2018-11-15T08:05:58-06:00 2017-12-31 ERNST & YOUNG US LLP 1900 Scripps Center 312 Walnut St Cincinnati OH 45202 990 2017-01-01 310537095 UPPER VALLEY MEDICAL CENTER % J MICHAEL SIMS UPPE 9374999942 110 N MAIN ST 500 DAYTON OH 45402 TIMOTHY D SNIDER VP-CFO 9374999942 2018-11-12 true JULIE L SPARKS P01268401 5136121400 108.206.163.59 31499120183195000003 2018-11-15 P 582F47EFACDD6166E52205D1FBFEA2601660FA18 770194AAF055F9EA87E64CA02E08FE540289067F 2017 2018-06-14 16:35:46Z THOMAS R PARKER 3130 N COUNTY RD 25 A TROY OH 45373 158683386 false X WWW.PREMIERHEALTH.COM X 1926 OH WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH SERVICES. 7 2 1600 132 111160 -39575 172769 173653 147916213 140040738 2070570 2809093 1738653 1539425 151898205 144562909 550292 900212 0 0 76668833 71557239 0 0 0 67469708 65415776 144688833 137873227 7209372 6689682 187350287 171626840 105229559 94045521 82120728 77581319 X WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH SERVICES. false false 125627530 900212 140248774 See Schedule H and Schedule O. 125627530 true true false true false false false false false false true true false false true true false true false false true false false false false false true true true false true true false false false false false false false false false false false false false false false true true true false false true 88 0 true 1600 true true true false false false false false false false false false X 7 2 false true false false true true true true true false false true true true true true true true true false OH X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 500 Dayton OH 45402 ROWAN R NICKOL MD BOARD CHAIR 0.5 2.5 X X 0 0 0 REBECCA A RICE PRESIDENT & CEO 38.0 2.0 X X 512767 0 46447 MARY H BOOSALIS PREMIER PRESIDENT & CEO 7.5 8.5 X X 0 0 0 RAFAY ATIQ MD TRUSTEE 0.5 39.5 X 100 511403 34154 JENNIFER J HAULER MD TRUSTEE / CMO (TO AUG) 8.0 32.0 X 0 366374 1542 SCOTT B KANAGY DO TRUSTEE / CMO (FROM AUG) 40.0 0.0 X 156270 0 8589 PATRICK A LARREATEGUI DO TRUSTEE 0.5 39.5 X 0 385805 27018 SCOTT SWABB DO TRUSTEE 0.5 0.0 X 1250 0 0 DALE E CREECH JR BOARD SECRETARY & PREMIER CLO 6.0 33.0 X 0 631976 62931 DIANE L PLEIMAN COO 39.5 0.5 X 298414 0 26871 TIMOTHY D SNIDER BOARD TREASURER &CFO-SEE SCH O 18.0 2.0 X 282546 0 30211 BENJAMIN A WATSON RECORDING SECRETARY 0.5 2.0 X 0 0 0 THOMAS R CURTIN SYSTEM VP - REVENUE CYCLE 8.0 31.0 X 0 306577 58768 GARY G GINTER SYSTEM VP - CIO 8.0 32.0 X 0 525006 87150 BARBARA A JOHNSON SYSTEM VP - HR OPERATIONS 8.0 32.0 X 0 508775 38453 TAMMY S LUNDSTROM MD SYSTEM VP - CMO (TO AUG) / CCO 8.0 32.0 X 0 722423 83950 MARGARET W MARK SYSTEM VP - CNO (FROM JUN) 8.0 32.0 X 0 345867 35411 THOMAS