PREMIER HEALTH PARTNERS: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- PREMIER HEALTH PARTNERS (EIN 31-1446699)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201713189349305941
- Schema version
- 2016v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T13:07:47-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 YARD ST 200 | AddressLine1Txt |
| City | GRANDVIEW HEIGHTS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43212 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311446699 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Premier Health Partners | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % J MICHAEL SIMS | InCareOfNm |
| Business Name Control | PREM | BusinessNameControlTxt |
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST 500 | AddressLine1Txt |
| City | Dayton | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | J MICHAEL SIMS | PersonNm |
| Person Title | VP FINANCE | PersonTitleTxt |
| Phone | 9374999942 | PhoneNum |
| Signature | 2017-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DIANE L BEAN | PreparerPersonNm |
| PTIN | P00104972 | PTIN |
| Phone | 6142245678 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 108.206.163.59 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 31049020173185000009 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2017-11-14 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 582F47EFACDD6166E52205D1FBFEA2601660FA18 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 582F47EFACDD6166E52205D1FBFEA2601660FA18 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2018-03-14 21:41:22Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PREMIER HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Mary H Boosalis | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST Suite 500 | AddressLine1Txt |
| City | Dayton | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,540,089 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.premierhealth.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | WE 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 Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 29 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$96,042 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $871,013 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,540,089 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,574,791 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $3,445,804 | PYTotalRevenueAmt |
| CY Total Revenue | $1,540,089 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $100 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $519 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,789,320 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $61,565 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,333,738 | PYOtherExpensesAmt |
| CY Other Expenses | $2,084,453 | CYOtherExpensesAmt |
| PY Total Expenses | $7,123,158 | PYTotalExpensesAmt |
| CY Total Expenses | $2,146,537 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$3,677,354 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$606,448 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $290,232 | TotalAssetsBOYAmt |
| Total Assets EOY | $104,049 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,712,705 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $927,709 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,422,473 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$823,660 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | We 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 Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,957,710 | ExpenseAmt |
| Grant | $519 | GrantAmt |
| Revenue | $1,540,089 | RevenueAmt |
| Desc | See Schedule O | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $0 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $1,957,710 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 175 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 29 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | J MICHAEL SIMS | PersonNm |
