THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO DTD 01251995: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO DTD 01251995 (EIN 31-0537486)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-10
IRS object ID
201231319349302153
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-10T13:17:31-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1312 WALNUT STREET SUITE 3000AddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN310537486EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIOBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGOODNameControl
Phone5135696575Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1619 OAK STREET - ACCOUNTING 3 WESTAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45206ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL CROFTONName
TitleVP-FINANCETitle
Phone5135696575Phone
Date Signed2012-05-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone5136218300Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN PROUTNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1619 OAK STREET - ACCOUNTING 3 WESTAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45206ZIPCode
FieldValueIRS element (for citing)
Gross Receipts519094931GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.TRIHEALTH.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1852YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionTHE ORGANIZATION'S MISSION IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY IT SERVES.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees3893TotalNbrEmployees
Total Nbr Volunteers1093TotalNbrVolunteers
Total Gross UBI599620TotalGrossUBI
Net Unrelated Business Txbl Income-356418NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2011657ContributionsGrantsPriorYear
Contributions Grants Current Year1819755ContributionsGrantsCurrentYear
Program Service Revenue Prior Year452506006ProgramServiceRevenuePriorYear
Program Service Revenue CY477423089ProgramServiceRevenueCY
Investment Income Prior Year17517998InvestmentIncomePriorYear
Investment Income Current Year26589936InvestmentIncomeCurrentYear
Other Revenue Prior Year7757833OtherRevenuePriorYear
Other Revenue Current Year12262151OtherRevenueCurrentYear
Total Revenue Prior Year479793494TotalRevenuePriorYear
Total Revenue Current Year518094931TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year565970GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY571927GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year209583482SalariesEtcPriorYear
Salaries Etc Current Year221197407SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year225744205OtherExpensePriorYear
Other Expenses Current Year238726565OtherExpensesCurrentYear
Total Expenses Prior Year435893657TotalExpensesPriorYear
Total Expenses Current Year460495899TotalExpensesCurrentYear
Revenues Less Expenses Prior Year43899837RevenuesLessExpensesPriorYear
Revenues Less Expenses CY57599032RevenuesLessExpensesCY
Total Assets BOY587586475TotalAssetsBOY
Total Assets EOY696050814TotalAssetsEOY
Total Liabilities BOY236475946TotalLiabilitiesBOY
Total Liabilities EOY233617196TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY351110529NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY462433618NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE OMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense393386491Expense
Grants571927Grants
Revenue486942795Revenue
DescriptionSEE SCHEDULE HDescription
Total Program Service Expense393386491TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096274NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees3893NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMICHAEL CROFTONNamePerson
Telephone Number5135695677TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1619 OAK STREET - ACCOUNTING 3 WESTAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45206ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
ROBERT WALKER
CHAIRPERSON (START 3/2011)1.00XX000
JAMES SCHWAB
CHAIRPERSON (END 2/2011)1.00XX000
STEPHEN SCHRANTZ
VICE CHAIRPERSON1.00XX000
MICHAEL MCGRAW
SECRETARY/TREASURER1.00XX000
PAUL EDGETT III
TRUSTEE1.00X059646178607
MICHAEL HAVERKAMP
TRUSTEE1.00X000
THOMAS FINN
TRUSTEE1.00X000
MYRTIS POWELL
TRUSTEE1.00X000
SR MARY ELLEN MURPHY
TRUSTEE1.00X000
EDWARD HARNESS JR
TRUSTEE (END 3/11)1.00X000
SILVANIA NG MD
TRUSTEE (MED STAFF PRES.)1.00X0450000
MARC ALEXANDER MD
TRUSTEE (MED STAFF PRES.)1.00X4500000
JOHN PROUT
PRESIDENT/CEO (SCH O)1.00XX01216064299811
DONNA NIENABER ESQ
ASSISTANT SECRETARY (SCH O)1.00X0480976138646
CRAIG RUCKER
ASSISTANT TREASURER (SCH O)1.00X0492908115752
DAVE DORNHEGGEN
CHIEF OPERATING OFFICER-GSH60.000347377109208X
WILLIAM GRONEMAN
EXECUTIVE VP (SCH O)1.000511263166581X
GERALD OLIPHANT
EXEC VP & COO (SCH O)1.000547879117654X
GEORGES FEGHALI MD
CHIEF MEDICAL OFFICER (SCH O)1.000493357137101X
ROBERT ROHS MD
PHYSICIAN40.00341719040185X
MICHAEL HOLBERT MD
PHYSICIAN40.00265559022576X
MICHAEL MARCOTTE MD
PHYSICIAN40.00200367042394X
HELEN KOSELKA MD
PHYSICIAN40.00200630047826X
SAMATHA MAST MD
PHYSICIAN40.00155921023245X
MICHAEL CROFTON
FORMER OFFICER (SCH O)0.00026109167993X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1209196TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs4992376TotalReportableCompFrmRltdOrgs
Total Other Compensation1407579TotalOtherCompensation
Number Individuals GT100 K59NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
TRI-STATE HEALTHCARE LAUNDRY INC
551 S LOOP ROADEDGEWOODKY41017LAUNDRY1610272
AMERICAN NURSING CARE INC
1700 EDISON DRIVE SUITE 300MILFORDOH45150NURSING1244326
PHYSICIANS ANESTHESIA SERVICES INC
20 MEDICAL VILLAGE DRIVEEDGEWOODKY41017ANESTHESIA970250
MORRISON MANAGEMENT SPECIALISTS
PO BOX 102289ATLANTAGA30368FOOD SERVICE763142
ESKRIBE INC
6770 COMMERCE COURTBLACKLICKOH43004MEDICAL TRANSCRIPTION655719
FieldValueIRS element (for citing)
Number Of Contractors GT100 K43NumberOfContractorsGT100K
Related Organizations1818228RelatedOrganizations
All Other Contributions1527AllOtherContributions
Total Contributions1819755TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICES621990475555556475030106525450
JOA REVENUE99000978109517810951
AFFILIATED ORG. RENTAL53200013312141331214
EQUITY CHANGE IN ORGS.990009-7274632-7274632
FieldValueIRS element (for citing)
Total Program Service Revenue477423089TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column9875083TotalRevenueColumn
Unrelated Business Revenue22635UnrelatedBusinessRevenue
Exclusion$9,852,448ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real906290Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real906290Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column906290TotalRevenueColumn
Exclusion$906,290ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities16671903Securities
Other1042950Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other1000000Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities16671903Securities
Other42950Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column16714853TotalRevenueColumn
Exclusion$16,714,853ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CAFETERIA7221002184090$2,184,090
PHARMACY4461101836155$1,836,155
RESEARCH90009912042011204201

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column6131415TotalRevenueColumn
Related Or Exempt Function Income6079880RelatedOrExemptFunctionIncome
Unrelated Business Revenue51535UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue11355861TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column518094931TotalRevenueColumn
Related Or Exempt Function Income484181720RelatedOrExemptFunctionIncome
Unrelated Business Revenue599620UnrelatedBusinessRevenue
Exclusion$31,493,836ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total565806Total
Program Services565806ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total6121Total
Program Services6121ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total171569260Total
Program Services145152760ProgramServices
Management And General26416500ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total11149602Total
Program Services8749035ProgramServices
Management And General2400567ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total25809528Total
Program Services19911744ProgramServices
Management And General5897784ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total12669017Total
Program Services10953863ProgramServices
Management And General1715154ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1453717Total
Program Services1389819ProgramServices
Management And General63898ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2410753Total
Management And General2410753ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total212408Total
Management And General212408ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1207057Total
Management And General1207057ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total17343631Total
Program Services14620535ProgramServices
Management And General2723096ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total2151799Total
Program Services305613ProgramServices
Management And General1846186ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total6771462Total
Program Services4602206ProgramServices
Management And General2169256ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total7749403Total
Program Services648223ProgramServices
Management And General7101180ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total8688500Total
Program Services7428785ProgramServices
Management And General1259715ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total627767Total
Program Services270614ProgramServices
Management And General357153ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total6789964Total
Program Services6789964ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total5885160Total
Management And General5885160ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total21089197Total
Program Services17546156ProgramServices
Management And General3543041ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total4392315Total
Program Services4238662ProgramServices
Management And General153653ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL/DIETARY SUPPLIE101032584100735403297181
BAD DEBTS3689791836897918
REPAIRS AND MAINTENANCE66108246177489433335
OHIO HOSPITAL FEE38102093810209
O&M COST TRACK FEES678411678411

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2923486Total
Program Services1907155ProgramServices
Management And General1016331ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total460495899Total
Program Services393386491ProgramServices
Management And General67109408ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY18384195BOY
EOY24981720EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY28099105BOY
EOY49421712EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY298360BOY
EOY99690EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1449355BOY
EOY3005214EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY177600BOY
EOY167400EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis519461641LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec335646159LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY173571630BOY
EOY183815482EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY44927953BOY
EOY41516113EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY309592250BOY
EOY366526724EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY11086027BOY
EOY26516759EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY587586475BOY
EOY696050814EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY44394290BOY
EOY52467167EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY47034BOY
EOY91310EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY134295401BOY
EOY147851989EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY57739221BOY
EOY33206730EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY236475946BOY
EOY233617196EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY345900651BOY
EOY457130498EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY5209878BOY
EOY5303120EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY351110529BOY
EOY462433618EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY587586475BOY
EOY696050814EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses57599032ReconcilationRevenueExpenses
Reconcilation Other Changes53724057ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$91,955GrantsOtherOrganizationsAmount
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$8,555OtherActivitiesAmount
Total Lobbying Expenditures IIB100510TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES:PART II-B, LINE 1I:DURING THE TAX YEAR, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("HOSPITAL") PAID ANNUAL MEMBERSHIP DUES TO VARIOUS NATIONAL, STATE AND LOCAL ORGANIZATIONS, A PORTION ($1,762) OF WHICH RELATED TO LOBBYING ACTIVITIES. IN ADDITION, TRIHEALTH, INC., A RELATED ORGANIZATION OF HOSPITAL, WHICH PROVIDES ADMINISTRATIVE SUPPORT SERVICES TO HOSPITAL, PAID ANNUAL MEMBERSHIP DUES TO VARIOUS NATIONAL, STATE AND LOCAL ORGANIZATIONS A PORTION OF WHICH RELATED TO LOBBYING ACTIVITIES. A PORTION OF THE AFOREMENTIONED ADMINISTRATIVE SUPPORT SERVICES ARE ALLOCATED TO HOSPITAL AND $3,430 OF THE AMOUNT SHOWN ON LINE 1I REPRESENTS HOSPITAL'S SHARE OF THESE LOBBYING EXPENSES. FINALLY, HOSPITAL'S CONTROLLING ORGANIZATION, CATHOLIC HEALTH INITIATIVES, PAYS ANNUAL DUES TO THE AMERICAN HOSPITAL ASSOCIATION ("AHA") AND CATHOLIC HOSPITAL ASSOCIATION ("CHA"), A PORTION OF WHICH IS ALLOCATED TO LOBBYING ACTIVITIES. FOR THE TAX YEAR, THE AMOUNT SHOWN ON LINE 1I ABOVE REPRESENTS HOSPITAL'S SHARE OF ALLOCATED LOBBYING EXPENSES: AHA $839; CHA $2,524.
PART IV, SUPPLEMENTAL INFORMATION:PART II-B, LINE 1(F), GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING: TRIHEALTH, INC., A RELATED ORGANIZATION OF HOSPITAL, WHICH PROVIDES ADMINISTRATIVE SUPPORT SERVICES TO HOSPITAL, PAID FEES TO CASSIDY AND ASSOCIATES, A LEADER IN THE GOVERNMENT RELATIONS INDUSTRY FOR OVER THIRTY YEARS, FOR PROFESSIONAL SERVICES. A PORTION OF THE AFOREMENTIONED ADMINISTRATIVE SUPPORT SERVICES ARE ALLOCATED TO HOSPITAL AND THE AMOUNT SHOWN ON LINE 1F REPRESENTS HOSPITAL'S SHARE OF THESE EXPENSES.

