2016-11-12T09:38:47-06:00 2015-12-31 ERNST & YOUNG US LLP 800 YARD ST 200 GRANDVIEW HEIGHTS OH 43212 990 2015-01-01 310537504 Miami Valley Hospital % J MICHAEL SIMS MIAM 9374999942 110 N MAIN ST 500 Dayton OH 45402 J MICHAEL SIMS VP FINANCE 9374999942 2016-11-01 true DIANE L BEAN P00104972 6142245678 2015 2017-02-10 21:41:12Z Mark Shaker 1 WYOMING ST DAYTON OH 45409 1164526289 false X WWW.PREMIERHEALTH.COM X 1890 OH MIAMI VALLEY HOSPITAL WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH CARE SERVICES. 7 1 8544 875 0 1267479 723021 810326961 857340306 29383034 22982712 12950814 15616631 853928288 896662670 6996495 6066395 0 0 358735989 386317219 0 0 0 441197514 437879367 806929998 830262981 46998290 66399689 1477252193 1459578649 802871708 795115226 674380485 664463423 X MIAMI VALLEY HOSPITAL WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH CARE SERVICES. false false 765473764 6066395 857340306 PLEASE REFER TO SCHEDULE H. 765473764 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 true false false false false false true true true true false false true 347 0 true 8544 true false false false false false false false false false false X 7 1 true true true false true true true true true false false true true true true true true true true true true X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 500 Dayton OH 45402 X CHRISTOPHER J DANIS MD BOARD CHAIR 0.5 39.5 X X 0 363070 32260 MARK S SHAKER PRESIDENT & CEO 40.0 0.0 X X 856296 0 32548 MARY M CLANCY COO 40.0 0.0 X X 495319 0 41015 JAMES R PANCOAST TRUSTEE / PREMIER PRESIDENT 7.5 8.5 X 0 1805699 58093 MARC R BELCASTRO MD TRUSTEE & CHIEF OF STAFF 39.5 0.5 X 170298 3263 335 DAVID W KEY MD TRUSTEE 0.5 0.0 X 0 0 0 JAMES M PACENTA MD TRUSTEE 0.5 39.5 X 0 691969 37203 CARA W POWERS BOARD SECRETARY 39.5 0.5 X 309221 0 47885 LISA A GIBBS-SEE SCH O BOARD TREASURER & CFO 20.0 0.0 X 217618 0 20278 MARK E WILLIAMS MD CMO 40.0 0.0 X 512873 0 35005 ROBERT M BOWMAN VP - HOSPITAL OPERATIONS 40.0 0.0 X 264729 0 46616 DALE E CREECH SYSTEM VP - CLO 7.5 32.5 X 624758 0 60638 THOMAS R CURTIN SYSTEM VP - REVENUE CYCLE 7.0 33.0 X 0 276277 37323 GARY G GINTER SYSTEM VP - CIO 8.0 32.0 X 493377 0 53719 KIMBERLY A HENSLEY VP - HOSPITAL OPERATIONS 40.0 0.0 X 273330 0 39512 BARBARA A JOHNSON SYSTEM VP - HR OPERATIONS 8.0 32.0 X 491255 0 17489 TAMMY S LUNDSTROM SYSTEM VP - CMO 8.0 32.0 X 656668 0 10493 THOMAS R PARKER SYS VP-CHF EXPERIENCE OFFICER 8.0 32.0 X 0 481498 38310 JOANN R RINGER VP - COO MVH SOUTH 40.0 0.0 X 359994 0 32799 CRAIG SELF SYSTEM VP - CSO 8.0 32.0 X 0 380470 37955 MARK W SHAW SYSTEM VP - MANAGED CARE 8.0 32.0 X 393525 0 61180 SCOTT A SHELTON SYSTEM VP - CPO 8.0 32.0 X 313527 0 29282 SYLVAIN TREPANIER DNP RN CENP SYSTEM VP - CNO 7.0 33.0 X 386458 0 17725 JOLYN M ANGUS VP HOSP OPS/CHIEF NSG OFFICER 40.0 0.0 X 300331 0 30923 DIANE L EWING VP COMMUNICATIONS 40.0 0.0 X 347288 0 19019 MOLLY J HALL VP - ACADEMIC AFFAIRS 40.0 0.0 X 534416 0 11987 WALTER REILING JR MD CHIEF MEDICAL INFO OFFICER 40.0 0.0 X 371518 0 37322 J MICHAEL SIMS VP FINANCE 39.5 0.5 X 330362 0 56042 GEOFFREY P WALKER FORMER BOARD SECRETARY 40.0 0.0 X 325650 0 82703 RENEE P GEORGE FORMER KEY EMPLOYEE 0.0 40.0 X 0 300232 21000 J NICK LAIR FORMER KEY EMPLOYEE 0.0 40.0 X 0 294314 46572 9028811 4596792 1093231 291 true true false COMPUNET CLINICAL LABORATORIES 2308 SANDRIDGE DR MORAINE OH 45349 CLINICAL LAB 21732232 ANESTHESIOLOGY SERVICES NETWORK PO BOX 349 DAYTON OH 45409 Medical Services 9487559 DAWSON HEALTHCARE 3650 OLENTANGY RIVER RD 450 COLUMBUS OH 43214 AGENCY STAFF 9830843 EVOLENT HEALTH LLC 800 N GLEBE RD 500 ARLINGTON VA 22203 CONSULTANTS 46916688 WRIGHT STATE UNIVERSITY 3640 COLONEL GLEN HWY 430 DAYTON OH 45435 MEDICAL SERVICES 12860218 93 614178 108843 723021 NET PATIENT REVENUE 900099 433934275 433934275 MEDICARE/MEDICAID 900099 398953009 398953009 HOSPITAL FRANCHISE TAX RECOVERIES 900099 23810103 23810103 HEALTH EDUCATION 900099 66360 66360 MEDICAL RECORDS 900099 44385 44385 532174 532174 857340306 8665101 8665101 0 0 4122522 2168072 1954450 0 1954450 1954450 272671469 840886 258270314 924430 14401155 -83544 14317611 14317611 0 0 7467270 6500803 966467 966467 CAFETERIA SALES 812930 5967362 5967362 JOINT VENTURES 900099 2545654 2545654 PARKING GARAGE 900099 1452456 1452456 2730242 2730242 12695714 896662670 857340306 38599343 6066395 6066395 0 0 0 7365765 6661597 704168 0 538468 486990 51478 292384586 264432620 27951966 25568129 23123816 2444313 38892574 35174444 3718130 21567697 19505825 2061872 77450 70046 7404 924461 836083 88378 552667 552667 51382 46470 4912 0 1847625 1847625 71935126 65058128 6876998 5510489 5510489 4432651 4008890 423761 17252854 15603481 1649373 0 17596993 15914720 1682273 656666 593889 62777 0 6164 5575 589 9340697 9340697 0 77317015 69925508 7391507 5105033 4616992 488041 OPERATING SUPPLIES 140999043 140999043 PURCHASED SERVICES 30201438 27314181 2887257 JOINT OPERATING AGREEMENT 19361000 17510088 