2015-11-13T16:08:21-06:00 2014-12-31 ERNST & YOUNG US LLP 800 YARD ST 200 GRANDVIEW HEIGHTS OH 43212 990 2014-01-01 310537504 Miami Valley Hospital % J MICHAEL SIMS MIAM 9374999942 110 N MAIN ST 500 Dayton OH 45402 LISA A GIBBS VICE PRESIDENT & CFO 6142245678 2015-11-05 true DIANE L BEAN P00104972 6142245678 2014 2016-03-07 17:11:31Z Mark Shaker 110 N MAIN ST SUITE 500 DAYTON OH 45402 1234020760 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. 12 6 7142 756 0 0 2132786 1267479 783525711 810326961 32688738 29383034 36007842 12950814 854355077 853928288 11321408 6996495 0 0 378436847 358735989 0 0 0 392396992 441197514 782155247 806929998 72199830 46998290 1467588789 1477252193 680566074 802871708 787022715 674380485 MIAMI VALLEY HOSPITAL WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH CARE SERVICES. false false 696587804 6996495 810326961 PLEASE REFER TO SCHEDULE H. 696587804 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 true false false false false true true true true false false true 377 0 true 7142 true false false false false false false false false false false X 12 6 false true false false true true true true true false false true true true true true true true true true true OH X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 500 Dayton OH 45402 X ANITA J MOORE BOARD CHAIR 0.5 1.0 X X 0 0 0 JAMES M PACENTA MD TRUSTEE 0.5 39.5 X 0 670555 32922 ANGELA CLEMENTS CPA TRUSTEE 0.5 0.0 X 0 0 0 WILLIAM L GILLISPIE TRUSTEE 0.5 0.0 X 0 0 0 DAVID W KEY MD TRUSTEE 0.5 0.0 X 0 0 0 MARY C NUTTER TRUSTEE 0.5 0.0 X 0 0 0 KEITH BRICKING MD TRUSTEE & CHIEF OF STAFF ELECT 0.5 0.0 X 20520 0 0 JAMES J MURPHY MD TRUSTEE &CHF OF STAFF (TO JUN) 0.5 0.5 X 2500 0 0 CHRISTOPHER DANIS MD TRUSTEE 0.5 39.5 X 0 359839 29511 MARC R BELCASTRO MD TRUSTEE & CHF STAFF (FROM JUN) 0.5 0.5 X 54450 0 0 JACK LOHBECK TRUSTEE 0.5 0.0 X 0 0 0 JAMES R PANCOAST TRUSTEE / PREMIER PRES & CEO 8.0 6.5 X 0 1239223 59975 MARK S SHAKER PRESIDENT & CEO 40.0 0.0 X X 750334 0 166845 SCOTT A SHELTON TREASURER/CFO (TO SEP) 8.0 31.5 X 250720 184646 38447 MARY M CLANCY CHIEF OPERATING OFFICER 40.0 0.0 X 496587 0 69115 CARA W POWERS BOARD SECRETARY 39.5 0.5 X 255982 0 48736 LISA A GIBBS - See Sched O TREASURER/CFO (FROM OCT) 20.0 0.0 X 34127 0 3686 MARK E WILLIAMS MD CHIEF MEDICAL OFFICER 40.0 0.0 X 455662 0 35187 BARBARA A JOHNSON SYSTEM VP - HR OPERATIONS 8.0 32.0 X 462639 0 21525 DALE E CREECH SYSTEM VP - CLO 7.25 31.75 X 576691 0 155680 RENEE P GEORGE SYS VP-REVENUE CYCLE (TO SEP) 8.0 32.0 X 262907 0 21843 MARK W SHAW SYSTEM VP - MANAGED CARE 8.0 32.0 X 388917 0 99374 MICHAEL MAIBERGER SYSTEM SR VP - CSO 8.0 32.0 X 0 564224 46894 ROBERT M BOWMAN VP - HOSPITAL OPERATIONS 40.0 0.0 X 258207 0 50474 KIMBERLY A HENSLEY VP - HOSPITAL OPERATIONS 40.0 0.0 X 256203 0 42969 JOANN R RINGER VP - COO MVH SOUTH 40.0 0.0 X 356950 0 65372 THOMAS A NASH SYSTEM VP - CPO (TO JUL) 8.0 32.0 X 284206 0 111206 TAMMY S LUNDSTROM SYSTEM VP - CMO 8.0 32.0 X 614198 0 9696 THOMAS R CURTIN SYS VP-REVENUE CYCLE (FRM SEP) 8.0 32.0 X 0 232395 53830 GARY G GINTER SYSTEM VP - CIO 8.0 32.0 X 338708 0 41276 THOMAS R PARKER SYSTEM VP - SERVICE LINES 8.0 32.0 X 0 454750 28492 SYLVAIN TREPANIER DNP RN CENP SYSTEM VP - CNO 8.0 32.0 X 354001 0 13675 GARY S COLLIER VP CLINICAL CONSULTING 40.0 0.0 X 329761 0 161409 MOLLY J HALL VP - ACADEMIC AFFAIRS 40.0 0.0 X 522341 0 18878 J MICHAEL SIMS VP FINANCE 39.5 0.5 X 321853 0 66423 DIANE L EWING VP COMMUNICATIONS 40.0 0.0 X 317747 0 19214 WALTER REILING JR MD CHIEF MEDICAL INFO OFFICER 40.0 0.0 X 349065 0 37860 BOBBIE L GERHART FORMER PRESIDENT & CEO 0.0 0.0 X 262638 0 46 GEOFFREY P WALKER FORMER OFFICER 40.0 0.0 X 298974 0 70398 WILLIAM E LINESCH FORMER KEY EMPLOYEE 40.0 0.0 X 306670 0 37851 J NICK LAIR FORMER KEY EMPLOYEE 0.0 40.0 X 0 291654 60819 DIANE L PLEIMAN FORMER KEY EMPLOYEE 40.0 0.0 X 263309 0 31696 9446867 3997286 1751324 220 true true false COMPUNET CLINICAL LABORATORIES 2308 SANDRIDGE DR MORAINE OH 45349 CLINICAL LAB 21120936 ANESTHESIOLOGY SERVICES NETWORK PO BOX 349 DAYTON OH 45409 Medical Services 6973258 MIAMI VALLEY EMERGENCY SPECIALISTS 2400 MIAMI VALLEY WAY 220 CENTERVILLE OH 45459 Medical Services 8359055 EVOLENT HEALTH INC 800 N GLEBE RD 500 ARLINGTON VA 22203 SOFTWARE IMPLEMENT 25582589 WRIGHT STATE UNIVERSITY 3640 COLONEL GLEN HWY 430 DAYTON OH 45435 MEDICAL SERVICES 10278985 93 1179854 87625 1267479 NET PATIENT REVENUE 900099 414955780 414955780 MEDICARE/MEDICAID 900099 376944563 376944563 HOSPITAL FRANCHISE TAX RECOVERIES 900099 17717109 17717109 PURCHASE DISCOUNTS 900099 128759 128759 HEALTH EDUCATION 900099 77160 77160 503590 503590 810326961 8244640 8244640 0 0 4424851 2024895 2399956 0 2399956 2399956 393308148 662766 372832520 20475628 662766 21138394 21138394 0 0 6242185 5235057 1007128 1007128 CAFETERIA SALES 812930 5401985 5401985 PARKING GARAGE 900099 1590223 1590223 JOINT VENTURES 900099 121271 121271 2430251 2430251 9543730 853928288 810326961 42333848 6996495 6996495 0 0 0 7561308 6485335 1075973 0 705299 604935 100364 273305556 234414175 38891381 18506270 15872828 2633442 37969770 32566672 5403098 20687786 17743914 2943872 81000 69474 11526 2793942 2396364 397578 222304 222304 51974 51974 0 1295886 1295886 37487867 37487867 4106064 4106064 4078083 3497772 580311 15354814 13169824 2184990 0 19627849 16834806 2793043 533844 457878 75966 0 4121 3535 586 10477854 10477854 0 73296595 62866490 10430105 5238902 4493406 745496 OPERATING SUPPLIES 135506239 135506239 PURCHASED SERVICES 54332570 46601045 7731525 LOSS ON INTEREST SWAP ADJ 25544194 25544194 JOINT OPERATING AGREEMENT 24519000 21029946 3489054 26644412 22852912 3791500 806929998 696587804 110342194 0 30110 29980 52490524 51799574 0 0 123951353 133391182 0 0 0 0 3078325 