2014-11-13T09:17:29-06:00 2013-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIR 4000 INDIANAPOLIS IN 46204 990 2013-01-01 310537504 Miami Valley Hospital % J MICHAEL SIMS MIAM 9374999942 110 N MAIN ST Suite 500 Dayton OH 45402 SCOTT A SHELTON CFO 9372088000 2014-11-11 true CHRISTOPHER B BOGGS P00032493 9372088000 2013 2015-11-30 17:44:51Z Mark Shaker 110 N MAIN ST SUITE 500 DAYTON OH 45402 2456713326 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 7 8264 974 0 2675858 2132786 835144825 783525711 27250377 32688738 17225886 36007842 882296946 854355077 5913883 11321408 0 0 384995078 378436847 0 0 0 419188073 392396992 810097034 782155247 72199912 72199830 1384625214 1467588789 771936176 680566074 612689038 787022715 MIAMI VALLEY HOSPITAL WILL BUILD HEALTHIER COMMUNITIES WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTH CARE SERVICES. false false 698875181 11321408 783525711 PLEASE REFER TO SCHEDULE H. 698875181 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 781 0 true 8264 true false false false false false false false false false false X 12 7 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 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 653276 32866 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 3000 0 0 MARY C NUTTER TRUSTEE 0.5 0.0 X 0 0 0 SR RABBI DAVID SOFIAN TRUSTEE (THRU 01/2013) 0.5 0.0 X 0 0 0 JAMES J MURPHY MD TRUSTEE 0.5 0.5 X 0 0 0 CHRISTOPHER DANIS MD TRUSTEE 0.5 39.5 X 0 401793 18299 MARC BELCASTRO TRUSTEE 0.5 0.0 X 35100 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 4351056 56516 BOBBIE L GERHART PRESIDENT & CEO 40.0 0.0 X X 729179 0 34752 REV DR BRODIE MATHIS TRUSTEE (THRU 10/2013) 0.5 0.0 X 0 0 0 BARBARA A JOHNSON VP & COO (thru 6/2/13) 40.0 0.0 X 484685 0 13860 SCOTT A SHELTON TREASURER/CFO 20.0 0.0 X 144937 0 12360 MARY M CLANCY VP & COO (From 6/3/13) 40.0 0.0 X 470879 0 35207 CARA W POWERS BOARD SECRETARY 39.5 0.5 X 213144 0 36281 DALE E CREECH VP & CLO (PREMIER) 8.25 31.75 X 576123 0 53790 RENEE P GEORGE VP - REVENUE CYCLE (PREMIER) 8.0 32.0 X 276642 0 33291 WILLIAM E LINESCH VP - HUMAN RESOURCES (PREMIER) 8.0 32.0 X 450825 0 37280 MARK W SHAW VP - MANAGED CARE (PREMIER) 8.0 32.0 X 428171 0 54122 MARK S SHAKER SR VP SRVCE INTEGRATE(PREMIER) 8.0 32.0 X 725914 0 29963 MICHAEL MAIBERGER SR VP-CHIEF STRATEGY (PREMIER) 8.0 32.0 X 0 546586 75119 ROBERT M BOWMAN VP - OPERATIONS 40.0 0.0 X 274329 0 40563 KIMBERLY A HENSLEY VP - OPERATIONS 40.0 0.0 X 217469 0 28488 JOANN R RINGER COO MVH SOUTH 40.0 0.0 X 370142 0 27303 DEBORAH A MALS VP & CNO 40.0 0.0 X 352498 0 41817 THOMAS A NASH VP-CHF PURCH OFFICER (PREMIER) 8.0 32.0 X 263269 0 21245 MARK E WILLIAMS VP MEDICAL AFFAIRS / CMO 40.0 0.0 X 385007 0 29525 ANN M SCHUERMAN VP OPERATION INNOVATE(PREMIER) 40.0 0.0 X 396184 0 42986 GARY S COLLIER VP CLINICAL CONSULTING 40.0 0.0 X 414066 0 52112 MOLLY J HALL VP - ACADEMIC AFFAIRS 40.0 0.0 X 470552 0 29659 TAMMY S LUNDSTROM VP MEDICAL AFFAIRS/CMO PREMIER 40.0 0.0 X 570927 0 6461 J MICHAEL SIMS VP FINANCE (PREMIER) 39.5 0.5 X 339128 0 47683 GEOFFREY P WALKER FORMER BOARD SECRETARY 40.0 0.0 X 294107 0 44978 J NICK LAIR FORMER KEY EMPLOYEE 40.0 0.0 X 0 288403 40600 DIANE L PLEIMAN FORMER KEY EMPLOYEE 40.0 0.0 X 271498 0 23074 9157775 6241114 1000200 236 true true false COMPUNET CLINICAL LABORATORIES 2308 SANDRIDGE DR MORAINE OH 45349 CLINICAL LAB 23332321 ANESTHESIOLOGY SERVICES NETWORK PO BOX 