| Phone | 9374999942 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST SUITE 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (42 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ANITA J MOORE | ||||||||||
| BOARD CHAIR | 0.5 | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| JAMES R PANCOAST | ||||||||||
| TRUSTEE / PREMIER CEO | 8.0 | 32.0 | Yes (X) | Yes (X) | $0 | $1,611,877 | $60,435 | |||
| STEVE BEINLICH | ||||||||||
| TRUSTEE (FROM FEB) | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| GEORGE T BRODERICK JR MD | ||||||||||
| TRUSTEE | 0.5 | 1.0 | Yes (X) | $0 | $630,205 | $18,445 | ||||
| KATHLEEN A CARLSON | ||||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| LARRY L HOLLINGSHEAD | ||||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| DANIEL L HOOD MD | ||||||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| CHARLES A JONES | ||||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| JEFFREY S LEVINE | ||||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN W JACK LOHBECK | ||||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| WILLIAM E LUKENS | ||||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| MITCH MELFI | ||||||||||
| TRUSTEE (EX OFFICIO) | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| DOUGLAS R MURRAY | ||||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| PETER E NIMS MD | ||||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| DARIN J PANGALANGAN MD | ||||||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $35,975 | $0 | ||||
| EDGAR M PURVIS JR | ||||||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| COLLEEN RYAN | ||||||||||
| TRUSTEE (FROM FEB) | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| BELINDA STENSON | ||||||||||
| TRUSTEE | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| THOMAS G THORNTON MD | ||||||||||
| TRUSTEE (TO DEC) | 0.5 | 0.0 | Yes (X) | $0 | $417,813 | $32,452 | ||||
| SUBODH K WADHWA MD | ||||||||||
| TRUSTEE (FROM FEB) | 0.5 | 0.5 | Yes (X) | $0 | $257,393 | $31,873 | ||||
| JILL WILSON | ||||||||||
| TRUSTEE | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| MARY H BOOSALIS | ||||||||||
| PREMIER PRESIDENT (FROM MAR) | 24.0 | 16.0 | Yes (X) | $0 | $1,155,577 | $49,668 | ||||
| DALE E CREECH | ||||||||||
| BOARD SECRETARY & CLO | 8.0 | 32.0 | Yes (X) | $708,171 | $0 | $62,021 | ||||
| THOMAS M DUNCAN | ||||||||||
| BOARD TREASURER & CFO | 0.5 | 39.5 | Yes (X) | $0 | $920,332 | $814,026 | ||||
| MICHAEL J MAIBERGER | ||||||||||
| EXEC VP & COO (FROM APR) | 0.5 | 39.5 | Yes (X) | $0 | $887,043 | $94,748 | ||||
| THOMAS R CURTIN | ||||||||||
| SYSTEM VP - REVENUE CYCLE | 8.0 | 31.0 | $293,603 | $0 | $61,061 | Yes (X) | ||||
| KATHLEEN L FORBES | ||||||||||
| PHG CHIEF INTEGRATION OFFICER | 40.0 | 0.0 | $584,119 | $0 | $26,132 | Yes (X) | ||||
| GARY G GINTER | ||||||||||
| SYSTEM VP - CIO | 8.0 | 32.0 | $537,399 | $0 | $73,245 | Yes (X) | ||||
| BARBARA A JOHNSON | ||||||||||
| SYSTEM VP - HR OPERATIONS | 8.0 | 32.0 | $523,006 | $0 | $30,879 | Yes (X) | ||||
| TAMMY S LUNDSTRUM MD | ||||||||||
| SYSTEM VP - CMO | 8.0 | 32.0 | $716,856 | $0 | $59,414 | Yes (X) | ||||
| THOMAS R PARKER | ||||||||||
| SYS VP-CHF EXPERIENCE OFFICER | 8.0 | 32.0 | $496,641 | $0 | $54,594 | Yes (X) | ||||
| CRAIG SELF | ||||||||||
| SYS VP-CHIEF STRATEGY OFFICER | 8.0 | 32.0 | $497,273 | $0 | $39,370 | Yes (X) | ||||
| MARK W SHAW | ||||||||||
| SYSTEM VP - MANAGED CARE | 8.0 | 32.0 | $458,030 | $0 | $61,038 | Yes (X) | ||||
| SCOTT A SHELTON | ||||||||||
| SYSTEM VP - CPO | 8.0 | 32.0 | $358,074 | $0 | $32,224 | Yes (X) | ||||
| SYLVAIN TREPANIER DNP RN CENP | ||||||||||
| SYSTEM VP - CNO | 8.0 | 31.0 | $398,678 | $0 | $35,692 | Yes (X) | ||||
| JERRY CLARK MD FACP | ||||||||||
| PREMIER HLTH GRP PRESIDENT/CMO | 40.0 | 0.0 | $459,099 | $0 | $49,863 | Yes (X) | ||||
| RENEE P GEORGE | ||||||||||
| PREMIER HEALTH PLAN - VP OPS | 40.0 | 0.0 | $324,102 | $0 | $24,786 | Yes (X) | ||||
| HAROLD T KEPLER DO | ||||||||||
| PREMIER HEALTH PLAN-MED DIR | 40.0 | 0.0 | $270,193 | $0 | $46,444 | Yes (X) | ||||
| J NICK LAIR | ||||||||||
| PREMIER HLTH GRP-VP MKT DVLP | 40.0 | 0.0 | $324,961 | $0 | $56,822 | Yes (X) | ||||
| EVANTHIA STEFFENS | ||||||||||
| PHG-DIR CLINICAL INTEGRATION | 40.0 | 0.0 | $185,189 | $0 | $33,520 | Yes (X) | ||||