1850912 HOSPITAL FRANCHISE TAX 13342242 13342242 21368371 19325555 2042816 830262981 765473764 64789217 0 29980 29580 51799574 48909454 0 0 133391182 155582835 0 0 0 0 3339528 4815573 8377513 8853212 12650384 15011401 1275325789 690919507 614456999 584406282 430123261 445419260 192227372 158510578 0 0 9470134 9436403 21386266 28604071 1477252193 1459578649 68793045 58405404 3775147 3744328 1637755 1609238 418538301 412953275 0 0 0 0 10354755 3494398 0 0 299772705 314908583 802871708 795115226 X 674380485 664463423 0 0 0 0 674380485 664463423 1477252193 1459578649 X 66399689 -26971533 -49345218 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 137882 false false true 13500 151382 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. FUNDS WERE ALSO GRANTED TO CITIZENS FOR SINCLAIR IN SUPPORT OF THE SINCLAIR COMMUNITY COLLEGE LEVY CAMPAIGN. PART II-B, LINE 1I: THE HOSPITAL CONTRACTS WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. 36995269 36995269 702044458 377971298 324073160 5870549 2566133 3304416 491503579 310382076 181121503 38911934 0 38911934 584406282 ALTERNATIVE INVESTMENTS 158510578 F 158510578 0 PENSION OBLIGATION 231123628 SWAP LIABILITY 27788077 MALPRACTICE INSURANCE 21257329 JOINT OPERATING AGREEMENT 19361000 LOAN GUARANTEE & OTHER LTL 5744463 HOSPITAL FRANCHISE TAX PAYABLE 3373176 WORKERS COMP RESERVE 1854470 OTHER 4406440 314908583 X Schedule D, Part X, Line 2: THE FOLLOWING FOOTNOTE IS FROM THE AUDITED COMBINED FINANCIAL STATEMENTS FOR PREMIER HEALTH AND AFFILIATES. MEDAMERICA HEALTH SYSTEMS IS THE PARENT ORGANIZATION OF MIAMI VALLEY HOSPITAL. PREMIER HEALTH (PREMIER), MEDAMERICA HEALTH SYSTEMS (MAHS), 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. SAMARITAN HEALTH PARTNERS (SHP) IS TAX-EXEMPT UNDER SECTION 501(C)(3) AND IS A PUBLIC CHARITY BY REASON OF BEING INCLUDED IN THE GROUP RULING ISSUED TO THE U.S. CATHOLIC CHURCH. AS TAX-EXEMPT ORGANIZATIONS, THEIR INCOME IS EXEMPT FROM FEDERAL INCOME TAX EXCEPT TO THE EXTENT OF ANY UNRELATED BUSINESS ACTIVITIES. PREMIER, MAHS, SHP, AHS, AND UVMC ALSO OWN OR CONTROL CERTAIN SUBSIDIARIES, WHICH ARE FOR PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. TAXES PAYABLE AT DECEMBER 31, 2015 AND 2014, 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. Central America and the Caribbean Investments 110757000 Central America and the Caribbean Program Services INSURANCE 25000 110782000 110782000 false false false false false false true true X true X true X true true false true true 19802000 10493000 9309000 0.01140 198127000 152918000 45209000 0.05550 6037000 3677000 2360000 0.00290 223966000 167088000 56878000 0.06980 2084000 2084000 0.00260 24687000 22063000 2624000 0.00320 18639000 18639000 0.02290 3438000 3438000 0.00420 48848000 22063000 26785000 0.03290 272814000 189151000 83663000 0.10270 145000 145000 0.00020 94000 94000 0.00010 155000 155000 0.00020 69000 69000 0.00010 386000 386000 0.00050 849000 849000 0.00110 true 12735211 130079000 145509000 -15430000 X true true 2 1 MIAMI VALLEY HOSPITAL ONE WYOMING ST DAYTON OH 45409 WWW.PREMIERHEALTH.COM SEE PART V SECT C X X X X X A 2 MIAMI VALLEY HOSPITAL SOUTH 2400 MIAMI VALLEY DR CENTERVILLE OH 45459 WWW.PREMIERHEALTH.COM SEE PART V SECT C X X X A A 12 false false true X X X X X X X X 13 true true true true X SEE PART V, SECTION C X true 14 true SEE PART V, SECTION C false false true X 200. 400. X X true true X X X true X WWW.PREMIERHEALTH.COM X WWW.PREMIERHEALTH.COM X WWW.PREMIERHEALTH.COM X X X X X true X false X X X X true X false false PART V, SECTION A, 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. MIAMI VALLEY HOSPITAL'S REGISTRATION NUMBER IS 1247. MIAMI VALLEY HOSPITAL SOUTH'S REGISTRATION NUMBER IS 1489. PART V, SECTION B, QUESTION 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 MIAMI VALLEY HOSPITAL, COMMUNITY HEALTH COLLABORATIVES FEATURING COMMUNITY, HEALTH, AND BUSINESS STAKEHOLDERS/ADVOCATES ORGANIZED BY BOTH MIAMI VALLEY HOSPITAL, AND THE GREATER DAYTON AREA HOSPITAL ASSOCIATION WITH ITS MEMBER HOSPITALS. PART V, SECTION B, QUESTION 6A & 6B: MIAMI VALLEY HOSPITAL PARTNERED WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION AND WRIGHT STATE UNIVERSITY TO PREPARE THEIR COMMUNITY HEALTH NEEDS ASSESSMENT. PART V, SECTION B, LINE 7A: THE DIRECT WEBSITE ADDRESS WHERE THE CHNA CAN BE ACCESSED IS: HTTP://WWW.MIAMIVALLEYHOSPITAL.ORG/WORKAREA/DOWNLOADASSET.ASPX?ID=76902 PART V, SECTION B, LINE 10A: THE DIRECT WEBSITE ADDRESS WHERE THE IMPLEMENTATION STRATEGY CAN BE ACCESSED IS: HTTP://WWW.PREMIERHEALTH.COM/OUR-COMMUNITY/MAKING-A-DIFFERENCE/COMMUNITY-H EALTH-IMPROVEMENT-PLAN/MVH/ PART V, SECTION B, LINE 11: Premier Health was part of a collaboration in 2013 with the Greater Dayton Area Hospital Association and hospitals throughout Southwestern Ohio to conduct a regional Community Health Needs Assessment. IDENTIFIED PRIORITIES --------------------- In the Community Health Assessment, researchers identified priority areas for community health improvement using a variety of criteria. The priorities that are included and excluded in the plan are outlined here. Priorities that are included in the plan are not listed in order of importance. Priorities Included in the Plan: ------------------------------- Through the Community Health Risk Assessment, the following priorities were identified for Montgomery and Greene counties. These priorities are outlined in this plan. Primary and Chronic Diseases: 1. Hypertension: Hypertension rates are higher in the service area than in the state and nation. It is the leading inpatient discharge diagnosis and the 3rd leading ED discharge diagnosis. 