, AND THE GREATER DAYTON AREA HOSPITAL ASSOCIATION WITH ITS MEMBER HOSPITALS. THE PARTICIPATING HOSPITALS INVITED A BROAD RANGE OF NONPROFIT AGENCIES AND ORGANIZATIONS, WHICH ASSIST THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS, TO ATTEND COMMUNITY MEETINGS AND COMPLETE SURVEYS. PART V, SECTION B, LINES 6A & 6B: UPPER VALLEY MEDICAL CENTER PARTNERED WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, MIAMI COUNTY PUBLIC HEALTH, SHELBY COUNTY HEALTH DEPARTMENT, DARKE COUNTY GENERAL HEALTH DISTRICT, AND THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, XAVIER UNIVERSITY AND AN INDEPENDENT CONSULTANT TO PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT. PART V, SECTION B, LINES 7A & 10A: THE DIRECT WEBSITE ADDRESS WHERE THE 2016 CHNA AND THE 2017 COMMUNITY HEALTH IMPLEMENTATION PLAN CAN BE ACCESSED IS: HTTP://WWW.PREMIERHEALTH.COM/OUR-COMMUNITY/MAKING-A-DIFFERENCE/ COMMUNITY-HEALTH-IMPROVEMENT/ PART V, SECTION B, LINE 11: UPPER VALLEY MEDICAL CENTER (UPPER VALLEY), AS A MEMBER OF THE PREMIER HEALTH SYSTEM, WAS PART OF A COLLABORATION IN 2016 WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, MIAMI COUNTY PUBLIC HEALTH, SHELBY COUNTY HEALTH DEPARTMENT, DARKE COUNTY GENERAL HEALTH DISTRICT, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, XAVIER UNIVERSITY AND AN INDEPENDENT CONSULTANT TO PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT. BASED ON THE RESULTS OF THIS ASSESSMENT, UPPER VALLEY MEDICAL CENTER ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE FOLLOWING PRIORITIZED NEEDS: * BEHAVIORAL HEALTH/SUBSTANCE ABUSE * CHRONIC DISEASES HEALTH ISSUE: BEHAVIORAL HEALTH ----------------- UPPER VALLEY MEDICAL CENTER (UPPER VALLEY) IS WORKING WITH THE LOCAL ADAMHS BOARD TO IMPROVE ACCESS TO, AND INTEGRATION OF, PRIMARY CARE AND BEHAVIORAL HEALTH IN THE TRI-COUNTY AREA. ONE WELLNESS PLACE IS A PLANNED NEW FACILITY ON COUNTY ROAD 25-A BETWEEN TROY AND PIQUA. DEVELOPED BY THE ADAMHS TRI-COUNTY BOARD OF RECOVERY AND MENTAL HEALTH SERVICES, IT WILL HOUSE MENTAL HEALTH AND ADDICTION TREATMENT PROVIDERS, PUBLIC HEALTH, AND AN ARRAY OF WRAPAROUND SUPPORT SERVICES IN AN INTEGRATED, EASY-TO-NAVIGATE FACILITY. THERE MAY BE AN OPPORTUNITY TO HOUSE UPPER VALLEY'S PROPOSED FEDERALLY QUALIFIED HEALTH CENTER IN THIS FACILITY TO SUPPORT BOTH PHYSICAL AND BEHAVIORAL HEALTH ISSUES. UPPER VALLEY SHARES MANY OF THESE CLIENTS WITH THE AGENCIES CONTRACTUALLY SUPPORTED BY THE ADAMHS BOARD. ADDITIONAL PARTNERS IN THIS PROJECT INCLUDE COMMUNITY HOUSING INC., NAMI OF DARKE, MIAMI AND SHELBY COUNTIES, RECOVERY & WELLNESS CENTER OF MIDWEST OHIO, MIAMI COUNTY RECOVERY COUNCIL, MIAMI COUNTY DENTAL CLINIC, MIAMI COUNTY PUBLIC HEALTH, AND SAFEHAVEN INC. UPPER VALLEY ALSO SUPPORTS THE LOCAL COUNTY SCHOOLS IN THEIR EFFORTS TO COMBAT BULLYING AND VIOLENCE IN THE SCHOOL SETTING THROUGH RACHEL'S CHALLENGE. RACHEL'S CHALLENGE IS A PROGRAM DESIGNED TO MAKE SCHOOLS SAFER, MORE CONNECTED PLACES WHERE BULLYING AND VIOLENCE ARE REPLACED WITH KINDNESS AND RESPECT. UPPER VALLEY SUPPORTS DELIVERY OF THIS K-12 PROGRAM IN EIGHT SCHOOL DISTRICTS, PLUS TWO FAITH-BASED SCHOOLS, FOR A TOTAL OF 29-36 SCHOOL BUILDINGS PARTICIPATING, DEPENDING UPON THE YEAR. FOR THE 2017-2018 SCHOOL YEAR, THE HOSPITAL IS PLANNING FOR ASSEMBLIES AND CHAIN REACTION DAYS (ALL-DAY TRAINING PROGRAMS FOR ADULTS AND STUDENTS) AT MIDDLE AND HIGH SCHOOLS IN EIGHT COUNTY SCHOOLS. UPPER VALLEY HAS PLEDGED TO CONTINUE FUNDING THIS PROGRAM IN AREA SCHOOLS THROUGH THE 2018-2019 ACADEMIC YEAR. UPPER VALLEY'S AFFILIATE, SAMARITAN BEHAVIORAL HEALTH, INC., ALSO PROVIDES FOUR FULL-TIME MENTAL HEALTH THERAPISTS WHO WORK IN PIQUA AND MILTON UNION SCHOOLS TO PROVIDE BEHAVIORAL HEALTH SERVICES FOR STUDENTS COVERED BY MEDICAID. HEALTH ISSUE: BEHAVIORAL HEALTH AND SUBSTANCE ABUSE ------------------------------------- UPPER