3339528 6904712 8377513 10679656 12650384 1265922085 651465086 641013820 614456999 426179064 430123261 153989569 192227372 0 0 9534039 9470134 39737617 21386266 1467588789 1477252193 74399877 68793045 3139995 3775147 1685764 1637755 423884455 418538301 0 0 0 0 14976182 10354755 0 0 162479801 299772705 680566074 802871708 X 787022715 674380485 0 0 0 0 787022715 674380485 1467588789 1477252193 X 46998290 -7049885 -152590635 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 37600 false false true 13770 51370 false PART II-B, LINE 1F: PORTION OF DUES PAID TO GREATER DAYTON AREA HOSPITAL ASSOCIATION, DAYTON DEVELOPMENT COALITION, AMERICAN HOSPITAL ASSOCIATION, AND OHIO HOSPITAL ASSOCIATION. PART II-B, LINE 1I: WE CONTRACT WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. 35978435 35978432 692894251 346801172 346093079 5068772 2000939 3067833 502613238 302662975 199950263 29367392 29367392 614456999 ALTERNATE INVESTMENTS 192227372 F 192227372 0 PENSION OBLIGATION 197113935 SWAP LIABILITY 25872460 MALPRACTICE INSURANCE 25151935 JOINT OPERATING AGREEMENT 24513000 AFFILIATES PAYABLE 13822830 LOAN GUARANTEE & OTHER LTL 4868560 HOSPITAL FRANCHISE TAX PAYABLE 3322997 OTHER 5106988 299772705 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. TAXES PAYABLE AT DECEMBER 31, 2014 AND 2013 FOR SUCH UNRELATED BUSINESS ACTIVITIES ARE NOT SIGNIFICANT. PREMIER, MAHS, SHP, AHS, AND UVMC ALSO OWN OR CONTROL CERTAIN SUBSIDIARIES, WHICH ARE FOR PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. THESE ARE: PREMIER HEALTH INSURING COMPANY (PHIC) (A WHOLLY OWNED SUBSIDIARY OF PREMIER HEALTH) PREMIER HEALTH PLAN (PHPLAN) (A WHOLLY OWNED SUBSIDIARY OF PHIC) MVHE, INC AND PREMIER HEALTH SPECIALISTS, INC. (FORMERLY HEALTH SPECIALISTS OF DAYTON, INC.) (SUBSIDIARIES OF MAHS) SAMARITAN FAMILY CARE (SUBSIDIARY OF SHP) AND SAMARITAN NORTH SURGERY CENTER LIMITED (A JOINT-VENTURE PARTNERSHIP OF WHICH GSH IS AN 80% OWNER) MIDDLETOWN SURGERY CENTER, LLC (A JOINT VENTURE PARTNERSHIP OF WHICH AMC IS AN 80.5% OWNER) (SUBSIDIARY OF AHS) UVMC MANAGEMENT CORPORATION AND AFTER HOURS FAMILY CARE, INC. (SUBSIDIARIES OF UVMC) MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS. 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X X true true X X X true X X 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 2014, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $18,507,000. Part II, Line 1: Miami Valley Hospital (MVH) participates in the following community building activity: The Genesis Project is a collaborative effort between the hospital, 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. PART II, LINE 9: MIAMI VALLEY HOSPITAL (MVH) PROVIDES OTHER COMMUNITY BUILDING ACTIVITIES INCLUDING THE FOLLOWING: 1. BOARD CHARITABLE CREDIT FUND: AS PART OF MIAMI VALLEY HOSPITAL'S COMMUNITY PARTNERSHIP ACTIVITY, BOARD MEMBERS OF THE HOSPITAL ARE GRANTED 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 2014 WAS $252,000. 