349 DAYTON OH 45409 Medical Services 8623116 MIAMI VALLEY EMERGENCY SPECIALISTS 35 MILLARD CT SPRINGBORO OH 45066 Medical Services 7473242 EVOLENT HEALTH INC 800 N GLEBE RD 500 ARLINGTON VA 22203 SOFTWARE INPLEMENT 4780185 AIR METHODS CORP 3800 CLEARVIEW RD MORAINE OH 45439 MEDICAL SERVICES 4505575 61 2132786 2132786 NET PATIENT REVENUE 900099 416121576 416121576 MEDICARE/MEDICAID 900099 344612567 344612567 HOSPITAL FRANCHISE TAX RECOVERIES 900099 22043770 22043770 PURCHASE DISCOUNTS 900099 122650 122650 DENTAL CLINIC 900099 82449 82449 542699 542699 783525711 5867103 5867103 0 0 4333683 659235 3674448 0 3674448 3674448 1625951937 131682 1599261984 26689953 131682 26821635 26821635 0 0 3757812 2437030 1320782 1320782 GAIN ON INTEREST SWAP ADJ 900099 21016118 21016118 CAFETERIA SALES 812930 5504318 5504318 PARKING GARAGE 900099 1657728 1657728 2834448 2834448 31012612 854355077 783525711 68696580 11321408 11321408 0 0 0 6893060 5922517 970543 0 0 279669160 240291742 39377418 27878029 23952803 3925226 42894416 36854882 6039534 21102182 18130995 2971187 110846 95239 15607 2485763 2135768 349995 466022 466022 43735 43735 0 1496511 1496511 37918106 37918106 2114797 2114797 4435149 3810680 624469 14589989 12535719 2054270 0 13037603 11201908 1835695 567536 487627 79909 0 3879 3333 546 10726946 10726946 0 76154888 65432280 10722608 2715366 2333042 382324 OPERATING SUPPLIES 128979916 128979916 PURCHASED SERVICES 65445898 56231116 9214782 HOSPITAL FRANCHISE TAX 11548504 11548504 REPAIRS AND MAINTENANCE 4866667 4181440 685227 14688871 12620678 2068193 782155247 698875181 83280066 0 30351 30110 19703994 52490524 0 0 139987178 123951353 0 0 0 0 7097941 3078325 6136215 6904712 9700599 10679656 1233574209 592560389 671771604 641013820 268900915 426179064 190583524 153989569 0 0 24735557 9534039 45977336 39737617 1384625214 1467588789 82730168 74399877 571795 3139995 1304271 1685764 430412394 423884455 0 0 0 0 6009302 14976182 0 0 250908246 162479801 771936176 680566074 X 612689038 787022715 0 0 0 0 612689038 787022715 1384625214 1467588789 X 72199830 32378282 69755565 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 30235 false false true 13500 43735 false PART II-B, LINE 1F: PORTION OF DUES PAID TO GREATER DAYTON AREA HOSPITAL ASSOCIATION, DAYTON DEVELOPMENT COALITION, AND OHIO HOSPITAL ASSOCIATION. PART II-B, LINE 1I: WE CONTRACT WITH A LOBBYIST FOR HEALTHCARE RELATED ISSUES. 36464941 36464941 693251631 317684224 375567407 4814053 1547555 3266498 475016722 273328610 201688112 24026862 24026862 641013820 ALTERNATE INVESTMENTS 153989569 153989569 0 PENSION OBLIGATION 116835376 MALPRACTICE INSURANCE 22694880 JOINT OPERATING AGREEMENT 8544000 LOAN GUARANTEE & OTHER LTL 4207183 SWAP LIABILITY 4159056 HOSPITAL FRANCHISE TAX PAYABLE 3069063 WORKERS COMP RESERVE 1267198 OTHER 1703045 162479801 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, Inc. (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, 2013 and 2012 for such unrelated business activities are not significant. MAHS, SHP, AHS, and UVMC also own or control certain subsidiaries, which are for profit corporations subject to federal income taxes. These are: 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 its tax positions and has determined that there are no material uncertain tax positions. Central America and the Caribbean Investments 107621000 Central America and the Caribbean Program