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance12221795BeginningOfYearBalance
Contributions66487Contributions
End Of Year Balance12288282EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance12018000BeginningOfYearBalance
Contributions203795Contributions
End Of Year Balance12221795EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance11923322BeginningOfYearBalance
Contributions94678Contributions
End Of Year Balance12018000EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis10489392OtherCostOrOtherBasis
Book Value10489392BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis297768906OtherCostOrOtherBasis
Depreciation183848022Depreciation
Book Value113920884BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis7698256OtherCostOrOtherBasis
Depreciation3882026Depreciation
Book Value3816230BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis187094074OtherCostOrOtherBasis
Depreciation147916111Depreciation
Book Value39177963BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis16411013OtherCostOrOtherBasis
Book Value16411013BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings183815482TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionCHI OPERATING INVESTMENT PROGRAMDescription
Book Value366526724BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities366526724TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
RETIREMENT PLAN LIABILITY$22,799,269
LEASE PAYMENT LIABILITY$8,357,447
ENVIRONMENTAL REMEDIATION LIABILITY$1,502,422
UNCLAIMED PROPERTY$547,592
FieldValueIRS element (for citing)
Total Of Amounts33206730TotalOfAmounts
Total Revenue518094931TotalRevenue
Total Expenses460495899TotalExpenses
Excess Or Deficit For Year57599032ExcessOrDeficitForYear
Net Unrealized GL On Investments33042181NetUnrealizedGLOnInvestments
Other$20,681,876OtherAmount
Total Adjustments53724057TotalAdjustments
Excess Or Deficit Per FS111323089ExcessOrDeficitPerFS

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE FINANCIAL STATEMENTS OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("HOSPITAL") ARE AUDITED WITH ITS SUBSIDIARIES. FOLLOWING IS THE TEXT OF THE FOOTNOTE TO HOSPITAL'S AUDITED FINANCIAL STATEMENTS THAT REPORTS ITS AND ITS SUBSIDIARY'S LIABILITY, IF APPLICABLE, FOR UNCERTAIN TAX POSITIONS UNDER ASC 740-10-25: THE COMPANY COMPLETED AN ANALYSIS OF UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AT JUNE 30, 2011 AND 2010, AND DETERMINED NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2011 AND 2010. IN ADDITION, HOSPITAL'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION. CHI IS A TAX-EXEMPT COLORADO CORPORATION AND HAS BEEN GRANTED AN EXEMPTION FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CHI OWNS CERTAIN TAXABLE SUBSIDIARIES AND ENGAGES IN CERTAIN ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE AND THEREFORE SUBJECT TO INCOME TAX. AS OF JUNE 30, 2011, CHI HAS NET DEFERRED TAX ASSETS OF $2.1 MILLION AND A NONCURRENT NET DEFERRED TAX LIABILITY OF $5.4 MILLION RELATED TO THESE TAXABLE ACTIVITIES. MANAGEMENT ANNUALLY REVIEWS ITS POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS.
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE PENSION PLAN/SERP FUNDED STATUS 24,738,916. TRANSFER TO CHI CAPITAL RESOURCE POOL -4,024,236. MISCELLANEOUS ADJUSTMENT -32,804.

Schedule F IRS990ScheduleF

FieldValueIRS element (for citing)
Subtotal Number Of Offices0SubtotalNumberOfOffices
Subtotal Number Of Employees0SubtotalNumberOfEmployees
Cont Number Of Offices0ContNumberOfOffices
Cont Number Of Employees0ContNumberOfEmployees
Total Number Of Offices0TotalNumberOfOffices
Total Number Of Employees0TotalNumberOfEmployees
Subtotal Amount Spent0SubtotalAmountSpent
Cont Amount Spent0ContAmountSpent
Total Amount Spent0TotalAmountSpent
Transfer To Foreign Corp1TransferToForeignCorp
Interest In Foreign Trust0InterestInForeignTrust
Own Foreign Corp0OwnForeignCorp
Passive Foreign Invest Co0PassiveForeignInvestCo
Foreign Partnership1ForeignPartnership
Boycott Countries0BoycottCountries

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense19548484TotalCommunityBenefitExpense
Direct Offsetting Revenue6414967DirectOffsettingRevenue
Net Community Benefit Expense13133517NetCommunityBenefitExpense
Percent Of Total Expense0.03100PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense71710690TotalCommunityBenefitExpense
Direct Offsetting Revenue54792091DirectOffsettingRevenue
Net Community Benefit Expense16918599NetCommunityBenefitExpense
Percent Of Total Expense0.03990PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense91259174TotalCommunityBenefitExpense
Direct Offsetting Revenue61207058DirectOffsettingRevenue
Net Community Benefit Expense30052116NetCommunityBenefitExpense
Percent Of Total Expense0.07090PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1530924TotalCommunityBenefitExpense
Direct Offsetting Revenue37149DirectOffsettingRevenue
Net Community Benefit Expense1493775NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense21016731TotalCommunityBenefitExpense
Direct Offsetting Revenue10034128DirectOffsettingRevenue
Net Community Benefit Expense10982603NetCommunityBenefitExpense
Percent Of Total Expense0.02590PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense5101366TotalCommunityBenefitExpense
Direct Offsetting Revenue4080746DirectOffsettingRevenue
Net Community Benefit Expense1020620NetCommunityBenefitExpense
Percent Of Total Expense0.00240PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense2565642TotalCommunityBenefitExpense
Net Community Benefit Expense2565642NetCommunityBenefitExpense
Percent Of Total Expense0.00610PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense112285TotalCommunityBenefitExpense
Net Community Benefit Expense112285NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense30326948TotalCommunityBenefitExpense
Direct Offsetting Revenue14152023DirectOffsettingRevenue
Net Community Benefit Expense16174925NetCommunityBenefitExpense
Percent Of Total Expense0.03820PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense121586122TotalCommunityBenefitExpense
Direct Offsetting Revenue75359081DirectOffsettingRevenue
Net Community Benefit Expense46227041NetCommunityBenefitExpense
Percent Of Total Expense0.10910PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense356750TotalCommunityBuildingExpense
Net Community Building Expense356750NetCommunityBuildingExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense2136TotalCommunityBuildingExpense
Net Community Building Expense2136NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense358886TotalCommunityBuildingExpense
Net Community Building Expense358886NetCommunityBuildingExpense
Percent Of Total Expense0.00080PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$9,250,997BadDebtExpenseAmount
Amount Reimbursed By Medicare96578589AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare96576469CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall2120MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1GOOD SAMARITAN HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1375 DIXMYTH AVENUEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45220ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Research FacilityXResearchFacility
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
GOOD SAMARITAN MEDICAL CENTER
6949 GOOD SAMARITAN DRIVECINCINNATIOH45247EMERGENCY DEPARTMENT/OUTPATIENT SERVICES
GOOD SAMARITAN PHYSICAL THERAPY
8748 UNION CENTRE DRIVEWEST CHESTEROH45069PHYSICAL THERAPY
GOOD SAMARITAN HOSPITAL OUTPATIENT CTR
6350 GLENWAY AVENUECINCINNATIOH45211OUTPATIENT PHYSICIAN CLINIC
GOOD SAMARITAN HOSPITAL WEIGHT MGMT CTR
3219 CLIFTON AVENUE SUITE 225CINCINNATIOH45220WEIGHT MANAGEMENT SERVICES
GOOD SAMARITAN HOSPITAL WOMEN'S CENTER
3219 CLIFTON AVENUE SUITE 100CINCINNATIOH45220WOMEN'S HEALTH SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanation
PART I, LINE 3C: THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO UTILIZES THE FEDERAL POVERTY GUIDELINES ("FPG") IN DETERMINING CHARITY CARE ELIGIBILITY. SEE THE RESPONSES TO PART I, LINE 3A AND 3B.AN INDIVIDUAL'S INCOME UNDER FPG IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR CHARITY CARE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT A PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES.
PART I, LINE 6A: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH, INC. TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. THE COMMUNITY BENEFIT PROVIDED BY THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO IS TRACKED ON A STANDALONE BASIS, HOWEVER ITS COMMUNITY BENEFIT IS REPORTED IN COMBINATION WITH BETHESDA HOSPITAL, INC.'S COMMUNITY BENEFIT IN A REPORT PREPARED BY TRIHEALTH, INC.
PART I, LINE 7: FOR THE AMOUNTS REPORTED AT COST IN PART I, LINE 7, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO UTILIZED WORKSHEET 2 - RATIO OF PATIENT CARE COST-TO-CHARGES, WHICH WAS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H, TO CALCULATE THE COST-TO-CHARGE RATIO.
PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES COMMUNITY BENEFIT AMOUNT REPORTED IN PART I, LINE 7(G) DOES NOT INCLUDE COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS.
PART I, L7 COL(F): $36,897,918 OF BAD DEBT EXPENSES THAT WAS INCLUDED IN FORM 990, PART IX, LINE 25, COLUMN (A) HAS BEEN REMOVED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES IN SCHEDULE H, PART I, LINE 7, COLUMN (F).
PART II: THE UPTOWN CONSORTIUM ("CONSORTIUM") IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). IT IS MADE UP OF THE FIVE LARGEST EMPLOYERS OF CINCINNATI'S "UPTOWN" INCLUDING THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. "UPTOWN" GENERALLY INCLUDES THE NEIGHBORHOODS OF AVONDALE, CLIFTON, CLIFTON HEIGHTS, CORRYVILLE, FAIRVIEW, MT. AUBURN AND UNIVERSITY HEIGHTS. THE CONSORTIUM IS DEDICATED TO BUILDING THE HUMAN, SOCIAL AND PHYSICAL IMPROVEMENT OF UPTOWN CINCINNATI. IT WILL UNDERTAKE A VARIETY OF INVESTMENT AND PROGRAM ACTIVITIES IN UPTOWN TO HELP PROVIDE HOUSING, HEALTH CARE AND JOB OPPORTUNITIES.IN ADDITION, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ASSISTS, THROUGH VOLUNTEERING, VARIOUS ORGANIZATIONS INCLUDING THE WORK RESOURCE CENTER OF CINCINNATI WHICH PROVIDES SKILLS TRAINING FOR INDIVIDUALS WITH DISABILITIES AND DISADVANTAGES TO INCREASE THEIR INDEPENDENCE THROUGH EMPLOYMENT.
PART III, LINE 4: NET PATIENT ACCOUNTS RECEIVABLE (PART OF FOOTNOTE A)NET PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE HAVE BEEN ADJUSTED TO THE ESTIMATED AMOUNTS EXPECTED TO BE COLLECTED. THESE ESTIMATED AMOUNTS ARE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS.THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY AS NECESSARY THE PROVISIONS FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE COMPANY FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH THE COMPANY. FINANCIAL INSTRUMENTS THAT POTENTIALLY SUBJECT THE COMPANY TO CONCENTRATIONS OF CREDIT RISK CONSIST PRIMARILY OF NON-GOVERNMENTAL PATIENT ACCOUNTS RECEIVABLE. THE COMPANY GRANTS CREDIT WITHOUT COLLATERAL TO ITS PATIENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE PERCENTAGES OF GROSS PATIENT ACCOUNTS RECEIVABLE FROM PATIENTS AND THIRD-PARTY PAYORS AT JUNE 30 APPROXIMATED THE FOLLOWING: 2011 - MEDICARE 18%, MEDICAID 3%, MANAGED CARE 21%, SELF PAY 22%, COMMERCIAL AND OTHER 36%2010 - MEDICARE 18%, MEDICAID 4%, MANAGED CARE 19%, SELF PAY 23%, COMMERCIAL AND OTHER 36%AS FOR THE AMOUNT OF BAD DEBT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO DOES NOT REPORT ACTUAL BAD DEBT EXPENSE AS COMMUNITY BENEFIT. IF UPON FURTHER RESEARCH, IT IS ULTIMATELY DETERMINED THAT A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER TRIHEALTH'S CHARITY CARE POLICY, THOSE COSTS WOULD BE RECLASSIFIED, AS APPROPRIATE, TO COMMUNITY BENEFIT AT THAT TIME.
