2024-11-14T17:06:11-06:00 2023-12-31 990 2023-01-01 237296923 GOOD SAMARITAN FOUNDATION - DAYTON GOOD 9374999942 110 N MAIN ST SUITE 200 DAYTON OH 45402 J MICHAEL SIMS TREASURER 9374999942 2024-11-14 1 2023 2024-10-15 13:58:12Z JENNY M LEWIS ONE WYOMING ST DAYTON OH 45402 8016666 0 X WWW.PREMIERHEALTH.COM X 1973 OH SEE PART III, LINE 1 13 11 3 91 0 0 433870 605019 0 0 319648 830850 650 -5741 754168 1430128 292670 212520 0 0 241478 361856 0 0 207146 77973 80175 612121 654551 142047 775577 11970218 13088472 51601 146678 11918617 12941794 X INSPIRE PHILANTHROPY TO ENHANCE THE HEALTH AND WELL-BEING OF THE GREATER DAYTON COMMUNITIES AND THE HEALTHCARE PROFESSIONALS WHO CARE FOR THEM. 0 0 37614 37614 MOTHERS EMPOWERED PROVIDES HIGH-QUALITY, COMPREHENSIVE PRENATAL CARE AND PARENTING EDUCATION TO PREGNANT WOMEN IN GREATER DAYTON WHO ARE AT RISK OF LOSING A BABY TO INFANT MORTALITY. MOTHERS EMPOWERED IS A COLLABORATION BETWEEN LIFESTAGES CENTERS FOR WOMEN, A LOCAL OB/GYN PRACTICE, AND GOOD SAMARITAN FOUNDATION-DAYTON. THE PROGRAM IS COMPRISED OF AN RN PROGRAM COORDINATOR, A PART TIME MEDICAL ASSISTANT, AND A CERTIFIED NURSE MIDWIFE. THESE HEALTH CARE PROFESSIONALS PROVIDE THE EVIDENCE-BASED, BEST-PRACTICE "CENTERINGPREGNANCY" GROUP MODEL OF PRENATAL CARE. PREGNANT MOTHERS ARE GROUPED BY DUE DATE, SO THEY GO THROUGH THE SAME STAGE OF PREGNANCY TOGETHER, LEARNING ABOUT THEIR NEW BABIES WHILE FORMING FRIENDSHIPS WITH OTHER MOMS AND BUILDING TRUSTING RELATIONSHIPS WITH THEIR MEDICAL PROVIDERS. IN 2023, 60 WOMEN WERE SERVED. 34094 34094 GOOD SAMARITAN FOUNDATION-DAYTON IS COMMITTED TO SUPPORTING ONCOLOGY PATIENTS AT MIAMI VALLEY HOSPITAL NORTH DURING THEIR CANCER JOURNEY. IN 2023, 852 CANCER PATIENTS WERE TREATED WITH 3,699 TOTAL CANCER RELATED VISITS AT THE NORTH CAMPUS. THE NORTH CAMPUS IS THE BUSIEST IN THE PREMIER HEALTH SYSTEM FOR BREAST SCREENING AND DIAGNOSTICS ALONG WITH LUNG LOW DOSE CT CANCER SCREENING. GOOD SAMARITAN FOUNDATION-DAYTON PROVIDES FINANCIAL ASSISTANCE FOR ESSENTIALS, SUCH AS RENT, UTILITIES, TRANSPORTATION TO TREATMENT, AND MEDICATION TO BREAST CANCER PATIENTS EXPERIENCING FINANCIAL HARDSHIP. ONCOLOGY PATIENTS ALSO RECEIVE THERAPEUTIC PILLOWS TO COMFORT THEM POST-SURGERY PROCEDURES AND FINANCIAL SUPPORT FOR LYMPHEDEMA GARMENTS TO AID IN THE MANAGEMENT OF THE CONDITION AS A RESULT OF CANCER TREATMENTS. IN ADDITION, ALL CANCER PATIENTS ARE GIVEN THE OPPORTUNITY TO PARTICIPATE IN SPECIALIZED EXERCISE CLASSES AT ANY POINT IN THE CANCER CARE CONTINUUM FROM DIAGNOSIS TO SURVIVORSHIP. THE CLASSES ARE DELIVERED BY A CERTIFIED EXERCISE ONCOLOGY INSTRUCTOR AND INDIVIDUALIZED FOR EACH PATIENT'S HEALTH STATUS AND GOALS. 