| MARY M CLANCY | ||||||||||
| FORMER KEY | 0.0 | 40.0 | $0 | $552,211 | $45,704 | Yes (X) | ||||
| MARK S SHAKER | ||||||||||
| FORMER KEY | 0.0 | 40.0 | $0 | $974,760 | $33,895 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $7,135,394 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $7,443,186 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,928,351 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PLATINUM MARKETING GROUP | |||||
| 700 W PETE ROSE WAY 535 | CINCINNATI | OH | 45203 | PROFESSIONAL SERVICE | $2,892,795 |
| STUDER GROUP LLC | |||||
| PO BOX 71676 | CHICAGO | IL | 60694 | PROFESSIONAL SERVICE | $1,516,408 |
| PHILIPS HEALTHCARE INFORMATICS | |||||
| 4100 E THIRD AVE 101 | FOSTER CITY | CA | 94404 | SOFTWARE MAINTENANCE | $1,310,063 |
| VERSANT HOLDINGS LLC | |||||
| PO BOX 713461 | CINCINNATI | OH | 452713461 | PROFESSIONAL SERVICE | $1,210,000 |
| RSM US LLP | |||||
| 9225 PRIORITY WAY WEST DR SUITE 3 | INDIANAPOLIS | IN | 46240 | PROFESSIONAL SERVICE | $971,688 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 65 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | POPULATION HEALTH REVENUE | Desc |
| Total Revenue Column | $1,540,089 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,540,089 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,540,089 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,540,089 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,540,089 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $519 | TotalAmt |
| Program Services | $519 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,479 | TotalAmt |
| Program Services | $50,597 | ProgramServicesAmt |
| Management And General | $4,882 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $478 | TotalAmt |
| Program Services | $436 | ProgramServicesAmt |
| Management And General | $42 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,877 | TotalAmt |
| Program Services | $2,624 | ProgramServicesAmt |
| Management And General | $253 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,731 | TotalAmt |
| Program Services | $2,491 | ProgramServicesAmt |
| Management And General | $240 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143 | TotalAmt |
| Program Services | $130 | ProgramServicesAmt |
| Management And General | $13 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67 | TotalAmt |
| Management And General | $67 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,077,224 | TotalAmt |
| Program Services | $1,894,428 | ProgramServicesAmt |
| Management And General | $182,796 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $950 | TotalAmt |
| Program Services | $950 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $505 | TotalAmt |
| Program Services | $461 | ProgramServicesAmt |
| Management And General | $44 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34 | TotalAmt |
| Program Services | $31 | ProgramServicesAmt |
| Management And General | $3 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $698 | TotalAmt |
| Program Services | $637 | ProgramServicesAmt |
| Management And General | $61 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $476 | TotalAmt |
| Program Services | $434 | ProgramServicesAmt |
| Management And General | $42 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $337 | TotalAmt |
| Program Services | $307 | ProgramServicesAmt |
| Management And General | $30 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $830 | TotalAmt |
| Program Services | $757 | ProgramServicesAmt |
| Management And General | $73 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $2,635 | $2,403 | $232 |
| OPERATING SUPPLIES | $325 | $296 | $29 |
| TRAINING AND EDUCATION | $144 | $131 | $13 |
| OTHER | $85 | $78 | $7 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,146,537 | TotalAmt |
| Program Services | $1,957,710 | ProgramServicesAmt |
| Management And General | $188,827 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,066 | BOYAmt |
| EOY | $58,599 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $76,111 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $30,661 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,166 | BOYAmt |