Services Insurance 25000 107646000 107646000 false false false false false false true true X true X true X true true true false true true 54989000 17565000 37424000 0.04780 153713000 122112000 31601000 0.04040 7477000 4642000 2835000 0.00360 216179000 144319000 71860000 0.09180 8852000 8852000 0.01130 22660000 19881000 2779000 0.00360 18195000 18195000 0.02330 2616000 2616000 0.00330 52323000 19881000 32442000 0.04150 268502000 164200000 104302000 0.13330 1224000 1224000 0.00160 1224000 1224000 0.00160 true 11744429 0 136872000 152868000 -15996000 X true true 1 1 MIAMI VALLEY HOSPITAL ONE WYOMING ST DAYTON OH 45409 WWW.PREMIERHEALTH.COM SEE PART V SECT C X X X X X 1 Miami Valley Hospital 1 true X X X X X X X X X 13 true true true X SEE PART V, SECTION C X X X X X X X true false true true 200. true 400. true X X X X true true X X X X X X true 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. Part V, Section B, Question 3 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 4 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, QUESTION 5A: 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 12I: IF THE PATIENT'S FAMILY'S INCOME FALLS WITHIN 400% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT QUALIFIES FOR ASSISTANCE UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY. ALL OR PART OF THE ACCOUNT WILL BE WRITTEN OFF TO CHARITY CARE, BASED UPON A SLIDING FEE SCHEDULE. THE AMOUNTS CHARGED TO PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT BILLED GROSS CHARGES FOR EMERGENCY OR MEDICALLY NECESSARY CARE. WE OFFER REASONABLE PAYMENT PLANS TO THOSE WHO HAVE QUALIFIED FOR CHARITY CARE. PATIENTS MAY ALSO QUALIFY FOR CHARITY CARE DISCOUNTS DUE TO A MEDICALLY-BASED CATASTROPHIC EVENT WHICH HAS OCCURRED IN THEIR LIFE. IF A PATIENT QUALIFIES FOR THIS DISCOUNT, HE/SHE WOULD ONLY BE HELD RESPONSIBLE FOR PAYMENT OF HIS/HER FAMILY'S MEDICAL EXPENSES UP TO 15% OF THEIR ANNUAL INCOME. PART V, SECTION B, LINE 14G: THE HOSPITAL WIDELY DISTRIBUTES INFORMATION ABOUT ITS FINANCIAL ASSISTANCE POLICY WITHIN THE AREA THAT IT SERVES. THIS INFORMATION INCLUDES THE METHOD OF APPLYING FOR AND ACCESSING FINANCIAL ASSISTANCE. NOTICES ARE PUBLICIZED IN PATIENTS' BILLS AND ARE POSTED IN THE EMERGENCY ROOM, ADMITTING AND REGISTRATION AREAS, AS WELL AS OTHER PUBLIC AREAS. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FINANCIAL COUNSELORS, PATIENT ADVOCATES, AND CUSTOMER SERVICE REPRESENTATIVES DISCUSS THE FINANCIAL ASSISTANCE POLICY WITH ALL UNINSURED PATIENTS, AND ANY PATIENT WHO EXPRESSES FINANCIAL HARDSHIP WITH PAYING THEIR BILL. APPLICATIONS FOR FINANCIAL ASSISTANCE POLICY ARE AVAILABLE IN BOTH ENGLISH AND SPANISH. PART V, SECTION B, LINE 18E: BEFORE INITIATING COLLECTIONS ACTIONS, THE HOSPITAL NOTIFIES SELF-PAY PATIENTS OF ITS FINANCIAL ASSISTANCE POLICY. NOTICES OF THE POLICY ARE PUBLICIZED IN THE PATIENTS' BILLS AND ARE ALSO POSTED IN THE EMERGENCY ROOM, ADMITTING AND REGISTRATION AREAS, AS WELL AS OTHER PUBLIC AREAS. A SUMMARY OF THE FINANCIAL ASSISTANCE IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FINANCIAL COUNSELORS, PATIENT ADVOCATES, PATIENT REGISTRATION, AND CUSTOMER SERVICE REPRESENTATIVES DISCUSS THE FINANCIAL ASSISTANCE POLICY WITH ALL UNINSURED PATIENTS WHO ARE ADMITTED TO THE HOSPITAL. FINANCIAL COUNSELORS ALSO CONTACT UNINSURED OUTPATIENTS WHO ARE SCHEDULED TO HAVE MAJOR PROCEDURES. IN ANY INSTANCE WHERE A PATIENT CALLS THE HOSPITAL AND EXPRESSES A CONCERN ABOUT THEIR ABILITY TO PAY, THE FINANCIAL ASSISTANCE POLICY IS EXPLAINED. 