22576 22576 PREMIER HEALTH WAS A SUB AWARDEE FOR FUNDING FROM THE OHIO DEPARTMENT OF HEALTH FOR THE COMPREHENSIVE CARE FOR SUBSTANCE USE IN OHIO EMERGENCY DEPARTMENTS (CCOED) GRANT. THE CCOED GRANT HAS THREE OVERARCHING GOALS FOCUSED ON TREATING SUBSTANCE USE DISORDER AND OPIOID USE DISORDER:1) IDENTIFYING PATIENTS WITH OPIOID USE DISORDER BY IMPLEMENTING A SCREENING PROCESS IN OUR EMERGENCY DEPARTMENTS.2) MANAGING OPIOID USE DISORDER BY IMPLEMENTING EVIDENCE-BASED PRACTICES IN OUR EMERGENCY MEDICINE.3) TRANSITIONING PATIENTS TO LONG-TERM CARE AND SUPPORTIVE SERVICES USING INNOVATIVE PROCESSES THAT IMPROVE PATHWAYS TO TREATMENT.PREMIER HEALTH HAS IMPLEMENTED SEVERAL INNOVATIVE APPROACHES FOR TREATING SUBSTANCE USE DISORDER AND ADDICTION MEDICINE WITH THIS GRANT. PREMIER HEALTH WAS THE FIRST IN THE MIAMI VALLEY REGION TO HIRE A SUBSTANCE USE NAVIGATOR (SUN). THE SUN WORKS WITH PATIENTS IN THE EMERGENCY DEPARTMENT TO COMPLETE CHEMICAL DEPENDENCY ASSESSMENTS AND PROVIDE LINKAGES TO CARE, PLACEMENT IN TREATMENT FACILITIES, AND OTHER WRAPAROUND SERVICES WITH WARM HANDOFFS.IN 2023, MORE THAN 41,000 PATIENTS WERE SCREENED IN MIAMI VALLEY HOSPITAL NORTH'S EMERGENCY DEPARTMENT FOR SUBSTANCE USE DISORDER. IN 2023, 267 PATIENTS HAVE BEEN TREATED BY SUBSTANCE USE NAVIGATORS, AND THE PROGRAM DISTRIBUTED MORE THAN 15 NALOXONE KITS. 226984 118236 THIS NUMBER REPRESENTS THE BALANCE OF TOTAL EXPENDITURES OF TEMPORARILY RESTRICTED FUNDS FOR RELATED HOSPITALS NET OF PROGRAMS DESCRIBED IN SERVICE ACCOMPLISHMENTS. 226984 118236 321268 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 200 DAYTON OH 45402 JENNY M LEWIS PRESIDENT/SYS VP OF PHILANTHROPY 13.33 26.67 X X 0 361379 56194 MILINDA S NIMMO ZABRAMBA TRUSTEE 0.50 39.50 X 0 170263 20271 JO ANNE REILING BOARD CHAIR 0.50 X X 0 0 0 FR BENJAMIN SPEARE-HARDY II BOARD SECRETARY 0.50 X X 0 0 0 GEORGE T BRODERICK JR MD BOARD VICE-CHAIR 0.50 X 0 0 0 DIANE ANDERSON DO TRUSTEE 0.50 X 0 0 0 ALEC CARNES TRUSTEE (FROM FEB) 0.50 X 0 0 0 SUZANNE DONOVAN SC TRUSTEE 0.50 X 0 0 0 CHARLES ELLINGTON TRUSTEE (FROM FEB) 0.50 X 0 0 0 RICHARD T FERGUSON TRUSTEE 0.50 X 0 0 0 PAMELA A PHELPS TRUSTEE 0.50 X 0 0 0 CHARLENE J SIMS TRUSTEE 0.50 X 0 0 0 MARIANNE WEBER TRUSTEE (FROM AUG) 0.50 X 0 0 0 J MICHAEL SIMS BOARD TREASURER 0.50 39.50 X 0 659279 54727 CHRISTINA E KNOWLES DIR-DEVELOPMENT 40.00 X 115133 0 21935 115133 1190921 153127 1 0 1 0 0 1716 95812 13750 493741 52859 605019 205441 205441 7201106 6575697 625409 625409 625409 5100 95812 10841 -5741 -5741 1430128 0 0 825109 196520 196520 16000 16000 305275 76319 76319 152637 39734 9934 9934 19866 16847 4212 4212 8423 21545 21545 25170 6293 6293 12584 4907 1227 1227 2453 7901 1975 1975 3951 1920 1440 480 331 331 SPECIAL EVENTS 11492 2873 2873 5746 DUES AND SUBSCRIPTIONS 1277 319 319 639 MINOR EQUIPMENT 36 36 5596 5596 654551 321268 126137 207146 100819 90387 192583 261795 0 0 7315 0 7381796 8622885 4212705 4038405 75000 75000 11970218 13088472 32342 30006 19259 