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ObjectId: 202043219349312889 - Submission: 2020-11-16
TIN: 02-0633634
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
19
Open to Public Inspection
Name of the organization
SAMARITAN BEHAVIORAL HEALTH INC
Employer identification number
02-0633634
Part I
Identification of Disregarded Entities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
Part II
Identification of Related Tax-Exempt Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
PREMIER HEALTH (PREMIER)
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1446699
PARENT
OH
501 (C) (3)
12B
N/A
No
(2)
MEDAMERICA HEALTH SYSTEMS CO (MAHS)
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1040228
SUPPORT ORG
OH
501 (C) (3)
12B
N/A
No
(3)
MIAMI VALLEY HOSPITAL (MVH)
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-0537504
HOSPITAL
OH
501 (C) (3)
3
PREMIER
No
(4)
MIAMI VALLEY HOSPITAL FOUNDATION
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1040231
FOUNDATION
OH
501 (C) (3)
7
PREMIER
No
(5)
FIDELITY HEALTH CARE INC (FHC)
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1075381
HOME HEALTH
OH
501 (C) (3)
10
PREMIER
No
(6)
PREMIER COMMUNITY HEALTH
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1122883
HEALTH EDU
OH
501 (C) (3)
10
FIDELITY HEALTH CARE
No
(7)
SAMARITAN HEALTH PARTNERS (SHP)
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1107411
SUPPORT ORG
OH
501 (C) (3)
12B
PREMIER
No
(8)
GOOD SAMARTIAN FOUNDATION - DAYTON
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
23-7296923
FOUNDATION
OH
501 (C) (3)
7
PREMIER
No
(9)
ATRIUM HEALTH SYSTEM
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-0537492
SUPPORT ORG
OH
501 (C) (3)
12B
N/A
No
(10)
ATRIUM MEDICAL CENTER
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1079309
HOSPITAL
OH
501 (C) (3)
3
PREMIER
No
(11)
UVMC
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
34-1850683
SUPPORT ORG
OH
501 (C) (3)
12B
N/A
No
(12)
UPPER VALLEY MEDICAL CENTER
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-0537095
HOSPITAL
OH
501 (C) (3)
3
PREMIER
No
(13)
UPPER VALLEY PROFESSIONAL CORP (UVPC)
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1400963
HEALTH CARE
OH
501 (C) (3)
10
PREMIER
No
(14)
UVPC SPECIALISTS
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
20-3687536
HEALTH CARE
OH
501 (C) (3)
10
UPPER VALLEY PROFESSIONAL CORP
No
(15)
UVMC NURSING CARE INC
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1224064
NURSING HOME
OH
501 (C) (3)
10
PREMIER
No
(16)
HEART INSTITUTE OF DAYTON
110 MAIN STREET SUITE 500
DAYTON
,
OH
45402
30-0502367
EDUCATION
OH
501 (C) (3)
10
PREMIER
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Page 2
Schedule R (Form 990) 2019
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
PREMIER PLAZA LLC
110 N MAIN STREET SUITE 500
DAYTON
,
OH
45402
80-0708185
HOLDING COMPANY
OH
MAHS
EXCLUDED
No
No
(2)
COMPUNET CLINICAL LABORATORIES
2308 SANDRIDGE DRIVE
MORAINE
,
OH
45439
31-1258010
MEDICAL LABS
OH
MVHE INC
RELATED
No
No
(3)
SWEITZER STREET LLC
110 N MAIN STREET SUITE 500
DAYTON
,
OH
45402
45-4700417
REAL ESTATE
OH
MVHE INC
EXCLUDED
No
No
(4)
SWEITZER MOB LLC
110 N MAIN STREET SUITE 500
DAYTON
,
OH
45402
47-4554657
REAL ESTATE
OH
MVHE INC
EXCLUDED
No
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
MVHE INC
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1185270
PHYSICIAN SVCS
OH
PREMIER HOLDING
C
No
(2)
PREMIER HEALTH SPECIALISTS
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
06-1744704
PHYSICIAN SVCS
OH
PREMIER HOLDING
C
No
(3)
SAMARITAN FAMILY CARE
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1299450
PHYSICIAN SVCS
OH
PREMIER HOLDING
C
No
(4)
AFTER HOURS FAMILY CARE
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1269483
HEALTH CARE
OH
UVPC
C
No
(5)
UVMC MANAGEMENT CORP
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-1360489
MANAGEMENT COMPANY
OH
PREMIER
C
No
(6)
PREMIER HEALTH URGENT CARE INC
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
82-2079409
URGENT CARE
OH
PREMIER HOLDING
C
No
(7)
PREMIER HEALTH PLAN INC
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
46-3024049
HEALTH INSURANCE
OH
PHIC
C
No
(8)
GOOD SAMARITAN HOSPITAL
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
31-0536981
HOSPITAL
OH
PREMIER
C
No
(9)
PREMIER HEALTH ACO OF OHIO
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
47-4049773
MEDICARE ACO
OH
PREMIER
C
No
(10)
PREMIER HEALTH HOLDING (PREMIER HOLDING)
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
81-2419110
HOLDING CO
OH
PREMIER
C
No
(11)
PREMIER HEALTH INSURING CO (PHIC)
110 NORTH MAIN STREET SUITE 500
DAYTON
,
OH
45402
46-4766841
HEALTH INSURANCE
OH
PREMIER
C
No
Schedule R (Form 990) 2019
Page 3
Schedule R (Form 990) 2019
Page
3
Part V
Transactions With Related Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
1s
Yes
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
Schedule R (Form 990) 2019
Page 4
Schedule R (Form 990) 2019
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2019
Page 5
Schedule R (Form 990) 2019
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2019
Additional Data
Software ID:
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