2. NICHE: MIAMI VALLEY HOSPITAL PROVIDES 100% SUPPORT TO THIS PROGRAM. NICHE IS A GERIATRICS PROGRAM THAT SUPPORTS PROVIDING HEALTHCARE FOR THE ELDERLY. THE AMOUNT PROVIDED IN 2014 WAS $138,000. 3. UNITED WAY: MIAMI VALLEY HOSPITAL PROVIDED $63,000 SUPPORT TO THIS PROGRAM IN 2014. 4. CITY OF DAYTON: MIAMI VALLEY HOSPITAL (MVH) PAYS FOR TWO COMMUNITY POLICE PATROL OFFICERS IN THE NEIGHBORHOOD WHERE THE HOSPITAL IS LOCATED IN AN EFFORT TO MAKE THE AREA SAFER FOR OUR PATIENTS. MVH ALSO JOINED WITH THE UNIVERSITY OF DAYTON AND THE CITY OF DAYTON TO FUND THE BROWN STREET RECONSTRUCTION PROJECT. THE AMOUNT OF SUPPORT PROVIDED IN 2014 WAS $325,000. 5. MIAMI VALLEY HOSPITAL ALSO PROVIDED SUPPORT TO VARIOUS OTHER PROGRAMS AND LOCAL NOT-FOR-PROFIT ORGANIZATIONS TO BENEFIT THE COMMUNITY. THE AMOUNT CONTRIBUTED IN 2014 WAS $541,000. 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 $109,297,000 AND INCURRED COST OF $143,873,000, FOR AN ADDITIONAL NET SHORTFALL OF $34,576,000 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) $137,513,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $109,297,000 TOTAL MEDICARE ASSOCIATED REVENUE $246,810,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT (PART III, SECTION B) $142,683,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B $143,873,000 TOTAL MEDICARE ASSOCIATED COST $286,556,000 MEDICARE SHORTFALL PER PART III, SECTION B $5,170,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $34,576,000 TOTAL MEDICARE SHORTFALL $39,746,000 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 39% 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 COUNSELORS MEET WITH INPATIENT, OUTPATIENT, SELF-PAY, AND OTHER PATIENTS UPON REQUEST WHO MAY NEED FINANCIAL ASSISTANCE. IN ADDITION TO ASSISTING PATIENTS WHO WANT TO APPLY FOR ASSISTANCE THROUGH THE MEDICAID PROGRAM, THE FINANCIAL COUNSELOR WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION. PART VI, LINE 2: The organization works with the community on programs that address the underlying causes of persistent health problems as part of a comprehensive strategy to improve the health status and quality of life for identified members of the community who are economically disadvantaged, disenfranchised and/or who have disproportionate unmet health needs. The organization strives to work with Premier Health, the Miami Valley Hospital Board of Directors, executive management, managers, staff members, community groups, and individuals to provide a collaborative approach to the governance and management of community benefit activities. PART VI, LINE 3: THERE ARE SEVERAL WAYS IN WHICH OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR SERVICES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FIRST, NOTIFICATION OF SUCH AVAILABLE ASSISTANCE IS CLEARLY POSTED