2. Breast cancer: The breast cancer rate is 244.8 per 100,000, and the rate is increasing as opposed to historically prevalent cancers. 3. Diabetes: The prevalence of diabetes is substantially greater in the service area compared to the State and nation. It is the 3rd most common inpatient discharge diagnosis and the 7th most common ER discharge diagnosis. Discharge diagnosis rates have increased from 2004 to 2012. Priorities Addressed Through Collaboration ------------------------------------------ All identified priorities are important elements of improving the health of our community. In some instances, priorities are already being targeted by collaborative groups of which Miami Valley Hospital is a part. Additional strategies will not be developed independent of these efforts. Because of the importance of these community-wide efforts, the following identified priorities are not included in the Community Health Improvement Plan. Maternal and Infant Priorities: 1. First trimester prenatal care 2. Low birth weight 3. Infant mortality rate Miami Valley Hospital is involved in several state-wide initiatives addressing these issues. As part of these collaborations, Miami Valley Hospital will share the goals and objectives developed by those groups for program implementation and measurement. Ohio Perinatal Quality Collaborative ------------------------------------ Miami Valley Hospital is a charter member of this organization as a neonatal hospital and as a maternity hospital. The mission of the Collaborative is, "Through collaborative use of improvement science methods, reduce preterm births and improve outcomes of pre-term newborns in Ohio as quickly as possible." Projects of the collaborative include: * 39 Weeks Delivery Charter Project - To reduce elective unnecessary scheduled births before 39 weeks gestational age. (Reduce infant mortality and low birth weights.) * 39 Weeks Dissemination and Birth Registry Accuracy Project - This project was to address inaccuracies in birth certificate data within the Quality Improvement framework. * Obstetrics Antenatal Corticosteroids Project- This project focuses on increasing the use of antenatal corticosteroids to reduce mortality and morbidity among preterm infants. (Reduce infant mortality.) * Progesterone Project - This project intends to help raise awareness about the need for screening and intervention for progesterone, provide support to teams to implement screening, identification and treatment, develop the capacity and capability of skilled ultrasound technicians and remove administrative barriers to the administration of progesterone. (Reduce infant mortality and low birth weights.) Ohio Hospital Association (OHA): -------------------------------- OHA has developed a plan to reduce infant mortality (which also addresses low infant birth weight and first trimester care) in Ohio which includes: * Safe sleep (infant mortality) * Eliminating elective deliveries before 39 weeks (infant mortality) * Progesterone for high risk mothers (infant mortality) * Eliminating health disparities * Safe spacing (infant mortality and low birth weight) * Access to prenatal care (First trimester care, infant mortality and low birth weight) * Promote breast milk * These program areas also then address increasing first trimester care, improving low birth weight and decreasing infant mortality. Ohio Collaborative to Prevent Infant Mortality. ----------------------------------------------- This group, which is coordinated by the Ohio Department of Health, works together to formulate a statewide strategic plan to reduce infant mortality and birth outcome disparities. Miami Valley Hospital is part of this collaborative. Primary and Chronic Diseases: 4. Alcohol and drug discharge diagnosis In Montgomery County, Alcohol and Drug Abuse services are coordinated by the ADAMHS Board (Alcohol, Drug Addiction and Mental Health Services.) The ADAMHS Board administrates the planning, development, funding and evaluation of behavioral health services delivered by a network of nearly 30 community-based organizations. The ADAMHS Collaborative Coalition issued, "Report to Improve Alcohol and Other Drug Abuse and Addiction Services in Montgomery