TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) MARY H BOOSALIS...................................................................... TRUSTEE / PREMIER PRESIDENT & CEO	0.50 ................. 39.50	X			0	3,030,456	40,515
(2) KEITH D BRICKING MD...................................................................... PRESIDENT & CEO	39.00 ................. 0.50	X	X		711,680	0	85,869
(3) JOHN M MILLER MD...................................................................... TRUSTEE	0.50 ................. 39.50	X			0	746,117	41,450
(4) JOSHUA J ORDWAY MD...................................................................... TRUSTEE	0.50 ................. 39.50	X			0	647,858	38,791
(5) ANDRE T HARRIS MD...................................................................... TRUSTEE / VP OPERATIONS & CMO	40.00 ................. 0.00	X			361,311	0	39,292
(6) KIMBERLY A HENSLEY...................................................................... TRUSTEE / COO & CNO	40.00 ................. 0.00	X	X		353,820	9,997	31,906
(7) RHONDA L SEIDENSCHMIDT...................................................................... TRUSTEE & VP OPERATIONS	40.00 ................. 0.00	X			249,005	0	39,463
(8) WILLIAM ANDREW MD...................................................................... TRUSTEE	0.50 ................. 0.00	X			0	188,000	0
(9) PERCY DAVID MITCHELL JR MD...................................................................... TRUSTEE	0.50 ................. 0.00	X			0	68,850	0
(10) GREGORY W SIEWNY MD...................................................................... BOARD CHAIR	0.50 ................. 0.00	X	X		0	0	0
(11) BENJAMIN A WATSON ESQ...................................................................... DIRECTOR - LEGAL SERVICES	0.50 ................. 39.50		X		0	209,508	17,224
(12) LYNDSEY A PITTMAN...................................................................... BOARD TREASURER / DIRECTOR FINANCE & OPERATIONS	39.00 ................. 1.00		X		167,425	0	7,841
(13) GEOFFREY P WALKER...................................................................... SYSTEM VP - CHIEF LEGAL OFFICER	10.00 ................. 30.00			X	0	924,392	47,873
(14) MARC R BELCASTRO DO...................................................................... VP MEDICAL AFFAIRS & PREMIER CMO	10.00 ................. 30.00			X	0	800,172	35,402
(15) MARY M CLANCY...................................................................... CHIEF DIGITAL OFFICER	10.00 ................. 30.00			X	0	660,172	127,089
(16) J MICHAEL SIMS...................................................................... SYS VP & CORPORATE CONTROLLER	10.00 ................. 30.00			X	0	623,246	48,840
(17) MARGARET PEGGY W MARK...................................................................... VP NURSING / CNO / PATIENT EXP	10.00 ................. 30.00			X	0	586,889	39,660

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) THOMAS R CURTIN........................................................................ SYSTEM VP REVENUE CYCLE	10.00 .......................30.00	X			0	385,866	67,243
(19) JOANNE R MORGAN........................................................................ SYSTEM VP - PHARMACY OPERATIONS	40.00 .......................0.00		X		305,700	0	24,298
(20) JEANNA R SEVERT........................................................................ DIRECTOR - HUMAN RESOURCES	40.00 .......................0.00		X		225,986	0	35,727
(21) AMANDA K RICCI........................................................................ SYSTEM VP REVENUE CYCLE	40.00 .......................0.00		X		209,096	0	18,646
(22) ROBYN S MYERS........................................................................ DIRECTOR - QUALITY, SYS PATIENT SAFETY	40.00 .......................0.00		X		202,377	0	18,350
(23) WENDY H PARKS........................................................................ DIR - MARKETING	40.00 .......................0.00		X		193,804	0	10,310
(24) MICHAEL R UHL........................................................................ FORMER OFFICER	0.00 .......................40.00			X	0	908,883	148,354
(25) MARQUITA L TURNER........................................................................ FORMER OFFICER	0.00 .......................40.00			X	11,573	372,764	36,433
(26) SCOTT A SHELTON........................................................................ FORMER OFFICER	0.00 .......................0.00			X	0	886,751	10,687
(27) BARBARA A JOHNSON........................................................................ FORMER KEY EMPLOYEE	0.00 .......................40.00			X	0	1,109,672	26,089
(28) JENNIFER J HAULER DO........................................................................ FORMER KEY EMPLOYEE	0.00 .......................40.00			X	0	817,844	100,077
(29) GARY G GINTER........................................................................ FORMER KEY EMPLOYEE	0.00 .......................40.00			X	0	566,099	100,663
(30) ELAINE LAINIE M DEAN........................................................................ FORMER KEY EMPLOYEE	0.00 .......................40.00			X	0	511,637	26,575
(31) BILLIE L LUCENTE-BAKER........................................................................ FORMER KEY EMPLOYEE	0.00 .......................40.00			X	0	320,650	34,596
(32) THOMAS R PARKER........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00			X	0	288,611	23,566
(33) KIM K STRAHL........................................................................ FORMER KEY EMPLOYEE	0.00 .......................40.00			X	0	207,605	23,724