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 2013, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $18,195,000. 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 2013 WAS $221,000. 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 2013 WAS $121,000. 3. UNITED WAY: MIAMI VALLEY HOSPITAL PROVIDED $63,000 SUPPORT TO THIS PROGRAM IN 2013. 4. CITY OF DAYTON: MIAMI VALLEY HOSPITAL 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. THE AMOUNT PROVIDED IN 2013 WAS $184,000. 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 2013 WAS $635,000. 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 120 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 $94,987,000 AND INCURRED COST OF $134,536,000, FOR AN ADDITIONAL NET SHORTFALL OF $39,549,000 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) 136,872,000 MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B 94,987,000 TOTAL MEDICARE ASSOCIATED REVENUE 231,859,000 ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT (PART III, SECTION B) 152,868,000 MEDICARE COST NOT REPORTED IN PART III, SECTION B 134,536,000 TOTAL MEDICARE ASSOCIATED COST 287,404,000 MEDICARE SHORTFALL PER PART III, SECTION B 15,996,000 ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B 39,549,000 TOTAL MEDICARE SHORTFALL 55,545,000 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 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'S COMMUNITY BENEFIT PLAN IS BASED ON OUR UNDERSTANDING OF UNIQUE COMMUNITIES' NEEDS DERIVED FROM COLLABORATIVE NEEDS ASSESSMENTS, FOCUS GROUPS AND SURVEYS CONDUCTED WITH OUR COMMUNITY PARTNERS. WE RELY ON DATA PROVIDED BY THE GREATER DAYTON AREA HOSPITAL ASSOCIATION TO ASSIST WITH THE NEEDS OF THE COMMUNITY. MIAMI VALLEY HOSPITAL, AS AN AFFILIATE OF PREMIER HEALTH, ALSO PARTICIPATES IN THE HOMELESS SHELTER TASK FORCE AND THE MONTGOMERY COUNTY HEALTHCARE SAFETY NET TASK FORCE. THE HOMELESS SHELTER TASK FORCE OFFERS STRATEGIC SOLUTIONS TO THE OVER 6,000 HOMELESS PEOPLE LIVING IN DAYTON AND MONTGOMERY COUNTY. THESE SOLUTIONS INCLUDE EVALUATING THE LOCATION OF THE DAY SHELTER AND THE GOOD SAMARITAN HOMELESS CLINIC TO ENSURE THEY ARE LOCATED IN A PLACE EASILY ACCESSIBLE TO THE HOMELESS. THE PRIMARY GOAL IS TO PROVIDE SUPPORT FOR THE HOMELESS, GET THEM INTO PERMANENT HOUSING AND EMPLOYED SO THEY CAN BE SELF-SUFFICIENT. THE MONTGOMERY COUNTY HEALTHCARE SAFETY NET TASK FORCE WAS APPOINTED IN SEPTEMBER 2006 BY THE MONTGOMERY COUNTY COMMISSIONERS. THE TASK FORCE WAS CHARGED WITH RECOMMENDING AN INNOVATIVE VISION AND ACHIEVABLE SETS OF STRATEGIES TO IMPROVE AND FINANCE THE HEALTHCARE SAFETY NET FOR VULNERABLE POPULATIONS IN MONTGOMERY COUNTY. THE TASK FORCE, COMPRISED OF 19 MEMBERS, INCLUDED HOSPITAL SYSTEM LEADERSHIP, SAFETY NET CLINICAL PROVIDERS, THE DEAN OF WRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE, UNITED WAY, MAJOR INSURANCE COMPANIES AND OTHER KEY STAKEHOLDERS. THE REPORT FROM THEIR EVALUATION SHOWED THAT APPROXIMATELY 60,300 PEOPLE OR NEARLY 11% OF MONTGOMERY COUNTY RESIDENTS DO NOT HAVE HEALTHCARE INSURANCE. APPROXIMATELY 84,082 RESIDENTS OR OVER 12% IN MONTGOMERY COUNTY WERE ENROLLED IN MEDICAID. MONTGOMERY COU true THE DAYTON FOUNDATION 40 N MAIN ST 500 DAYTON OH 45423 316027287 501(C)(3) 6561750 VARIOUS CHILDRENS MEDICAL CENTER ONE CHILDRENS