County, Ohio". This plan includes recommendations for: * Building infrastructure and capacity * Prevention * Building linkages * Treatment * Data sharing Premier Health is involved in these initiatives. James Pancoast, Premier Health President and CEO, is the Co-Chair of the Alcohol and Other Drug Abuse Implementation Advisory Team. In Greene County, the Mental Health and Recovery Board of Clark, Greene and Madison Counties serves a similar purpose. Its mission is to support the system for delivering effective mental health, alcohol and other drug treatment, prevention, education and advocacy services for residents. Key Health Priorities by Objective Priority Area 1: ---------------- Reduce the incidence and complications from adult hypertension. Blood pressure is how hard blood pushes against the walls of our arteries when our heart pumps blood. When someone has high blood pressure, which is also called hypertension, the increased pressure against the arteries causes damage. Hypertension is called the silent killer because usually those who have it do not feel anything. High blood pressure increases risk for heart disease, stroke, heart failure, kidney disease, and blindness. In many cases hypertension can be prevented by maintaining a healthy weight, being active, eating healthy, not using tobacco, and limiting alcohol. Most people who are diagnosed with high blood pressure can have their high blood pressure controlled. Those with high blood pressure should take the same steps that may prevent high blood pressure. If medication is needed, it is imperative to take it every day. Hypertension rates are higher in the service area than in the State and nation. It is the leading inpatient discharge diagnosis and the 3rd leading ED discharge diagnosis. Because of the significant health threat posed by hypertension, a community-focused, population health improvement strategy would benefit all parts of the community. Priority Area 1: Reduce the proportion of adults with hypertension. ------------------------------------------------------------------- Objective 1.1: Increase the proportion of adults with hypertension whose blood pressure is under control. Evidence-based Strategies: * Coordinate a hypertension education health communications campaign that will include commun 3 Dialysis Centers of Dayton LLC 110 N MAIN ST Dayton OH 45402 Dialysis Treatment Lincoln Park Manor 694 Isaac Prugh Way Kettering OH 45429 Assisted Living Jamestown Emergency Center 4940 Cottonville Rd Jamestown OH 45335 Emergency Center PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT FOR MIAMI VALLEY HOSPITAL IS PART OF THE PREMIER HEALTH REPORT. 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: MIAMI VALLEY HOSPITAL (MVH) PROVIDES THE FOLLOWING SUBSIDIZED SERVICE: EMERGENCY SERVICES: MVH OPERATES 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 2015, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $18,639,000. Part II, Line 1: Miami Valley Hospital worked with local businesses to plan revitalization of neighborhood property. The plans included improving access to healthcare for vulnerable patients in our community and continuing to revitalize the housing and overall living conditions to adjacent areas. The amount provided in 2015 was $145,000. In ongoing efforts to improve the economic condition in Dayton and the Miami Valley, the Miami Valley Hospital supported the Omega Community Development Corporations capital campaign project to build and develop a new community center. The center will be located in an under-privileged community where approximately 30% of the families live below the poverty level. The community center will reinforce early learning, inter-generational and family engagement, population health and advocacy and workforce development. Miami Valley Hospital (MVH) contributed $52,000 to this project in 2015. In addition, MVH provided $41,000 in support of the Minority Business Partnership (MBP), a program of the Dayton Area Chamber of Commerce. The MBP is an economic development initiative which seeks to help grow the local economy and strengthen area businesses by leveraging Dayton region minority assets. MBP creates supply chain opportunities for local businesses with an emphasis on minority business participation. Part II, Line 3: The Genesis project is a collaborative effort between MVH, the University of Dayton, PNC Bank, Citywide Development Corporation, County Corp and the City of Dayton to revitalize the Montgomery County Fairgrounds neighborhood. Efforts included removing or rehabilitating deteriorating structures, building new homes, dedicating a social worker for neighborhood residents and funding additional community-based police officers in the neighborhood. The amount contibuted in 2015 for this program was $26,000. In partnership with the University of Dayton and the City of Dayton, the hospital provided funds for the reconstruction of