IN REGISTRATION AREAS, AS WELL AS MATERNITY AND EMERGENCY DEPARTMENTS. NEXT true THE DAYTON FOUNDATION 40 N MAIN ST 500 DAYTON OH 45423 316027287 501(C)(3) 4148070 VARIOUS Greater Dayton Regional Transit Authority 4 S MAIN ST DAYTON OH 45402 237182735 Government 650000 Community Development PREMIER COMMUNITY HEALTH C/O FIDELITY HEALTH CARE 3832 KETTERING BLVD DAYTON OH 45439 311122883 501(C)(3) 551154 COMMUNITY HEALTH CITY OF DAYTON 335 W THIRD ST DAYTON OH 45402 316000175 GOVERNMENT 324658 Good Neighbor Police Program and Brown Street Reconstruction. Dayton Performing Arts Alliance 109 N MAIN ST 200 DAYTON OH 45402 316000101 501(C)(3) 129846 Support Goodwill Easter Seals 660 S MAIN STREET DAYTON OH 45402 310537112 501(C)(3) 109650 Support AIDS Resource Center Ohio 15 W FOURTH ST 200 DAYTON OH 45402 311126780 501(C)(3) 44625 Various CITYWIDE DEVELOPMENT CORPORATION 8 N MAIN ST DAYTON OH 45402 310821189 501(C)(4) 43850 GENESIS PROJECT DOWNTOWN DAYTON Dayton Art Institute 456 BELMONTE PARK N DAYTON OH 45405 310537480 501(C)(3) 26774 Support Culture Works 110 N MAIN STREET 165 DAYTON OH 45402 237412338 501(C)(3) 24719 Support Atrium Medical Center Foundation ONE MEDICAL CENTER DR MIDDLETOWN OH 45005 311079213 501(C)(3) 23816 SUPPORT Wright State University 3640 COLONEL GLENN HWY 430 DAYTON OH 45435 310732831 501(C)(3) 21736 Support Miami Valley Hospital Foundation ONE WYOMING ST DAYTON OH 45409 311040231 501(C)(3) 16822 Support Project Hope Inc 1510 N MAIN ST DAYTON OH 45405 341421548 501(C)(3) 12750 SUPPORT March of Dimes PO BOX 932852 ATLANTA GA 31193 131846366 501(C)(3) 11730 Support Good Samaritan Hospital Foundation-Dayton 2222 PHILADELPHIA DR 500 DAYTON OH 45406 237296923 501(C)(3) 10933 SUPPORT Dayton Early College Academy 300 COLLEGE PARK AVENUE DAYTON OH 45469 260463618 501(C)(3) 10140 SUPPORT Dayton Contemporary Dance Company 840 GERMANTOWN ST DAYTON OH 45402 237220259 501(C)(3) 9323 SUPPORT Middletown Community Foundation 300 N MAIN ST 300 MIDDLETOWN OH 45042 310898380 501(C)(3) 8021 SUPPORT AMERICAN CANCER SOCIETY 2808 READING RD CINCINNATI OH 45206 237354328 501(C)(3) 7650 SUPPORT Hospice of Dayton 324 WILMINGTON AVE DAYTON OH 45420 310933339 501(C)(3) 7650 SUPPORT Chaminade Julienne High School 505 S LUDLOW ST DAYTON OH 45402 310832408 501(c)(3) 6890 SUPPORT YWCA of Dayton 141 W THIRD ST DAYTON OH 45402 310537168 501(c)(3) 6790 SUPPORT SC Ministry Foundation 345 NEEB RD CINCINNATI OH 45233 311185570 501(C)(3) 6500 SUPPORT Health Partners Free Clinic 1300 N CO RD 25A TROY OH 45373 311596731 501(C)(3) 6396 SUPPORT Central State University Foundation PO BOX 1004 WILBERFORCE OH 45384 310749885 501(C)(3) 6375 SUPPORT Upper Valley Medical Center Foundation 3130 N CO RD 25A TROY OH 45373 311581859 501(C)(3) 6253 SUPPORT Daybreak 605 S LUDLOW ST DAYTON OH 45410 310864474 501(C)(3) 6099 SUPPORT Muse Machine Inc 126 N MAIN ST 310 DAYTON OH 45402 311028673 501(C)(3) 5100 SUPPORT United Way of the Greater Dayton Area PO BOX 634625 CINCINNATI OH 45263 310536658 501(C)(3) 69338 SUPPORT Reach Out Montgomery County 25 E FORAKER ST DAYTON OH 45409 311434282 501(C)(3) 54063 RX Assistance for Indigent Patients 30 1 SCHEDULE I, PART I, LINE 2: 1) THE COMMUNITY BENEFIT BUDGET IS APPROVED BY THE MIAMI VALLEY HOSPITAL BOARD ANNUALLY. 