R PARKER CHIEF EXPERIENCE OFFICER 8.0 32.0 X 0 526374 67212 CRAIG SELF SYS VP -CHIEF STRATEGY OFFICER 8.0 32.0 X 0 536933 50456 MARK W SHAW SYSTEM VP - MANAGED CARE 8.0 32.0 X 0 514343 61788 SCOTT A SHELTON SYS VP-CHF PURCHASING OFFICER 8.0 32.0 X 0 380597 29234 SYLVAIN TREPANIER DNP RN CENP SYSTEM VP - CNO (TO APR) 8.0 31.0 X 0 215751 28526 TERRY R FRY VICE PRESIDENT - CNO 40.0 0.0 X 232364 0 40263 MELISSA M TALLMADGE DIRECTOR NURSING SURG/ICU/PCU 40.0 0.0 X 165403 0 27651 TERESA A GULKER DIRECTOR NURSING MED SURG/OB 40.0 0.0 X 165064 0 13512 KATHRYN M BOERGER DIRECTOR HR 40.0 0.0 X 161597 0 3437 KATHLEEN J SCARBROUGH PRES/EXEC DIR-UVMC FOUNDATION 10.0 30.0 X 109665 45497 28273 RENEE P GEORGE FORMER KEY EMPLOYEE 0.0 40.0 X 0 396472 28198 MICHAEL J MAIBERGER FORMER KEY EMPLOYEE 0.0 39.5 X 0 1045111 33228 2085440 7965284 953273 31 true true false SKANSKA USA 1633 LITTLETON RD PARSIPPANY NJ 07054 CONSTRUCTION 3825744 VALLEY ANESTHESIA INC 3130 N CO RD 25A TROY OH 45373 MEDICAL SERVICES 2020583 CATHOLIC HEALTH INITIATIVES 3900 OLYMPIC BLVD 400 ERLANGER KY 41018 CLINICAL ENGINEERING 1723387 COMPUNET CLINICAL LABORATORIES 2308 SANDRIDGE DR MORAINE OH 45349 LABORATORY SERVICES 1395146 DAWSON HEALTHCARE 1114 DUBLIN RD COLUMBUS OH 43215 MEDICAL SERVICES 1003340 33 173653 173653 NET PATIENT CARE REVENUE 621110 67203034 67103659 99375 MEDICARE/MEDICAID 621110 70077646 70077646 HOSPITAL FRANCHISE TAX RECOVERIES 900099 2656087 2656087 ATHLETIC TRAINING 900099 65684 65684 MEDICAL RECORDS 900099 36994 36994 1293 1293 140040738 689215 689215 0 0 2608085 2164017 444068 0 444068 444068 13508188 197450 11505496 80264 2002692 117186 2119878 2119878 0 0 0 0 0 0 427615 370700 56915 56915 CAFETERIA SALES 721210 702840 702840 ELECTRONIC MEDICAL RECORD MGMT SVC 900099 208036 208036 ALL OTHER REVENUE 900099 127566 11785 115781 1038442 144562909 140149399 111160 4128697 900212 900212 0 0 0 1363465 1221665 141800 0 0 57242681 51289442 5953239 1401039 1255331 145708 7589678 6800351 789327 3960376 3548497 411879 94212 84414 9798 513295 459912 53383 75957 75957 14286 14286 0 0 109752 109752 8879282 7955837 923445 0 1311777 1311777 1038933 930884 108049 4967392 4450783 516609 0 2275267 2038639 236628 131298 117643 13655 0 0 1424802 1424802 0 12290326 11012132 1278194 0 OPERATING SUPPLIES 15893039 15893039 PURCHASED SERVICES 8779415 7866356 913059 JOINT OPERATING AGREEMENT 3590000 3216640 373360 HOSPITAL FRANCHISE TAX 2181983 2181983 1844760 1652905 191855 137873227 125627530 12245697 0 2860 3810 3808655 5734097 0 0 21116723 19970158 0 0 0 0 0 134000 503818 558451 1493024 1274017 204722183 117013417 91485593 87708766 48768299 39014538 14696404 11823680 0 0 0 0 