2012-05-10T13:17:31-05:00 2011-06-30 DELOITTE TAX LLP 250 EAST FIFTH STREET SUITE 1900 CINCINNATI OH 45202 990 2010-07-01 311438846 TRIHEALTH INC TRIH 5135696575 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 MICHAEL CROFTON 5135696575 2012-05-10 1 5137847100 2010 2016-02-24 21:20:13Z JOHN S PROUT 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 130712406 0 X WWW. TRIHEALTH.COM X 1994 OH TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. 11 8 1483 8 0 0 0 766417 1015262 129902057 0 0 0 43932 1015262 130712406 0 0 0 0 0 0 0 0 0 1462292 130269670 1462292 130269670 -447030 442736 84765596 124814844 104842139 107801550 -20076543 17013294 X SEE SCHEDULE O 0 0 130269670 129133456 SEE SCHEDULE O 130269670 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 218 0 1 1483 1 0 0 0 0 0 0 0 0 0 0 X 11 8 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X MICHAEL CROFTON 5135696577 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 STEPHEN SCHRANTZ 1.00 X X 0 0 0 JAMES SCHWAB 1.00 X X 0 0 0 MICHAEL HAVERKAMP 1.00 X 0 0 0 ROBERT WALKER 1.00 X X 0 0 0 JOHN PROUT 60.00 X X 1216064 0 299811 PAUL EDGETT III 1.00 X 0 0 0 SILVANIA NG MD 1.00 X 0 45000 0 THOMAS FINN 1.00 X 0 0 0 MYRTIS POWELL 1.00 X 0 0 0 EDWARD HARNESS JR 1.00 X 0 0 0 MARC ALEXANDER MD 1.00 X 0 433277 44344 SR MARY ELLEN MURPHY 1.00 X 0 0 0 MICHAEL MCGRAW 1.00 X X 0 0 0 DONNA NIENABER ESQ 60.00 X 480976 0 138646 CRAIG RUCKER 60.00 X 492908 0 115752 WILLIAM GRONEMAN 60.00 X 511263 0 166581 GERALD OLIPHANT 60.00 X 547879 0 117654 GEORGES FEGHALI MD 60.00 X 493357 0 137101 RICHARD MOORE 60.00 X 387516 0 101861 STEPHEN SCHWALBE 60.00 X 356051 0 128123 WALTER MCLARTY 60.00 X 369421 0 112501 SHER MCCLANAHAN 60.00 X 357292 0 86142 DAVE DORNHEGGEN 60.00 X 347377 0 109208 MICHAEL CROFTON 60.00 X 261091 0 67993 5821195 478277 1625717 126 1 1 0 TAFT STETTINIUS & HOLLISTER LLP 425 WALNUT STREET SUITE 1800 CINCINNATI OH 45202 LEGAL 1816894 COMPUTER TASK GROUP INC 312 PLUM ST SUITE 700 CINCINNATI OH 45202 INFORMATION TECHNOLOGY 1579777 NORTHLICH 720 E PETE ROSE WAY CINCINNATI OH 45202 ADVERTISING 1206328 FROST BROWN TODD LLC 301 E FOURTH ST STE 3300 CINCINNATI OH 45202 LEGAL 1148980 EPIC SYSTEMS CORP 1979 MILKY WAY VERONA WI 53593 INFORMATION TECHNOLOGY 998764 82 766417 766417 SHARED SERVICES REV. 900099 129133456 129133456 AFFILIATED RENTAL REV. 531120 768601 768601 129902057 43932 43932 43932 43932 130712406 129133456 0 812533 23445 23445 582986 582986 491161 491161 SHARED SERVICES ALLOC. 129133456 129133456 INTERCOMPANY ALLOCATION 38622 38622 130269670 130269670 0 0 1500 779276 4189717 19371922 675660 108600 50684355 22310716 19299418 28373639 60599301 76181407 84765596 124814844 23524603 23985445 392955 196477 80924581 83619628 104842139 107801550 X -20076543 17013294 -20076543 17013294 84765596 124814844 X 442736 36647101 X X 0 0 0 X X X 0 0 0 BETHESDA HOSPITAL INC 310537122 3 1 1 1 57797530 GOOD SAMARITAN HOSPITAL OF CINTI 310537486 3 1 1 1 60156612 2 117954142 