116672 51601 146678 X 2345422 2318297 9573195 10623497 11918617 12941794 11970218 13088472 X 775577 497708 21659 -271767 X 0 1 X 1 0 X 615433 802762 608096 433870 605019 3065180 615433 802762 608096 433870 605019 3065180 384830 2680350 216433 156350 153863 145044 205441 877131 3942311 10402 0.67990 0.67340 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9573195 565019 985690 -500406 10623497 11706800 416984 -1437430 -1113160 9573195 10656520 522412 1132315 604446 11706800 9446814 680596 1059761 530651 10656520 8570381 503148 1335433 962148 9446814 0.00000 0.43000 0.57000 0 0 0 SECURITIES 4038405 F 4038405 AFFILIATES PAYABLE 113229 DEFERRED ANNUITIES 3443 116672 X PART V, LINE 4: THE GOOD SAMARITAN FOUNDATION-DAYTON (GSF-DAYTON) MAKES EVERY EFFORT TO FOLLOW THE INTENT AND WISHES OF ALL ITS DONORS. THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS AND/OR EARNINGS FROM ENDOWMENT FUNDS ARE DRIVEN BY THE WISHES/RESTRICTIONS PLACED ON THE FUNDS BY THE DONOR. A PERMANENT ENDOWMENT RESULTS WHEN A DONATION IS RECEIVED WITH A RESTRICTION THAT THE PRINCIPAL OR GIFT AMOUNT IS TO BE RETAINED IN PERPETUITY AND CANNOT BE SPENT. THE EARNINGS FROM THE PERMANENT ENDOWMENT ARE USED FOR THE PURPOSE SPECIFIED BY THE DONOR. TEMPORARY ENDOWMENTS ARE FUNDS IN WHICH ALL OR PART OF THE PRINCIPAL MAY BE EXPENDED ONLY AFTER THE EXPIRATION OF A STATED PERIOD OF TIME OR OCCURRENCE OF A SPECIFIED EVENT, DEPENDING ON THE DONOR'S WISHES. EARNINGS FROM TEMPORARILY RESTRICTED ENDOWMENTS CAN BE EITHER UNRESTRICTED OR RESTRICTED. THE GSF-DAYTON USES THE TEMPORARILY RESTRICTED ENDOWMENTS FOR THE INTENDED PURPOSE SETUP BY THE DONOR, ONLY AFTER THE PERIOD OF TIME OR SPECIFIED EVENT SET BY THE DONOR HAS BEEN MET. THE CATEGORIES OF PERMANENTLY AND TEMPORARILY RESTRICTED ENDOWMENTS ARE AS FOLLOWS: TO SUPPORT THE LOCAL COMMUNITY HOMELESS CLINIC OPERATIONS (18%); TO FUND EDUCATIONAL PROGRAMS/SCHOLARSHIPS (18%); TO FUND THE FOUNDATION OPERATIONS (16%); TO SUPPORT HEART DISEASE (9%); TO SUPPORT MOTHERS EMPOWERED (ME) TO PROVIDE FREE MEDICAL CARE AND PRENATAL AND PARENTING EDUCATION TO PREGNANT WOMEN IN NEED (8%), TO SUPPORT ELDER CARE (2%); TO BENEFIT SPECIFIC PROGRAMS FOR A SAMARITAN HEALTH PARTNER'S AFFILIATE (8%); AND MISCELLANEOUS (21%). PART X, LINE 2: THE FOLLOWING FOOTNOTE IS FROM THE 2023 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF GOOD SAMARITAN FOUNDATION-DAYTON. PHP HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE A TAX-EXEMPT NON-PROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS A TAX-EXEMPT ORGANIZATION, ITS INCOME IS EXEMPT FROM FEDERAL INCOME TAX EXCEPT TO THE EXTENT OF ANY UNRELATED BUSINESS ACTIVITIES. PHP CONSOLIDATES CERTAIN SUBSIDIARIES WHICH ARE FOR-PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. THESE ARE: * PREMIER HEALTH HOLDING COMPANY (PHHC) (WHOLLY