Brown Street between MVH and the University of Dayton. The reconstruction included new base, pavement, sidewalks, curbs, catch basins and street lights. Total funding for this project in 2015 was $122,000. Part II, line 8: Miami Valley Hospital donated $69,000 to the Montgomery County Ohio College Promise organization during 2015 to help develop the Dayton-area workforce. This program provides a life-changing opportunity for up to 50 Montgomery County poverty-stricken students a year. The students are selected during their 8th grade year and are supported through high school by a caring adult mentor who meets weekly with them at their school. Upon successful completion of high school and admission to one of several 4-year university partners, the selected student will be awarded scholarships that will allow them to attend college at little to no cost to them or their families. PART II, LINE 9: Miami Valley Hospital (MVH) provides Community Support by granting Board Members of the hospital with charitable credits to be donated in the name of the board member with priorities to not-for-profit, tax-exempt 501(c)(3) health and human services organizations, arts and culture organizations, as well as other community activities in the Dayton area. Also suggested are organizations that focus on supporting youth, education, underserved groups, and safe neighborhoods. The amount of support provided in 2015 was $386,000. PART III, LINE 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 BACK 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 THAT THERE ARE ACCOUNTS WRITTEN OFF TO BAD DEBT THAT MAY HAVE QUALIFIED FOR CHARITY CARE IF THE PATIENT HAD PROVIDED THE NECESSARY FINANCIAL INFORMATION. IN ORDER 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 $118,809,000 AND INCURRED COST OF $168,206,000, FOR AN ADDITIONAL NET SHORTFALL OF $49,397,000 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) $130,079,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $118,809,000 TOTAL MEDICARE ASSOCIATED REVENUE $248,888,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT (PART III, SECTION B) $145,509,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $168,206,000 TOTAL MEDICARE ASSOCIATED COST $313,715,000 MEDICARE SHORTFALL PER PART III, SECTION B $15,430,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $49,397,000 TOTAL MEDICARE SHORTFALL $64,827,000 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 40% 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. DOCUMENTED 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 COUNSELOR true THE DAYTON FOUNDATION 40 N MAIN ST 500 DAYTON OH 45423 316027287 501(C)(3) 3997970 VARIOUS SINCLAIR COMMUNITY COLLEGE FOUNDATION 444 W 3RD STREET DAYTON OH 45469 310723444 501(C)(3) 420680 CAPITAL RENOVATION & EXPANSION PREMIER COMMUNITY HEALTH co FIDELITY HEALTH 3170 KETTERING BLVD DAYTON OH 45439 311122883 501(C)(3) 366021 COMMUNITY HEALTH UNIVERSITY OF DAYTON 300 COLLEGE PARK DAYTON OH 45469 310536715 501(C)(3) 260000 CYBERSECURITY & DATA INTELLIGENCE VICTORIA THEATRE ASSOCIATION 138 N MAIN ST DAYTON OH 45402 310897638 501(C)(3) 235820 Support AIDS RESOURCE CENTER 15 W FOURTH ST 200 DAYTON OH 45402 311126780 501(C)(3) 149549 VARIOUS AMERICAN HEART ASSOCIATION 5211 MADISON RD CINCINNATI OH 45227 135613797 501(C)(3) 145080 Support MILLER VALENTINE 137 N MAIN ST DAYTON OH 45402 200785272 NONE 144981 COMMUNITY DEVELOPMENT REACH OUT MONTGOMERY COUNTY 25 E FORAKER ST DAYTON OH 45409 311434282 501(C)(3) 128661 RX ASSISTANCE FOR INDIGENT PATIENTS CITY OF DAYTON 335 W THIRD STREET DAYTON OH 45402 316000175 GOVERNMENT 122312 POLICE PROGRAM CITIZENS FOR SINCLAIR 120 W SECOND ST 614 DAYTON OH 45402 611529465 NONE 104000 Support MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311040231 501(C)(3) 53664 Support OMEGA COMMUNITY DEVELOPMENT 1800 HARVARD BLVD DAYTON OH 45406 311561713 501(C)(3) 53300 SUPPORT DAYTON AREA CHAMBER OF COMMERCE 1 CHAMBER PLAZA 5TH MAIN DAYTON OH 45402 310257370 501(C)(6) 41400 MINORITY SUPPORT GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON 110 N MAIN ST 500 DAYTON OH 45402 237296923 501(C)(3) 32630 Support ATRIUM MEDICAL CENTER FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311079213 501(C)(3) 31252 SUPPORT CITYWIDE DEVELOPMENT CORPORATION 8 N MAIN ST DAYTON OH 45402 310821189 501(C)(4) 25800 GENESIS PROJECT & DOWNTOWN DAYTON MIDDLETOWN COMMUNITY FOUNDATION 300 N MAIN ST 300 MIDDLETOWN OH 45042 310898380 501(C)(3) 20020 SUPPORT PROJECT HOPE 1510 N MAIN ST DAYTON OH 45405 341421548 501(C)(3) 18200 SUPPORT UNITED WAY OF THE GREATER DAYTON AREA 33 W THIRD ST 500 DAYTON OH 45402 310536658 501(C)(3) 17940 SUPPORT UVMC FOUNDATION 110 N MAIN ST 500 DAYTON OH 45402 311581859 501(C)(3) 16705 SUPPORT DAYTON CONTEMPORARY DANCE COMPANY 840 GERMANTOWN ST DAYTON OH 45402 237220259 501(C)(3) 16640 SUPPORT DAYBREAK 605 S LUDLOW ST DAYTON OH 45410 310864474 501(C)(3) 15990 SUPPORT OHIO HOSPITAL