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: PART I, LINE 11H(I), COLUMN (VII) - AMOUNT OF SUPPORT TRIHEALTH, INC. ("TRIHEALTH") IS A JOINT VENTURE EQUALLY OWNED BY BETHESDA HOSPITAL, INC. ("BETHESDA") AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("GOOD SAM"). TRIHEALTH WAS FORMED TO PROVIDE A COMPREHENSIVE AND INTEGRATED PROVIDER BASE TO OPTIMIZE THE HEALTH STATUS OF THE COMMUNITY. TRIHEALTH PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR BOTH BETHESDA AND GOOD SAM. ADMINISTRATIVE SUPPORT SERVICES INCLUDE GENERAL ADMINISTRATION, INFORMATION SYSTEMS, FINANCE, HUMAN RESOURCES, AND OTHER GENERAL SUPPORT SERVICES. TRIHEALTH CASH FLOWS ARE FUNDED EQUALLY BY BETHESDA AND GOOD SAM. THE AMOUNT OF SUPPORT SHOWN ON LINE 11H, COLUMN (VII) ARE THE ADMINISTRATIVE SUPPORT SERVICES COSTS ALLOCATED BY TRIHEALTH TO BETHESDA AND GOOD SAM WHO RECORD THE ALLOCATION AS EXPENSES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 180306 0 0 1 6727 187033 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: DURING THE TAX YEAR, TRIHEALTH, INC. PAID ANNUAL MEMBERSHIP DUES TO VARIOUS NATIONAL, STATE AND LOCAL ORGANIZATIONS, A PORTION OF WHICH RELATED TO LOBBYING ACTIVITIES. PART IV, SUPPLEMENTAL INFORMATION: PART II-B, LINE 1(F), GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES: AMOUNT IS RELATED TO FEES PAID TO CASSIDY AND ASSOCIATES, A LEADER IN THE GOVERNMENT RELATIONS INDUSTRY FOR OVER THIRTY YEARS, FOR PROFESSIONAL SERVICES. 6719612 2276001 4443611 1758087 889398 868689 30148692 19145317 11003375 12057964 12057964 28373639 DUE FROM RELATED ORGANIZATIONS 76161407 INVESTMENT IN OHIO PURCHASE ALLIANCE 20000 76181407 INVESTMENT IN TRIHEALTH PHYSICIAN SOLUTIONS, INC. 10466566 INVESTMENT IN TRIHEALTH PHYSICIAN ENTERPRISE CORP. 46762771 PENSION LIABILITY 20855384 ACCRUED EIB 5231439 ACCRUED WORKERS COMPENSATION 303468 83619628 130712406 130269670 442736 36647101 36647101 37089837 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN EQUITY OF UNCONSOLIDATED SUBSIDIARIES -12,329,984. CHANGE IN PENSION PLAN/SERP FUNDED STATUS 6,977,085. FUNDING FROM SUPPORTED ORGANIZATION 42,000,000. CENTRAL AMERICA AND THE CARIBBEAN INVESTMENTS 17812756 0 0 0 0 0 0 17812756 0 17812756 1 0 1 1 0 0 OTHER INFORMATION SCHEDULE F, PART V PART I, LINE 3 - ACTIVITIES PER REGION TRIHEALTH, INC. IS THE SPONSOR OF THE TRIHEALTH PENSION PLAN WHICH IS THE HOLDER OF THE ASSOCIATED INVESTMENTS DISCLOSED ON SCHEDULE F. THESE INVESTMENTS ARE DISCLOSED BY TRIHEALTH, INC. AS ITS EIN IS USED BY THE TRIHEALTH PENSION PLAN FOR IRS REPORTING PURPOSES. 1 UPTOWN CONSORTIUM INC 629 OAK STREET SUITE 306 CINCINNATI OH 45206 200688727 501(C)(3) 290000 GENERAL PURPOSES VOLUNTEERS IN MEDICAL MISSIONS PO BOX 756 SENECA SC 29679 621361564 501(C)(3) 12250 MEDICAL MISSION SPONSORSHIP THE CENTER FOR CLOSING THE HEALTH GAP IN GREATER CINCINNATI 3120 BURNET AVENUE SUITE 201 CINCINNATI OH 45229 200902286 501(C)(3) 211500 GENERAL PURPOSES BETHESDA FOUNDATION 619 OAK STREET CINCINNATI OH 45206 237374129 501(C)(3) 67250 