2) INVOICES ARE RECEIVED IN ACCOUNTS PAYABLE AFTER APPROPRIATE APPROVAL FOR PAYMENT. 3) DISBURSEMENTS OCCUR ACCORDING TO STANDARD ACCOUNTS PAYABLE GUIDELINES. X X X X true true false false false false false false false JAMES M PACENTA MD TRUSTEE 0 453899 0 106172 0 110484 0 8900 0 24022 0 703477 0 0 CHRISTOPHER DANIS MD TRUSTEE 0 343308 0 12619 0 3912 0 8189 0 21322 0 389350 0 0 JAMES R PANCOAST TRUSTEE / PREMIER PRES & CEO 0 965241 0 233636 0 40346 0 34699 0 25276 0 1299198 0 0 GEOFFREY P WALKER FORMER OFFICER 222343 0 58593 0 18038 0 44701 0 25697 0 369372 0 0 0 BOBBIE L GERHART FORMER PRESIDENT & CEO 19809 0 137141 0 105688 0 0 0 46 0 262684 0 0 0 BARBARA A JOHNSON SYSTEM VP - HR OPERATIONS 358650 0 97078 0 6911 0 10423 0 11102 0 484164 0 0 0 SCOTT A SHELTON TREASURER/CFO (TO SEP) 149221 84135 16782 16781 84717 83730 25295 10134 1927 1091 277942 195871 0 0 MARY M CLANCY CHIEF OPERATING OFFICER 346734 0 103179 0 46674 0 53764 0 15351 0 565702 0 0 0 DALE E CREECH SYSTEM VP - CLO 370828 0 95619 0 110244 0 128946 0 26734 0 732371 0 0 0 RENEE P GEORGE SYS VP-REVENUE CYCLE (TO SEP) 230033 0 32277 0 597 0 8355 0 13488 0 284750 0 0 0 WILLIAM E LINESCH FORMER KEY EMPLOYEE 161530 0 79381 0 65759 0 34883 0 2968 0 344521 0 0 0 MARK W SHAW SYSTEM VP - MANAGED CARE 265641 0 72161 0 51115 0 73213 0 26161 0 488291 0 0 0 MARK S SHAKER PRESIDENT & CEO 481425 0 106006 0 162903 0 162548 0 4297 0 917179 0 0 0 MICHAEL MAIBERGER SYSTEM SR VP - CSO 0 320114 0 103541 0 140569 0 15964 0 30930 0 611118 0 0 J NICK LAIR FORMER KEY EMPLOYEE 0 195567 0 69780 0 26307 0 34808 0 26011 0 352473 0 0 ROBERT M BOWMAN VP - HOSPITAL OPERATIONS 207898 0 42556 0 7753 0 23453 0 27021 0 308681 0 0 0 KIMBERLY A HENSLEY VP - HOSPITAL OPERATIONS 198147 0 56817 0 1239 0 29103 0 13866 0 299172 0 0 0 CARA W POWERS BOARD SECRETARY 208220 0 47218 0 544 0 23092 0 25644 0 304718 0 0 0 GARY S COLLIER VP CLINICAL CONSULTING 209309 0 44148 0 76304 0 156669 0 4740 0 491170 0 0 0 JOANN R RINGER VP - COO MVH SOUTH 256263 0 55901 0 44786 0 61732 0 3640 0 422322 0 0 0 MOLLY J HALL VP - ACADEMIC AFFAIRS 390864 0 102639 0 28838 0 16404 0 2474 0 541219 0 0 0 DIANE L PLEIMAN FORMER KEY EMPLOYEE 211060 0 46624 0 5625 0 26001 0 5695 0 295005 0 0 0 THOMAS A NASH SYSTEM VP - CPO (TO JUL) 131219 0 64106 0 88881 0 86773 0 24433 0 395412 0 0 0 MARK E WILLIAMS MD CHIEF MEDICAL OFFICER 341617 0 95042 0 19003 0 9353 0 25834 0 490849 0 0 0 TAMMY S LUNDSTROM SYSTEM VP - CMO 478960 0 129296 0 