VALLEY MEDICAL CENTER WILL PROVIDE EDUCATION THAT ADDICTION IS A DISEASE AND AS A RESULT, CHANGE PERCEPTIONS, FIRST OF HOSPITAL PERSONNEL AND MEDICAL PROFESSIONALS, AND THEN OF THE COMMUNITY. THE OBJECTIVES ARE 1) TO PROVIDE CEU'S TO FRONT-LINE STAFF AND PHYSICIANS FOR EDUCATION ON THIS TOPIC, WITH CURRICULUM DELIVERED BY ADAMHS; AND 2) TO OFFER EDUCATION IN THE COMMUNITY. IN ADDITION TO ASSISTANCE FROM THE ADAMHS BOARD, RESOURCES WILL BE OBTAINED FROM SAMARITAN BEHAVIORAL HEALTH, PHYSICIAN PRACTICES, AND THE HEROIN COALITIONS OF DARKE, MIAMI, AND SHELBY COUNTIES. HEALTH ISSUE: CHRONIC DISEASES ---------------- UPPER VALLEY WILL PARTNER WITH LOCAL SCHOOL DISTRICTS TO PLAN TWO WELLNESS INITIATIVES AIMED AT REDUCING OBESITY IN SCHOOL-AGED CHILDREN. IN ONE PROGRAM, THE HOSPITAL WILL BUILD ON ITS EXISTING RELATIONSHIP WITH THE MIAMI COUNTY DENTAL CLINIC AND THEIR TRAVELING SMILES PROGRAM TO INTRODUCE THE DRINKING WATER CHALLENGE INITIATIVE. THE DRINKING WATER CHALLENGE (ALSO KNOWN AS "CAVITY-FREE KIDS") IS A PUBLIC ORAL HEALTH EDUCATIONAL CAMPAIGN FOCUSED ON DRINKING WATER INSTEAD OF SUGAR-SWEETENED BEVERAGES (SOFT DRINKS, SPORTS DRINKS, AND FRUIT JUICES). THE PUBLIC EDUCATION CAMPAIGN INCLUDES BILLBOARDS, NEWS ARTICLES, LOCAL RADIO STATIONS, PSA'S, AND FLYERS. THE INITIATIVE WILL ENGAGE SCHOOLS, LOCAL DENTISTS, DENTAL CLINICS, PEDIATRICIANS AND FAMILY PRACTICE PHYSICIANS, LOCAL COMMUNITIES, ETC. THE SECOND PROGRAM, KNOWN AS CATCH (COORDINATED APPROACH TO CHILD HEALTH), IS AN EVIDENCE-BASED, COORDINATED SCHOOL HEALTH PROGRAM DESIGNED TO PROMOTE PHYSICAL ACTIVITY AND HEALTHY FOOD CHOICES AND TO PREVENT TOBACCO USE IN CHILDREN FROM PRESCHOOL THROUGH GRADE EIGHT. BY TEACHING CHILDREN THAT EATING HEALTHY AND BEING PHYSICALLY ACTIVE EVERY DAY CAN BE FUN, THE CATCH PROGRAM HAS PROVEN THAT ESTABLISHING HEALTHY HABITS IN CHILDHOOD CAN PROMOTE BEHAVIOR CHANGES THAT CAN LAST A LIFETIME. FOR MORE THAN 25 YEARS, THE CATCH PLATFORM HAS BEEN PROVEN TO LAUNCH KIDS AND COMMUNITIES TOWARD HEALTHIER LIFESTYLES. CATCH IS SUPPORTED BY MORE THAN 120 ACADEMIC PAPERS, INDICATING AS MUCH AS AN 11 PERCENT DECREASE IN OVERWEIGHT AND OBESE INDIVIDUALS IN THE ENVIRONMENTS IN WHICH IT HAS BEEN IMPLEMENTED. UPPER VALLEY WILL COLLABORATE WITH EIGHT LOCAL PUBLIC SCHOOL DISTRICTS, TWO FAITH-BASED SCHOOLS, AND THE MIAMI COUNTY DENTAL CLINIC IN THE PLANNING AND IMPLEMENTATION OF THIS PROGRAM. IN THE BROADER COMMUNITY, UPPER VALLEY MEDICAL CENTER WILL IMPLEMENT A STRATEGY TO INCREASE THE AMOUNT OF HEALTHY FOOD AVAILABLE FOR PEOPLE WITH HEALTH RELATED NUTRITIONAL NEEDS. THE SHORT-TERM OBJECTIVES ARE 1) TO ENSURE THAT ALL ELIGIBLE PATIENTS ARE SIGNED UP FOR SUPPLEMENTAL NUTRITIONAL ASSISTANCE PROGRAM (SNAP) AND/OR WOMEN INFANT CHILDREN (WIC) BENEFITS; AND 2) TO INCREASE THE AVAILABILITY OF FRESH PRODUCE IN PARTNERSHIP WITH LOCAL FOOD PANTRIES, AREA FARMERS, AND/OR COMMUNITY GARDENS. THE HOSPITAL MAY BEGIN SCREENING FOR HUNGER TO ASCERTAIN THE SCOPE OF THE PROBLEM. IF DETERMINED FEASIBLE, THE HOSPITAL, ALONG WITH ITS AFFILIATES IN PREMIER HEALTH, WOULD LIKE TO CREATE A FOOD PHARMACY, OR SIMILAR PRESCRIPTION FOR FOOD PROGRAM BY 2019. A FOOD PHARMACY ACCEPTS PEOPLE WITH A PHYSICIAN REFERRAL AND OFFERS TWO TO THREE DAYS' WORTH OF FOOD PER VISIT. PATIENTS CAN RETURN TO THE FOOD PHARMACY ONCE PER MONTH FOR UP TO SIX MONTHS, AT WHICH TIME THEY CAN RETURN TO THEIR PHYSICIAN FOR ANOTHER REFERRAL IF THEY ARE STILL IN NEED. OTHER SERVICES MAY INCLUDE NUTRITION COUNSELING, COOKING CLASSES, AND CONNECTION TO COMMUNITY RESOURCES. MAJOR LOCAL FOOD PANTRIES IN MIAMI COUNTY WILL BE USED AS RESOURCES TO IMPLEMENT THIS STRATEGY. UPPER VALLEY MEDICAL CENTER IS ONE OF FIVE HOSPITALS IN THE PREMIER HEALTH SYSTEM. ALL FIVE HOSPITALS PARTICIPATED WITH OTHER HEALTH CARE ORGANIZATIONS TO CREATE A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). BASED ON THE RESULTS OF THE ASSESSMENT, THE FIVE PREMIER HOSPITALS JOINTLY IDENTIFIED THREE SHARED HEALTH CARE NEED PRIORITIES THAT ARE CRITICAL THROUGHOUT THE PREMIER SERVICE AREA: BIRTH OUTCOMES, CHRONIC DISEASES AND BEHAVIORAL HEALTH/SUBSTANCE ABUSE. THE REMAINING HEALTH CARE NEEDS IDENTIFIED IN THE ASSESSMENT ARE SHARED WITH MANY LOCAL HEALTH DEPARTMENTS IN OUR REGION, AS WELL AS STATE AGENCIES. THESE INCLUDE ACCESS TO CARE, SOCIAL DETERMINANTS, PROVIDER SHORTAGES, TRANSPORTATION, CARE FOR CHILDREN /ExplanationTxt