| EOY | $45,450 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,232 | BOYAmt |
| EOY | $104,049 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,712,705 | BOYAmt |
| EOY | $927,709 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,712,705 | BOYAmt |
| EOY | $927,709 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,422,473 | BOYAmt |
| EOY | -$823,660 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,422,473 | BOYAmt |
| EOY | -$823,660 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,232 | BOYAmt |
| EOY | $104,049 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$606,448 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,205,261 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 4 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (4 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| ATRIUM MEDICAL CENTER | ||||
| 311079309 | 3 | Yes (true) | $0 | $0 |
| GOOD SAMARITAN HOSPITAL | ||||
| 310536981 | 3 | Yes (true) | $0 | $0 |
| MIAMI VALLEY HOSPITAL | ||||
| 310537504 | 3 | Yes (true) | $0 | $0 |
| UPPER VALLEY MEDICAL CENTER | ||||
| 310537095 | 3 | Yes (true) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 4 | SupportedOrganizationsTotalCnt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (true) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | false | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, SECTION B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | Collectively, each hospitals corporate member appoints Premier Healths (Premier) board members. Those corporate members elect the Trustees of Premier and their respective supported hospital. Control over the appointment of the majority of Premier's Trustees effectively rests in the hands of the same persons who govern Premier's corporate members and their supported hospital organizations. Consequently, actions taken by the corporate members are essentially those of the supported hospital boards as well. In this regard, Catholic Health Initiatives, through Samaritan Health Partners, the corporate member of Good Samaritan Hospital, elects 7 board members; Atrium Health System, the corporate member of Atrium Medical Center, elects 3 board members; and UVMC, the corporate member of Upper Valley Medical Center, elects 3 board members of Premier. MedAmerica, the corporate member of Miami Valley Hospital, elects the remaining 8 board members of Premier. The terms of the Joint Operating Agreement (the document that served as the foundation for the creation of Premier) among these parties provides for detailed powers and authorities over certain aspects of the collective group. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Land | LandGrp | |
| Buildings | BuildingsGrp |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,428 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,309 | DepreciationAmt |
| Book Value | $8,119 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $66,683 | OtherCostOrOtherBasisAmt |
| Depreciation | $29,352 | DepreciationAmt |
| Book Value | $37,331 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildingsGrp | |
| Total Book Value Land Buildings | $45,450 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
| Total Liability | $0 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. THE ENTITIES CONTROLLED OR OWNED BY PREMIER ARE: * PREMIER HEALTH INSURING COMPANY (PHIC) (A WHOLLY OWNED SUBSIDIARY OF PREMIER) * PREMIER HEALTH HOLDING COMPANY (PHHC) (A WHOLLY OWNED SUBSIDIARY OF PREMIER) * PREMIER HEALTH ACO OF OHIO (A WHOLLY OWNED SUBSIDIARY OF PREMIER) * PREMIER HEALTH PLAN (PHPLAN) (A WHOLLY OWNED SUBSIDIARY OF PHIC) Taxes payable at December 31, 2016 and 2015, 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 J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (25 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARY H BOOSALIS | ||||||||||||||
| PREMIER PRESIDENT (FROM MAR) | $0 | $788,942 | $0 | $337,371 | $0 | $29,264 | $0 | $39,513 | $0 | $10,155 | $0 | $1,205,245 | $0 | $0 |
| JAMES R PANCOAST | ||||||||||||||
| TRUSTEE / PREMIER CEO | $0 | $1,012,775 | $0 | $566,187 | $0 | $32,915 | $0 | $35,837 | $0 | $24,598 | $0 | $1,672,312 | $0 | $0 |