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization ATRIUM MEDICAL CENTER

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization ATRIUM MEDICAL CENTER		Employer identification number 31-1079309

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization ATRIUM MEDICAL CENTER			Employer identification number 31-1079309
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

4,421

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

4,421

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	PAYMENTS FOR LOBBYING ACTIVITIES INCLUDE DUES PAID TO GREATER DAYTON AREA HOSPITAL ASSOCIATION, AND OHIO HOSPITAL ASSOCIATION.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	131,340	131,340	131,340	131,340	131,340
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	131,340	131,340	131,340	131,340	131,340

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

100.000 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	24,729,765		24,729,765
b	Buildings ....	257,121,528	144,165,160	112,956,368
c	Leasehold improvements	923,922	787,005	136,917
d	Equipment ....	120,572,034	103,984,204	16,587,830
e	Other .....	2,569,155		2,569,155
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				156,980,035

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) ALTERNATIVE INVESTMENTS	37,342,288	F
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	37,342,288

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	67,712,416
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART V, LINE 4:

THE ORGANIZATION'S ENDOWMENT FUNDS ARE DESIGNATED TO SUPPORT SPECIFIC HEALTHCARE SERVICES OR CAPITAL NEEDS.

PART X, LINE 2:

THE FOLLOWING FOOTNOTE IS FROM THE 2021 CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR PREMIER HEALTH (PHP) AND AFFILIATES. PHP IS THE SOLE MEMBER OF ATRIUM MEDICAL CENTER (AMC). 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 INSURING CO. (PHIC), AND PREMIER HEALTH HOLDING COMPANY (PHHC) (WHOLLY OWNED SUBSIDIARIES OF PHP), * PREMIER HEALTH PLAN (PHPLAN) (A WHOLLY OWNED SUBSIDIARY OF PHIC), * MVHE, INC., SAMARITAN FAMILY CARE, INC., PREMIER HEALTH SPECIALISTS, INC. AND PREMIER HEALTH URGENT CARE, INC. (SUBSIDIARIES OF PHHC), *GOOD SAMARITAN HOSPITAL AND UVMC MANAGEMENT CORPORATION (SUBSIDIARIES OF PHP) MANAGEMENT ANNUALLY REVIEWS THE TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization
ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in the region	(f) Total expenditures for and investments in the region
	CENTRAL AMERICA/CARIBBEAN	0	0	PROGRAM SERVICES	INSURANCE	26,000
















3a	Sub-total ....	0	0			26,000
b	Total from continuation sheets to Part I ...	0	0			0
c	Totals (add lines 3a and 3b)	0	0			26,000

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2021

Schedule F (Form 990) 2021

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2021

Schedule F (Form 990) 2021Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of noncash assistance	(g) Description of noncash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2021

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2021

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
PART III ACCOUNTING METHOD:

Schedule F (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	4,263,000	2,186,000	2,077,000	0.990 %
b	Medicaid (from Worksheet 3, column a) . . . . .	49,512,094	29,425,094	20,087,000	9.540 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	703,000		703,000	0.330 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	54,478,094	31,611,094	22,867,000	10.860 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	538,000	200,000	338,000	0.160 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	6,843,000		6,843,000	3.250 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	187,000		187,000	0.090 %
j	Total. Other Benefits . .	7,568,000	200,000	7,368,000	3.500 %
k	Total. Add lines 7d and 7j .	62,046,094	31,811,094	30,235,000	14.360 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

9,274,988

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

44,652,000

Enter Medicare allowable costs of care relating to payments on line 5.....

47,852,000

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-3,200,000

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	ATRIUM MEDICAL CENTER ONE MEDICAL CENTER DR MIDDLETOWN,OH45044 WWW.PREMIERHEALTH.COM SEE PART V SECTION C	X	X	X

Schedule H (Form 990) 2021

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	ATRIUM MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 20