PLAZA DAYTON OH 45404 310672132 501(C)(3) 2500000 COMMUNITY HEALTH PREMIER COMMUNITY HEALTH 601 W RIVERVIEW AVE DAYTON OH 45404 311122883 501(C)(3) 389545 COMMUNITY HEALTH VICTORIA THEATRE ASSOCIATION 138 N MAIN ST DAYTON OH 45402 310897638 501(C)(3) 225000 CORPORATE PLEDGE REACH OUT MONTGOMERY COUNTY 25 E FORAKER ST DAYTON OH 45409 311434282 501(C)(3) 199468 RX ASSISTANCE FOR INDIGENT PATIENTS CITY OF DAYTON 335 W THIRD ST DAYTON OH 45402 316000175 GOVERNMENT 184250 GOOD NEIGHBOR POLICE PROGRAM DAYTON ART INSTITUTE 456 BELMONTE PARK N DAYTON OH 45405 310537480 501(C)(3) 76200 CORPORATE PLEDGE UNITED WAY OF THE GREATER DAYTON AREA 333 W FIRST ST 500 DAYTON OH 45402 310536658 501(C)(3) 65750 CORPORATE PLEDGE WRIGHT STATE UNIVERSITY 3640 COLONEL GLENN HWY DAYTON OH 45435 310732831 501(C)(3) 65500 SPONSORSHIP CITYWIDE DEVELOPMENT CORPORATION 8 N MAIN ST DAYTON OH 45402 310821189 501(C)(4) 52100 GENESIS PROJECT DOWNTOWN DAYTON GOODWILL EASTER SEALS 1511 KUNTZ RD DAYTON OH 45404 310537112 501(C)(3) 43750 CAR SEAT PROGRAM AIDS RESOURCE CENTER OHIO 15 W FOURTH ST 200 DAYTON OH 45402 311126780 501(C)(3) 37500 AFRICAN AMERICAN OUTREACH DOWNTOWN DAYTON PARTNERSHIP 10 W SECOND ST 511 DAYTON OH 45402 341722175 501(C)(3) 32000 SUPPORT MIAMI VALLEY HOSPITAL FOUNDATION 110 N MAIN ST DAYTON OH 45402 311040231 501(C)(3) 23250 HEALTH PROMOTION CULTURE WORKS 110 N MAIN ST 165 DAYTON OH 45402 237412338 501(C)(3) 16175 ANNUAL CAMPAIGN GOOD NEIGHBOR HOUSE 844 S PATTERSON BLVD DAYTON OH 45402 311374154 501(C)(3) 13960 ANNUAL PLEDGE CENTRAL STATE UNIVERSITY 1400 BRUSH ROW RD WIBERFORCE OH 45384 310675386 501(C)(3) 12500 SPONSORSHIP DAYTON CONTEMPORARY DANCE COMPANY 840 GERMANTOWN ST DAYTON OH 45402 237220259 501(C)(3) 11500 SPONSORSHIP PROJECT HOPE INC 1510 N MAIN ST DAYTON OH 45404 341421548 501(C)(3) 10000 SUPPORT MUSE MACHINE INC 126 N MAIN ST 310 DAYTON OH 45402 311028673 501(C)(3) 10000 SUPPORT ATRIUM MEDICAL CENTER FOUNDATION 110 N MAIN ST DAYTON OH 45402 311079213 501(C)(3) 9750 SUPPORT AMERICAN CANCER SOCIETY 5555 FRANTZ RD DUBLIN OH 43017 340726080 501(C)(3) 8750 SUPPORT MARCH OF DIMES FOUNDATION 3131 S DIXIE DR 313 DAYTON OH 45439 131846366 501(C)(3) 7500 SPONSORSHIP HOSPICE OF DAYTON FOUNDATION 324 WILMINGTON AVE DAYTON OH 45420 310933339 501(c)(3) 7375 SPONSOR DAYBREAK 605 S LUDLOW ST DAYTON OH 45410 310864474 501(c)(3) 7000 SUPPORT CHAMINADE JULIENNE HIGH SCHOOL 505 S LUDLOW ST DAYTON OH 45402 310832408 501(C)(3) 7000 SPONSORSHIP COUNTRYSIDE YMCA 1699 DEERFIELD RD LEBANON OH 45036 510181689 501(C)(3) 6920 SUPPORT DAYTON PERFORMING ARTS ALLIANCE 109 N MAIN ST 200 DAYTON OH 45402 316000101 501(C)(3) 6750 SUPPORT BOONSHOFT MUSEUM OF DISCOVERY 2600 DEWEESE PKWY DAYTON OH 45414 310585917 501(C)(3) 6750 SUPPORT DAYTON EARLY COLLEGE ACADEMY INC 300 COLLEGE PARK AVE DAYTON OH 45469 260436618 501(C)(3) 6500 SUPPORT MONTGOMERY COUNTY OHIO COLLEGE PROMISE 500 KETTERING TOWER DAYTON OH 45423 311358532 501(C)(3) 6250 SUPPORT MIDDLETOWN COMMUNITY FOUNDATION 300 N MAIN ST 300 MIDDLETOWN OH 45042 310898380 501(C)(3) 6000 SUPPORT SAINT PETER CATHOLIC CHURCH 6161 CHAMBERSBURG HUBER HEIGHTS OH 45424 310626310 501(C)(3) 5250 SUPPORT ST VINCENT DEPAUL 1133 S EDWIN C MOSES BLVD 300 DAYTON OH 45408 311011485 501(C)(3) 5250 SUPPORT UNIVERSITY OF DAYTON 300 COLLEGE PARK AVE DAYTON OH 45469 310536715 501(C)(3) 5250 SUPPORT 34 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 true