FieldValueIRS element (for citing)
Facility6FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
HYATT CENTER
450 HYATT STTIPP CITYOH45371LABORATORY, IMAGING, SPORTS MEDICINE, SURGERY
OUTPATIENT CARE CENTER NORTH
280 LOONEY RDPIQUAOH45356LABORATORY, IMAGING, REHABILITATIVE THERAPY
OUTPATIENT CARE CENTER SOUTH
998 S DORSET RDTROYOH45373LABORATORY, IMAGING OCCUPATIONAL HEALTH REHABILITATIVE THERAPY
STANFIELD PLACE
31 STANFIELD RDTROYOH45373IMAGING
JACOB DETTMER BUILDING
3130 N COUNTY RD 25ATROYOH45373Behavorial Health
VERSAILLES CENTER
471 MARKER RDVERSAILLESOH45380LABORATORY

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 6A:FormAndLineReferenceDesc
ExplanationTHE COMMUNITY BENEFIT REPORT FOR UPPER VALLEY MEDICAL CENTER IS PART OF THE PREMIER HEALTH REPORT (EIN# 31-1446699). PART I, LINE 7: A COST TO CHARGE RATIO WAS USED TO CALCULATE THIS FINANCIAL ASSISTANCE AT COST. THIS CALCULATION TAKES TOTAL OPERATING EXPENSES LESS OTHER OPERATING REVENUES DIVIDED BY TOTAL GROSS REVENUES. UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENTAL PROGRAMS WERE CALCULATED USING A COST ACCOUNTING SYSTEM. THIS SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND INCLUDES FULLY LOADED COSTS. FOR THE REMAINING ITEMS THE ORGANIZATION USED SPECIFIC NUMBERS FOR EXPENSE PAID DIRECTLY FOR THESE SERVICES. PART I, LINE 7G: UPPER VALLEY MEDICAL CENTER PROVIDES SUBSIDIZED EMERGENCY SERVICES BY OPERATING A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THIS EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL INCURS EXPENSES RELATED TO CALL TIME AND PHYSICIAN SUBSIDIES DUE TO THE LARGE NUMBER OF INDIGENT PATIENTS COMING THROUGH THE EMERGENCY ROOM. FOR 2017, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $3,185,000. PART II, LINE 2: UPPER VALLEY MEDICAL CENTER (UPPER VALLEY) IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH A VARIETY OF PREVENTION, HEALTH IMPROVEMENT AND ENGAGEMENT PROGRAMS. AS PART OF ITS OVERALL COMMITMENT TO THE COMMUNITY, UPPER VALLEY FOCUSES ON FOUR AREAS OF SERVICE: --INVESTING IN THE COMMUNITY --PREVENTION AND WELLNESS --COMMITMENT TO THE UNDER-SERVED --COMMUNITY ENGAGEMENT SOME OF THE PROGRAMS SUPPORTED BY UPPER VALLEY DURING 2017 INCLUDE: 1) ONGOING EFFORTS TO IMPROVE THE ECONOMIC CONDITION IN THE MIAMI VALLEY. A TOTAL OF $100,000 WAS CONTRIBUTED TOWARD A CAPITAL CAMPAIGN PROJECT TO BUILD AND DEVELOP A NEW FACILITY TO HOUSE MENTAL HEALTH AND ADDICTIONS TREATMENT PROVIDERS, PUBLIC HEALTH, AND AN ARRAY OF WRAPAROUND SUPPORT SERVICES IN AN INTEGRATED, EASY-TO-NAVIGATE FACILITY. THIS FACILITY IS SCHEDULED TO BE OPERATIONAL IN 2018. 2) CONTRIBUTED $15,000 TOWARDS THE ECONOMIC DEVELOPMENT AND REVITALIZATION OF THE COMMUNITY WITHIN THE HOSPITAL'S SERVICE AREA. THIS PROJECT INCLUDES A COOPERATIVE EFFORT AMONGST BUSINESS LEADERS WITHIN THE TROY COMMUNITY TO UNITE BUSINESS AND GOVERNMENT ENTERPRISES TO WORK TOGETHER TO KEEP THE COMMUNITY AND LOCAL COMPANIES GLOBALLY COMPETITIVE WHILE CONTINUING TO CREATE AND RETAIN HIGH SKILL - HIGH WAGE JOBS FOR OUR COMMUNITY. PART III, LINES 2 & 3: BAD DEBT EXPENSE IS INCURRED WHEN AN ACCOUNT IS TAKEN OUT OF ACCOUNTS RECEIVABLE AND TURNED OVER TO A COLLECTION AGENCY. THIS ACTION MAY OCCUR IF A PATIENT REFUSES PAYMENT ARRANGEMENTS, REFUSES TO APPLY