GENERAL PURPOSES CENTER FOR RESPITE CARE INC PO BOX 141301 CINCINNATI OH 45229 202544994 501(C)(3) 50000 GENERAL PURPOSES GOOD SAMARITAN HOSPITAL FOUNDATION OF CINCINNATI INC 619 OAK STREET CINCINNATI OH 45206 311206047 501(C)(3) 12000 GENERAL PURPOSES HEALTH IMPROVEMENT COLLABORATIVE OF GREATER CINCINNATI INC 2100 SHERMAN AVE NO 100 CINCINNATI OH 45212 311449807 501(C)(3) 46950 GENERAL PURPOSES COLLEGE OF MOUNT SAINT JOSEPH 5701 DELHI ROAD CINCINNATI OH 45233 237179567 501(C)(3) 20000 GENERAL PURPOSES 8 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: TRIHEALTH OBTAINS AND STORES ALL NECESSARY INFORMATION FROM THE RECIPIENT ORGANIZATION RELATIVE TO HOW THE FUNDS WILL BE SPENT. X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 JOHN PROUT 826309 0 325512 0 64243 0 290415 0 9396 0 1515875 0 0 0 MARC ALEXANDER MD 0 317190 0 68363 0 47724 0 27448 0 16896 0 477621 0 0 DONNA NIENABER ESQ 285693 0 112845 0 82438 0 122081 0 16565 0 619622 0 0 0 CRAIG RUCKER 356895 0 119103 0 16910 0 108173 0 7579 0 608660 0 0 0 WILLIAM GRONEMAN 340571 0 112569 0 58123 0 143853 0 22728 0 677844 0 15009 0 GERALD OLIPHANT 394187 0 128877 0 24815 0 96037 0 21617 0 665533 0 0 0 GEORGES FEGHALI MD 345269 0 124696 0 23392 0 114648 0 22453 0 630458 0 0 0 RICHARD MOORE 287257 0 79838 0 20421 0 89447 0 12414 0 489377 0 0 0 STEPHEN SCHWALBE 259500 0 76723 0 19828 0 110901 0 17222 0 484174 0 0 0 WALTER MCLARTY 262294 0 76286 0 30841 0 98135 0 14366 0 481922 0 0 0 SHER MCCLANAHAN 259673 0 77355 0 20264 0 73735 0 12407 0 443434 0 0 0 DAVE DORNHEGGEN 255360 0 71524 0 20493 0 95545 0 13663 0 456585 0 0 0 MICHAEL CROFTON 191909 0 48549 0 20633 0 45715 0 22278 0 329084 0 0 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS UP PAYMENTS: ALL DIRECTORS IN AN EMPLOYMENT POSITION OF VICE PRESIDENT AND HIGHER WITHIN TRIHEALTH, INC. ARE ELIGIBLE TO RECEIVE TAX GROSS-UP PAYMENTS ON THE FOLLOWING BENEFITS: * SUPPLEMENTAL OR SPLIT DOLLAR LIFE INSURANCE * EXECUTIVE HEALTH PROGRAM SERVICES * LONG-TERM DISABILITY INSURANCE * LONG-TERM CARE INSURANCE * FINANCIAL COUNSELING * BUSINESS CLUB MEMBERSHIPS * HEALTH CLUB MEMBERSHIPS IN ADDITION, DURING THE CALENDAR YEAR 2010, WILLIAM GRONEMAN RECEIVED A TAX INDEMNIFICATION AND GROSS UP PAYMENT ON A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PAYMENT. TRIHEALTH, INC. INCLUDED THE ENTIRE TAX INDEMNIFICATION AND GROSS UP PAYMENT AS TAXABLE INCOME ON THE INDIVIDUAL'S FORM W-2 FOR 2010. HEALTH OR SOCIAL CLUB OR INITIATION FEES: TRIHEALTH, INC. MAINTAINS A MEMBERSHIP IN A LOCAL SOCIAL CLUB IN THE NAME OF THE PRESIDENT & CEO AS THE SOCIAL CLUB REQUIRES THE MEMBERSHIP TO BE IN AN INDIVIDUAL'S NAME. THIS MEMBERSHIP IS A BUSINESS MEMBERSHIP FOR THE BENEFIT OF TRIHEALTH, INC. AS SUCH, THE MONTHLY DUES ARE PAID BY TRIHEALTH, INC. DURING THE CURRENT YEAR, THERE WAS NOT ANY PERSONAL USE BY THE PRESIDENT & CEO. PART I, LINE 4B ELIGIBLE EXECUTIVES (GENERALLY VICE PRESIDENT 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. 