5942 0 8159 0 1537 0 623894 0 0 0 J MICHAEL SIMS VP FINANCE 221069 0 56630 0 44154 0 38164 0 28259 0 388276 0 0 0 THOMAS R CURTIN SYS VP-REVENUE CYCLE (FRM SEP) 0 184090 0 45762 0 2543 0 24688 0 29142 0 286225 0 0 GARY G GINTER SYSTEM VP - CIO 309065 0 27885 0 1758 0 28460 0 12816 0 379984 0 0 0 THOMAS R PARKER SYSTEM VP - SERVICE LINES 0 353725 0 77093 0 23932 0 24748 0 3744 0 483242 0 0 SYLVAIN TREPANIER DNP RN CENP SYSTEM VP - CNO 310122 0 42753 0 1126 0 2664 0 11011 0 367676 0 0 0 DIANE L EWING VP COMMUNICATIONS 247044 0 44620 0 26083 0 8468 0 10746 0 336961 0 0 0 WALTER REILING JR MD CHIEF MEDICAL INFO OFFICER 294958 0 49989 0 4118 0 9327 0 28533 0 386925 0 0 0 PART I, LINE 4A: THOMAS A. NASH RECEIVED SEVERANCE PAYMENTS OF $85,768. 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), 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 2014. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2014: ROBERT BOWMAN $5,445; MARY CLANCY $43,562; GARY COLLIER $55,048; DALE CREECH $103,141; MOLLY HALL $4,860; NICK LAIR $7,833; WILLIAM LINESCH $42,596; DIANE PLEIMAN $3,853; JOANN RINGER $42,197; MARK SHAKER $140,478; MARK SHAW $43,312; SCOTT A. SHELTON $164,741; J. MICHAEL SIMS $24,462; GEOFFREY WALKER $15,328. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2014: DIANE L. EWING $20,969; BOBBIE L. GERHART $64,365; JAMES PANCOAST $3,442; MICHAEL MAIBERGER $36,545. 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. 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 144095000 0 234895988 0 0 0 2119000 0 0 33744883 198698052 334053 2008 true false true true B 115000000 0 126463824 0 0 0 2293824 0 0 0 124170000 0 2009 true false true true C 2035000 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 0.00717 0.00000 0.00717 false false false true B false true false false 0.00717 0.00000 0.00717 false false false true C false false false false 0.00000 0.00000 0.00000 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 22. true false false 0 false true D false true false false true true BarclaysWells Fargo 31.5 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 1, 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 0.00717 0.00000 0.00717 false false false true A false true false false true true PNCDEUTSCHE BANK 25. true false false 0 false true A true ROBERT BOWMAN SPOUSE 62022 INFECTION PREVENT SPEC SALARY false SCOTT SHELTON OFFICER SEE SCHEDULE L PART V false Diane Pleiman FORMER KEY EMPLOYEE SEE SCHEDULE L PART V false CLANCY MARY M OFFICER SEE SCHEDULE L PART V false CURTIN THOMAS KEY EMPLOYEE SEE SCHEDULE L PART V false LISA BISHOP CHILD 11221 CAP ACQ SOURCING BUYER SALARY false Schedule L - Part IV: Miami Valley Hospital contracts with Compunet for the provision of laboratory services. Scott Shelton (to September 14), Diane Pleiman (to May 14), Mary Clancy (from May 14), and Thomas Curtin (from September 