ASSOCIATION 155 E BROAD ST 301 COLUMBUS OH 43215 314270340 501(C)(6) 13000 SUPPORT AMERICAN CANCER SOCIETY 2808 READING RD CINCINNATI OH 45206 340726080 501(C)(3) 10660 SUPPORT GOODWILL EASTER SEALS 660 S MAIN STREET DAYTON OH 45402 310537112 501(C)(3) 10057 SUPPORT CULTURE WORKS 110 N MAIN ST 165 DAYTON OH 45402 237412338 501(C)(3) 9880 SUPPORT YWCA OF DAYTON 141 W THIRD ST DAYTON OH 45402 310537168 501(C)(3) 9100 SUPPORT SAINT PETER CATHOLIC CHURCH 6161 CHAMBERSBURG RD HUBER HTS OH 45424 310626310 501(C)(3) 8840 SUPPORT COUNTRYSIDE YMCA 1699 DEERFIELD RD LEBANON OH 45036 510181689 501(C)(3) 8840 SUPPORT HEALTH PARTNERS FREE CLINIC 1300 N COUNTY RD 25A TROY OH 45373 311596731 501(C)(3) 8320 SUPPORT PARITY INC PO BOX 60624 DAYTON OH 45406 311345623 501(C)(3) 7540 SUPPORT WRIGHT STATE UNIVERSITY 3640 COLONEL GLENN HWY DAYTON OH 45402 310732831 501(C)(3) 6800 SUPPORT THE HUMAN RACE THEATRE COMPANY 126 N MAIN ST 300 DAYTON OH 45402 311176135 501(C)(3) 6760 SUPPORT COUNTYLINE CHRISTIAN ASSOCIATION 203 E MAIN ST BRADFORD OH 45308 311484771 501(C)(3) 6760 SUPPORT MUSE MACHINE INC 126 N MAIN ST 310 DAYTON OH 45402 311028673 501(C)(3) 6500 SUPPORT HOSPICE OF DAYTON 324 WILMINGTON AVE DAYTON OH 45420 310933339 501(C)(3) 6320 SUPPORT SOUTHBROOK CHRISTIAN CHURCH 9095 WASHINGTON CHURCH MIAMISBURG OH 45342 311170733 501(C)(3) 6240 SUPPORT SC MINISTRY FOUNDATION 345 NEEB RD CINCINNATI OH 45233 311185570 501(C)(3) 6240 SUPPORT MARCH OF DIMES 3280 SUMMIT RIDGE PKWY DULUTH GA 30096 131846366 501(C)(3) 5980 SUPPORT SALVATION ARMY - DAYTON 1000 N KEOWEE ST DAYTON OH 45404 135562351 501(C)(3) 5954 SUPPORT PIQUA EDUCATION FOUNDATION 719 E ASH ST PIQUA OH 45356 311117501 501(C)(3) 5889 SUPPORT MIAMI VALLEY COUNCIL BSA 4999 NORTHCUTT PLACE DAYTON OH 45413 310537124 501(C)(3) 5720 SUPPORT DAYTON EARLY COLLEGE ACADEMY 300 COLLEGE PARK AVENUE DAYTON OH 45469 260463618 501(C)(3) 5460 SUPPORT FOODBANK INC 56 ARMOR PLACE DAYTON OH 45417 861082880 501(C)(3) 5460 SUPPORT GALA OF HOPE FOUNDATION 3500 PENTAGON BLVD BEAVERCREEK OH 45431 464277044 501(C)(3) 5200 SUPPORT WACO HISTORICAL SOCIETY INC 1865 S COUNTY RD 25A TROY OH 45373 310969657 501(C)(3) 5200 SUPPORT 42 5 SCHEDULE I, 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 CHRISTOPHER J DANIS MD BOARD CHAIR 0 357716 0 0 0 5354 0 9086 0 23174 0 395330 0 0 MARK S SHAKER PRESIDENT & CEO 542207 0 153918 0 160171 0 28201 0 4347 0 888844 0 0 0 MARY M CLANCY COO 375335 0 91082 0 28902 0 26749 0 14266 0 536334 0 0 0 JAMES R PANCOAST TRUSTEE / PREMIER PRESIDENT 0 1019394 0 395850 0 390455 0 33677 0 24416 0 1863792 0 0 MARC R BELCASTRO MD TRUSTEE & CHIEF OF STAFF 170298 3263 0 0 0 0 335 0 0 0 170633 3263 0 0 JAMES M PACENTA MD TRUSTEE 0 480029 0 101266 0 110674 0 10330 0 26873 0 729172 0 0 CARA W POWERS BOARD SECRETARY 231740 0 76837 0 644 0 22738 0 25147 0 357106 0 0 0 LISA A GIBBS-SEE SCH O BOARD TREASURER & CFO 185461 0 31151 0 1006 0 6087 0 14191 0 237896 0 0 0 MARK E WILLIAMS MD CMO 387466 0 105718 0 19689 0 9759 0 25246 0 547878 0 0 0 ROBERT M BOWMAN VP - HOSPITAL OPERATIONS 224145 0 37805 0 2779 0 20415 0 26201 0 311345 0 0 0 DALE E CREECH SYSTEM VP - CLO 395325 0 127297 0 102136 0 34542 0 26096 0 685396 0 0 0 THOMAS R CURTIN SYSTEM VP - REVENUE CYCLE 0 217857 0 55160 0 3260 0 8232 0 29091 0 313600 0 0 GARY G GINTER SYSTEM VP - CIO 351975 0 139106 0 2296 0 26339 0 27380 0 547096 0 0 0 KIMBERLY A HENSLEY VP - HOSPITAL OPERATIONS 224871 0 47115 0 1344 0 26749 0 12763 0 312842 0 0 0 BARBARA A JOHNSON SYSTEM VP - HR OPERATIONS 372517 0 106120 0 12618 0 7701 0 9788 0 508744 0 0 0 TAMMY S LUNDSTROM SYSTEM VP - CMO 519002 0 131441 0 6225 0 8908 0 1585 0 667161 0 0 0 THOMAS R PARKER SYS VP-CHF EXPERIENCE OFFICER 0 369184 0 87253 0 25061 0 26354 0 11956 0 519808 0 0 JOANN R RINGER VP - COO MVH SOUTH 275583 0 49866 0 34545 0 29337 0 3462 0 392793 0 0 0 CRAIG SELF SYSTEM VP - CSO 0 314509 0 64068 0 1893 0 11333 0 26622 0 418425 0 0 MARK W SHAW SYSTEM VP - MANAGED CARE 282789 0 65769 0 44967 0 35804 0 25376 0 454705 0 0 0 SCOTT A SHELTON SYSTEM VP - CPO 250217 0 50865 0 12445 0 25280 0 4002 0 342809 0 0 0 SYLVAIN TREPANIER DNP RN CENP SYSTEM VP - CNO 329769 0 55449 0 1240 0 7971 0 9754 0 404183 0 0 0 JOLYN M ANGUS VP HOSP OPS/CHIEF NSG OFFICER 246644 0 48332 0 5355 0 3764 0 27159 0 331254 0 0 0 DIANE L EWING VP COMMUNICATIONS 267843 0 73838 0 5607 0 9575 0 9444 0 366307 0 0 0 MOLLY J HALL VP - ACADEMIC AFFAIRS 371254 0 129997 0 33165 0 9679 0 2308 0 546403 0 0 0 WALTER REILING JR MD CHIEF MEDICAL INFO OFFICER 313869 0 53413 0 4236 0 9261 0 28061 0 408840 0 0 0 J MICHAEL SIMS VP FINANCE 236555 0 65613 0 28194 0 28062 0 27980 0 386404 0 0 0 RENEE P GEORGE FORMER KEY EMPLOYEE 0 253960 0 45640 0 632 0 9526 0 11474 0 321232 0 0 J NICK LAIR FORMER KEY EMPLOYEE 0 224436 0 41191 0 28687 0 21914 0 24658 0 340886 0 0 GEOFFREY P WALKER FORMER BOARD SECRETARY 233665 0 73540 0 18445 0 56849 0 25854 0 408353 0 0 0 SCHEDULE J, 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, MIAMI VALLEY HOSPITAL (MVH) AND ITS AFFILIATED ORGANIZATIONS COMPENSATES FOR THIS LIMITATION AND SUPPLEMENTS THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. MVH 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 2015. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2015: ROBERT BOWMAN $518; MARY CLANCY $24,100; DALE CREECH $94,589; MOLLY HALL $7,729; BARBARA JOHNSON $5,674; NICK LAIR $9,733; JOANN RINGER $29,876; MARK SHAKER $132,010; MARK SHAW $37,161; SCOTT A. SHELTON $8,625; J. MICHAEL SIMS $7,761; GEOFFREY WALKER $15,612. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2015: JAMES PANCOAST $353,371. 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: Lisa Gibbs serves as an officer for both Miami Valley Hospital and another unrelated hospital. However, 100% of her compensation is paid by Miami Valley Hospital. Lisa Gibbs spends approximately one-half of her working hours at each Hospital. The compensation reported on Schedule J includes all of her reportable compensation, even though Miami Valley Hospital is reimbursed by the unrelated hospital for her time spent at that institution. A COUNTY OF MONTGOMERY OH 316000172 613549GP3 2008-11-13 234895988 SEE PART VI - Note A false false false B COUNTY OF MONTGOMERY OH 316000172 613549GZ1 2009-02-24 126463824 SEE PART VI - Note B false false false C COUNTY OF MONTGOMERY OH 316000172 613549JL9 2011-04-12 106431124 SEE PART VI - Note C false false false D COUNTY OF MONTGOMERY OH 316000172 613549JX3 2011-04-26 85000000 SEE PART VI - Note C false false false A 148425000 0 234895988 0 0 0 2119000 0 0 33745109 198698053 333826 2008 true false true true B 115000000 0 126463824 0 0 0 2293824 0 0 0 124170000 0 2009 true false true true C 2700000 0 106431124 0 0 0 1203000 0 0 105228124 0 0 2011 false false true true D 0 0 85000000 0 0 0 727500 0 0 84272499 0 1 2011 false false true true A false true false false 0.00704 0.00000 0.00704 false false false true B false true false false 0.00704 0.00000 0.00704 false false false true C false false false false 0 false false false true D false false false false 0 false false false true A false false false true true true MERRILL LYNCH true true false 0 false true B false false false true false false 0 false 0 false true C false true false false false true BARCLAYSWELLS FARGO 21. true false false 0 false true D false true false false true true BARCLAYSWELLS FARGO 30.5 true false false 0 false true A true B true C true D true NOTE A, PART 1, LINE A, COLUMN F REFUND MIAMI VALLEY HOSPITAL BOND SERIES 1992B, 1998A, 2003A, 2003B, & 2003C, AND TO PROVIDE FUNDS TO CONSTRUCT THE SOUTH EAST TOWER ON THE HOSPITAL'S CAMPUS. NOTE B, PART I, LINE B, COLUMN F REFUND PORTION OF MIAMI VALLEY HOSPITAL SERIES 2008A AND 2008B BONDS. NOTE C, PART 1, LINE C & D, COLUMN F PROVIDE FUNDS TO CONSTRUCT THE SOUTH EAST TOWER ON THE HOSPITAL'S CAMPUS. Note D, PART 1, LINE A, COLUMN F: REFUND MIAMI VALLEY HOSPITAL SERIES 2009A BONDS. PART IV, ARBITRAGE, LINE 2C: COMPUTATION DATE WAS NOVEMBER 13, 2013 FOR THE 2008ABC COMPUTATION DATE WAS NOVEMBER 17, 2014 FOR THE 2009AB. A COUNTY OF MONTGOMERY OH 316000172 2012-11-20 128640000 SEE PART VI - Note D false false false A 3000000 0 128640000 0 0 0 375517 0 0 0 128264483 0 2012 false true true true A false true false false 0.00704 0.00000 0.00704 false false false true A false true false false true true PNCDEUTSCHE BANK 24. true false false 0 false true A true ROBERT BOWMAN SPOUSE 69208 INFECTION PREVENT SPEC SALARY false LISA GIBBS CHILD 46892 CAP ACQ SOURCING BUYER SALARY false ROBERT BOWMAN CHILD 13925 PATIENT CARE TECH SALARY false FORM 990, PART VI, SECTION A, QUESTION 2: Mary M. Clancy (trustee) and Thomas R. Curtin (Key Employee) are both on the board of Compunet Clinical Laboratory. FORM 990, PART VI, SECTION A, QUESTION 3: PREMIER HEALTH (PREMIER) AS THE OPERATOR OF MIAMI VALLEY HOSPITAL (MVH) DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR MVH, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. MVH SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. MVH SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. MVH SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF MVH WITH ALL THIRD PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO INSURERS. MVH 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. MVH 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, QUESTION 6: MIAMI VALLEY HOSPITAL HAS TWO CORPORATE MEMBERS. ONE MEMBER IS MEDAMERICA HEALTH SYSTEMS, THE PARENT COMPANY OF THE HOSPITAL. THE SECOND MEMBER IS PREMIER HEALTH, AN OHIO NON-PROFIT CORPORATION FORMED PURSUANT TO THE JOINT OPERATING AGREEMENT. MEDAMERICA HEALTH SYSTEMS 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, QUESTION 7A: MEDAMERICA HEALTH SYSTEMS (MAHS) HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR MIAMI VALLEY HOSPITAL (MVH). FROM AMONG THOSE RECOMMENDED BY THE NOMINATING