FOR FINANCIAL ASSISTANCE, AND THERE IS NOT AN INSURANCE BALANCE BEING CONTENDED. AN ACCOUNT IS WRITTEN OFF TO BAD DEBT AFTER 130 DAYS IF AN ATTEMPT TO COLLECT FROM THE PATIENT IS MADE WITHIN OUR COLLECTION POLICY. THE COLLECTION AGENCY ATTEMPTS TO COLLECT THE ACCOUNT IN ACCORDANCE WITH ESTABLISHED GUIDELINES. COLLECTION ATTEMPTS ARE CEASED AND THE ACCOUNT RETURNED TO THE ORGANIZATION IF THE PATIENT APPLIES FOR FINANCIAL ASSISTANCE. ANY AMOUNTS COLLECTED FROM THESE ACCOUNTS ARE CREDITED BACK AGAINST BAD DEBT EXPENSE. THE ORGANIZATION RECOGNIZES THERE ARE ACCOUNTS WRITTEN OFF TO BAD DEBT THAT MAY HAVE QUALIFIED FOR CHARITY CARE IF THE PATIENT HAD PROVIDED THE NECESSARY FINANCIAL INFORMATION. TO RESOLVE THIS, THE ORGANIZATION HAS ENGAGED A THIRD-PARTY VENDOR TO ANALYZE DATA BASED ON CREDIT SCORES TO REALLOCATE SOME OF THIS EXPENSE TO CHARITY CARE. A REPRESENTATIVE SAMPLE OF THESE ACCOUNTS IS THEN SENT TO OUR THIRD-PARTY VENDOR WHO GATHERS EXTERNAL CREDIT DATA THAT PRESENTS THE ACCOUNT AS LESS THAN 100% FEDERAL POVERTY LEVEL OR NOT ENOUGH INFORMATION (TYPICALLY INDICATIVE OF INDIGENT). THESE ACCOUNTS ARE RECLASSED FROM BAD DEBT EXPENSE TO CHARITY EXPENSE ON OUR INCOME STATEMENT. ANY CREDIT SCORE THAT PRESENTS THE ACCOUNTS AS GREATER THAN 100% FEDERAL POVERTY LEVEL REMAINS IN BAD DEBT EXPENSE. DUE TO THIS PROCESS, THE ORGANIZATION HAS USED BEST EFFORTS TO NOT REPORT BAD DEBT EXPENSE FOR PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. PART III, LINE 4: THE ORGANIZATION DOES NOT HAVE A FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS WHICH DISCUSSES THIS CALCULATION. PART III, SECTION B, LINES 5, 6, AND 7: THE AMOUNTS REPORTED ON LINES 5, 6, AND 7 DO NOT INCLUDE CERTAIN MEDICARE PROGRAM REVENUES AND COSTS, AND THUS DO NOT REFLECT ALL OF THE ORGANIZATION'S REVENUES AND COSTS ASSOCIATED WITH ITS PARTICIPATION IN MEDICARE PROGRAMS. IN ADDITION TO THE AMOUNTS REPORTED ON LINE 5, 6, AND 7, THE ORGANIZATION RECEIVED REVENUE OF $19,979,000 AND INCURRED COST OF $26,973,000, FOR AN ADDITIONAL NET SHORTFALL OF $6,994,000 ASSOCIATED WITH THESE PROGRAMS. BELOW IS A RECONCILIATION OF THE AMOUNTS ASSOCIATED WITH MEDICARE PROGRAMS. ALLOWABLE MEDICARE REVENUE PER MEDICARE COST REPORT (PART III, SECTION B) $29,045,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $19,979,000 TOTAL MEDICARE ASSOCIATED REVENUE $49,024,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT (PART III, SECTION B) $32,056,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $26,973,000 TOTAL MEDICARE ASSOCIATED COST $59,029,000 MEDICARE SHORTFALL PER PART III, SECTION B $3,011,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $6,994,000 TOTAL MEDICARE SHORTFALL $10,005,000 PART III, LINE 8: THE ORGANIZATION'S SHORTFALL SHOULD BE CONSIDERED CHARITY CARE BECAUSE IT IS PROVIDING HIGH-QUALITY CARE IN EXCESS OF THE COST TO OUR COMMUNITY RESIDENTS THAT NEED CARE. THE MEDICARE POPULATION AT THE ORGANIZATION IS IN EXCESS OF 45% OF NET PATIENT REVENUE. THE ORGANIZATION USED A COST ACCOUNTING SYSTEM TO CALCULATE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: THE ORGANIZATION MAKES REASONABLE EFFORTS TO DETERMINE WHETHER OR NOT AN INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THE STATE OR HOSPITAL FINANCIAL ASSISTANCE POLICY BEFORE ENGAGING IN EXTRAORDINARY COLLECTIVE ACTIONS AGAINST THAT INDIVIDUAL. PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE OFFERED REASONABLE PAYMENT PLAN ARRANGEMENTS FOR ANY REMAINING BALANCES. ANY THIRD-PARTY COLLECTING SELF-PAY RECEIVABLES ON OUR BEHALF IS REQUIRED TO MAKE REASONABLE EFFORTS TO DETERMINE IF THE INDIVIDUAL MEETS THE QUALIFICATIONS OF THE STATE OR OF OUR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS. REASONABLE EFFORTS INCLUDE: A. VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENT HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL. B. DOCUMENTING THAT THE ORGANIZATION HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE UNDER ITS FINANCIAL ASSISTANCE POLICY. C. DOCUMENT THAT THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE. D. DOCUMENT THAT THE PATIENT HAS BEEN OFFERED AND ACCEPTED TERMS FOR A PAYMENT PLAN, BUT HAS NOT HONORED THE TERMS OF THAT PLAN. THE FINANCIAL COUNSELORS MEET WITH INPATIENT, OUTPATIENT, SELF-PAY, AND OTHER PATIENTS UPON REQUEST WHO MAY NEED FINANCIAL ASSISTANCE. IN ADDITION TO ASSISTING PATIENTS WHO WANT TO APPLY FOR ASSISTANCE THROUGH THE MEDICAID PROGRAM, THE FINANCIAL COUNSELOR WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 2: THE ORGANIZATION WORKS WITH THE COMMUNITY ON PROGRAMS THAT ADDRESS THE UNDERLYING CAUSES OF PERSISTENT HEALTH PROBLEMS AS PART OF A COMPREHENSIVE STRATEGY TO IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE FOR IDENTIFIED MEMBERS OF THE COMMUNITY WHO ARE ECONOMICALLY DISADVANTAGED, DISENFRANCHISED AND/OR WHO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE ORGANIZATION STRIVES TO WORK WITH PREMIER HEALTH, THE HOSPITAL BOARD OF TRUSTEES, EXECUTIVE MANAGEMENT, MANAGERS, STAFF MEMBERS, COMMUNITY GROUPS, AND INDIVIDUALS TO PROVIDE A COLLABORATIVE APPROACH TO THE GOVERNANCE AND MANAGEMENT OF COMMUNITY BENEFIT ACTIVITIES. PART VI, LINE 3: THERE ARE SEVERAL WAYS IN WHICH OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR SERVICES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FIRST, NOTIFICATION OF SUCH AVAILABLE ASSISTANCE IS CLEARLY POSTED IN REGISTRATION AREAS, AS WELL AS MATERNITY AND EMERGENCY DEPARTMENTS. NEXT, PATIENT ADVOCATES, PATIENT ACCESS STAFF MEMBERS, AND FINANCIAL COUNSELORS IN THE INPATIENT AND EMERGENCY DEPARTMENTS MEET WITH UNINSURED AND UNDERINSURED PATIENTS, AND THOSE WITH ONLY MEDICARE COVERAGE TO DISCUSS ELIGIBILITY FOR ASSISTANCE. FINANCIAL COUNSELORS ALSO DISCUSS OPTIONS TO RESOLVE UNPAID ACCOUNT BALANCES WITH UNINSURED AND UNDERINSURED PATIENTS. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE, ALONG WITH INFORMATION ON HOW TO OBTAIN AN APPLICATION. WHEN A PATIENT RECEIVES A BILL, THE REVERSE SIDE OF THE BILL CONTAINS INFORMATION ABOUT THE STATE OF OHIO FREE CARE PROGRAM (CARE ASSURANCE) AND A FINANCIAL ASSISTANCE APPLICATION. THE BILLING STATEMENTS OFFER THE FINANCIAL ASSISTANCE OPTIONS AVAILABLE, AND THE CONTACT INFORMATION FOR ASSISTANCE. PART VI, LIExplanationTxt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (15 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
SAMARITAN BEHAVIORAL HEALTH INC
601 S EDWIN C MOSES BLVDDAYTONOH45408020633634501(C)(3)$190,464SUPPORT
MIAMI COUNTY RECOVERY COUNCIL INC
1059 N MARKET STTROYOH45373310917327501(C)(3)$139,073SUPPORT
TROY FOUNDATION
216 W FRANKLIN STTROYOH45373316018703501(C)(3)$106,000SUPPORT
PIQUA COMMUNITY FOUNDATION
126 HIGH STPIQUAOH45356311391908501(C)(3)$102,000SUPPORT
HEALTH PARTNERS FREE CLINIC
1300 N CO RD 25ATROYOH45373311596731501(C)(3)$98,150SUPPORT
MIAMI COUNTY DENTAL CLINIC
1364 W MAIN STTROYOH45373204901192501(C)(3)$65,350SUPPORT
DAYTON FOUNDATION DEPOSITORY
40 N MAIN ST 500DAYTONOH45423311044298501(C)(3)$40,400SUPPORT
HOSPICE OF MIAMI COUNTY
550 SUMMIT AVE 101TROYOH45373311031277501(C)(3)$33,850SUPPORT
MIAMI VALLEY HOSPITAL
110 N MAIN ST 500DAYTONOH45402310537504501(C)(3)$29,317AFRICAN AMERICAN WOMEN'S HEALTH PROGRAM & BRIDGE PROGRAM
TROY DEVELOPMENT COUNCIL
405 SW PUBLIC SQ 330TROYOH45373311736034501(C)(3)$15,000SUPPORT
REACH OUT MONTGOMERY COUNTY
25 E FORAKER STDAYTONOH45409311434282501(C)(3)$14,559RX ASSIST FOR INDIGENT
UVMC FOUNDATION
110 N MAIN ST 500DAYTONOH45402311581859501(C)(3)$13,170SUPPORT
DECOLORES MONTESSORI SCHOOL
312 CENTRAL AVEGREENVILLEOH45331311166242501(C)(3)$12,500SUPPORT
AIR CAMP
PO BOX 752332DAYTONOH45475272186089501(C)(3)$6,450SUPPORT
MIAMI COUNTY YMCA