14) are board members of Compunet Clinical Lab. In addition, Scott Shelton was the Chief Financial Officer of Miami Valley Hospital (to Sep 14), Diane Pleiman is a FORMER key employee of Miami Valley Hospital, Mary Clancy is the CHIEF OPERATING OFFICER of Miami Valley Hospital, and Thomas Curtin is a key employee of Miami Valley Hospital. Compunet is owned 51% by MVHE, Inc., which is a related organization of Miami Valley Hospital. The amounts paid under this contract are competitive and the transaction is at arms-length. The total amount paid in 2014 was $21,120,936. 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: PREMIER HEALTH, OF WHICH MIAMI VALLEY HOSPITAL IS AN AFFILIATE, 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 THE COMPANY WEBSITE. 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. FORM 990, PART XI, LINE 9: PENSION FASB 158 ADJUSTMENT (93,569,052) EQUITY TRANSFERS (32,902,705) PHO EQUITY INFUSION (24,104,726) PHIC EQUITY INFUSION (3,372,917) FOUNDATION CONTRIBUTION ADJUSTMENT (1,199,428) RECLASSIFICATION OF PHG RELATED EXPENSES (806,252) SWAP AMORTIZATION (168,214) DISCONTINUED OPS-DIALYSIS & TRANSPLANT SVCS (11,585) JOA - DIALYSIS & TRANSPLANT SERVICES 6,000 CAPITAL DONATION 3,538,244 TOTAL (152,590,635) DIALYSIS CENTERS OF DAYTON LLC 110 N MAIN ST SUITE 500 DAYTON OH 45402 311607686 DIALYSIS OH 5254181 11365216 MVH PREMIER HEALTH 110 N MAIN ST SUITE 500 DAYTON OH 45402 311446699 SUPPRTG. ORG. OH 501(C)(3) 11-I NA false MEDAMERICA HEALTH SYSTEMS CORP (MAHS) 110 N MAIN ST SUITE 500 DAYTON OH 45402 311040228 PARENT OH 501(C)(3) 11-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 3170 KETTERING BLVD MORAINE OH 45439 311122883 Health Educat OH 501(C)(3) 7 MAHS true FIDELITY HEALTH CARE 3170 KETTERING BLVD MORAINE OH 45439 311075381 HOME HEALTH OH 501(C)(3) 9 MAHS true Premier Plaza LLC 110 N Main St Suite 500 Dayton OH 45402 800708185 Holding Compa OH MAHS EXCLUDED -15529 183156 false 0 false 0.01000 SOUTHWEST OHIO NEONATAL COLLABORATIVE 110 NORTH MAIN ST DAYTON OH 45402 463231330 NEONATOLOGY OH CHILDRENS MEDIC EXCLUDED -308 -308 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 true true true false false false true true false true true false true false true true true true true PREMIER HEALTH B 806252 FMV MIAMI VALLEY HOSPITAL FOUNDATION C 4718093 CASH MIAMI VALLEY HOSPITAL FOUNDATION Q 765489 FMV Premier Health Specialists Inc B 25908756 FMV Premier Health Specialists Inc C 8000000 FMV Premier Health Specialists Inc M 2165816 FMV Premier Health Specialists Inc O 145751 FMV Premier Health Specialists Inc Q 3986458 FMV MVHE INC A-IV 30932 FMV MVHE INC B 26530960 FMV MVHE INC C 11537012 FMV MVHE INC O 327444 FMV MVHE INC Q 4532389 FMV PREMIER COMMUNITY HEALTH A-IV 63578 FMV PREMIER COMMUNITY HEALTH R 492000 FMV PREMIER PLAZA LLC K 1933113 FMV Premier Health Specialists Inc G 155000 FMV