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 MICHAEL CROFTON - $14,108 CRAIG RUCKER - $63,874 WILLIAM GRONEMAN - $75,052 GERALD OLIPHANT - $73,468 GEORGES FEGHALI, MD - $72,079 RICHARD MOORE - $47,529 STEVE SCHWALBE - $42,568 WALTER MCLARTY - $43,044 SHER MCCLANAHAN - $39,917 DAVE DORNHEGGEN - $39,203 IN ADDITION, THE FOLLOWING INDIVIDUAL LISTED IN SCHEDULE J, PART II, RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH WAS TREATED AS TAXABLE COMPENSATION BY TRIHEALTH, INC.: WILLIAM GRONEMAN - $15,009 SUPPLEMENTAL INFORMATION PART III PART I, LINE 4A - SEVERANCE PAYMENTS THE REPORTABLE INDIVIDUALS OF TRIHEALTH, INC. DO NOT HAVE EMPLOYMENT AGREEMENTS SO NO SPECIAL ARRANGEMENTS EXIST BEYOND ITS 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. DESCRIPTION OF ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 THE MISSION OF TRIHEALTH, INC. IS TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. WE PURSUE OUR MISSION BY PROVIDING A FULL RANGE OF HEALTH RELATED SERVICES INCLUDING PREVENTION, WELLNESS AND EDUCATION. CARE IS PROVIDED WITH COMPASSION CONSISTENT WITH THE VALUES OF OUR ORGANIZATION. TRIHEALTH, INC. SERVES AS THE ENTITY THAT PROVIDES JOINT MANAGEMENT OF BETHESDA HOSPITAL AND GOOD SAMARITAN HOSPITAL UNDER AN AFFILIATION AGREEMENT BETWEEN BETHESDA, INC. AND CATHOLIC HEALTH INITIATIVES. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4B TRIHEALTH, INC. ("TRIHEALTH") COMBINES THE STRENGTHS OF TWO OF GREATER CINCINNATI'S FINEST HEALTH CARE ORGANIZATIONS, BETHESDA HOSPITAL, INC. ("BETHESDA") AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO ("GOOD SAMARITAN"). FORMED IN 1995, TRIHEALTH CREATED AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE IT SERVES, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. TRIHEALTH IS DEDICATED TO DELIVERING THE BEST CARE POSSIBLE. BETHESDA AND GOOD SAMARITAN HAVE VALUES ROOTED IN SPIRITUAL HERITAGE AND COMPASSIONATE SERVICES TO THE COMMUNITY. BETHESDA WAS FOUNDED IN 1896 BY GERMAN METHODIST DEACONESSES TO CARE FOR CINCINNATI'S SICK AND POOR. A CATHOLIC ORGANIZATION, GOOD SAMARITAN WAS ESTABLISHED IN 1852 UNDER THE SPONSORSHIP OF THE SISTERS OF CHARITY TO PROVIDE CARE FOR THE POOR AND MEDICALLY UNDERSERVED. IN KEEPING WITH THESE EARLY PURPOSES, TRIHEALTH CONTINUES TO PROVIDE UNCOMPENSATED CARE TO THOSE IN NEED. THE "TRI" IN TRIHEALTH REPRESENTS ITS HOSPITALS, PHYSICIANS AND COMMUNITY WORKING TOGETHER TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE IT SERVES. THE "TRI" ALSO EXPRESSES OUR COMMITMENT TO THE PHYSICAL, MENTAL AND SPIRITUAL ASPECTS OF HEALTH. IN SERVING THE COMMUNITY'S NEEDS, TRIHEALTH OFFERS COMPREHENSIVE SERVICES AT MORE THAN 50 CONVENIENT LOCATIONS IN THE GREATER CINCINNATI AND TRISTATE AREA. ITS SITES INCLUDE TWO HOSPITAL LOCATIONS AND PHYSICIAN OFFICE BUILDINGS IN ADDITION TO FITNESS, REHABILITATION, OCCUPATIONAL HEALTH AND OUTPATIENT CENTERS. TRIHEALTH ALSO PROVIDES SERVICES IN THE HOME AND IN THE WORKPLACE AND DELIVERS CARE AND EDUCATION COOPERATIVELY THROUGH COMMUNITY-BASED