| GEORGE T BRODERICK JR MD | ||||||||||||||
| TRUSTEE | $0 | $393,451 | $0 | $104,372 | $0 | $132,382 | $0 | $8,177 | $0 | $10,268 | $0 | $648,650 | $0 | $0 |
| THOMAS G THORNTON MD | ||||||||||||||
| TRUSTEE (TO DEC) | $0 | $367,697 | $0 | $41,899 | $0 | $8,217 | $0 | $6,625 | $0 | $25,827 | $0 | $450,265 | $0 | $0 |
| SUBODH K WADHWA MD | ||||||||||||||
| TRUSTEE (FROM FEB) | $0 | $238,466 | $0 | $0 | $0 | $18,927 | $0 | $7,545 | $0 | $24,328 | $0 | $289,266 | $0 | $0 |
| DALE E CREECH | ||||||||||||||
| BOARD SECRETARY & CLO | $384,517 | $0 | $157,999 | $0 | $165,655 | $0 | $35,724 | $0 | $26,297 | $0 | $770,192 | $0 | $0 | $0 |
| THOMAS M DUNCAN | ||||||||||||||
| BOARD TREASURER & CFO | $0 | $585,788 | $0 | $311,254 | $0 | $23,290 | $0 | $794,861 | $0 | $19,165 | $0 | $1,734,358 | $0 | $0 |
| MICHAEL J MAIBERGER | ||||||||||||||
| EXEC VP & COO (FROM APR) | $0 | $363,714 | $0 | $239,684 | $0 | $283,645 | $0 | $65,488 | $0 | $29,260 | $0 | $981,791 | $0 | $0 |
| THOMAS R CURTIN | ||||||||||||||
| SYSTEM VP - REVENUE CYCLE | $217,200 | $0 | $73,402 | $0 | $3,001 | $0 | $31,381 | $0 | $29,680 | $0 | $354,664 | $0 | $0 | $0 |
| KATHLEEN L FORBES | ||||||||||||||
| PHG CHIEF INTEGRATION OFFICER | $533,842 | $0 | $44,958 | $0 | $5,319 | $0 | $234 | $0 | $25,898 | $0 | $610,251 | $0 | $0 | $0 |
| GARY G GINTER | ||||||||||||||
| SYSTEM VP - CIO | $371,557 | $0 | $162,212 | $0 | $3,630 | $0 | $47,670 | $0 | $25,575 | $0 | $610,644 | $0 | $0 | $0 |
| BARBARA A JOHNSON | ||||||||||||||
| SYSTEM VP - HR OPERATIONS | $358,532 | $0 | $148,857 | $0 | $15,617 | $0 | $21,090 | $0 | $9,789 | $0 | $553,885 | $0 | $0 | $0 |
| TAMMY S LUNDSTRUM MD | ||||||||||||||
| SYSTEM VP - CMO | $511,262 | $0 | $200,578 | $0 | $5,016 | $0 | $57,992 | $0 | $1,422 | $0 | $776,270 | $0 | $0 | $0 |
| THOMAS R PARKER | ||||||||||||||
| SYS VP-CHF EXPERIENCE OFFICER | $369,275 | $0 | $103,016 | $0 | $24,350 | $0 | $42,604 | $0 | $11,990 | $0 | $551,235 | $0 | $0 | $0 |
| CRAIG SELF | ||||||||||||||
| SYS VP-CHIEF STRATEGY OFFICER | $361,101 | $0 | $134,279 | $0 | $1,893 | $0 | $12,640 | $0 | $26,730 | $0 | $536,643 | $0 | $0 | $0 |
| MARK W SHAW | ||||||||||||||
| SYSTEM VP - MANAGED CARE | $297,362 | $0 | $94,038 | $0 | $66,630 | $0 | $35,596 | $0 | $25,442 | $0 | $519,068 | $0 | $0 | $0 |
| SCOTT A SHELTON | ||||||||||||||
| SYSTEM VP - CPO | $241,172 | $0 | $85,638 | $0 | $31,264 | $0 | $28,797 | $0 | $3,427 | $0 | $390,298 | $0 | $0 | $0 |
| SYLVAIN TREPANIER DNP RN CENP | ||||||||||||||
| SYSTEM VP - CNO | $317,525 | $0 | $78,603 | $0 | $2,550 | $0 | $9,718 | $0 | $25,974 | $0 | $434,370 | $0 | $0 | $0 |
| JERRY CLARK MD FACP | ||||||||||||||
| PREMIER HLTH GRP PRESIDENT/CMO | $314,471 | $0 | $92,502 | $0 | $52,126 | $0 | $39,444 | $0 | $10,419 | $0 | $508,962 | $0 | $0 | $0 |
| RENEE P GEORGE | ||||||||||||||
| PREMIER HEALTH PLAN - VP OPS | $248,408 | $0 | $74,875 | $0 | $819 | $0 | $12,854 | $0 | $11,932 | $0 | $348,888 | $0 | $0 | $0 |
| HAROLD T KEPLER DO | ||||||||||||||
| PREMIER HEALTH PLAN-MED DIR | $208,793 | $0 | $38,644 | $0 | $22,756 | $0 | $25,513 | $0 | $20,931 | $0 | $316,637 | $0 | $0 | $0 |
| J NICK LAIR | ||||||||||||||
| PREMIER HLTH GRP-VP MKT DVLP | $221,875 | $0 | $74,484 | $0 | $28,602 | $0 | $25,951 | $0 | $30,871 | $0 | $381,783 | $0 | $0 | $0 |
| EVANTHIA STEFFENS | ||||||||||||||
| PHG-DIR CLINICAL INTEGRATION | $157,931 | $0 | $25,009 | $0 | $2,249 | $0 | $22,930 | $0 | $10,590 | $0 | $218,709 | $0 | $0 | $0 |
| MARY M CLANCY | ||||||||||||||
| FORMER KEY | $0 | $375,430 | $0 | $131,830 | $0 | $44,951 | $0 | $30,807 | $0 | $14,897 | $0 | $597,915 | $0 | $0 |
| MARK S SHAKER | ||||||||||||||
| FORMER KEY | $0 | $541,791 | $0 | $206,876 | $0 | $226,093 | $0 | $29,173 | $0 | $4,722 | $0 | $1,008,655 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3: | FormAndLineReferenceDesc |