OWNED SUBSIDIARY OF PHP) * MVHE, INC., (AND ITS WHOLLY OWNED SUBSIDARY EXTENDED CARE), SAMARITAN FAMILY CARE, INC., PREMIER HEALTH SPECIALISTS, INC. AND PREMIER HEALTH URGENT CARE, INC. (WHOLLY OWNED SUBSIDIARIES OF PHHC) MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS. RAYS OF HOPE 62035 62035 6660 THREADS OF STRENGTH 38877 33777 5100 4181 100912 95812 5100 10841 10841 -5741 1 MIAMI VALLEY HOSPITAL 110 N MAIN ST SUITE 500 DAYTON OH 45402 310537504 501(C)(3) 94246 25982 FAIR MARKET VALUE PERSONAL PROTECTION EQUIPMENT AND FOOD OPERATIONS SAMARITAN BEHAVIORAL HEALTH 110 N MAIN ST SUITE 500 DAYTON OH 45402 020633634 501(C)(3) 39532 5400 FAIR MARKET VALUE FOOD OPERATIONS PREMIER HEALTH PARTNERS 110 N MAIN ST SUITE 500 DAYTON OH 45402 311446699 501(C)(3) 14412 0 N/A N/A OPERATIONS WRIGHT STATE UNIVERSITY FOUNDATION 3070 PRESIDENTIAL DR FAIRBORN OH 45324 237019799 501(C)(3) 5774 0 N/A N/A OPERATIONS COMPUNET CLINICAL LABS 110 N MAIN ST SUITE 500 DAYTON OH 45402 311258010 501(C)(3) 0 5040 FAIR MARKET VALUE FOOD OPERATIONS 5 0 EDUCATIONAL SCHOLARSHIPS 16 16000 PART I, LINE 2: ALL DISTRIBUTIONS (GRANTS PAID) FOLLOW THE ENTITY'S DISBURSEMENT POLICY, INCLUDING: (A) ASSUMING FUNDS AVAILABILITY, HOSPITAL DEPARTMENT PERSONNEL COMPLETE A FOUNDATION REQUEST FORM. FOR AMOUNTS IN EXCESS OF $1,000, DIRECTOR'S & VICE-PRESIDENT'S SIGNATURES ARE REQUIRED TO REQUEST FOUNDATION FUNDING. (B) FOR A REQUEST GREATER THAN $5,000, THE FOUNDATION'S DISTRIBUTION COMMITTEE REVIEWS AND APPROVES THE REQUEST. THE CHECK ALSO REQUIRES A SECOND SIGNATURE. (C) REPORTING FOR GRANTS IS THE RESPONSIBILITY OF THE OPERATIONAL UNIT. (D) BEFORE DISBURSING FUNDS, EACH REQUEST IS VERIFIED/MATCHED FOR ITS INTENDED PURPOSE. FOR EXAMPLE, SCHOLARSHIP REQUIREMENTS INCLUDE: A) GPA REQUIREMENTS; B) LENGTH OF SERVICE; C) SPECIFIC FIELDS OF STUDY. 0 1 0 0 0 0 0 0 0 J MICHAEL SIMS BOARD TREASURER 0 370642 0 66308 0 222329 0 22390 0 32337 0 714006 0 0 JENNY M LEWIS PRESIDENT/SYS VP OF PHILANTHROPY 0 286243 0 71848 0 3288 0 26583 0 29611 0 417573 0 0 MILINDA S NIMMO ZABRAMBA TRUSTEE 0 155078 0 4500 0 10685 0 8489 0 11782 0 190534 0 0 PART I, LINE 3 COMPENSATION FOR THE GSF-DAYTON CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH GSF-DAYTON IS AN AFFILIATE. PART I, LINE 4B DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, CERTAIN PERSONS ARE LIMITED IN THE AMOUNT OF BENEFIT THAT CAN BE EARNED UNDER A QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, GOOD SAMARITAN FOUNDATION-DAYTON (GSF-DAYTON) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. GSF-DAYTON SUPPLEMENTS THE AFFECTED EXECUTIVES THROUGH A PENSION RESTORATION PLAN AND A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE BENEFITS UNDER THESE SUPPLEMENTAL NONQUALIFIED PLANS ARE SUBJECT TO MULTI-YEAR VESTING AND A PARTICIPANT CAN FORFEIT BENEFITS EARNED IF VESTING REQUIREMENTS ARE NOT SATISFIED. UNDER THE TERMS OF THE SUPPLEMENTAL PLANS, AND BECAUSE OF TAX RULES PERTAINING TO TAXATION OF THE EARNED BENEFITS UPON VESTING, CERTAIN INDIVIDUALS RECEIVED A PAYOUT OF THE CUMULATIVE VESTED BENEFITS UNDER THEIR SUPPLEMENTAL PLAN DURING 2023. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2023: J. MICHAEL SIMS $193,261. BASED ON THE GUIDANCE PROVIDED IN THE INSTRUCTIONS TO THE FORM 990, ANY PAYMENTS TO THE PARTICIPANTS RELATED TO THESE PLANS THAT WERE MADE WITHIN 2-1/2 MONTHS AFTER THE END OF THE ORGANIZATION'S TAX YEAR ARE NOT TREATED AS DEFERRED COMPENSATION FOR PURPOSES OF SCHEDULE J. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. X 25471 X EMPLOYEE FOOD 5 26689 FMV X SUPPLIES/PRIZES 1 700 FMV 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 6 THE GOOD SAMARITAN FOUNDATION-DAYTON (GSF-DAYTON) HAS ONE CORPORATE MEMBER: PREMIER HEALTH (PREMIER), AN OHIO NON-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A PREMIER HAS THE SOLE AUTHORITY TO ELECT THE BOARD OF TRUSTEES FOR GSF-DAYTON. PREMIER HAS THE AUTHORITY TO REMOVE SUCH TRUSTEES AT ANY REGULAR OR SPECIAL MEETING OR BY WRITTEN CONSENT. FORM 990, PART VI, SECTION A, LINE 7B SEE 7A FORM 990, PART VI, SECTION B, LINE 11B THIS 990 FILING AND ATTACHED SCHEDULES (THE RETURN) ARE PREPARED BY A STAFF MEMBER IN THE TAX DEPARTMENT OF PREMIER, WITH WHICH GSF-DAYTON IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. AFTER ALL CHANGES FROM THE ABOVE PERSONS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER. A FINAL VERSION OF THE RETURN IS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT THE BOARD OF TRUSTEES' MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESS ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 FILING IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER. FORM 990, PART VI, SECTION B, LINE 12C PREMIER, WITH WHICH GSF-DAYTON IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, BOARD COMMITTEE MEMBERS, MEDICAL DIRECTORS, SUPPLY CHAIN DIVISION MEMBERS, AUTHORIZED SIGNERS, DIRECTORS, EXECUTIVES, MEDICAL EXECUTIVE COMMITTEE MEMBERS, MEDICAL DEPARTMENT AND SECTION CHAIRS, PHYSICIAN PARTNERSHIP COMMITTEE MEMBERS, PHYSICIAN GUIDANCE GROUP MEMBERS, AND ALL EMPLOYED PHYSICIANS TO ANNUALLY REVIEW THE PREMIER COMPREHENSIVE CONFLICT OF INTEREST STATEMENT, AN EXPLANATORY MEMORANDUM, THE ANTITRUST COMPLIANCE POLICY, AND COMPLETE AN INDIVIDUAL QUESTIONNAIRE DISCLOSING ANY POTENTIAL CONFLICTS AS DEFINED IN THE CONFLICT OF INTEREST POLICY. THIS IS ACCOMPLISHED EITHER BY WAY OF AN ELECTRONIC COMMUNICATION SENT OUT DIRECTLY BY THE CORPORATE COMPLIANCE DEPARTMENT OR BY WAY OF A MEMO SENT OUT FROM THE CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER OF PREMIER. IT ALSO INCLUDES AN EXPLANATORY MEMORANDUM OF SPECIFIC