5474911 5405323 187350287 171626840 10782754 9763541 279110 362618 51388 65844 63100490 60339258 0 0 0 0 350903 126785 0 0 30664914 23387475 105229559 94045521 X 82120728 77581319 0 0 0 0 82120728 77581319 187350287 171626840 X 6689682 4684950 -15914041 X false true X true false X false false false false false true 11586 false false true 2700 14286 false false PART II-B, LINE 1F: PAYMENTS 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. 1247083 1247083 128448464 67438676 61009788 71869873 49574741 22295132 3156763 3156763 87708766 ALTERNATIVE INVESTMENTS 11823680 F 11823680 0 PENSION OBLIGATION 12711874 JOINT OPERATING AGREEMENT 3590000 MALPRACTICE INSURANCE 2900191 DEFERRED COMPENSATION 2507603 WORKER'S COMP RESERVE 919294 SETTLEMENT - 3RD PARTY PAYOR 698355 LOAN GUAR & OTHER LTL 51565 OTHER 8593 23387475 X PART X, LINE 2: THE 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. 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X X true true X X X true X SEE PART V, SEC C X SEE PART V, SEC C X SEE PART V, SEC C X X X X X X X true X false X X X X true X false false PART V, SECTION B, LINE 1: THE 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 / 6 HYATT CENTER 450 HYATT ST TIPP CITY OH 45371 LABORATORY, IMAGING, SPORTS MEDICINE, SURGERY OUTPATIENT CARE CENTER NORTH 280 LOONEY RD PIQUA OH 45356 LABORATORY, IMAGING, REHABILITATIVE THERAPY OUTPATIENT CARE CENTER SOUTH 998 S DORSET RD TROY OH 45373 LABORATORY, IMAGING OCCUPATIONAL HEALTH REHABILITATIVE THERAPY STANFIELD PLACE 31 STANFIELD RD TROY OH 45373 IMAGING JACOB DETTMER BUILDING 3130 N COUNTY RD 25A TROY OH 45373 Behavorial Health VERSAILLES CENTER 471 MARKER RD VERSAILLES OH 45380 LABORATORY PART I, LINE 6A: THE 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, LI true SAMARITAN BEHAVIORAL HEALTH INC 601 S EDWIN C MOSES BLVD DAYTON OH 45408 020633634 501(C)(3) 190464 SUPPORT MIAMI COUNTY RECOVERY COUNCIL INC 1059 N MARKET ST TROY OH 45373 310917327 501(C)(3) 139073 SUPPORT TROY FOUNDATION 216 W FRANKLIN ST TROY OH 45373 316018703 501(C)(3) 106000 SUPPORT PIQUA COMMUNITY FOUNDATION 126 HIGH ST PIQUA OH 45356 311391908 501(C)(3) 102000 SUPPORT HEALTH PARTNERS FREE CLINIC 1300 N CO RD 25A TROY OH 45373 311596731 501(C)(3) 98150 SUPPORT MIAMI COUNTY DENTAL CLINIC 1364 W MAIN ST TROY OH 45373 204901192 501(C)(3) 65350 SUPPORT DAYTON FOUNDATION DEPOSITORY 40 N MAIN ST 500 DAYTON OH 45423 311044298 501(C)(3) 40400 SUPPORT HOSPICE OF MIAMI COUNTY 550 SUMMIT AVE 101 TROY OH 45373 311031277 501(C)(3) 33850 SUPPORT MIAMI VALLEY HOSPITAL 110 N MAIN ST 500 DAYTON OH 45402 310537504 501(C)(3) 29317 AFRICAN AMERICAN WOMEN'S HEALTH PROGRAM & BRIDGE PROGRAM TROY DEVELOPMENT