true X X X X true true false false false true true false false JAMES M PACENTA MD TRUSTEE 0 567627 0 78683 0 6966 0 10194 0 22672 0 686142 0 0 CHRISTOPHER DANIS MD TRUSTEE 0 398593 0 0 0 3200 0 0 0 18299 0 420092 0 0 JAMES R PANCOAST TRUSTEE / PREMIER PRES & CEO 0 936016 0 333569 0 3081471 0 29657 0 26859 0 4407572 0 0 GEOFFREY P WALKER FORMER BOARD SECRETARY 220302 0 60183 0 13622 0 23513 0 21465 0 339085 0 0 0 BOBBIE L GERHART PRESIDENT & CEO 468267 0 155354 0 105558 0 23778 0 10974 0 763931 0 0 0 BARBARA A JOHNSON VP & COO (thru 6/2/13) 353819 0 108224 0 22642 0 4649 0 9211 0 498545 0 0 0 SCOTT A SHELTON TREASURER/CFO 115021 0 28635 0 1281 0 10621 0 1739 0 157297 0 0 0 MARY M CLANCY VP & COO (From 6/3/13) 331213 0 108348 0 31318 0 21570 0 13637 0 506086 0 0 0 DALE E CREECH VP & CLO (PREMIER) 367721 0 97597 0 110805 0 30227 0 23563 0 629913 0 0 0 RENEE P GEORGE VP - REVENUE CYCLE (PREMIER) 218785 0 57230 0 627 0 7790 0 25501 0 309933 0 0 0 WILLIAM E LINESCH VP - HUMAN RESOURCES (PREMIER) 302375 0 85347 0 63103 0 29823 0 7457 0 488105 0 0 0 MARK W SHAW VP - MANAGED CARE (PREMIER) 259238 0 77695 0 91238 0 31273 0 22849 0 482293 0 0 0 MARK S SHAKER SR VP SRVCE INTEGRATE(PREMIER) 416041 0 119115 0 190758 0 25000 0 4963 0 755877 0 0 0 MICHAEL MAIBERGER SR VP-CHIEF STRATEGY (PREMIER) 0 311209 0 108151 0 127226 0 48688 0 26431 0 621705 0 36422 J NICK LAIR FORMER KEY EMPLOYEE 0 195320 0 61980 0 31103 0 17586 0 23014 0 329003 0 0 ROBERT M BOWMAN VP - OPERATIONS 197802 0 70790 0 5737 0 17150 0 23413 0 314892 0 0 0 KIMBERLY A HENSLEY VP - OPERATIONS 179981 0 36457 0 1031 0 17387 0 11101 0 245957 0 0 0 CARA W POWERS BOARD SECRETARY 188421 0 24271 0 452 0 12323 0 23958 0 249425 0 0 0 ANN M SCHUERMAN VP OPERATION INNOVATE(PREMIER) 261407 0 79014 0 55763 0 33965 0 9021 0 439170 0 0 0 GARY S COLLIER VP CLINICAL CONSULTING 257017 0 92484 0 64565 0 31871 0 20241 0 466178 0 0 0 JOANN R RINGER COO MVH SOUTH 242065 0 103309 0 24768 0 24451 0 2852 0 397445 0 0 0 DEBORAH A MALS VP & CNO 222010 0 66551 0 63937 0 28767 0 13050 0 394315 0 0 0 MOLLY J HALL VP - ACADEMIC AFFAIRS 312073 0 121797 0 36682 0 8930 0 20729 0 500211 0 0 0 DIANE L PLEIMAN FORMER KEY EMPLOYEE 203126 0 64627 0 3745 0 17260 0 5814 0 294572 0 0 0 THOMAS A NASH VP-CHF PURCH OFFICER (PREMIER) 185778 0 20000 0 57491 0 0 0 21245 0 284514 0 0 0 MARK E WILLIAMS VP MEDICAL AFFAIRS / CMO 314166 0 52719 0 18122 0 7831 0 21694 0 414532 0 0 0 TAMMY S LUNDSTROM VP MEDICAL AFFAIRS/CMO PREMIER 452195 0 116033 0 2699 0 4451 0 2010 0 577388 0 0 0 J MICHAEL SIMS VP FINANCE (PREMIER) 220065 0 64479 0 54584 0 24880 0 22803 0 386811 0 0 0 PART 1, LINE 1A: THE COMPANY PROVIDED MR. NASH WITH TEMPORARY HOUSING AND PAID FOR AIRLINE TRAVEL FOR MR. NASH'S SPOUSE. THE ITEMS CHECKED WERE PROPERLY TREATED FOR PAYROLL TAX PURPOSES. 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 2013. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2013: ROBERT BOWMAN $3,464; MARY CLANCY $28,232; GARY COLLIER $42,676; DALE CREECH $106,150; BOBBIE GERHART $68,913; MOLLY HALL $12,971; BARBARA JOHNSON $17,835; NICK LAIR $12,923; WILLIAM LINESCH $36,185; DEBORAH MALS $47,309; DIANE PLEIMAN $2,559; JOANN RINGER $23,040; ANN SCHUERMAN $49,895; MARK SHAKER $168,642; MARK SHAW $83,410; J. MICHAEL SIMS $34,837; GEOFFREY WALKER $12,183. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PAYMENT IN 2013: JAMES PANCOAST $3,047,215; MICHAEL MAIBERGER $36,422. 