ORGANIZATIONS, SUCH AS CHURCHES, SCHOOLS, CLINICS AND SOCIAL AGENCIES. TRIHEALTH HOSPITALS HAVE BEEN RECOGNIZED LOCALLY AND NATIONALLY AS TOP-RATED IN MATERNITY CARE, NEONATAL INTENSIVE CARE, CARDIAC SURGERY AND CARDIOLOGY, ORTHOPEDICS, UROLOGY, NEUROLOGY/NEUROSURGERY, AND ENDOCRINOLOGY. TRIHEALTH PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR BOTH BETHESDA AND GOOD SAMARITAN AS WELL AS VARIOUS SUBSIDIARIES AND AFFILIATES. THE ADMINISTRATIVE SUPPORT SERVICES INCLUDE GENERAL ADMINISTRATION, INFORMATION SYSTEMS, FINANCE, HUMAN RESOURCES AND OTHER GENERAL SUPPORT SERVICES. THESE COSTS ARE ALLOCATED TO THE VARIOUS TRIHEALTH ENTITIES AND THE ENTITIES REIMBURSE TRIHEALTH AT COST. IN ADDITION, BETHESDA AND GOOD SAMARITAN EQUALLY FUND THE CASH FLOWS OF TRIHEALTH AND AS SUCH THE COSTS ALLOCATED BY TRIHEALTH ARE RECORDED AS EXPENSES ON THE FINANCIAL STATEMENTS OF BETHESDA AND GOOD SAMARITAN. THEREFORE, THE ALLOCATED SERVICE COSTS ARE PRESENTED ON TRIHEALTH'S FORM 990, PARTS VIII AND IX IN THE AGGREGATE AS THE EXPENSES ARE PRESENTED AS MANAGEMENT AND GENERAL EXPENSES ON THE FORMS 990 FOR BETHESDA AND GOOD SAMARITAN. FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS, DIRECTORS AND TRUSTEES OF TRIHEALTH, INC. 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 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, 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 MARC ALEXANDER, MD 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 6 TRIHEALTH, INC. HAS TWO CORPORATE MEMBERS, BETHESDA, INC. AND CATHOLIC HEALTH INITIATIVES, THE PARENT ORGANIZATION OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. FORM 990, PART VI, SECTION A, LINE 7A TRIHEALTH, INC. HAS TWO CORPORATE MEMBERS, BETHESDA, INC. AND CATHOLIC HEALTH INITIATIVES, THE PARENT ORGANIZATION OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, WHO HAVE THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF TRIHEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7B TRIHEALTH, INC. HAS TWO CORPORATE MEMBERS, BETHESDA, INC. AND CATHOLIC HEALTH INITIATIVES, THE PARENT ORGANIZATION OF THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, WHO MUST APPROVE AMENDMENTS TO TRIHEALTH INC.'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 MEMBERS OF THE BOARD ARE PROVIDED AN ELECTRONIC COPY OF 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 RETURNS MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH NON-SUBSTANTIVE CHANGES ARE NOT SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C ALL 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 THE 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. ALL DIRECTORS AND MANAGERS, WHICH INCLUDE OFFICERS AND KEY EMPLOYEES, ARE REQUIRED TO ANNUALLY DISCLOSE ANY CIRCUMSTANCES, INCLUDING FAMILY AND BUSINESS RELATIONSHIPS, THAT MAY CREATE A CONFLICT OF INTEREST FOR THE ORGANIZATION. THESE RESPONSES ARE REVIEWED AND ACTED UPON BY A CONFLICT OF INTEREST COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, THE ANNUAL PROCESS PERFORMED BY TRIHEALTH, INC. 