COUNCIL 405 SW PUBLIC SQ 330 TROY OH 45373 311736034 501(C)(3) 15000 SUPPORT REACH OUT MONTGOMERY COUNTY 25 E FORAKER ST DAYTON OH 45409 311434282 501(C)(3) 14559 RX ASSIST FOR INDIGENT UVMC FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311581859 501(C)(3) 13170 SUPPORT DECOLORES MONTESSORI SCHOOL 312 CENTRAL AVE GREENVILLE OH 45331 311166242 501(C)(3) 12500 SUPPORT AIR CAMP PO BOX 752332 DAYTON OH 45475 272186089 501(C)(3) 6450 SUPPORT MIAMI COUNTY YMCA 223 W HIGH ST PIQUA OH 45356 310537179 501(C)(3) 5500 SUPPORT 15 0 PART I, LINE 2: 1) 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. X X X X false true false false false false false false false REBECCA A RICE PRESIDENT & CEO 331441 0 131371 0 49955 0 32933 0 13514 0 559214 0 0 0 RAFAY ATIQ MD TRUSTEE 100 370697 0 138495 0 2211 0 8286 0 25868 100 545557 0 0 JENNIFER J HAULER MD TRUSTEE / CMO (TO AUG) 0 337058 0 28191 0 1125 0 0 0 1542 0 367916 0 0 SCOTT B KANAGY DO TRUSTEE / CMO (FROM AUG) 115917 0 15000 0 25353 0 0 0 8589 0 164859 0 0 0 PATRICK A LARREATEGUI DO TRUSTEE 0 363083 0 19917 0 2805 0 8828 0 18190 0 412823 0 0 DALE E CREECH JR BOARD SECRETARY & PREMIER CLO 0 398677 0 146709 0 86590 0 37157 0 25774 0 694907 0 0 DIANE L PLEIMAN COO 232890 0 63905 0 1619 0 21587 0 5284 0 325285 0 0 0 TIMOTHY D SNIDER BOARD TREASURER &CFO-SEE SCH O 203133 0 78387 0 1026 0 6037 0 24174 0 312757 0 0 0 THOMAS R CURTIN SYSTEM VP - REVENUE CYCLE 0 231960 0 68571 0 6046 0 28926 0 29842 0 365345 0 0 GARY G GINTER SYSTEM VP - CIO 0 385251 0 135949 0 3806 0 61801 0 25349 0 612156 0 0 BARBARA A JOHNSON SYSTEM VP - HR OPERATIONS 0 363394 0 124821 0 20560 0 28293 0 10160 0 547228 0 0 TAMMY S LUNDSTROM MD SYSTEM VP - CMO (TO AUG) / CCO 0 524280 0 192978 0 5165 0 81162 0 2788 0 806373 0 0 MARGARET W MARK SYSTEM VP - CNO (FROM JUN) 0 267121 0 70931 0 7815 0 9544 0 25867 0 381278 0 0 THOMAS R PARKER CHIEF EXPERIENCE OFFICER 0 378787 0 121190 0 26397 0 52371 0 14841 0 593586 0 0 CRAIG SELF SYS VP -CHIEF STRATEGY OFFICER 0 389413 0 144360 0 3160 0 23805 0 26651 0 587389 0 0 MARK W SHAW SYSTEM VP - MANAGED CARE 0 307295 0 118673 0 88375 0 36068 0 25720 0 576131 0 0 SCOTT A SHELTON SYS VP-CHF PURCHASING OFFICER 0 252664 0 116419 0 11514 0 24804 0 4430 0 409831 0 0 SYLVAIN TREPANIER DNP RN CENP SYSTEM VP - CNO (TO APR) 0 111026 0 103825 0 900 0 19789 0 8737 0 244277 0 0 TERRY R FRY VICE PRESIDENT - CNO 175717 0 35905 0 20742 0 24799 0 15464 0 272627 0 0 0 MELISSA M TALLMADGE DIRECTOR NURSING SURG/ICU/PCU 147156 0 17570 0 677 0 10240 0 17411 0 193054 0 0 0 TERESA A GULKER DIRECTOR NURSING MED SURG/OB 145977 0 17987 0 1100 0 3213 0 10299 0 178576 0 0 0 KATHRYN M BOERGER DIRECTOR HR 123234 0 19719 