ACTIVITIES THAT MIGHT GIVE CAUSE TO A CONFLICT AND AN INDIVIDUAL QUESTIONNAIRE TO DISCLOSE ALL SUCH ACTIVITIES. THIS QUESTIONNAIRE MUST BE COMPLETED AND SIGNED BY THE INDIVIDUAL. THIS CORRESPONDENCE INCLUDES A COPY OF THE ANTITRUST COMPLIANCE POLICY THAT MUST BE SIGNED BY THE INDIVIDUAL. ALL OF THESE DOCUMENTS ARE SENT TO THE CORPORATE COMPLIANCE DEPARTMENT. THE CORPORATE COMPLIANCE DEPARTMENT ENSURES ALL FORMS ARE RETURNED AND RETAINS THE DOCUMENTS FOR FIVE YEARS. IN ADDITION, AT EACH MEETING OF THE BOARD OR ANY BOARD COMMITTEE, FOLLOWING APPROVAL OF THE PREVIOUS MEETING'S MINUTES, THE BOARD OR COMMITTEE CHAIR SHALL REQUEST ANY BOARD MEMBER WHO PERCEIVES A POTENTIAL CONFLICT OF INTEREST ON ANY OF THE MEETING'S AGENDA ITEMS TO DISCLOSE THE POTENTIAL CONFLICT. ADDITIONALLY, AT ANY BOARD OR BOARD COMMITTEE MEETING WHERE THE SUBJECT OF CONFLICT OF INTEREST IS DISCUSSED, THE MINUTES SHALL CONTAIN THE NAME OF THE PARTY DISCUSSING A POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE POTENTIAL CONFLICT OF INTEREST AND WHETHER A CONFLICT OF INTEREST WAS FOUND TO EXIST. IF A CONFLICT OF INTEREST IS DETERMINED BY THE BOARD TO EXIST, THE MEMBER WILL BE EXCUSED FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON THE PARTICULAR AGENDA ITEM. THE CHIEF COMPLIANCE AND ENTERPRISE RISK OFFICER REPORTS THE RESULTS OF THE PREMIER CONFLICT OF INTEREST QUESTIONNAIRES NO LESS THAN ANNUALLY TO THE BOARD OF TRUSTEES BY WAY OF THE COMPLIANCE AND AUDIT COMMITTEE. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE MEETING. PERIODICALLY, THE INTERNAL AUDIT DEPARTMENT WILL REVIEW A SAMPLE OF COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND REPORT THE RESULTS TO THE COMPLIANCE AND AUDIT COMMITTEE. THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE INDIVIDUALLY SUMMARIZED IN A DOCUMENT AND SENT ELECTRONICALLY TO THE FINANCE DEPARTMENT FOR ANY NECESSARY DISCLOSURES REQUIRED ON THE 990 FILING. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC WHEN REQUIRED BY LAW OR FOR ACCREDITATION PURPOSES. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CAPITAL DONATIONS -264,077. PLEDGE RESERVE -7,690. PREMIER HEALTH 110 MAIN STREET SUITE 200 DAYTON OH 45402 311446699 PARENT OH 501 (C) (3) 12B N/A 0 MEDAMERICA HEALTH SYSTEMS CO 110 MAIN STREET SUITE 200 DAYTON OH 45402 311040228 SUPPORT ORG OH 501 (C) (3) 12B N/A 0 MIAMI VALLEY HOSPITAL 110 MAIN STREET SUITE 200 DAYTON OH 45402 310537504 HOSPITAL OH 501 (C) (3) 3 PREMIER HEALTH 0 MIAMI VALLEY HOSPITAL FOUNDATION 110 MAIN STREET SUITE 200 DAYTON OH 45402 311040231 FOUNDATION OH 501 (C) (3) 7 PREMIER HEALTH 0 FIDELITY HEALTH CARE INC 110 MAIN STREET SUITE 200 DAYTON OH 45402 311075381 HOME HEALTH OH 501 (C) (3) 10 PREMIER HEALTH 0 PREMIER COMMUNITY HEALTH 110 MAIN STREET SUITE 200 DAYTON OH 45402 311122883 HEALTH EDUCATION OH 501 (C) (3) 