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 19 TRIHEALTH, INC.'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN EQUITY OF UNCONSOLIDATED SUBSIDIARIES -12,329,984. CHANGE IN PENSION PLAN/SERP FUNDED STATUS 6,977,085. FUNDING FROM SUPPORTED ORGANIZATION 42,000,000. TOTAL TO FORM 990, PART XI, LINE 5: 36,647,101. EXECUTIVE COMMITTEE COMPOSITION & AUTHORITY FORM 990, PART VI, LINE 1A THE BOARD OF TRUSTEES OF TRIHEALTH, INC. ("THE CORPORATION"), ESTABLISHED AN 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 & CEO, SECRETARY AND TWO OTHER BOARD MEMBERS ALL IN ACCORDANCE WITH THE NETWORK AFFILIATION AGREEMENT. ESTIMATE OF HOURS DEVOTED TO RELATED ORGANIZATION FORM 990, PART VII, SECTION A THE DIRECTOR (AS NOTED WITH A "SCH O" REFERENCE) FOR TRIHEALTH, INC. PROVIDES SERVICES TO TRIHEALTH PHYSICIAN ENTERPRISE CORP. (A RELATED ORGANIZATION WHO PAID THE INDIVIDUAL). THE COMPENSATION REPORTED ON THE FORM 990, PART VII WAS PAID TO THIS INDIVIDUAL IN FULFILLMENT OF THE INDIVIDUAL'S DUTIES AS A FULL-TIME, 60 HOURS-PER-WEEK EMPLOYEE OF TRIHEALTH PHYSICIAN ENTERPRISE CORP. DIRECTORS (AS NOTED WITH A "SCH O-MED STAFF PRES." REFERENCE) FOR TRIHEALTH, INC. SERVE ON THE BOARD IN THEIR CAPACITY AS MEDICAL STAFF PRESIDENT FOR EITHER BETHESDA HOSPITAL, INC. OR THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. COMPENSATION SHOWN IS FOR HIS/HER DUTIES AS MEDICAL STAFF PRESIDENT OF THE RESPECTIVE HOSPITAL AND NOT FOR SERVING AS A DIRECTOR. 7819 LAUREL LLC 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 REAL ESTATE HOLDING COMPANY OH 0 0 N/A BETHESDA HOSPITAL INC 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 310537122 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 1 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 310537486 INPATIENT AND OUTPATIENT SERVICES OH SECTION 501(C)(3) SCHEDULE A, LINE 3 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN ENTERPRISE CORP 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 311383365 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 9 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN INSTITUTE 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 311074519 PHYSICIAN PRACTICES OH SECTION 501(C)(3) SCHEDULE A, LINE 9 TRIHEALTH INC 1 GOOD SAMARITAN HOSPITAL FREE CLINIC 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 273893817 FREE CLINIC OH SECTION 501(C)(3) SCHEDULE A, LINE 7 TRIHEALTH INC 1 TRIHEALTH PHYSICIAN SOLUTIONS INC 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 311444353 CLAIMS ADMINISTRATION OH N/A C 3876780 575058 1.00000 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 1 0 TRIHEALTH PHYSICIAN ENTERPRISE CORP A 768601 FMV THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO J 1214 FMV BETHESDA HOSPITAL INC L 60000 FMV THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO P 60156612 COST BETHESDA HOSPITAL INC P 57797530 COST TRIHEALTH PHYSICIAN ENTERPRISE CORP Q 298260 FMV TRIHEALTH PHYSICIAN SOLUTIONS N 2363586 FMV