0 18644 0 2860 0 577 0 165034 0 0 0 KATHLEEN J SCARBROUGH PRES/EXEC DIR-UVMC FOUNDATION 75231 31212 22293 9249 12141 5036 12703 6099 6467 3004 128835 54600 0 0 RENEE P GEORGE FORMER KEY EMPLOYEE 0 323626 0 71751 0 1095 0 15853 0 12345 0 424670 0 0 MICHAEL J MAIBERGER FORMER KEY EMPLOYEE 0 302116 0 292508 0 450487 0 2700 0 30528 0 1078339 0 0 PART I, LINE 4B: DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, CERTAIN PERSONS ARE LIMITED IN THE AMOUNT OF BENEFIT THAT CAN BE EARNED UNDER A QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, 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. A County of Miami Ohio 316000055 2016-08-31 33210000 SEE PART VI false false false A 2800000 0 33210000 0 0 0 111568 0 0 0 33098432 0 2009 true false true true A false true true true false 0.00050 0.00240 0.00290 false false false true A false true false false true true BOAML 0. true true false 0 true true A true SCHEDULE K, PART I, LINE A, COLUMN F PURPOSE OF BOND: THE BOND ISSUE OF 08/31/2016 WAS USED TO CURRENTLY REFUND THE 2006 SERIES BOND. FORM 990, PART III, LINE 4A: THE 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) UVMC 110 N Main St 500 DAYTON OH 45402 341850683 PARENT OH 501(c)(3) 12C III FI NA false UVMC FOUNDATION 110 N Main St 500 DAYTON OH 45402 311581859 FOUNDATION OH 501(c)(3) 7 NA false PREMIER HEALTH 110 N MAIN ST 500 DAYTON OH 45402 311446699 JOA PARENT OH 501(c)(3) 12A I NA false UPPER VALLEY PROFESSIONAL CORP (UVPC) 110 N MAIN ST 500 DAYTON OH 45402 311400963 HEALTH CARE OH 501(c)(3) 10 UVMC true UVPC SPECIALISTS INC 110 N MAIN ST 500 DAYTON OH 45402 203687536 HEALTH CARE OH 501(c)(3) 10 UVPC true UVMC NURSING CARE INC 110 N MAIN ST 500 DAYTON OH 45402 311224064 NURSING HOME OH 501(c)(3) 10 UVMC true UVMC MANAGEMENT CORPORATION 110 N MAIN ST 500 DAYTON OH 45402 311360489 MGT COMPANY OH UVMC C CORP 0 0 0.00000 true AFTER HOURS FAMILY CARE 110 N MAIN ST 500 Dayton OH 45402 311269483 Health Care OH UVPC C Corp 0 0 0.00000 true false true true false false false false false false true false true true false true true true true true UVMC FOUNDATION C 872556 FMV UVMC FOUNDATION Q 86608 FMV UPPER VALLEY PROFESSIONAL CORP O 1166366 FMV UPPER VALLEY PROFESSIONAL CORP Q 89129 FMV UPPER VALLEY PROFESSIONAL CORP S 457735 FMV UVPC SPECIALISTS INC O 699436 FMV UVMC MANAGEMENT CORP O 996799 FMV UVMC MANAGEMENT CORP Q 404511 FMV UVMC MANAGEMENT CORP S 398145 FMV PREMIER HEALTH C 236289 FMV UPPER VALLEY PROFESSIONAL CORP B 4245155 FMV AFTER HOURS FAMILY CARE B 207421 FMV AFTER HOURS FAMILY CARE C 71108 FMV UVPC SPECIALISTS INC B 7022939 FMV UVMC C 616074 FMV UVMC MANAGEMENT CORP C 370002 FMV UVMC NURSING CARE INC B 185355 FMV