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 I, LINE 6A AND 6B: PREMIER HEALTH (PREMIER), OF WHICH MIAMI VALLEY HOSPITAL IS AN AFFILIATE, HAS AN INCENTIVE COMPONENT FOR ALL EXECUTIVE AND DIRECTOR LEVEL EMPLOYEES THAT TIES A PORTION OF THEIR TOTAL COMPENSATION TO ORGANIZATIONAL AND INDIVIDUAL OBJECTIVES AND OUTCOMES. THE ORGANIZATIONAL CRITERION IS WEIGHTED ACCORDING TO BALANCED SCORECARD CATEGORIES: POSITIVE WORK ENVIRONMENT (15%), QUALITY (30%), PATIENT SATISFACTION (15%), PHYSICIAN PARTNERSHIP (15%), AND FINANCIAL (25%). THE FINANCIAL CATEGORY OF THE SCORECARD IS BASED ON NET EARNINGS OF THE INDIVIDUAL HOSPITAL AND THE NET EARNINGS OF THE SYSTEM OF A WHOLE. THIS FINANCIAL TARGET IS SET BASED ON THE OPERATING AND CASH FLOW MARGINS REQUIRED TO MAINTAIN THE SYSTEM'S AA CREDIT RATINGS. INCENTIVE OBJECTIVES FOR DIRECTORS AND ABOVE ARE WEIGHTED 45% ON ORGANIZATIONAL CRITERIA, 45% ON INDIVIDUAL CRITERIA, AND 10% ON OPERATIONAL EFFECTIVENESS. THE 2013 INCENTIVE PLAN AMOUNTS WERE PAID TO THE PARTICIPANTS IN 2014. THESE ARE NOT REPORTED AS DEFERRED COMPENSATION ON THE 2013 FORM 990 BASED ON THE DEFINITION OF DEFERRED COMPENSATION CONTAINED IN THE FORM 990 INSTRUCTIONS. PER THE INSTRUCTIONS, "DEFERRED COMPENSATION IS GENERALLY TREATED AS EARNED OR ACCRUED IN THE YEAR THAT SERVICES ARE RENDERED, EXCEPT WHEN ENTITLEMENT TO PAYMENT IS CONTINGENT ON SATISFACTION OF SPECIFIED ORGANIZATIONAL GOALS OR PERFORMANCE CRITERIA (OTHER THAN MERE LONGEVITY OF SERVICE) UNDER THE DEFERRED COMPENSATION PLAN." BASED ON THE INCENTIVE PROGRAM CRITERIA OUTLINED ABOVE, WE BELIEVE THE INCENTIVE PAYMENTS MEET THE EXCEPTION NOTED IN THE INSTRUCTIONS. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. PART II, LINE 7: Scott Shelton is also the CFO of Atrium Medical Center, which is a Premier Health affiliated hospital. Mr. Shelton also receives compensation from Atrium Medical Center related to this position. 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 140050000 0 234895988 0 3259952 0 2119000 0 0 34304034 0 334051 2010 true false true true B 115000000 0 126463824 0 5944090 0 2293824 0 0 0 0 0 2010 true false true true C 1330000 0 106431124 0 1828756 0 1203000 0 0 105228124 0 0 2010 false false true true D 0 0 85000000 0 20534 0 727500 0 0 84272500 0 1 2010 false false true true A false true false false 0.00748 0.00000 0.00748 false false false true B false true false false 0.00748 0.00000 0.00748 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 0. true true false 0 false true B false true false false false false 0 false 0 false true C false true false false false true BARCLAYSWELLS FARGO 23. true false false 0 false true D false true false false true true BARCLAYSWELLS FARGO 32.5 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. A COUNTY OF MONTGOMERY OH 316000172 2012-11-20 79830687 SEE PART VI - Note D false false false B COUNTY OF MONTGOMERY OH 316000172 2012-11-20 48433796 SEE PART VI - Note D false false false A 1865000 0 79830687 0 230389 0 169313 0 0 0 0 0 2010 true false true true B 1135000 0 48433796 0 145428 0 206204 0 0 0 0 23526 2010 true false true true A false true false false 0.00748 0.00000 0.00748 false false false true B false true false false 0.00748 0.00000 0.00748 false false false true A false true false false true true PNC 26. true false false 0 false true B false true false false true true DEUTSCHE BANK 26. true