| Explanation | THE CEO AND CFO'S COMPENSATION IS REPORTED AS PAID BY MEDAMERICA HEALTH SYSTEMS. THE COO'S COMPENSATION IS REPORTED AS PAID BY UVMC MANAGEMENT COMPANY (AN AFFILIATE OF PREMIER HEALTH). SEE COMMENT IN SCHEDULE O PERTAINING TO PART VI, SECTION B, LINE 15A & 15B FOR FURTHER EXPLANATION. 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, PREMIER HEALTH (PREMIER) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. PREMIER 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 2016. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2016: MARY CLANCY $40,883; DALE CREECH $159,735; J. NICK LAIR $9,782; MARK SHAKER $199,626; MARK SHAW $53,557; SCOTT SHELTON $28,038. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENTS IN 2016: BARBARA JOHNSON $10,303; MICHAEL MAIBERGER $34,406. 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: JERRY CLARK $8,887; THOMAS CURTIN $1,493; THOMAS DUNCAN $764,196; KATHLEEN FORBES $234; RENEE GEORGE $1,610; GARY GINTER $18,847; BARBARA JOHNSON $10,811; TAMMY LUNDSTROM, M.D. $49,100; MICHAEL MAIBERGER $50,476; THOMAS PARKER $14,575; CRAIG SELF $1,462. BASED ON THE GUIDANCE PROVIDED IN THE INSTRUCTIONS TO THE FORM 990, ANY PAYMENTS TO THE PARTICIPANTS RELATED TO THESE PLANS THAT WERE MADE WITHIN 2-1/2 MONTHS AFTER THE END OF THE ORGANIZATION'S TAX YEAR ARE NOT TREATED AS DEFERRED COMPENSATION FOR PURPOSES OF SCHEDULE J. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. ANY PAYMENTS MADE AFTER THE 2-1/2 MONTHS WERE PROPERLY REPORTED ON PRIOR YEARS' FILED IRS FORM 990 RETURNS, DISCLOSING COMPENSATION EARNED BY THESE INDIVIDUALS UNDER THE PLANS FOR EACH SUCH YEAR. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART I, LINE 7B: | NET UNRELATED BUSINESS TAXABLE INCOME/(LOSS) IS AMOUNTS FROM PARTNERSHIP INVESTMENTS THAT IS NOT RECOGNIZED FOR BOOK PURPOSES, THEREFORE NO UNRELATED BUSINESS INCOME/(LOSS) APPEARS ON PART VIII. FORM 990, PART III, LINE 4A: Premier Health Group (PHG) is a non-equity model Physician Hospital Organization created to clinically integrate physicians and hospitals in the common interest of achieving the Triple Aim: Improved consumer experience with the healthcare system and lowering total cost of care, while maintaining or improving quality outcomes. PHG serves as the provider network for, and provides continuous quality improvement functions for Premier Health Plan, Premier Health Insuring Corporation AND PREMIER HEALTH ACO OF OHIO, ALL affiliates of Premier Health. Through our physicianled organization, we deploy various population health models to our providers to help them better coordinate care for their patients in our efforts to serve Premier Healths mission of Building Healthier Communities. FORM 990, Part III, LINE 4B: The primary exempt purpose of Premier Health (Premier) is to establish, maintain, support, and stimulate the development of four healthcare systems including without limitation, hospitals, clinics, and other facilities that provide inpatient or outpatient care or ambulatory services, accommodations, diagnostics, and treatments to persons suffering from illness. As such, Premier is responsible for oversight of the four hospital entities as its charitable goal, and the information below is cumulative of their separate reports: QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT COMMUNITY BENEFIT SUMMARY FROM RELATED HOSPITALS SCHEDULE H For the year ended December 31, 2016 (in thousands) Charity And Means-tested Government Programs and Certain Other Community Benefits at Cost: Charity Care at cost $26,906 Unreimbursed Medicaid $89,081 Unreimbursed Costs of other means-tested government programs $6,215 -------- Total $122,202 Other Benefits: Community Health Improvement services & Community benefit operations $3,361 Health Professions education $1,783 Subsidized health services $46,149 Cash and in-kind contributions for community groups $6,394 -------- Total $57,687 -------- Grand Total PROGRAM & OTHER COMMUNITY BENEFITS $179,889 Community Building Activities: Physical Improvements $432 Other $1,616 ------ Total COMMUNITY BUILDING ACTIVITIES $2,048 Unpaid Cost of Medicare (Allowable Cost and Reimbursements reported on Medicare Cost Report) $42,219 Other Unpaid Cost of Medicare (Cost and Reimbursements not reported on Medicare Cost Report) $82,986 -------- Total UNPAID COST OF MEDICARE $125,205 Total Community Benefit including the Unpaid -------- Costs of Medicare $307,142 