223 W HIGH STPIQUAOH45356310537179501(C)(3)$5,500SUPPORT
FieldValueIRS element (for citing)
Total501c3 Org15Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
Explanation1) DISBURSEMENTS ARE ANALYZED MONTHLY THROUGH VARIOUS REPORTS AND COMMITTEE MEETINGS. 2) INVOICES ARE RECEIVED IN ACCOUNTS PAYABLE AND APPROVED AND DISBURSED PER ORGANIZATIONAL POLICY. 3) GRANT SPENDING IS MONITORED AGAINST BUDGETED AMOUNTS ON AN ONGOING BASIS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (25 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
REBECCA A RICE
PRESIDENT & CEO$331,441$0$131,371$0$49,955$0$32,933$0$13,514$0$559,214$0$0$0
RAFAY ATIQ MD
TRUSTEE$100$370,697$0$138,495$0$2,211$0$8,286$0$25,868$100$545,557$0$0
JENNIFER J HAULER MD
TRUSTEE / CMO (TO AUG)$0$337,058$0$28,191$0$1,125$0$0$0$1,542$0$367,916$0$0
SCOTT B KANAGY DO
TRUSTEE / CMO (FROM AUG)$115,917$0$15,000$0$25,353$0$0$0$8,589$0$164,859$0$0$0
PATRICK A LARREATEGUI DO
TRUSTEE$0$363,083$0$19,917$0$2,805$0$8,828$0$18,190$0$412,823$0$0
DALE E CREECH JR
BOARD SECRETARY & PREMIER CLO$0$398,677$0$146,709$0$86,590$0$37,157$0$25,774$0$694,907$0$0
DIANE L PLEIMAN
COO$232,890$0$63,905$0$1,619$0$21,587$0$5,284$0$325,285$0$0$0
TIMOTHY D SNIDER
BOARD TREASURER &CFO-SEE SCH O$203,133$0$78,387$0$1,026$0$6,037$0$24,174$0$312,757$0$0$0
THOMAS R CURTIN
SYSTEM VP - REVENUE CYCLE$0$231,960$0$68,571$0$6,046$0$28,926$0$29,842$0$365,345$0$0
GARY G GINTER
SYSTEM VP - CIO$0$385,251$0$135,949$0$3,806$0$61,801$0$25,349$0$612,156$0$0
BARBARA A JOHNSON
SYSTEM VP - HR OPERATIONS$0$363,394$0$124,821$0$20,560$0$28,293$0$10,160$0$547,228$0$0
TAMMY S LUNDSTROM MD
SYSTEM VP - CMO (TO AUG) / CCO$0$524,280$0$192,978$0$5,165$0$81,162$0$2,788$0$806,373$0$0
MARGARET W MARK
SYSTEM VP - CNO (FROM JUN)$0$267,121$0$70,931$0$7,815$0$9,544$0$25,867$0$381,278$0$0
THOMAS R PARKER
CHIEF EXPERIENCE OFFICER$0$378,787$0$121,190$0$26,397$0$52,371$0$14,841$0$593,586$0$0
CRAIG SELF
SYS VP -CHIEF STRATEGY OFFICER$0$389,413$0$144,360$0$3,160$0$23,805$0$26,651$0$587,389$0$0
MARK W SHAW
SYSTEM VP - MANAGED CARE$0$307,295$0$118,673$0$88,375$0$36,068$0$25,720$0$576,131$0$0
SCOTT A SHELTON
SYS VP-CHF PURCHASING OFFICER$0$252,664$0$116,419$0$11,514$0$24,804$0$4,430$0$409,831$0$0
SYLVAIN TREPANIER DNP RN CENP
SYSTEM VP - CNO (TO APR)$0$111,026$0$103,825$0$900$0$19,789$0$8,737$0$244,277$0$0
TERRY R FRY
VICE PRESIDENT - CNO$175,717$0$35,905$0$20,742$0$24,799$0$15,464$0$272,627$0$0$0
MELISSA M TALLMADGE
DIRECTOR NURSING SURG/ICU/PCU$147,156$0$17,570$0$677$0$10,240$0$17,411$0$193,054$0$0$0
TERESA A GULKER
DIRECTOR NURSING MED SURG/OB$145,977$0$17,987$0$1,100$0$3,213$0$10,299$0$178,576$0$0$0
KATHRYN M BOERGER
DIRECTOR HR$123,234$0$19,719$0$18,644$0$2,860$0$577$0$165,034$0$0$0
KATHLEEN J SCARBROUGH
PRES/EXEC DIR-UVMC FOUNDATION$75,231$31,212$22,293$9,249$12,141$5,036$12,703$6,099$6,467$3,004$128,835$54,600$0$0
RENEE P GEORGE
FORMER KEY EMPLOYEE$0$323,626$0$71,751$0$1,095$0$15,853$0$12,345$0$424,670$0$0
MICHAEL J MAIBERGER
FORMER KEY EMPLOYEE$0$302,116$0$292,508$0$450,487$0$2,700$0$30,528$0$1,078,339$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 4B:FormAndLineReferenceDesc
ExplanationDUE 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, UPPER VALLEY MEDICAL CENTER (UPPER VALLEY) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. UPPER VALLEY 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 2017. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2017: DALE CREECH $80,472; BARBARA JOHNSON $15,163; REBECCA RICE $16,477; MARK SHAW $79,734; SCOTT SHELTON $8,114. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PLAN PAYMENT IN 2017: MICHAEL MAIBERGER $120,703. 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 $3,311; RENEE GEORGE $4,842; GARY GINTER $35,597; BARBARA JOHNSON $9,636; TAMMY LUNDSTROM, M.D. $71,860; MARGARET MARK $986; THOMAS PARKER $24,648; REBECCA RICE $2,381; CRAIG SELF $14,135; TIMOTHY SNIDER $657; SYLVAIN TREPANIER $11,028. 