false false 0 false true A true B true Note D, PART 1, LINE A & B, COLUMN F: REFUND MIAMI VALLEY HOSPITAL SERIES 2009A BONDS. PART IV, ARBITRAGE, LINE 2C; COMPUTATION DATE WAS NOVEMBER 13, 2013 ANGELA BOWMAN WIFE OF ROBERT BOWMAN 60290 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 Schedule L - Part IV: Miami Valley Hospital contracts with Compunet for the provision of laboratory services. Scott Shelton and Diane Pleiman are board members of Compunet Clinical Lab. In addition, Scott Shelton is the Chief Financial Officer of Miami Valley Hospital, and Diane Pleiman is a FORMER key employee of Miami Valley Hospital. Compunet is owned 33% 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 2013 was $23,335,730. Form 990 - Part I - Question 10: THIS ORGANIZATION HAS DESIGNATED ITS INVESTMENTS AS TRADING. IN ACCORDANCE WITH THE AICPA GUIDE FOR HEALTHCARE, ALL UNREALIZED GAINS AND LOSSES ARE RECOGNIZED THROUGH THE PROFIT AND LOSS STATEMENT. FOR 990 REPORTING, THIS ACTIVITY IS EXCLUDED PER THE INSTRUCTIONS BY THE INTERNAL REVENUE SERVICE. 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). 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 OFFICER. 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 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 CORPORATE COMPLIANCE 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 XI, LINE 9: Pension Adjustment 84,146,898 Allocation-Dialysis & Transplant Svcs Ops/Sale 16,429,257 Capital Donation 1,931,565 Swap Amortization (175,081) PHO Equity Infusion (1,250,000) Foundation Contribution Adjustment (2,179,970) Reclassification of PHG related expenses (3,662,862) Equity Transfers (25,988,593) Total 69,251,214 DIALYSIS CENTERS OF DAYTON LLC 110 N MAIN ST SUITE 500 DAYTON OH 45402 311607686 DIALYSIS OH 502712 10412343 MVH PREMIER HEALTH 110 N MAIN ST SUITE 500 DAYTON OH 45402 311446699 SUPPRTG. ORG. OH 501(C)(3) 11-1 NA false MEDAMERICA HEALTH SYSTEMS CORP (MAHS) 110 N MAIN ST SUITE 500 DAYTON OH 45402 311040228 PARENT OH 501(C)(3) 11-1 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 601 W RIVERVIEW AVE DAYTON OH 45406 311122883 Health Educat OH 501(C)(3) 7 MAHS true FIDELITY HEALTH CARE 3832 KETTERING BLVD DAYTON 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 -6798 203713 false false 0.01000 SOUTHWEST OHIO NEONATAL COLLABORATIVE 110 NORTH MAIN ST DAYTON OH 45402 463231330 NEONATOLOGY OH CHILDRENS MEDIC EXCLUDED 0 61500 false 0 0.61500 MVHE INC 110 N MAIN ST SUITE 500 DAYTON OH 45402 311185270 PHYS SVCS OH MAHS CORPORATION 0 0 0.00000 true PREMIER HEALTH SPECIALISTS INC 110 N MAIN ST SUITE 500 DAYTON OH 45402 061744704 PHYS SVCS OH MAHS CORPORATION 0 0 0.00000 true true true true false false false true false true true false true false true true true true false PREMIER HEALTH B 3733253 FMV MIAMI VALLEY HOSPITAL FOUNDATION C 4064351 CASH MIAMI VALLEY HOSPITAL FOUNDATION Q 818863 FMV Premier Health Specialists Inc B 21484682 FMV Premier Health Specialists Inc C 1389212 FMV Premier Health Specialists Inc M 2468437 FMV Premier Health Specialists Inc O 210772 FMV Premier Health Specialists Inc Q 7033299 FMV MVHE INC A-IV 30932 FMV MVHE INC B 11605622 FMV MVHE INC C 3424805 FMV MVHE INC O 296514 FMV MVHE INC P 181292 FMV MVHE INC Q 5543808 FMV PREMIER COMMUNITY HEALTH A-IV 63325 FMV PREMIER COMMUNITY HEALTH R 384000 FMV MEDAMERICA HEALTH SYSTEMS C 2358083 FMV PREMIER PLAZA LLC K 483278 FMV