10 FIDELITY HEALTH CARE 0 ATRIUM HEALTH SYSTEM 110 MAIN STREET SUITE 200 DAYTON OH 45402 310537492 SUPPORT ORG OH 501 (C) (3) 12B N/A 0 ATRIUM MEDICAL CENTER 110 MAIN STREET SUITE 200 DAYTON OH 45402 311079309 HOSPITAL OH 501 (C) (3) 3 PREMIER HEALTH 0 UVMC 110 MAIN STREET SUITE 200 DAYTON OH 45402 341850683 SUPPORT ORG OH 501 (C) (3) 12B N/A 0 UPPER VALLEY MEDICAL CENTER 110 MAIN STREET SUITE 200 DAYTON OH 45402 310537095 HOSPITAL OH 501 (C) (3) 3 PREMIER HEALTH 0 UPPER VALLEY PROFESSIONAL CORP 110 MAIN STREET SUITE 200 DAYTON OH 45402 311400963 HEALTH CARE OH 501 (C) (3) 10 PREMIER HEALTH HOLDING CO 0 UVPC SPECIALISTS 110 MAIN STREET SUITE 200 DAYTON OH 45402 203687536 HEALTH CARE OH 501 (C) (3) 10 PREMIER HEALTH HOLDING CO 0 UVMC NURSING CARE INC 110 MAIN STREET SUITE 200 DAYTON OH 45402 311224064 NURSING HOME OH 501 (C) (3) 10 PREMIER HEALTH 0 COMPUNET CLINICAL LABORATORIES LLC 110 MAIN STREET SUITE 200 DAYTON OH 45402 311258010 LAB OH 501 (C) (3) 12B PREMIER HEALTH 0 SAMARITAN BEHAVIORAL HEALTH INC 110 MAIN STREET SUITE 200 DAYTON OH 45402 020633634 BEHAVIORAL HEALTH OH 501 (C) (3) 7 PREMIER HEALTH 0 SWEITZER STREET LLC 110 MAIN STREET SUITE 200 DAYTON OH 45402 454700417 REAL ESTATE OH MVHE INC EXCLUDED 0 0 SWEITZER MOB LLC 110 MAIN STREET SUITE 200 DAYTON OH 45402 474554657 REAL ESTATE OH MVHE INC EXCLUDED 0 0 MVHE INC 110 MAIN STREET SUITE 200 DAYTON OH 45402 311185270 PHYSICIAN SVCS OH PREMIER HEALTH HOLDING CO C 0 PREMIER HEALTH SPECIALISTS 110 MAIN STREET SUITE 200 DAYTON OH 45402 061744704 PHYSICIAN SVCS OH PREMIER HEALTH HOLDING CO C 0 SAMARITAN FAMILY CARE 110 MAIN STREET SUITE 200 DAYTON OH 45402 311299450 PHYSICIAN SVCS OH PREMIER HEALTH HOLDING CO C 0 AFTER HOURS FAMILY CARE 110 MAIN STREET SUITE 200 DAYTON OH 45402 311269483 HEALTH CARE OH UPPER VALLEY PROFESSIONAL CORP C 0 UVMC MANAGEMENT CORP 110 MAIN STREET SUITE 200 DAYTON OH 45402 311360489 MANAGEMENT COMPANY OH PREMIER HEALTH C 0 PREMIER HEALTH URGENT CARE INC 110 MAIN STREET SUITE 200 DAYTON OH 45402 822079409 URGENT CARE OH PREMIER HEALTH HOLDING CO C 0 PREMIER HEALTH INT'L INSURANCE BUTTERFIELD BANK BLDG 6TH FLOOR 6 HAMILTON BD HM12 980548485 INSURANCE BD PREMIER HEALTH C 0 PREMIER HEALTH PLAN INC 110 MAIN STREET SUITE 200 DAYTON OH 45402 463024049 HEALTH INSURANCE OH PREMIER HEALTH INSURING CO C 0 GOOD SAMARITAN HOSPITAL 110 MAIN STREET SUITE 200 DAYTON OH 45402 310536981 HOSPITAL OH PREMIER HEALTH C 0 PREMIER HEALTH ACO OF OHIO 110 MAIN STREET SUITE 200 DAYTON OH 45402 474049773 MEDICARE ACO OH PREMIER HEALTH C 0 PREMIER HEALTH HOLDING CO 110 MAIN STREET SUITE 200 DAYTON OH 45402 812419110 HOLDING CO OH PREMIER HEALTH C 0 PREMIER HEALTH INSURING CO 110 MAIN STREET SUITE 200 DAYTON OH 45402 464766841 HEALTH INSURANCE OH PREMIER HEALTH C 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0