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. PART II, LINE 8: TIMOTHY SNIDER SERVES AS AN OFFICER FOR BOTH UPPER VALLEY MEDICAL CENTER AND ANOTHER UNRELATED HOSPITAL. HOWEVER, 100% OF HIS COMPENSATION IS PAID BY UPPER VALLEY MEDICAL CENTER. MR. SNIDER SPENDS APPROXIMATELY ONE-HALF OF HIS WORKING HOURS AT EACH HOSPITAL. THE COMPENSATION REPORTED ON PART VII & SCHEDULE J INCLUDES ALL OF HIS REPORTABLE COMPENSATION, EVEN THOUGH UPPER VALLEY MEDICAL CENTER IS REIMBURSED BY THE UNRELATED HOSPITAL FOR HIS TIME SPENT AT THAT INSTITUTION.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1County of Miami OhioBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN316000055BondIssuerEIN
Bond Issued2016-08-31BondIssuedDt
Issue Price$33,210,000IssuePriceAmt
PurposeSEE PART VIPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$2,800,000RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$33,210,000TotalProceedsAmt
In Reserve Fund$0InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$111,568IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$0CapitalExpendituresAmt
Other Spent Proceeds$33,098,432OtherSpentProceedsAmt
Unspent$0UnspentAmt
Substantial Completion2009SubstantialCompletionYr
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsYes (true)AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropYes (true)MgmtContractBondFincdPropInd
Engage Bond Counsel ContractsYes (true)EngageBondCounselContractsInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0.00050PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00240PrivateBusConcerningUBIPct
Total Private Business Use0.00290TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Remedial Action TakenfalseRemedialActionTakenInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetYes (true)RebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssueYes (true)VariableRateIssueInd
Hedge Identified In Bks And RecYes (true)HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line1BOAMLBusinessNameLine1Txt
FieldValueIRS element (for citing)
Term Of Hedge0.TermOfHedgePct
Superintegrated HedgeYes (true)SuperintegratedHedgeInd
Hedge TerminatedYes (true)HedgeTerminatedInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds InvestedYes (true)GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE K, PART I, LINE A, COLUMN F PURPOSE OF BOND:FormAndLineReferenceDesc
ExplanationTHE BOND ISSUE OF 08/31/2016 WAS USED TO CURRENTLY REFUND THE 2006 SERIES BOND.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990, PART III, LINE 4A:FormAndLineReferenceDesc
ExplanationTHE PRIMARY EXEMPT PURPOSE OF UPPER VALLEY MEDICAL CENTER IS TO PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES TO THE RESIDENTS OF MIAMI AND THE SURROUNDING COUNTIES. THE HOSPITAL FURTHERS ITS TAX-EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN MANY WAYS. SEE SCHEDULE H FOR MORE INFORMATION. FORM 990, PART VI, SECTION A, LINE 3: PREMIER HEALTH (PREMIER) AS THE OPERATOR OF UPPER VALLEY MEDICAL CENTER (UPPER VALLEY), DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR UPPER VALLEY, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. UPPER VALLEY SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. UPPER VALLEY SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. UPPER VALLEY SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF UPPER VALLEY WITH ALL THIRD-PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. UPPER VALLEY 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. UPPER VALLEY MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN PREMIER'S ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 6: UPPER VALLEY MEDICAL CENTER HAS TWO CORPORATE MEMBERS. ONE MEMBER IS UVMC. THE SECOND MEMBER IS PREMIER