FORM 990, PART VI, SECTION A, LINE 2: DANIEL HOOD, M.D. (TRUSTEE) AND THOMAS CURTIN (KEY EMPLOYEE)HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6: PREMIER HEALTH HAS FOUR CORPORATE MEMBERS; MEDAMERICA HEALTH SYSTEMS, CATHOLIC HEALTH INITIATIVES, ATRIUM HEALTH SYSTEM, AND UVMC. FORM 990, PART VI, SECTION A, LINES 7A & 7B: MedAmerica elects 8 board members, Catholic Health Initiatives elects 7 board members, Atrium Health System elects 3 board members and UVMC elects 3 board members. The members must approve any dissolution of assets and any changes in the Code of Regulations or Articles of Incorporation. The members do not approve any operations decisions of the Board. 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 TAX DEPARTMENT OF PREMIER HEALTH (PREMIER). THE RETURN IS REVIEWED BY THE TAX MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. THE RETURN IS CONCURRENTLY SENT TO ERNST & YOUNG U.S. LLP FOR THEIR REVIEW. AFTER ALL CHANGES FROM THE ABOVE GROUPS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER AND THE CHIEF FINANCIAL OFFICER OF THIS ENTITY. A FINAL VERSION OF THE RETURN IS SENT TO ERNST & YOUNG U.S. LLP FOR A FINAL REVIEW AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT A BOARD OF TRUSTEES MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESSES ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 TAX RETURN IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, LINE 12C: PREMIER HEALTH (PREMIER) REQUIRES ALL BOARD MEMBERS, OFFICERS, EXECUTIVE DIRECTORS, VICE PRESIDENTS, DIRECTORS, PURCHASING DEPARTMENT STAFF, AUTHORIZED PURCHASERS, MEDICAL DIRECTORS, DEPARTMENT AND SECTIONS CHAIRS, 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 AND 15B: | THE ANNUAL REVIEW PROCESS PERFORMED BY PREMIER FOLLOWS A MARKET BASED COMPENSATION PHILOSOPHY DESIGNED TO ATTRACT AND RETAIN THE EXECUTIVE TALENT REQUIRED TO MEET THE HIGH PERFORMANCE STANDARDS OF OUR BOARD AND OUR COMMUNITY. PREMIER ANNUALLY REVIEWS EXECUTIVE COMPENSATION SURVEY DATA FOR A REGIONAL PEER GROUP OF SYSTEMS AND HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO PREMIER AND ITS AFFILIATES. THE DATA FOR THE SURVEY IS PROVIDED BY A THIRD PARTY CONSULTANT GROUP THAT IS INDEPENDENT OF PREMIER. THIS REPORT INCLUDES COMPARABILITY FOR KEY EXECUTIVES, VICE PRESIDENTS, AND DIRECTOR LEVEL POSITIONS. THE INDEPENDENT COMPARABILITY DATA IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THIS COMMITTEE IS COMPRISED OF THREE MEMBERS, ALL OF WHOM ARE INDEPENDENT. THIS COMMITTEE REVIEWS IN DETAIL THE COMPENSATION FOR THE PREMIER CEO, COO, CFO, CHIEF STRATEGY OFFICER, CHIEF INTEGRATION OFFICER AND THE HOSPITAL CEOS. OTHER POSITIONS ARE REVIEWED AT A HIGH LEVEL FOR REASONABLENESS. ALL THE MEETING MINUTES ARE DOCUMENTED AND KEPT ON FILE ALONG WITH ANY COMPARABILITY DATA AND THE CONSULTANT REPORT. AFTER THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION ACTIONS, THE PROCESS IS AUDITED BY THE INTERNAL AUDIT DEPARTMENT. THE EXECUTIVE COMPENSATION COMMITTEE PRESENTS THE COMPENSATION ACTIONS TO THE PREMIER BOARD ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19: THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC WHEN REQUIRED BY LAW OR FOR ACCREDITATION PURPOSES. THE CONFLICT OF INTEREST POLICY IS AVAILABLE ON WWW.PREMIERHEALTH.COM. FORM 990, Part VII, Section A, System Key Employees: The System Key Employees' total compensation amount is accurately reported on the various entities they serve. The Key Employee's compensation is being reported as paid by Premier Health as the paymaster of their applicable affiliated organization in order to more clearly reflect their responsibilities across the Premier Health System. Compensation and related payroll reporting requirements for system key employees are processed and filed by affiliates of Premier. FORM 990, PART IX, LINE 11G: POPULATION HEALTH CONSULTING FEE $1,769,041 INCENTIVES-POPULATION HEALTH $274,250 CONSULTANT FEESNON-CLINICAL $33,333 PURCH LABOR-NONCLINICAL $600 ----------- $2,077,224 FORM 990, PART XI, LINE 9: EQUITY TRANSFERS FROM AFFILIATED ORGANIZATIONS $1,205,261 |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PREMIER HEALTH GROUP LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N MAIN ST 500 | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 461428664 | EIN |