COMMITTEE SET FORTH IN THE JOINT OPERATING AGREEMENT. MAHS HAS THE AUTHORITY TO REMOVE TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. PREMIER HEALTH (PREMIER) HAS THE RIGHT TO REQUEST THAT MAHS REMOVE A TRUSTEE OF MVH IF PREMIER HAS DETERMINED THAT SUCH TRUSTEE IS FRUSTRATING THE GOALS AND PURPOSES OF PREMIER'S NETWORK. SUCH REMOVAL SHALL NOT BE UNREASONABLY REFUSED BY MAHS. FORM 990, PART VI, SECTION A, QUESTION 7B: SEE THE RESPONSE ABOVE FOR FORM 990, PART VI, SECTION A, QUESTION 3. FORM 990, PART VI, SECTION B, QUESTION 11B: THIS 990 TAX RETURN AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE TAX DEPARTMENT OF PREMIER HEALTH (PREMIER), OF WHICH MIAMI VALLEY HOSPITAL IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE TAX MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. THE RETURN IS CONCURRENTLY SENT TO ERNST & YOUNG U.S. LLP FOR THEIR REVIEW. AFTER ALL CHANGES FROM THE ABOVE GROUPS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER AND THE CHIEF FINANCIAL OFFICER OF THIS ENTITY. A FINAL VERSION OF THE RETURN IS SENT TO ERNST & YOUNG U.S. LLP FOR A FINAL REVIEW AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT A BOARD OF TRUSTEES MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESSES ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 TAX RETURN IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, QUESTION 12C: PREMIER HEALTH (PREMIER), OF WHICH MIAMI VALLEY HOSPITAL IS AN AFFILIATE, 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, QUESTION 15A AND 15B: COMPENSATION TO MIAMI VALLEY HOSPITALS (MVH) CEO IS REVIEWED AND APPROVED BY PREMIER HEALTH (PREMIER), WITH WHICH MVH 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 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, QUESTION 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, LINE 1A, Item 17: Lisa Gibbs serves as an officer for both Miami Valley Hospital and another unrelated hospital. However, 100% of her compensation is paid by Miami Valley Hospital. Lisa Gibbs spends approximately one-half of her working hours at each Hospital. The compensation reported on Part VII includes all of her reportable compensation, even though Miami Valley Hospital is reimbursed by the unrelated hospital for her time spent at that institution. Part VII, Section A, System Key Employees: The System Key Employees' total compensation amount is accurately reported on the various entities they serve. If the System Key Employee's compensation is paid by an unrelated organization, their compensation is being reported as related compensation to avoid the erroneous perception that these individuals are being paid identical amounts by multiple parties. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS (35,345,156) PENSION FASB 158 ADJUSTMENT DIALYSIS CENTERS OF DAYTON LLC 110 N MAIN ST SUITE 500 DAYTON OH 45402 311607686 DIALYSIS OH 5522862 8883043 MVH PREMIER HEALTH 110 N MAIN ST SUITE 500 DAYTON OH 45402 311446699 SUPPRTG. ORG. OH 501(C)(3) 11A I NA false MEDAMERICA HEALTH SYSTEMS CORP (MAHS) 110 N MAIN ST SUITE 500 DAYTON OH 45402 311040228 PARENT OH 501(C)(3) 11C III FI NA false MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST SUITE 500 DAYTON OH 45402 311040231 Foundation OH 501(C)(3) 7 MAHS true PREMIER COMMUNITY HEALTH C/O FIDELITY 3170 KETTERING BLVD DAYTON OH 45439 311122883 Health Educat OH 501(C)(3) 9 FHC true FIDELITY HEALTH CARE 3170 KETTERING BLVD DAYTON OH 45439 311075381 HOME HEALTH OH 501(C)(3) 9 MAHS true Premier Plaza LLC 110 N Main St 500 Dayton OH 45402 800708185 Holding Compa OH MAHS EXCLUDED -8895 168844 false 0 false 0.02000 SOUTHWEST OHIO NEONATAL COLLABORATIVE 110 N MAIN ST 500 DAYTON OH 45402 463231330 NEONATOLOGY OH CHILDRENS MEDIC EXCLUDED 0 0 false 0 false 0.61500 MVHE INC 110 N MAIN ST SUITE 400 DAYTON OH 45402 311185270 PHYS SVCS OH MAHS CORPORATION 0 0 0.00000 true PREMIER HEALTH SPECIALISTS INC 110 N MAIN ST SUITE 400 DAYTON OH 45402 061744704 PHYS SVCS OH MAHS CORPORATION 0 0 0.00000 true false true true false false false false false false true true true true false true true true true true FIDELITY HEALTH CARE C 1000000 FMV FIDELITY HEALTH CARE O 1195568 FMV FIDELITY HEALTH CARE Q 6236199 FMV FIDELITY HEALTH CARE R 124729 FMV FIDELITY HEALTH CARE S 1321063 FMV MIAMI VALLEY HOSPITAL FOUNDATION C 614178 FMV MIAMI VALLEY HOSPITAL FOUNDATION Q 684062 FMV MIAMI VALLEY HOSPITAL FOUNDATION R 401082 FMV MVHE INC B 12042973 FMV MVHE INC C 478122 FMV MVHE INC O 250401 FMV MVHE INC Q 9003310 FMV MVHE INC S 1410245 FMV PREMIER COMMUNITY HEALTH C 5000001 FMV PREMIER COMMUNITY HEALTH J 58687 FMV PREMIER COMMUNITY HEALTH R 360000 FMV PREMIER HEALTH B 1040888 FMV PREMIER HEALTH SPECIALISTS B 29780305 FMV PREMIER HEALTH SPECIALISTS M 2248113 FMV PREMIER HEALTH SPECIALISTS O 1905372 FMV PREMIER HEALTH SPECIALISTS Q 9081182 FMV PREMIER HEALTH SPECIALISTS R 244185 FMV PREMIER HEALTH SPECIALISTS S 174932 FMV PREMIER PLAZA LLC K 1933113 FMV