HEALTH, AN OHIO NONPROFIT CORPORATION, FORMED PURSUANT TO THE JOINT OPERATING AGREEMENT. UVMC HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES OF THE CORPORATION. PREMIER HEALTH HAS THE GENERAL AUTHORITY TO OPERATE AND MANAGE THE OPERATIONAL ACTIVITIES OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINES 7A & 7B: UVMC HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR UPPER VALLEY MEDICAL CENTER FROM AMONG THOSE RECOMMENDED BY THE NOMINATING COMMITTEE SET FORTH IN THE JOINT OPERATING AGREEMENT. UVMC HAS THE AUTHORITY TO REMOVE SUCH TRUSTEES AT ANY REGULAR OR SPECIAL BOARD MEETING OR BY WRITTEN CONSENT. FORM 990, PART VI, SECTION B, LINE 11B: THIS 990 TAX RETURN AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE PREMIER HEALTH (PREMIER) TAX DEPARTMENT, OF WHICH UPPER VALLEY MEDICAL CENTER 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 QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 TAX RETURN IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, LINE 12C: PREMIER HEALTH (PREMIER), WITH WHICH UPPER VALLEY MEDICAL CENTER 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 TAX RETURN. FORM 990, PART VI, SECTION B, LINES 15A & 15B: COMPENSATION FOR UPPER VALLEY MEDICAL CENTER'S (UPPER VALLEY) CEO IS REVIEWED AND APPROVED BY PREMIER HEALTH (PREMIER), WITH WHICH UPPER VALLEY 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 19A: 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 ON WWW.PREMIERHEALTH.COM. FORM 990, PART VII, LINE 1A, ITEM 11: TIMOTHY SNIDER SERVES AS AN OFFICER FOR BOTH UPPER VALLEY MEDICAL CENTER AND ANOTHER UNRELATED HOSPITAL. HOWEVER, 100% OF HIS COMPENSATION IS PAID BY UPPER VALLEY MEDICAL CENTER. MR. SNIDER SPENDS APPROXIMATELY ONE-HALF OF HIS WORKING HOURS AT EACH HOSPITAL. THE COMPENSATION REPORTED ON PART VII INCLUDES ALL OF HIS REPORTABLE COMPENSATION, EVEN THOUGH UPPER VALLEY MEDICAL CENTER IS REIMBURSED BY THE UNRELATED HOSPITAL FOR HIS TIME SPENT AT THAT INSTITUTION. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES (14,587,025) PENSION FASB 158 ADJUSTMENT (1,814,022) FOUNDATION ADJUSTMENT (173,653) CHANGE IN UVMC AUXILIARY CASH POSITION (38,244) TRANSFER FROM AFFILIATE 698,903 ----------- TOTAL (15,914,041)ExplanationTxt

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
UVMC
110 N Main St 500DAYTONOH45402341850683PARENTOH501(c)(3)12C III FINAfalse
UVMC FOUNDATION
110 N Main St 500DAYTONOH45402311581859FOUNDATIONOH501(c)(3)7NAfalse
PREMIER HEALTH
110 N MAIN ST 500DAYTONOH45402311446699JOA PARENTOH501(c)(3)12A INAfalse
UPPER VALLEY PROFESSIONAL CORP (UVPC)
110 N MAIN ST 500DAYTONOH45402311400963HEALTH CAREOH501(c)(3)10UVMCYes (true)
UVPC SPECIALISTS INC
110 N MAIN ST 500DAYTONOH45402203687536HEALTH CAREOH501(c)(3)10UVPCYes (true)
UVMC NURSING CARE INC
110 N MAIN ST 500DAYTONOH45402311224064NURSING HOMEOH501(c)(3)10UVMCYes (true)

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
UVMC MANAGEMENT CORPORATION
110 N MAIN ST 500DAYTONOH45402311360489MGT COMPANYOHUVMCC CORP$0$00.00000Yes (true)
AFTER HOURS FAMILY CARE
110 N MAIN ST 500DaytonOH45402311269483Health CareOHUVPCC Corp$0$00.00000Yes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (17 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
UVMC FOUNDATION
C$872,556FMV
UVMC FOUNDATION
Q$86,608FMV
UPPER VALLEY PROFESSIONAL CORP
O$1,166,366FMV
UPPER VALLEY PROFESSIONAL CORP
Q$89,129FMV
UPPER VALLEY PROFESSIONAL CORP
S$457,735FMV
UVPC SPECIALISTS INC
O$699,436FMV
UVMC MANAGEMENT CORP
O$996,799FMV
UVMC MANAGEMENT CORP
Q$404,511FMV
UVMC MANAGEMENT CORP
S$398,145FMV
PREMIER HEALTH
C$236,289FMV
UPPER VALLEY PROFESSIONAL CORP
B$4,245,155FMV
AFTER HOURS FAMILY CARE
B$207,421FMV
AFTER HOURS FAMILY CARE
C$71,108FMV
UVPC SPECIALISTS INC
B$7,022,939FMV
UVMC
C$616,074FMV
UVMC MANAGEMENT CORP
C$370,002FMV
UVMC NURSING CARE INC
B$185,355FMV