PART III, LINE 8: THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO USES THE "STEPDOWN METHODOLOGY" IN DETERMINING THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT. THIS METHOD OF COST FINDING PROVIDES FOR THE ALLOCATION OF THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS WHICH UTILIZE SUCH SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO DID NOT REPORT ANY MEDICARE SHORTFALL AS COMMUNITY BENEFIT IN PART III, LINE 7 OF THIS SCHEDULE.
PART III, LINE 9B: AS OF THE FILING OF THIS RETURN, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, AS PART OF TRIHEALTH, INC., MAINTAINS A WRITTEN DEBT COLLECTION POLICY. TRIHEALTH, INC., WHO PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS, WILL NOT INITIATE COLLECTION PRACTICES ON PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BEFORE COLLECTION ACTIONS ARE TAKEN, TRIHEALTH, INC. WILL MAKE REASONABLE EFFORTS, GENERALLY AS EARLIER IN THE BILLING PROCESS AS POSSIBLE, TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. AFTER SUCH EFFORTS HAVE BEEN MADE AND A BALANCE REMAINS THAT IS THE RESPONSIBILITY OF THE PATIENT OR GUARANTOR, TRIHEALTH, INC. MAY PURSUE, IN ITS SOLE DISCRETION, WHATEVER ACTIONS IT MAY BE ENTITLED TO TAKE UNDER LAW.
PART VI, LINE 2: IN 1852, THE SISTERS OF CHARITY ESTABLISHED GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("GSH") IN AN EFFORT TO ADDRESS THE NEEDS OF THE GROWING CITY OF CINCINNATI. IN 1995, GSH & BETHESDA HOSPITAL, INC. ("BETHESDA") FORMED A PARTNERSHIP TO CREATE A LOCAL HEALTH SYSTEM: TRIHEALTH, INC. ("TRIHEALTH"). TRIHEALTH'S MISSION IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY THROUGH A FULL RANGE OF HEALTH RELATED SERVICES (E.G. PREVENTION, WELLNESS & EDUCATION)THE SERVICES DESCRIBED BELOW, & OTHERS NOT LISTED, PROMOTE A HEALTHY COMMUNITY. PROGRAMS SEEK TO REDUCE THE BURDENS ON THE GOVERNMENT. FOR EXAMPLE, IF GSH DID NOT ADDRESS THE ROOT CAUSES OF LOW BIRTH WEIGHT & PREMATURITY, THE BURDEN TO GOVERNMENT MEDICAL PROGRAMS SUCH AS MEDICAID WOULD BE EVEN GREATER.CURRENTLY, GSH, AS PART OF TRIHEALTH, IS INVOLVED IN THE PLANNING & IMPLEMENTATION OF A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT WITH AN ANTICIPATED COMPLETION TIMELINE OF 2012. THE ASSESSMENT REPORT WILL ASSIST PARTNER HOSPITALS & AGENCIES IN ADDRESSING UNMET HEALTH NEEDS, WITH AN OVERALL AIM OF IMPROVING POPULATION HEALTH. COMMUNITY HEALTH NEEDS, AS ASSESSED IN PRIOR YEARS BY INDEPENDENT GROUPS SUCH AS THE GREATER CINCINNATI UNITED WAY AS WELL AS THE HEALTH FOUNDATION OF GREATER CINCINNATI, HAVE SHOWN SIGNIFICANT HEALTH NEEDS FOR THE GREATER CINCINNATI AREA IN INFANT MORTALITY, OBESITY, DEPRESSION, HYPERTENSION & DIABETES. TWO MAJOR STRATEGIES ARE IN PLACE TO ADDRESS INFANT MORTALITY & DIABETES. THE REMAINING COMMUNITY HEALTH NEEDS RECEIVE TRIHEALTH'S EXPERTISE & FOCUS THROUGH ONGOING HOSPITAL & PHYSICIAN PRACTICE INITIATIVES.FREE & DISCOUNTED SERVICES ARE PROVIDED FOR THOSE UNABLE TO PAY & MEETING ELIGIBILITY CRITERIA. THROUGH THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP), GSH SERVES PATIENTS MEETING CRITERIA SET FORTH BY THE STATE OF OHIO. GSH POLICY IS TO PROVIDE CHARITY CARE ON A SLIDING SCALE DISCOUNTING WHEN THE FAMILY INCOME IS UP TO 400 % OF THE ANNUALLY ESTABLISHED FEDERAL POVERTY GUIDELINE. IT OFFERS AN UNINSURED DISCOUNT FOR MEDICALLY NECESSARY SERVICES FOR THOSE WHO HAVE NO INSURANCE & WHO DO NOT QUALIFY FOR OTHER FINANCIAL ASSISTANCE OPTIONS. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION WHICH IS AVAILABLE ON TRIHEALTHS WEBSITE & BROCHURES ABOUT FINANCIAL ASSISTANCE ARE VISIBLE & AVAILABLE IN HOSPITAL REGISTRATION & ADMITTING AREAS.GSH PROVIDED $46.2 MILLION IN TOTAL COMMUNITY BENEFIT FOR FISCAL YEAR 2011. OF THAT TOTAL, $30.1 MILLION REPRESENTED UNCOMPENSATED CARE. THE UNPAID COST OF MEDICARE IS NOT INCLUDED IN COMMUNITY BENEFIT.GSH FUNDS THE PARISH NURSE MINISTRY & COMMUNITY HEALTH WORKER PROGRAMS. THESE PROGRAMS PROVIDE, AT NO CHARGE, HOME VISITS TO LOW INCOME CLIENTS IN 9 NEIGHBORHOODS. CLIENTS INCLUDE SENIORS & FRAIL ELDERLY IN THEIR HOMES OR IN CONGREGATE SUBSIDIZED HOUSING, THE MENTALLY & PHYSICALLY HANDICAPPED LIVING ALONE OR IN GROUP HOMES, & MOTHERS WHO ARE PREGNANT OR WHO HAVE RECENTLY DELIVERED A BABY. REFERRALS COME FROM HOSPITAL CARE COORDINATORS, OTHER HOSPITALS & AGENCIES. THE TEAM PROVIDES HEALTH SCREENINGS, EDUCATION ON MANAGING CHRONIC ILLNESSES, & CONNECTIONS TO ASSISTANCE. THE NEWLY DEVELOPED PURPLE (PREVENTING REPEAT PERINATAL LOSS) PROJECT CONNECTS MOTHERS WHO HAVE EXPERIENCED THE LOSS OF A PREGNANCY GREATER THAN 20 WEEKS GESTATION WITH A PARISH NURSE WHO PROVIDES EMOTIONAL & SPIRITUAL SUPPORT, NUTRITION INFORMATION & EDUCATION ON INTER-CONCEPTION HEALTH.THE INPATIENT BEHAVIORAL HEALTH UNITS AT GSH ARE AMONG THE FEW SUCH UNITS IN THE GREATER CINCINNATI COMMUNITY. THE ADULT BEHAVIORAL HEALTH INPATIENT UNIT IS A 19-BED COMPREHENSIVE PSYCHIATRIC UNIT FOR ADULT PATIENTS REQUIRING ACUTE INPATIENT CARE. THE TEAM CONSISTS OF PSYCHIATRISTS, NURSING STAFF, SOCIAL WORKERS, OCCUPATIONAL THERAPISTS, THERAPEUTIC RECREATION SPECIALISTS, & ART THERAPISTS. THE FULL SERVICES OF THE HOSPITAL ARE AVAILABLE AS REQUIRED FOR THE PATIENT'S CARE. TREATMENT FOCUSES ON SYMPTOM & MEDICATION MANAGEMENT & EDUCATION, & SAFE DISCHARGE DISPOSITION WITH A LINK TO COMMUNITY RESOURCES. THE SENIOR BEHAVIORAL HEALTH INPATIENT UNIT IS A SPECIALTY BEHAVIORAL HEALTH INPATIENT UNIT ADDRESSING THE PSYCHOLOGICAL, MEDICAL, EMOTIONAL & SPIRITUAL NEEDS OF GREATER CINCINNATI'S OLDER ADULTS. THE TEAM OF PSYCHIATRISTS, PSYCHIATRIC NURSES, SOCIAL WORKERS, & ACTIVITY & OCCUPATIONAL THERAPISTS PROVIDES INDIVIDUALIZED TREATMENT FOR OLDER ADULTS WITH PHYSICAL & MENTAL HEALTH PROBLEMS.HEALTHY WOMEN HEALTHY LIVES IS A PROGRAM BASED ON THE PREMISE THAT PREVENTION, EARLY DETECTION, TREATMENT & ACCESS TO HEALTH CARE SERVICES IMPROVE INDIVIDUAL & COMMUNITY HEALTH OUTCOMES. THE FOCUS IS ON HEALTH RISKS ASSOCIATED WITH THE ONSET OF MENOPAUSE. WELL ORGANIZED SCREENING & EDUCATION EVENTS BRING THE SERVICES TO AT RISK POPULATIONS OF AFRICAN AMERICAN, APPALACHIAN, HISPANIC, UNINSURED & UNDERINSURED WOMEN FORTY YEARS OF AGE OR OLDER. SCREENING INCLUDES OSTEOPOROSIS, MAMMOGRAPHY, CHOLESTEROL, HYPERTENSION, & OBESITY. EVERY WOMAN RECEIVES A NURSE CONSULTATION, A COPY OF THEIR RESULTS & A WRITTEN PRIMARY CARE REFERRAL. WOMEN WITH ABNORMAL RESULTS ARE CONTACTED & ASSISTED IN ACCESSING PRIMARY CARE. IN FISCAL YEAR 2011 OVER 500 WOMEN WERE SERVED BY THIS PROGRAM. HAMILTON COUNTY'S INFANT MORTALITY RATE OF 19%, THE HIGHEST IN OHIO HAS LED GSH TO FOCUS ON MATERNAL & INFANT HEALTH PROGRAMS. STRATEGIES INCLUDE INVESTIGATING THE ROOT CAUSES OF PREMATURITY & LOW BIRTH WEIGHT.GSH HAD 6385 DELIVERIES IN FISCAL YEAR 2011. OF THESE BIRTHS, THE PERCENTAGE OF MOTHERS WITH PRETERM LABOR WAS 15% (A 2% INCREASE OVER FY10). THE PERCENTAGE OF BABIES BORN WEIGHING LESS THAN 2500 GRAMS WAS 14% (A SLIGHT DECREASE FROM FY10). THIS DECREASE MAY BE ATTRIBUTED IN PART TO GSH'S COLLABORATIVE EFFORTS TO REDUCE ELECTIVE DELIVERIES BEFORE THE 39TH WEEK. ADDITIONALLY, THE CARE MANAGEMENT PROVIDED TO MOTHERS BY GSH PERINATAL SOCIAL WORKERS & CARE COORDINATORS INCLUDES SPECIAL PROGRAMS IN CHEMICAL DEPENDENCY & OTHER PREGNANCY HIGH-RISK ISSUES. THE GSH PARISH NURSES & COMMUNITY HEALTH WORKERS VISIT REFERRED MOTHERS IN THEIR HOMES & WORK WITH THEM TO PROBLEM-SOLVE THE FREQUENT CHALLENGES FACED SUCH AS SAFE HOUSING & CARE OF CHILDREN, AS WELL AS HEALTHY MANAGEMENT OF THE PREGNANCY.PERINATAL CARE COORDINATION NURSES & SOCIAL WORKERS FROM GSH ASSIST MOTHERS IN THE GSH FACULTY MEDICAL CENTER. THEY ALSO TRAVEL TO CLINICS IN ORDER TO REACH OUT & HELP UNINSURED & UNDERINSURED MOTHERS ACCESS PUBLIC PROGRAMS, REFERRALS, EDUCATION, ASSESSMENT & RESOURCES.GSH CONTINUES A COMMITMENT TO EDUCATING THE NEXT GENERATION OF HEALTH CARE PROVIDERS--PHYSICIANS & ALLIED HEALTH PROFESSIONALS. GSH, AS PART OF TRIHEALTH, INC., SPONSORS MEDICAL RESIDENCIES. THERE WERE 28 RESIDENTS IN INTERNAL MEDICINE & 23 GENERAL SURGERY RESIDENTS AT GSH IN FISCAL YEAR 2011. 