| Primary Activities | DR NETWORK | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Total Income | $1,540,089 | TotalIncomeAmt |
| End Of Year Assets | $104,049 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PREMIER | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| MedAmerica Health Systems (MAHS) | ||||||||||
| 110 N MAIN ST 500 | Dayton | OH | 45402 | 311040228 | Parent | OH | 501(C)(3) | 12C III FI | NA | false |
| Miami Valley Hospital (MVH) | ||||||||||
| 110 N MAIN ST 500 | Dayton | OH | 45402 | 310537504 | Hospital | OH | 501(C)(3) | 3 | MAHS | Yes (true) |
| Atrium Health System (AHS) | ||||||||||
| 110 N MAIN ST 500 | Dayton | OH | 45402 | 310537492 | Parent | OH | 501(C)(3) | 12C III FI | NA | false |
| Atrium Medical Center (AMC) | ||||||||||
| 110 N MAIN ST 500 | Dayton | OH | 45402 | 311079309 | Hospital | OH | 501(C)(3) | 3 | AHS | Yes (true) |
| Samaritan Health Partners (SHP) | ||||||||||
| 110 N MAIN ST 500 | Dayton | OH | 45402 | 311107411 | Parent | OH | 501(C)(3) | 12C III FI | NA | false |
| Good Samaritan Hospital (GSH) | ||||||||||
| 110 N MAIN ST 500 | Dayton | OH | 45402 | 310536981 | Hospital | OH | 501(C)(3) | 3 | SHP | Yes (true) |
| UVMC | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 341850683 | Parent | OH | 501(C)(3) | 12C III FI | NA | false |
| Upper Valley Medical Center | ||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 310537095 | Hospital | OH | 501(C)(3) | 3 | UVMC | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | UBI Code VUBICodeVAmt | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COMPUNET CLINICAL LABORATORIES LLC | ||||||||||||||
| 2308 SANDRIDGE DRIVE | MORAINE | OH | 45439 | 311258010 | MEDICAL LABS | OH | MVHE INC | RELATED | $1,169,741 | $6,141,983 | false | $0 | false | 0.51000 |
| SWEITZER STREET LLC | ||||||||||||||
| 40 W 4TH STREET STE 1700 | DAYTON | OH | 45402 | 454700417 | REAL ESTATE | OH | MVHE INC | Excluded-Section 512 | $35,248 | $1,881,786 | false | $0 | false | 0.40000 |
| SWEITZER MOB LLC | ||||||||||||||
| 110 N MAIN ST STE 900 | DAYTON | OH | 45402 | 474554657 | Real Estate | OH | MVHE INC | Excluded-Section 512 | $16,694 | $935,639 | false | $0 | false | 0.40000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PREMIER HEALTH PLAN INC | ||||||||||||
| 110 N Main St 500 | Dayton | OH | 45402 | 463024049 | HEALTH INSURA | OH | PHIC | C CORP | $29,050,569 | $18,623,571 | 1.00000 | Yes (true) |
| PREMIER HEALTH INSURING CO (PHIC) | ||||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 464766841 | HEALTH INSURA | OH | PREMIER HEALTH | C CORP | $77,981,111 | $23,747,993 | 1.00000 | Yes (true) |
| PREMIER HEALTH ACO OF OHIO | ||||||||||||
| 110 N MAIN ST 500 | DAYTON | OH | 45402 | 474049773 | MEDICARE ACO | OH | PREMIER HEALTH | C CORP | $0 | $0 | 1.00000 | Yes (true) |
| MVHE INC | ||||||||||||
| 110 N MAIN ST 400 | DAYTON | OH | 45402 | 311185270 | PHYS SVCS | OH | PREMIER HEALTH | C CORP | $49,667,210 | $42,977,685 | 1.00000 | Yes (true) |
| PREMIER HEALTH SPECIALISTS | ||||||||||||
| 110 N MAIN ST 400 | DAYTON | OH | 45402 | 061744704 | PHYS SVCS | OH | PREMIER HEALTH | C CORP | $85,485,173 | $25,891,232 | 1.00000 | Yes (true) |
| SAMARITAN FAMILY CARE INC | ||||||||||||
| 110 N MAIN ST 400 | DAYTON | OH | 45402 | 311299450 | PHYS SVCS | OH | PREMIER HEALTH | C CORP | $28,956,085 | $32,947,985 | 1.00000 | Yes (true) |
| PREMIER HEALTH HOLDING COMPANY | ||||||||||||
| 110 N MAIN ST 400 | DAYTON | OH | 45402 | 812419110 | HOLDING CO | OH | PREMIER HEALTH | C CORP | $0 | $0 | 1.00000 | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (7 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| MIAMI VALLEY HOSPITAL | ||
| C | $638,789 | FMV |
| GOOD SAMARITAN HOSPITAL | ||
| C | $277,210 | FMV |
| ATRIUM MEDICAL CENTER | ||
| C | $180,789 | FMV |
| UPPER VALLEY MEDICAL CENTER | ||
| C | $108,473 | FMV |
| PREMIER HEALTH INSURING CO | ||
| Q | $3,184,155 | FMV |
| PREMIER HEALTH PLAN | ||
| Q | $884,126 | FMV |
| PREMIER HEALTH ACO OF OHIO | ||
| Q | $446,849 | FMV |