2 FELLOWS IN VASCULAR SURGERY RECEIVED EXTENDED LEARNING & PREPARATION IN THEIR FELLOWSHIP AT GSH. 32 TOTAL RESIDENTS IN OBSTETRICS & GYNECOLOGY LEARNED IN A JOINT RESIDENCY AT BOTH BETHESDA & GSH.IN THE GSH FACULTY MEDICAL CENTER ("FMC"), A MULTI-SPECIALTY CENTER, MEDICAL RESIDENTS PROVIDE CARE TO PATIENTS UNDER THE GUIDANCE OF ATTENDING PHYSICIANS. FMC SERVICES INCLUDE OBSTETRICS & GYNECOLOGY, INTERNAL MEDICINE, VASCULAR & GENERAL SURGERY, DYSPLASIA, HIGH-RISK PREGNANCY, URO-GYNECOLOGY & GASTRO-INTESTINAL. THE FMC PHARMACIST HELPS ELIGIBLE CLIENTS COMPLETE THE MEDICATION ASSISTANCE PROGRAMS APPLICATIONS. THE GSH ON-SITE PHARMACY PROVIDES PRESCRIPTIONS FOR THOSE IN NEED, AT REDUCED OR NO COST.GSH COLLABORATES WITH LOCAL & REGIONAL COLLEGES, UNIVERSITIES & TRAINING CENTERS TO PROVIDE MENTORING, INTERNSHIPS, CLERKSHIPS, SUPERVISED EDUCATION & CLINICAL ROTATIONS TO STUDENTS IN HEALTH FIELDS. THESE PARTNERSHIPS HELP STUDENTS LEARN ABOUT & PREPARE FOR PROFESSIONS IN NURSE PRACTITIONER, RESPIRATORY THERAPY, RADIOLOGY TECHNOLOGY, STERILE PROCESSING, PHLEBOTOMY, MEDICAL LABORATORY, CLINICAL DIETETICS, PHARMACY, SPEECH, AUDIOLOGY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, NURSE MIDWIFERY, & NEONATAL NURSE PRACTITIONER. PASTORAL CARE OFFERS A CLINICAL PASTORAL EDUCATION PROGRAM EDUCATING CLERGY & OTHERS IN PASTORAL SKILLS TO MINISTER EFFECTIVELY TO THE SICK & THE DYING.GSH'S RESEARCH PROGRAM MANAGES BASIC & APPLIED SCIENTIFIC STUDIES & SPONSORED CLINICAL TRIALS. IT ALSO SUPPORTS THE EDUCATION ACTIVITIES OF STAFF PHYSICIANS & SURGEONS, TEACHING FACULTY, RESIDENTS, & ALLIED HEALTH PROFESSIONALS. WHAT IS LEARNED THROUGH THE RESEARCH & EDUCATION PROGRAMS IS SHARED WITH THE LARGER COMMUNITY. THE RESEARCH PROGRAM HELPED RESEARCHERS GIVE 65 PROFESSIONAL PRESENTATIONS AT REGIONAL & NATIONAL MEETINGS. AN ESTIMATED 45 STUDIES & ARTICLES WERE PUBLISHED IN PEER-REVIEWED MEDICAL JOURNALS.THROUGH THESE PROGRAMS, GSH CONTINUES ITS SPECIAL CONCERN FOR THE VULNERABLE. EMPLOYEES, PHYSICIANS & LEADERS PROVIDING & GUIDING THESE PROGRAMS FOR COMMUNITY HEALTH ARE LIVING THE CORE VALUES OF STEWARDSHIP & RESPONSE TO COMMUNITY NEEDS.
PART VI, LINE 3: TRIHEALTH, INC. ("TRIHEALTH") PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS INCLUDING THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. BROCHURES/APPLICATIONS, PROVIDED IN MULTIPLE LANGUAGES, ARE VISIBLE AND AVAILABLE IN THE REGISTRATION AND ADMITTING AREAS OF ALL TRIHEALTH AFFILIATED HOSPITALS. IN ADDITION, THE APPLICATION IS PRINTED ON THE REVERSE SIDE OF A PATIENT'S BILL WITH INSTRUCTIONS ON HOW TO COMPLETE THE APPLICATION AS WELL AS HOW TO RETURN IT. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. FINALLY, TRIHEALTH INC.'S WEBSITE CONTAINS INFORMATION REGARDING ITS CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS WITH DIRECTIONS ON HOW TO CONTACT THE APPROPRIATE PERSONNEL TO INITIATE AN APPLICATION OR ASK QUESTIONS ABOUT THE PROCESS.
PART VI, LINE 4: LOCATED IN CINCINNATI, OHIO, GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND THE TRIHEALTH SYSTEM SERVE HAMILTON, BUTLER, WARREN AND CLERMONT COUNTIES, AS WELL AS PERSONS FROM INDIANA AND KENTUCKY. OHIO'S THIRD LARGEST CITY, CINCINNATI HAS AN ESTIMATED POPULATION OF 296,943. THE POPULATION WITHIN THE FOUR OHIO COUNTIES SERVED BY TRIHEALTH IS ESTIMATED TO BE 1,580,560 AND 12% PERCENT OF THIS POPULATION IS UNINSURED. THE GEOGRAPHIC AREA SERVED BY THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO IS PREDOMINANTLY URBAN WITH A LARGE SEGMENT OF ITS PATIENTS UNINSURED, UNDERINSURED OR MEDICAID RECIPIENTS.
PART VI, LINE 6: THE ONGOING PURPOSE OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("GSH") IS TO PROVIDE CARE WITH COMPASSION. ITS MISSION IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY THROUGH HEALTH RELATED SERVICES--PREVENTION, WELLNESS AND EDUCATION. ITS BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES. GSH IS AN ACUTE TERTIARY TEACHING HOSPITAL. AS PART OF TRIHEALTH A SYSTEM OF SERVICES SPANNING ACUTE CARE TO HOME CARE, BABIES TO SENIORS. IT PROVIDES A 24-HOUR EMERGENCY ROOM, FOUR INTENSIVE CARE UNITS FOR NEONATES AND ADULTS, ADULT AND GERIATRIC INPATIENT PSYCHIATRIC CARE, AND AN ACCREDITED REHABILITATION MEDICINE PROGRAM. SERVICES ARE OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. GSH HAS AN OPEN MEDICAL STAFF AND A HISTORY OF TRAINING AND EDUCATING MEDICAL RESIDENTS AND HEALTH CARE PROFESSIONALS. ITS MEDICAL AND SCIENTIFIC RESEARCH PROGRAMS INCLUDE STUDIES THAT ARE NOT COMMERCIALLY SPONSORED. GSH PARTICIPATES IN MEDICARE AND MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS, AND HAS AN ACTIVE CHARITY CARE PROGRAM.SEE RESPONSE TO PART VI, LINE 2 FOR ADDITIONAL INFORMATION.
PART VI, LINE 7: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH, INC. TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. TRIHEALTH, INC.'S SITES INCLUDE TWO HOSPITAL LOCATIONS AND VARIOUS PHYSICIAN OFFICE BUILDINGS THROUGHOUT THE GREATER CINCINNATI AREA IN ADDITION TO FITNESS, REHABILITATION, OCCUPATIONAL HEALTH, PALLIATIVE CARE SERVICES AND OUTPATIENT CENTERS. IT ALSO PROVIDES SERVICES IN HOMES AND WORKPLACES AND DELIVERS CARE AND EDUCATION COOPERATIVELY THROUGH COMMUNITY-BASED ORGANIZATIONS, SUCH AS CHURCHES, SCHOOLS, CLINICS AND SOCIAL AGENCIES.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (11 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
HEALTHY BEGINNINGS INC
47 E HOLLISTER STE 201CINCINNATIOH45219311380939501(C)(3)70000RESIDENCY SUPPORT
HEALTHY MOM AND BABIES INC
2270 BANNING ROADCINCINNATIOH45239311155292501(C)(3)103500CHARITY CARE
HARMONY GARDEN
1776 MENTOR AVE BOX 221CINCINNATIOH45212205461244501(C)(3)10000VIOLENCE PREVENTION GRANT
UPTOWN CONSORTIUM INC
629 OAK STREET SUITE 306CINCINNATIOH45206200688727501(C)(3)147900GENERAL PURPOSE
VOLUNTEERS IN MEDICAL MISSIONS
PO BOX 756SENECASC29679621361564501(C)(3)6250MEDICAL SERVICE TRIP
THE CENTER FOR CLOSING THE HEALTH GAP IN GREATER CINCINNATI
3120 BURNET AVENUE SUITE 201CINCINNATIOH45229200902286501(C)(3)107865GENERAL PURPOSE
BETHESDA FOUNDATION
619 OAK STREETCINCINNATIOH45206237374129501(C)(3)34300GENERAL PURPOSE
CENTER FOR RESPITE CARE INC
PO BOX 141301CINCINNATIOH45229202544994501(C)(3)25500GENERAL PURPOSE
GOOD SAMARITAN HOSPITAL FOUNDATION OF CINCINNATI INC
619 OAK STREETCINCINNATIOH45206311206047501(C)(3)6120GENERAL PURPOSE
HEALTH IMPROVEMENT COLLABORATIVE OF GREATER CINCINNATI INC
2100 SHERMAN AVE NO 100CINCINNATIOH45212311449807501(C)(3)23945GENERAL PURPOSE
COLLEGE OF MOUNT SAINT JOSEPH
5701 DELHI ROADCINCINNATIOH45233237179567501(C)(3)10200GENERAL PURPOSE
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants11TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantEDUCATIONAL ASSISTANCE (I.E. TUITION PAYMENT, INTERPRETER SERVICES, ETC.)TypeOfGrant
Number Of Recipients1NumberOfRecipients
Amount Of Cash Grant6121AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("HOSPITAL") PROVIDES GRANTS TO OTHER ORGANIZATIONS AND INDIVIDUALS ON A VERY LIMITED BASIS. IN THOSE INSTANCES, THE DEPARTMENT GRANTING THE FUNDS IS RESPONSIBLE FOR OBTAINING AND STORING ALL NECESSARY INFORMATION FROM THE OTHER ORGANIZATION AND INDIVIDUALS RELATIVE TO HOW THE FUNDS WILL BE SPENT. GENERALLY, GRANTS ARE PROVIDED, ON BEHALF OF HOSPITAL THOUGH TRIHEALTH, INC. ("TRIHEALTH"), A SUPPORTING ORGANIZATION OF HOSPITAL, WHICH PROVIDES ADMINISTRATIVE SUPPORT SERVICES TO HOSPITAL. AS SUCH, TRIHEALTH IS RESPONSIBLE FOR MONITORING THE USE OF HOW THE FUNDS WILL BE SPENT.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
PAUL EDGETT III
038447001121380998530597490188580675068077989
JOHN PROUT
082630903255120642430290415093960151587500
DONNA NIENABER ESQ
028569301128450824380122081016565061962200
CRAIG RUCKER
03568950119103016910010817307579060866000
DAVE DORNHEGGEN
0255360071524020493095545013663045658500
WILLIAM GRONEMAN
0340571011256905812301438530227280677844015009
GERALD OLIPHANT
03941870128877024815096037021617066553300
GEORGES FEGHALI MD
034526901246960233920114648022453063045800
ROBERT ROHS MD
338496000322303947207130381904000
MICHAEL HOLBERT MD
26510200045702201205640288135000
MICHAEL MARCOTTE MD
20036700000230630193310242761000
HELEN KOSELKA MD
19914808700612040963068630248456000
SAMATHA MAST MD
1556810002400111080121370179166000
MICHAEL CROFTON
0191909048549020633045715022278032908400

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BPART I, LINE 4B - NON-QUALIFIED DEFERRED COMPENSATION PLAN ELIGIBLE EXECUTIVES (GENERALLY VICE PRESIDENTS AND ABOVE) PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. TRIHEALTH, INC., THE RELATED ORGANIZATION THAT PAID THE SALARIES OF THE FOLLOWING INDIVIDUALS LISTED IN SCHEDULE J, PART II, CONTRIBUTED, ON BEHALF OF THE FOLLOWING INDIVIDUALS, TO A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE AMOUNTS AS NOTED: JOHN PROUT - $240,770 DONNA NIENABER, ESQ. - $67,368 CRAIG RUCKER - $63,874 MICHAEL CROFTON - $14,108 GERALD OLIPHANT - $73,468 DAVE DORNHEGGEN - $39,203 WILLIAM GRONEMAN - $75,052 GEORGES FEGHALI, MD - $72,079. IN ADDITION, THE FOLLOWING INDIVIDUALS LISTED IN SCHEDULE J, PART II, RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH WAS TREATED AS TAXABLE COMPENSATION BY THEIR RESPECTIVE EMPLOYERS: WILLIAM GRONEMAN - $15,009 (TRIHEALTH, INC.) PAUL EDGETT III - $77,989 (CATHOLIC HEALTH INITIATIVES)
PART I, LINE 7PART I, LINE 7: A PHYSICIAN HAS A BASE SALARY BUT IS ALSO ELIGIBLE FOR A BONUS. THE BONUS IS CONTINGENT ON THE PROFITABILITY OF HIS OR HER PRACTICE. ESSENTIALLY, THE PROFITABILITY OF HIS OR HER PRACTICE GETS PAID TO THE PHYSICIAN AS A BONUS UP TO A MAXIMUM OF $100,000.
PART IIIPART I, LINE 3 - METHODS USED TO ESTABLISH CEO COMPENSATION TRIHEALTH, INC., A RELATED ORGANIZATION OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, WHO PAID THE INDIVIDUAL, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE FILING ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: * COMPENSATION COMMITTEE; * INDEPENDENT COMPENSATION CONSULTANT; * COMPENSATION SURVEY OR STUDY; AND * APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4A - SEVERANCE PAYMENTS: THE REPORTABLE INDIVIDUALS OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ARE PAID BY TRIHEALTH, INC., A RELATED ORGANIZATION, RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). THESE INDIVIDUALS DO NOT HAVE EMPLOYMENT AGREEMENTS SO NO SPECIAL ARRANGEMENTS EXIST BEYOND TRIHEALTH, INC.'S STANDARD EMPLOYEE SEVERANCE PACKAGE. SEVERANCE PAY IS BASED ON LENGTH OF SERVICE. THE AMOUNT OF NOTICE PAY WILL BE DETERMINED BY HUMAN RESOURCES IN ACCORDANCE WITH TRIHEALTH, INC. POLICY. PAYMENTS OF SEVERANCE ARE CONDITIONED UPON SIGNING A SEPARATION AND RELEASE AGREEMENT. NO REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM TRIHEALTH, INC. DURING THE 2010 CALENDAR YEAR.SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF THE ORGANIZATION'S MISSIONFORM 990, PART III, LINE 1THE ORGANIZATION'S MISSION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY AND VIABILITY IN THE 21ST CENTURY. FIDELITY TO THE GOSPEL URGES US TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS WE MOVE TOWARD THE CREATION OF HEALTHIER COMMUNITIES.
FORM 990, PART VI, SECTION A, LINE 2THE OFFICERS, DIRECTORS AND TRUSTEES OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARDS OF BETHESDA HOSPITAL, INC. AND TRIHEALTH, INC., BOTH AFFILIATED ENTITIES OF TRIHEALTH, INC. SYLVANIA NG, MD, EDWARD HARNESS, ROBERT L. WALKER, MICHAEL HAVERKAMP, AND MYRTIS POWELL HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA, INC., THE SINGLE CORPORATE MEMBER OF BETHESDA HOSPITAL, INC. JOHN PROUT, DONNA NIENABER, ESQ., CRAIG RUCKER, WILLIAM GRONEMAN, GERALD OLIPHANT, GEORGES FEGHALI, MD AND DAVE DORNHEGGEN HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED ENTITY BOARDS OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES AS WELL AS BEING EMPLOYED BY TRIHEALTH, INC. OR ITS AFFILIATES/SUBSIDIARIES.
FORM 990, PART VI, SECTION A, LINE 6THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO HAS TWO (2) CORPORATE MEMBERS. CATHOLIC HEALTH INITIATIVES, A COLORADO NON-PROFIT CORPORATION, IS THE SOLE VOTING MEMBER AND TRIHEALTH, INC., AN OHIO NON-PROFIT CORPORATION, IS THE SOLE NON-VOTING MEMBER.
FORM 990, PART VI, SECTION A, LINE 7AIN ACCORDANCE WITH THE CORPORATE BYLAWS OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("HOSPITAL"), THE TRUSTEES OF THE HOSPITAL (OTHER THAN THE CHIEF EXECUTIVE OFFICER AND THE PRESIDENTS OF THE MEDICAL STAFFS OF GOOD SAMARITAN HOSPITAL AND BETHESDA NORTH HOSPITAL WHO SERVE BY VIRTUE OF THEIR OFFICES) SHALL BE NOMINATED AND ELECTED BY THE VOTING MEMBER NO LATER THAN JUNE 30 OF EACH YEAR IN THE MANNER PROVIDED IN THE NETWORK AFFILIATION AGREEMENT.
FORM 990, PART VI, SECTION A, LINE 7BCATHOLIC HEALTH INITIATIVES ("CHI") IS THE SOLE CORPORATE VOTING MEMBER OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("HOSPITAL"). PURSUANT TO SECTION 5.4.2 OF THE HOSPITAL'S BYLAWS AND THE NETWORK AFFILIATION AGREEMENT, THE VOTING MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX, THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI CHIEF EXECUTIVE OFFICER: * SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE HOSPITAL, * AMENDMENT OF THE CORPORATE DOCUMENTS OF THE HOSPITAL, * APPROVAL OF MEMBERS OF THE HOSPITAL'S BOARD, * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE HOSPITAL, * APPROVAL OF ISSUANCE OF DEBT BY THE HOSPITAL, * APPROVAL OF PARTICIPATION OF THE HOSPITAL IN A JOINT VENTURE, * APPROVAL OF FORMATION OF A NEW CORPORATION BY THE HOSPITAL, * APPROVAL OF A MERGER INVOLVING THE HOSPITAL, * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE HOSPITAL, * AUTHORITY TO REQUIRE THE TRANSFER OF ASSETS BY THE HOSPITAL TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS, AND * ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE HOSPITAL. PURSUANT TO SECTION 5.5.2 OF THE HOSPITAL'S BYLAWS AND THE NETWORK AFFILATION AGREEMENT, CHI MAY, IN EXERCISE OF ITS APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE HOSPITAL, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE.
FORM 990, PART VI, SECTION B, LINE 11MEMBERS OF THE BOARD ARE PROVIDED AN ELECTRONIC COPY OF THIS FORM 990 PRIOR TO FILING. HOWEVER, FOR THE PROTECTION OF DONOR PRIVACY, SCHEDULE B - SCHEDULE OF CONTRIBUTORS WAS REMOVED FROM THE COPY PROVIDED TO THE BOARD. SUBSEQUENT TO PRESENTATION TO THE BOARD, THE ORGANIZATION FILES THE RETURN MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD.
FORM 990, PART VI, SECTION B, LINE 12CALL BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE CERTAIN FINANCIAL INTERESTS AND FIDUCIARY RELATIONSHIPS. THE EXECUTIVE COMMITTEE AND CORPORATE COUNSEL REVIEW RESPONSES, CONDUCT FURTHER INVESTIGATION, IF NECESSARY, AND DETERMINE WHEN A CONFLICT EXISTS WITH RESPECT TO A CERTAIN TRANSACTION. IF A CONFLICT EXISTS, THE TRANSACTION IS NOT TO BE ENTERED INTO UNLESS ALTERNATIVES ARE FULLY INVESTIGATED AND, IN THEIR ABSENCE, THE BOARD, WITHOUT PARTICIPATION OF THE INTERESTED MEMBER(S), DETERMINES THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. PLANS TO MANAGE THE CONFLICT DURING THE RELATIONSHIP ARE IMPLEMENTED. ALL DISCUSSIONS ARE APPROPRIATELY DOCUMENTED.
FORM 990, PART VI, SECTION B, LINE 15IN DETERMINING COMPENSATION OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO'S OFFICERS AND DIRECTORS, THE ANNUAL PROCESS PERFORMED BY TRIHEALTH, INC. (A RELATED ORGANIZATION WHO PAID THE INDIVIDUALS) INCLUDED: * COMPENSATION COMMITTEE; * INDEPENDENT COMPENSATION CONSULTANT; * COMPENSATION SURVEY OR STUDY; AND * APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. ADDITIONALLY, ALL DISCUSSIONS AND DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED.
FORM 990, PART VI, SECTION C, LINE 19THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. IN ADDITION, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO'S FINANCIAL STATEMENTS ARE INCLUDED IN THE CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINT.ORG OR AT HTTP://WWW.DACBOND.COM.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 33,042,181. CHANGE PENSION PLAN/SERP FUNDED STATUS 24,738,916. TRANSFER TO CHI CAPITAL RESOURCE POOL -4,024,236. MISCELLANEOUS ADJUSTMENT -32,804. TOTAL TO FORM 990, PART XI, LINE 5: 53,724,057.
VOLUNTEER INFORMATIONFORM 990, PART I, LINE 6DURING THE TAX YEAR, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO WAS ASSISTED BY 1,093 VOLUNTEERS WHO DONATED 100,605 HOURS.
EXECUTIVE COMMUNITY COMPOSITION AND AUTHORITYFORM 990, PART VI, LINE 1PURSUANT TO ARTICLE SECTION 8.1.1 OF THE BYLAWS OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("HOSPITAL"), THE BOARD OF TRUSTEES MAY ESTABLISH AN THE EXECUTIVE COMMITTEE WHICH MAY EXERCISE SUCH POWER AND AUTHORITY OF THE BOARD OF TRUSTEES IN INTERVALS BETWEEN MEETINGS OF THE BOARD AS AUTHORIZED BY THE BOARD. THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT AND THE CHIEF EXECUTIVE OFFICER, THE SECRETARY AND TWO OTHER BOARD MEMBERS IN ACCORDANCE WITH THE NETWORK AFFILIATION AGREEMENT. PURSUANT TO SECTION 8.1.5 OF THE HOSPITAL'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS SHALL CONSIST OF AT LEAST THREE MEMBERS OF THE BOARD OF TRUSTEES. FURTHER, PURSUANT TO SECTION 8.1.1 OF THE HOSPITAL'S BYLAWS, FOUR MEMBERS OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTIONS OF BUSINESS AND THE ACT OF THE FOUR OF THEM SHALL CONSTITUTE THE ACT OF THE COMMITTEE.
ESTIMATE OF HOURS DEVOTED TO RELATED ORGANIZATIONSFORM 990, PART VII, SECTION AOFFICERS AND DIRECTORS (AS NOTED WITH A "SCH O" REFERENCE) FOR THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO PROVIDE SERVICES TO TRIHEALTH, INC. (A RELATED ORGANIZATION WHO THE INDIVIDUALS) AND ITS SUBSIDIARIES/AFFILIATES ("TRIHEALTH"). HOURS WORKED ARE NOT TRACKED ON AN ENTITY BY ENTITY BASIS. THE COMPENSATION REPORTED ON THE FORM 990, PART VII, SECTION A WAS PAID TO THESE INDIVIDUALS IN FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 60 HOURS-PER-WEEK EMPLOYEES OF TRIHEALTH.
CHANGE IN PROCESS OF AUDIT OVERSIGHT OR SELECTION OF INDEPENDENT AUDITORFORM 990, PART XI, LINE 2CTHE FINANCIAL STATEMENTS OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("HOSPITAL") ARE AUDITED WITH ITS SUBSIDIARIES. HOSPITAL HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF BOTH ITS AND ITS SUBSIDIARIES FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF THE INDEPENDENT AUDITOR. DURING THE TAX YEAR, THERE WAS NOT A CHANGE IN THE PROCESS OF AUDIT OVERSIGHT AND/OR SELECTION OF AN INDEPENDENT AUDITOR BY HOSPITAL.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1DIXMYTH PROPERTIES LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1619 OAK STREETAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45206ZIPCode
FieldValueIRS element (for citing)
Primary ActivitiesREAL ESTATE HOLDINGPrimaryActivities
Legal Domicile StateOHLegalDomicileState
Total Income0TotalIncome
EOY Assets0EOYAssets
Direct Controlling Entity NAN/ADirectControllingEntityNA

Form990 Schedule R Part II Form990ScheduleRPartII (127 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
CATHOLIC HEALTH INITIATIVES
198 INVERNESS DRIVE WESTENGLEWOODCO80112470617373HEALTHCARECO501(C)(3)9CHI1
BORNEMANN HEALTHCARE CORPORATION
2500 BERNVILLE ROAD PO BOX 316READINGPA19603232187242HEALTHCAREPA501(C)(3)11ACHI1
CHI INSTITUTE FOR RESEARCH AND INNOVATION
198 INVERNESS DRIVE WESTENGLEWOODCO80112271050565HEALTHCARECO501(C)(3)11ACHI1
CHI NATIONAL FOUNDATION
198 INVERNESS DRIVE WESTENGLEWOODCO80112270930004FUNDRAISINGCO501(C)(3)11ACHI1
CHI NATIONAL SERVICES
198 INVERNESS DRIVE WESTENGLEWOODCO80112452532084HEALTHCARECO501(C)(3)9CHI1
CHI NATIONAL HOME CARE
198 INVERNESS DRIVE WESTENGLEWOODCO80112451261716HEALTHCARECO501(C)(3)11ACHI1
GLOBAL HEALTH INITIATIVES
198 INVERNESS DRIVE WESTENGLEWOODCO80112201536108MINISTRIESCO501(C)(3)11ACHI1
ST JOSEPH PHYSICIAN ENTERPRISES
7601 OSLER DRIVETOWSONMD21204521311775PHYSICIANSMD501(C)(3)11ACHI1
ST VINCENT INFIRMARY MEDICAL CENTER
2 ST VINCENT CIRCLELITTLE ROCKAR72205710236917HEALTHCAREAR501(C)(3)3CHI1
ST ANTHONY'S HOSPITAL ASSOCIATION
4 HOSPITAL DRIVEMORRILTONAR72110710245507HEALTHCAREAR501(C)(3)3SVIMC1
ST VINCENT FOUNDATION
TWO ST VINCENT CIRCLELITTLE ROCKAR72205510169537FUNDRAISINGAR501(C)(3)11ASVIMC1
ST VINCENT MEDICAL GROUP
2 ST VINCENT CIRCLELITTLE ROCKAR72205710830696HEALTHCAREAR501(C)(3)9SVIMC1
CHI COLORADO
188 INVERNESS DRIVE WESTENGLEWOODCO80112840405257HEALTHCARECO501(C)(3)3CHI1
MERCY REGIONAL MEDICAL CENTER OF DURANGO
1010 THREE SPRINGS BLVDDURANGOCO81301840405515HEALTHCARECO501(C)(3)3CHI1
CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION
961 EAST COLORADO AVENUECOLORADO SPRINGSCO80903840902211FUNDRAISINGCO501(C)(3)7CHI COLORADO1
HEALTH SET
4200 WEST CONEJOS PLACE 436DENVERCO80204841102943LOW INC.CARECO501(C)(3)7CHI COLORADO1
PUEBLO STEPUP
1925 EAST ORMAN AVENUE SUITE G52PUEBLOCO81004841234295COMMUNITYCO501(C)(3)7CHI1
SET OF COLORADO SPRINGS INC
825 E PIKES PEAK AVENUE BLDG 29COLORADO SPRINGSCO80903841183335LTERM CARECO501(C)(3)7CHI COLORADO1
TOTAL HEALTHCARE
PO BOX 7021COLORADO SPRINGSCO80933840927232HEALTHCARECO501(C)(3)3CHI COLORADO1
CHI-IOWA CORP
1111 6TH AVENUEDES MOINESIA50314420680448HEALTHCAREIA501(C)(3)3MHN1
BISHOP DRUMM RETIREMENT CENTER
1111 6TH AVENUEDES MOINESIA50314420725196LTERM CAREIA501(C)(3)9CHI-IA CORP1
HOUSE OF MERCY
1111 6TH AVENUEDES MOINESIA50314421323808SHELTERIA501(C)(3)7CHI-IA CORP1
MERCY CLINICS INC
1111 6TH AVENUEDES MOINESIA50314421193699PHYSICIANIA501(C)(3)9CHI-IA CORP1
MERCY COLLEGE OF HEALTH SCIENCES
1111 6TH AVENUEDES MOINESIA50314421511682EDUCATIONIA501(C)(3)2CHI-IA CORP1
MERCY FOUNDATION OF DES MOINES IA
1111 6TH AVENUEDES MOINESIA50314237358794FUNDRAISINGIA501(C)(3)7CHI-IA CORP1
MERCY AUXILIARY OF CENTRAL IOWA
1111 6TH AVENUEDES MOINESIA50314426076069AUXILIARYIA501(C)(3)11ACHI-IA CORP1
MERCY PROFESSIONAL PRACTICE ASSOCIATES INC
1111 6TH AVENUEDES MOINESIA50314421470935PHYSICIANIA501(C)(3)9CHI-IA CORP1
MERCY MEDICAL CENTER - CENTERVILLE FKA ST JOSEPH'S MERCY HOSPITAL
1 ST JOSEPHS DRIVECENTERVILLEIA52544420680308HEALTHCAREIA501(C)(3)3CHI-IA CORP1
ST ROSE AMBULATORY AND SURGERY CENTER FKA CENTRAL KANSAS MEDICAL CENTER
3515 BROADWAYGREAT BENDKS67530480543724SURGERY CNTRKS501(C)(3)3CHI1
ST CATHERINE HOSPITAL
401 EAST SPRUCE STREETGARDEN CITYKS67846480543721HEALTHCAREKS501(C)(3)3CHI1
ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION
401 EAST SPRUCE STREETGARDEN CITYKS67846200598702FUNDRAISINGKS501(C)(3)11ASCH1
CHI KENTUCKY INC
3900 OLYMPIC BLVD SUITE 400ERLANGERKY41018202741651HEALTHCAREKY501(C)(3)11ACHI1
SAINT JOSEPH HEALTH SYSTEM INC
150 N EAGLE CREEK DRLEXINGTONKY40509611334601HEALTHCAREKY501(C)(3)3CHI1
CONTINUING CARE HOSPITAL
150 NORTH EAGLE CREEK DRIVELEXINGTONKY40509611400619LTACHKY501(C)(3)3SJHS1
FLAGET HEALTHCARE DBA FLAGET MEMORIAL HOSPITAL
4305 NEW SHEPHERDSVILLE ROADBARDSTOWNKY40004611345363HEALTHCAREKY501(C)(3)3CHI1
FLAGET MEMORIAL HOSPITAL FOUNDATION INC
4305 NEW SHEPHERDSVILLE ROADBARDSTOWNKY40004562351341FUNDRAISINGKY501(C)(3)11AFH1
SAINT JOSEPH LONDON FOUNDATION INC
310 EAST NINTH STREETLONDONKY40741260438748FUNDRAISINGKY501(C)(3)11ASJHS1
SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC
305 ESTILL STREETBEREAKY40403260152877FUNDRAISINGKY501(C)(3)7SJHS1
ST JOSEPH HOSPITAL FOUNDATION INC
ONE ST JOSEPH DRIVELEXINGTONKY40504611159649FUNDRAISINGKY501(C)(3)11ASJHS1
SAINT JOSEPH MEDICAL FOUNDATION INC
ONE ST JOSEPH DRIVELEXINGTONKY40504311539059PHY PRACTICESKY501(C)(3)3SJHS1
SAINT JOSEPH MOUNT STERLING FOUNDATION INC
50 STERLING AVENUEMOUNT STERLINGKY40353272884584FUNDRAISINGKY501(C)(3)7SJHS1
ST JOSEPH MEDICAL CENTER INC
7601 OSLER DRIVETOWSONMD21204520591461HEALTHCAREMD501(C)(3)3CHI1
ST JOSEPH MEDICAL CENTER FOUNDATION INC
7601 OSLER DRIVETOWSONMD21204521681044FUNDRAISINGMD501(C)(3)7SJMC1
ALVERNA APARTMENTS
300 SE 8TH AVENUELITTLE FALLSMN56345411351177LTERM CAREMN501(C)(3)9CHI1
LAKEWOOD HEALTH CENTER
600 MAIN AVENUE SOUTHBAUDETTEMN56623410758434LTERM CAREMN501(C)(3)3CHI1
ST FRANCIS HOME
2400 ST FRANCIS DRIVEBRECKENRIDGEMN56520410729978LTERM CAREMN501(C)(3)9CHI1
APPLETREE COURT
601 OAK STREETBRECKENRIDGEMN56520411850500SENIOR HOMESMN501(C)(3)9SFH1
ST FRANCIS MEDICAL CENTER
2400 ST FRANCIS DRIVEBRECKENRIDGEMN56520410695598HEALTHCAREMN501(C)(3)3CHI1
HEALTHCARE AND WELLNESS FOUNDATION
2400 ST FRANCIS DRIVEBRECKENRIDGEMN56520760761782FUNDRAISINGMN501(C)(3)11ASFMC1
ST JOSEPH'S AREA HEALTH SERVICES
600 PLEASANT AVENUEPARK RAPIDSMN56470410695603HEALTHCAREMN501(C)(3)3CHI1
UNITY FAMILY HEALTHCARE
815 2ND STREET SELITTLE FALLSMN56345410721642HEALTHCAREMN501(C)(3)3CHI1
ST JOHN'S REGIONAL MEDICAL CENTER
2727 MCCLELLAND BLVDJOPLINMO64804440545809HEALTHCAREMO501(C)(3)3CHI1
MERCY LIFECARE SYSTEMS
2727 MCCLELLAND BLVDJOPLINMO64804431305163PROPERTY MGMTMO501(C)(3)11ASJRMC1
MNMCH INC
220 NORTH PENNSYLVANIACOLUMBUSKS66725481216238HEALTHCAREKS501(C)(3)3SJRMC1
ST JOHN'S MEDICAL GROUP
2727 MCCLELLAND BLVDJOPLINMO64804431882377PHYS PRACTICEMO501(C)(3)9SJRMC1
ST JOHN'S MERCY REGIONAL FOUNDATION
2727 MCCLELLAND BLVDJOPLINMO64804431308084FUNDRAISINGMO501(C)(3)7SJRMC1
ALEGENT HEALTH - BERGAN MERCY HEALTH SYS
7500 MERCY ROADOMAHANE68124470484764HEALTHCARENE501(C)(3)3CHI1
ALEGENT HEALTH - MERCY HOSPITAL CORNING
PO BOX 368CORNINGIA50841420782518HEALTHCAREIA501(C)(3)3AHBMHS1
MERCY HEALTH CARE FOUNDATION
PO BOX 368CORNINGIA50841421461064FUNDRAISINGNE501(C)(3)11AAHMH1
MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS
800 MERCY DRIVECOUNCIL BLUFFSIA51503421178204FUNDRAISINGIA501(C)(3)11AAHBMHS1
CHI NEBRASKA
555 SOUTH 70TH STREETLINCOLNNE68510363233121HEALTHCARENE501(C)(3)11ACHI1
THE PHYSICIAN NETWORK
8055 O STREET SUITE 300LINCOLNNE68510470780857PHYS PRACTICENE501(C)(3)11ACHI NEBRASKA1
GOOD SAMARITAN HOSPITAL
PO BOX 1990KEARNEYNE68848470379755HEALTHCARENE501(C)(3)3CHI NEBRASKA1
GOOD SAMARITAN HOSPITAL FOUNDATION
PO BOX 1810KEARNEYNE68848470659443FUNDRAISINGNE501(C)(3)7GSH1
CATHOLIC HEALTH CARE FEDERATION
198 INVERNESS DRIVE WESTENGLEWOODCO80112208473567JURDIC PERSONCO501(C)(3)11ACHI1
SAINT ELIZABETH REGIONAL MEDICAL CENTER
555 SOUTH 70TH STREETLINCOLNNE68510470379836HEALTHCARENE501(C)(3)3CHI NEBRASKA1
SAINT ELIZABETH FOUNDATION
555 SOUTH 70TH STREETLINCOLNNE68510470625523FUNDRAISINGNE501(C)(3)7SERMC1
SAINT ELIZABETH HEALTH SERVICES
555 SOUTH 70TH STREETLINCOLNNE68510363233120HEALTHCARENE501(C)(3)3SERMC1
SAINT FRANCIS MEDICAL CENTER
PO BOX 9804GRAND ISLANDNE68802470376601HEALTHCARENE501(C)(3)3CHI NEBRASKA1
SAINT FRANCIS MEDICAL CENTER FOUNDATION
PO BOX 9804GRAND ISLANDNE68802470630267FUNDRAISINGNE501(C)(3)7SFMC1
ST MARY'S HOSPITAL
1314 3RD AVENUENEBRASKA CITYNE68410470443636HEALTHCARENE501(C)(3)3CHI NEBRASKA1
ST MARY'S HOSPITAL FOUNDATION
1314 3RD AVENUENEBRASKA CITYNE68410470707604FUNDRAISINGNE501(C)(3)7SMH1
SAINT CLARE'S HEALTH SERVICES INC
25 POCONO ROADDENVILLENJ07834223639733MANAGEMENTNJ501(C)(3)7CHI1
SAINT CLARE'S COMMUNITY CARE
66 FORD ROADDENVILLENJ07834222876836HEALTHCARENJ501(C)(3)11BSCHS1
SAINT CLARE'S FOUNDATION INC
66 FORD ROADDENVILLENJ07834222502997FUNDRAISINGNJ501(C)(3)7SCHS1
SAINT CLARE'S HOSPITAL
66 FORD ROADDENVILLENJ07834223319886HEALTHCARENJ501(C)(3)3CHI1
ST FRANCIS LIFE CARE CORPORATION
19 POCONO ROADDENVILLENJ07834222536017ELDERLY CARENJ501(C)(3)9SCHS1
VISITING NURSE ASSOCIATION OF SAINT CLARE'S
191 WOODPORT ROADSPARTANJ07871221768334HOME HEALTHNJ501(C)(3)9SCHS1
ST JOSEPH COMMUNITY HEALTH SERVICES
300 CENTRAL AVE SW SUITE 3000WALBUQUERQUENM87102710897107COMMUNITYNM501(C)(3)11ACHI1
CHI HEALTH CONNECT AT HOME - FARGO
4816 AMBER VALLEY PARKWAYFARGOND58104271966847HEALTHCAREND501(C)(3)3CHI1
CARRINGTON HEALTH CENTER
800 NORTH 4TH STREETCARRINGTONND58421450227311HEALTHCAREND501(C)(3)3CHI1
LISBON AREA HEALTH SERVICES
905 MAIN STREETLISBONND58054820558836HEALTHCAREND501(C)(3)3CHI1
MERCY HOSPITAL OF DEVILS LAKE
1031 EAST SEVENTH STREETDEVILS LAKEND58301450227012HEALTHCAREND501(C)(3)3CHI1
THE MERCY HOSPITAL OF DEVILS LAKE FDN
1031 EAST SEVENTH STREETDEVILS LAKEND58301352367360FUNDRAISINGND501(C)(3)11AMHDL1
MERCY HOSPITAL OF VALLEY CITY
570 CHAUTAUQUA BOULEVARDVALLEY CITYND58072450226553HEALTHCAREND501(C)(3)3CHI1
MERCY MEDICAL CENTER
1301 15TH AVENUE WESTWILLISTONND58801450231183HEALTHCAREND501(C)(3)3CHI1
MERCY MEDICAL FOUNDATION
1301 15TH AVENUE WESTWILLISTONND58801450381803FUNDRAISINGND501(C)(3)11AMMC1
OAKES COMMUNITY HOSPITAL
314 SOUTH 8TH STREETOAKESND58474450231675HEALTHCAREND501(C)(3)3CHI1
OAKES COMMUNITY HOSPITAL FOUNDATION
314 SOUTH 8TH STREETOAKESND58474710966606FUNDRAISINGND501(C)(3)11AOCH1
ST JOSEPH'S HOSPITAL AND HEALTH CENTER
30 WEST 7TH STREETDICKINSONND58601450226429HEALTHCAREND501(C)(3)3CHI1
SAINT JOSEPH'S HOSPITAL FOUNDATION
30 WEST 7TH STREETDICKINSONND58601363418207FUNDRAISINGND501(C)(3)11ASJHHC1
VILLA NAZARETH INC
801 PAGE DRIVEFARGOND58103450226714LT CAREND501(C)(3)9CHI1
SAMARITAN HEALTH PARTNERS
2222 PHILADELPHIA DRIVEDAYTONOH45406311107411HEALTHCAREOH501(C)(3)11ACHI1
SAMARITAN BEHAVIORAL HEALTH
601 S EDWIN C MOSES BLVDDAYTONOH45408020633634HEALTHCAREOH501(C)(3)3SHP1
SAMARITAN HEALTH FOUNDATION
2222 PHILADELPHIA DRIVEDAYTONOH45406237296923FUNDRAISINGOH501(C)(3)7SHP1
THE COMMUNITY LIMITED CARE DIALYSIS CENTER
619 OAK STREET ACCOUNTING-3 WESTCINCINNATIOH45206237419853TITLE HOLDINGOH501(C)(2)N/AGOOD SAM HOSPITAL1
GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE
375 DIXMYTH AVECINCINNATIOH45220311778403EDUCATIONOH501(C)(3)2GOOD SAM HOSPITAL1
GOOD SAMARITAN FOUNDATION OF CINCINNATI INC
619 OAK STREET ACCOUNTING-3 WESTCINCINNATIOH45206311206047FUNDRAISINGOH501(C)(3)11AGOOD SAM HOSPITAL1
HOSPITAL ASSOCIATION FOR ST JOSEPH HOSPITAL
7601 OSLER DRIVETOWSONMD21204526050777HEALTHCAREMD501(C)(3)9SJMC1
MERCY MEDICAL CENTER
2700 STEWART PARKWAYROSEBURGOR97470930386868HEALTHCAREOR501(C)(3)3CHI1
CENTENNIAL MEDICAL GROUP INC
2700 STEWART PARKWAYROSEBURGOR97470900433062PHYSICIANSOR501(C)(3)9MMC1
LINUS OAKES INC
2700 STEWART PARKWAYROSEBURGOR97470930821381SENIOR LIVINGOR501(C)(3)9MMC1
MERCY FOUNDATION INC
2700 STEWART PARKWAYROSEBURGOR97470936088946FUNDRAISINGOR501(C)(3)7MMC1
MT ST JOSEPH INC
3060 SE STARK STREETPORTLANDOR97214930386870NURSING CAREOR501(C)(3)9CHI1
ST ANTHONY HOSPITAL
1601 SE COURT AVENUEPENDLETONOR97801930391614HEALTHCAREOR501(C)(3)3CHI1
ST ANTHONY HOSPITAL FOUNDATION
1601 SE COURT AVENUEPENDLETONOR97801930992727FUNDRAISINGOR501(C)(3)11ASA HOSPITAL1
ST DOMINIC AT ONTARIO
351 SW 9TH STREETONTARIOOR97914930433692HEALTHCAREOR501(C)(3)3CHI1
ST FRANCIS OF BAKER CITY
3325 POCAHONTAS ROADBAKER CITYOR97814930412495HEALTHCAREOR501(C)(3)3CHI1
ST JOSEPH HEALTH MINISTRIES
1929 LINCOLN HWY E STE 150LANCASTERPA17602232342997HEALTHPA501(C)(3)11ACHI1
ST JOSEPH HEALTH MINISTRIES FOUNDATION
1929 LINCOLN HWY E STE 150LANCASTERPA17602232605579FUNDRAISINGPA501(C)(3)11ASJHM1
ST JOSEPH HEALTH SERVICES INC
1929 LINCOLN HWY E STE 150LANCASTERPA17602201425375DENTAL CAREPA501(C)(3)11ASJHM1
ST JOSEPH REGIONAL HEALTH NETWORK
2500 BERNVILLE ROAD PO BOX 316READINGPA19603231352211HEALTHCAREPA501(C)(3)3CHI1
ST JOSEPH MEDICAL GROUP
2500 BERNVILLE ROAD PO BOX 316READINGPA19603208544021HEALTHCAREPA501(C)(3)9BHC1
ST JOSEPH MEDICAL CENTER FOUNDATION
2500 BERNVILLE ROAD PO BOX 316READINGPA19603232649362FUNDRAISINGPA501(C)(3)11ASJRHN1
ST MARY'S HEALTHCARE CENTER
801 EAST SIOUX AVENUEPIERRESD57501460230199HEALTHCARESD501(C)(3)3CHI1
GETTYSBURG MEDICAL CENTER
606 EAST GARFIELD AVENUEGETTYSBURGSD57442460234354HEALTHCARESD501(C)(3)3SMHC1
MEMORIAL HEALTH CARE SYSTEM INC
2525 DE SALES AVENUECHATTANOOGATN37404620532345HEALTHCARETN501(C)(3)3CHI1
MEMORIAL HEALTH CARE SYSTEM FOUNDATION
2525 DE SALES AVENUECHATTANOOGATN37404621839548FUNDRAISINGTN501(C)(3)7MHCS1
MEMORIAL HEALTH PARTNERS FOUNDATION INC
6028 SHALLOWFORD ROADCHATTANOOGATN37421030417049HEALTHCARETN501(C)(3)9MHCS1
FRANCISCAN HEALTH SYSTEM FKA FRANCISCAN HEALTH SYSTEM - WEST
1717 SOUTH J STREETTACOMAWA98405910564491HEALTHCAREWA501(C)(3)3CHI1
ENUMCLAW REGIONAL HOSPITAL ASSOCIATION
1450 BATTERSBY AVENUEENUMCLAWWA98022910715805HEALTHCAREWA501(C)(3)3FHS1
FRANCISCAN FOUNDATION
1717 SOUTH J STREETTACOMAWA98405911145592FUNDRAISINGWA501(C)(3)9FHS1
FRANCISCAN MEDICAL GROUP
1708 SOUTH YAKIMA AVENUETACOMAWA98405911939739HEALTHCAREWA501(C)(3)9FHS1
FRANCISCAN VILLA OF SOUTH MILWAUKEE INC
3601 SOUTH CHICAGO AVENUESOUTH MILWAUKEEWI53172391093829HEALTHCAREWI501(C)(3)9CHI1
BETHESDA HOSPITAL INC
619 OAK STREET ACCOUNTING-3 WESTCINCINNATIOH45206310537122INPATIENT AND OUTPATIENT SERVICESOH501(C)(3)31N/A
TRIHEALTH INC
619 OAK STREET ACCOUNTING-3 WESTCINCINNATIOH45206311438846SUPPORT AFFILIATED HOSPITALSOH501(C)(3)11B1N/A
FUND OF THE DEPARTMENT OF OBGYN OF GOOD SAMARITAN HOSPITAL
375 DIXMYTH AVECINCINNATIOH45220316056217SUPPORT AFFILIATED HOSPITALOH501(C)(3)11A0N/A

Form990 Schedule R Part III Form990ScheduleRPartIII (20 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnershipDirect Controlling Entity NADirectControllingEntityNA
CHI OPERATING INVESTMENT PROGRAM LP
198 INVERNESS DRIVE WESTENGLEWOODCO80112470727942INVESTMENTSCOCHIINVESTMENT263029223665267250$22,63510.06320
NORTH RIVER SURGERY CENTER LLC
2209 WILDWOOD AVENUESHERWOODAR72120710799771AMBUL SURG CTRAR0.57450N/A
AUDUBON LAND COMPANY LLC
5390 N ACADEMY BLVD SUITE 300COLORADO SPRINGSCO80918841513085REAL ESTATECO0.50100N/A
ORTHOCOLORADO LLC
11650 WEST 2ND PLACELAKEWOODCO80255371577105ORTHO HOSPITALCO0.60000N/A
PENRAD IMAGING
1390 KELLY JOHNSON BLVDCOLORADO SPRINGSCO80920841072619MEDICAL IMAGINGCO0.70000N/A
ST ANTHONY REGIONAL MTN CANCER CENTER
4231 W 16TH AVENUEDENVERCO80112371568013CANCER CENTERCO0.51000N/A
ST FRANCIS LAND COMPANY
5390 N ACADEMY BLVD SUITE 300COLORADO SPRINGSCO80918263134100REAL ESTATECO0.51000N/A
BLUEGRASS REGIONAL IMAGING CENTER
1218 SOUTH BROADWAY SUITE 310LEXINGTONKY40504611386736DIAGNOSTICKY0.65000N/A
ST JOSEPH-PAML LLC
424 LEWIS HARGETT CIRCLE STE 160LEXINGTONKY40503452116736MGMT SVCSKY0.62500N/A
SAINT JOSEPH - SCA HOLDINGS LLC
424 LEWIS HARGETT CIRCLE STE 160LEXINGTONKY40503453801157OP SURGERYDE0.51000N/A
SURGERY CENTER OF LEXINGTON LLC
1451 HARRODSBURG ROADLEXINGTONKY40504621179539SURGERY CENTERDE0.51000N/A
RUXTON SURGICENTER LLC
8322 BELLONA AVENUE SUITE 201BALTIMOREMD21204522095835SURGERY CENTERMD0.51000N/A
AVANTAS LLC
1207 SOUTH 13 STREETOMAHANE68108392045003HEALTHCARENE0.95000N/A
HEALTHCARE SUPPORT SERVICES LLC
PO BOX 9804GRAND ISLANDNE68802721546196LAUNDRYNE1.00000N/A
CENTRAL NEBRASKA HOME CARE SERVICES
PO BOX 1146-4510 SECOND AVENUEKEARNEYNE68848470692112HEALTHCARE SRVCNE1.00000N/A
SUPERIOR MEDICAL IMAGING LLC
5000 NORTH 26TH STREETLINCOLNNE68521262884555OP DIAGNOSTICSNE0.51000N/A
CENTRAL NEBRASKA REHAB SERVICES
3004 W FAIDLEY AVEGRAND ISLANDNE68802810653461PHYSICAL THERAPYNE0.51000N/A
ST FRANCIS MEDICAL CENTER ASSOCIATES
1717 SOUTH J STREETTACOMAWA98405911352698MED. OFFICEWA0.54210N/A
PENINSULA RADIATION ONCOLOGY
314 MARTIN LUTHER KING JR WAY 11TACOMAWA98405870808610HEALTHCARE SRVCWA0.60000N/A
BERYWOOD OFFICE PROPERTIES LLC
400 BERYWOOD TRAILCLEVELANDTN37312621875199PHYS OFFICETN0.63000N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (45 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
ALTERNATIVE INSURANCE MANAGEMENT SERVICES
3900 OLYMPIC BOULEVARD SUITE 400ERLANGERKY41018841112049MANAGEMENT SERVICESCON/AC
CAPTIVE MANAGEMENT INITIATIVES
980663022CAPTIVE MANAGEMENTN/ACPO BOX 10073 APOGEORGETOWNGRAND CAYMANCJKY1-1001CJ
CENTER FOR TRANSLATIONAL RESEARCH
198 INVERNESS DRIVE WESTENGLEWOODCO80112272269511HEALTHCARECON/AC
FIRST INITIATIVES INSURANCE LTD
980203038INSURANCEN/ACPO BOX 10073 APOGEORGETOWNGRAND CAYMANCJKY1-1001CJ
FRANCISCAN SERVICES INC
198 INVERNESS DRIVE WESTENGLEWOODCO80112232487967HEALTHCARECON/AC
SJH SERVICES CORPORATION
198 INVERNESS DRIVE WESTENGLEWOODCO80112232307408HEALTHCARECON/AC
ST JOSEPH DEVELOPMENT COMPANY INC
1717 SOUTH J STREETTACOMAWA98405911480569RENTALWAN/AC
TOWSON MANAGEMENT INC
7601 OSLER DRIVETOWSONMD21204521710750MANAGEMENT SERVICESMDN/AC
NAZARETH ASSURANCE COMPANY
76 ST PAUL STREET SUITE 500BURLINGTONVT05401030304831INSURANCEVTN/AC
ST VINCENT COMMUNITY HEALTH SERVICES INC
TWO ST VINCENT CIRCLELITTLE ROCKAR72205710710785HEALTHCAREARN/AC
COMCARE SERVICES
4231 W 16TH AVENUEDENVERCO80204840904813INACTIVECON/AC
DES MOINES MEDICAL CENTER INC
1111 6TH AVENUEDES MOINESIA50314420837382REAL ESTATEIAN/AC
MERCY PARK APARTMENTS LTD
1111 6TH AVENUEDES MOINESIA50314421202422HOUSINGIAN/AC
CENTRAL KANSAS HEALTH SERVICES ASSOCIATION
3515 BROADWAYGREAT BENDKS67530481042853MEDICAL EQUIPMENTKSN/AC
SJL PHYSICIAN MANAGEMENT SERVICES INC
424 LEWIS HARGETT CR 160LEXINGTONKY40503270164198MANAGEMENTKYN/AC
ST JOSEPH OFFICE PARK ASSOCIATION
1401 HARRODSBURG ROAD BLDG B70LEXINGTONKY40504611079899MANAGEMENTKYN/AC
MERCY HEALTH SERVICES CORPORATION
2727 MCCLELLAND BLVDJOPLINMO64804431457881DMEMON/AC
GOOD SAMARITAN OUTREACH SERVICES
PO BOX 1990KEARNEYNE68848470659440MEDICAL CLINICNEN/AC
HEALTH SYSTEMS ENTERPRISES INC
PO BOX 1990KEARNEYNE68848470664558MANAGEMENTNEN/AC
SAINT CLARE'S PRIMARY CARE INC
66 FORD ROADDENVILLENJ07834222441202BILLING SERVICESNJN/AC
MEDQUEST
1301 15TH AVENUE WESTWILLISTONND58801450392137SALE OF DMENDN/AC
CONSOLIDATED HEALTH SERVICES
1700 EDISON DRIVEMILFORDOH45150311378212HOME HEALTHOHN/AC
AMERICAN NURSING CARE
1700 EDISON DRIVEMILFORDOH45150311085414HOME HEALTHOHN/AC
AMERIMED INC
1700 EDISON DRIVEMILFORDOH45150311158699HOME HEALTHOHN/AC
PATIENT TRANSPORT SERVICES INC
1700 EDISON DRIVEMILFORDOH45150311100798HOME HEALTHOHN/AC
SAMARITAN FAMILY CARE INC
40 W FOURTH ST 1700DAYTONOH45402311299450HEALTHCAREOHN/AC
MERCY SERVICES CORP
2700 STEWART PARKWAYROSEBURGOR97470930824308RETAIL SALESORN/AC
ST ANTHONY DEVELOPMENT COMPANY
1415 SOUTHGATEPENDLETONOR97801931216943ATHLETIC CLUBORN/AC
CGH REALTY COMPANY INC
215 N 12TH STREADINGPA19603232326801REAL ESTATEPAN/AC
CADUCEUS MEDICAL ASSOCIATES INC
6028 SHALLOWFORD ROAD SUITE DCHATTANOOGATN37422621570736HEALTHCARETNN/AC
MOUNTAIN MANAGEMENT SERVICES INC
6028D SHALLOWFORD ROADCHATTANOOGATN37422621570739MGMT SVC ORGTNN/AC
PHYSICIAN HEALTH SYSTEM NETWORK
1149 MARKET STTACOMAWA98402911746721HEALTH ORG.WAN/AC
HEALTHCARE MGMT SERVICES ORG INC
1149 MARKET STTACOMAWA98402911865474HEALTH ORG.WAN/AC
HAROLD W RASE 1995 CHARITABLE UNITTRUST
30 WEST 7TH STREETDICKINSONND58601456090420INVESTMENTSNDN/AT
HAROLD W RASE 1996 CHARITABLE UNITTRUST
30 WEST 7TH STREETDICKINSONND58601206037112INVESTMENTSNDN/AT
HAROLD W RASE 1997 CHARITABLE UNITTRUST
30 WEST 7TH STREETDICKINSONND58601206037104INVESTMENTSNDN/AT
HAROLD W RASE 1999 CHARITABLE UNITTRUST
30 WEST 7TH STREETDICKINSONND58601206037099INVESTMENTSNDN/AT
JAMES & HENRIETTA NISTLER UNITRUST
30 WEST 7TH STREETDICKINSONND58601206021899INVESTMENTSNDN/AT
JOSEPH A SCHUSTER ANNUITY TRUST #1
400 UNIVERITY AVENUEDES MOINESIA50314421195122INVESTMENTSIAN/AT
RAY & SHIRLEY DAVID 1999 UNITRUST
30 WEST 7TH STREETDICKINSONND58601206037077INVESTMENTSNDN/AT
TOM DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848476192393INVESTMENTSNEN/AT
DAVID DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848476192395INVESTMENTSNEN/AT
JEANNE DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848476192398INVESTMENTSNEN/AT
LODESCA MILLER CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848476186933INVESTMENTSNEN/AT
ROBERT & WANDA CHARITABLE REMAINDER UNITRUST
PO BOX 1810KEARNEYNE68848266191916INVESTMENTSNEN/AT
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (12 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
GOOD SAMARITAN HOSPITAL FOUNDATION OF CINCINNATI
B1396770CASH
GOOD SAMARITAN HOSPITAL FOUNDATION OF CINCINNATI
C1818228CASH
GOOD SAMARITAN HOSPITAL FOUNDATION OF CINCINNATI
N571138FMV
GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE
N4855327FMV
TRIHEALTH INC
O60188522COST
COMMUNITY LIMITED CARE DIALYSIS CENTER
R3330089CASH
CATHOLIC HEALTH INITIATIVES
I10807001FMV
CATHOLIC HEALTH INITIATIVES
O5798710COST
CATHOLIC HEALTH INITIATIVES
Q16258653FMV
BETHESDA HOSPITAL INC
C117082CASH
AMERICAN NURSING CARE
L1244326FMV
PATIENT TRANSPORT SERVICES INC
L524309FMV

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