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCHEDULE H, PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	ATRIUM MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SCHEDULE H, PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE SCHEDULE H, PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	ATRIUM MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	ATRIUM MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION A, LINE 1:	THE STATE OF OHIO DOES NOT LICENSE HOSPITALS, BUT THE OHIO DEPARTMENT OF HEALTH DOES REGISTER HOSPITALS. AS PART OF THIS REGISTRATION PROCESS, HOSPITALS IN THE STATE OF OHIO ARE REQUIRED TO COMPLETE AND SUBMIT THE ANNUAL HOSPITAL REGISTRATION AND PLANNING REPORT (AHR) EACH CALENDAR YEAR. ATRIUM MEDICAL CENTER'S REGISTRATION NUMBER IS 1116.
PART V, SECTION B, LINE 3E:	ATRIUM MEDICAL CENTER'S SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND WERE IDENTIFIED THROUGH THE CHNA.
PART V, SECTION B, LINE 5:	THE CHNA TEAM COLLECTED 140 MEASURES FROM PUBLICLY AVAILABLE SOURCES, STARTING WITH THE COUNTY HEALTH RANKINGS. CRITERIA FOR INCLUSION INCLUDED AVAILABILITY OF TREND DATA AT THE COUNTY LEVEL AND EASE OF COMPARISON AND UPDATING.THE COLLABORATIVE CHNA FOR 2019 SHARES DATA FOR THE WHOLE REGION AS WELL AS DETAILED COUNTY-LEVEL DATA. SERVICE AREAS OF HOSPITALS VARY, AND THIS APPROACH PROVIDES THE MOST THOROUGH PICTURE OF HEALTH NEEDS LOCALLY AND REGIONALLY. AN ADDED BONUS THIS CYCLE IS THE ACTIVE PARTICIPATION OF THE SOUTHWEST OHIO MEMBERS OF THE ASSOCIATION OF OHIO HEALTH COMMISSIONERS. THE CHNA TEAM REACHED OUT TO THEM IN SPRING 2017 TO TAKE THE FIRST STEPS TOWARDS THE STATE OF OHIO'S REQUIREMENT THAT HEALTH DEPARTMENTS AND HOSPITALS ALIGN THEIR ASSESSMENTS STARTING IN 2020. AS A RESULT, THE CHNA TEAM HAS RESEARCHED MORE SECONDARY DATA MEASURES, INCLUDED HOSPITAL UTILIZATION DATA, OVERSAMPLED VULNERABLE POPULATIONS, AND ENGAGED MORE PARTICIPANTS. A TOTAL OF 1,416 PEOPLE OR ORGANIZATIONS COMPLETED A SURVEY OR ATTENDED A MEETING. A SIGNIFICANT PART OF THE INCREASE WAS DUE TO LOCAL HEALTH DEPARTMENTS HELPING TO PROMOTE AND CONDUCT MEETINGS. THE PRIMARY DATA COLLECTION AND ANALYSIS USED THE NARRATIVE METHOD AND SPECIFICALLY THE TECHNIQUE OF DISCOURSE ANALYSIS. THE FOCUS WAS ON COLLECTING DATA FROM INDIVIDUALS BASED ON THEIR EXPERIENCE. THERE WERE SEVERAL IMPORTANT STEPS TO ENSURE A CONSISTENT PROCESS:1) VERBATIM ENTRY OF COMMENTS - THIS HAPPENS AUTOMATICALLY WITH THE ONLINE SURVEY PROCESS AND SCRIBES WERE TRAINED TO DO THIS AT THE COMMUNITY MEETINGS2) CREATING CUSTOM TAGS TO SUMMARIZE EACH RESPONSE, E.G., CANCER, DIABETES, HEART DISEASE3) CREATING THEMES THAT CONNECT SOME OF THE TAGS, E.G., CHRONIC DISEASE4) PROOFREADING EACH OTHER'S TAGS AND ANALYSIS, WITH REVIEW BY AT LEAST 3 DIFFERENT PEOPLE TO ENSURE OVERALL CONSISTENCY5) USE OF SURVEYMONKEY'S 'GOLD' LEVEL ENABLED THE CREATION OF CUSTOM TAGS AND INITIAL SORTING. IT ALSO PROVIDED A CONSISTENT WAY TO COMPARE SURVEY RESULTS WITH MEETING RESPONSES. IT WORKED FOR FACE-TO-FACE VERBAL ENCOUNTERS, SUCH AS IN MEETINGS, AS WELL AS WRITTEN RESPONSES. COMMENTS MADE IN PERSON WERE ENTERED INTO SURVEYMONKEY, TAGGED, ANDTHEMES IDENTIFIED. THE LEAD CONSULTANT CUSTOMIZED THE TAGGING IN SURVEYMONKEY BECAUSE SHE FOUND THAT ITS AUTOMATIC GROUPING OF IDEAS WAS NOT PRECISE ENOUGH AND COULD NOT ACCOUNT FOR CONTEXT OR ADAPT WHEN RESPONSES USED DIFFERENT WORDS FOR SIMILAR CONCEPTS.6) REVIEWING TAGS AT THE COUNTY-LEVEL, URBAN LEVEL, AND REGIONAL LEVEL WAS DONE TO ENSURE THAT THE TAGS AND THEMES MADE SENSE AND WERE APPLICABLE AT ALL LEVELS. FOR EXAMPLE, THE CONSULTANTS CREATED TAGS FOR 'ADDICTION,' 'HEROIN,' 'METH' AS SUBSETS OF THE 'SUBSTANCE ABUSE' THEME, BECAUSE OF THEIR APPARENT FREQUENCY AT THE BEGINNING OF THE TAGGING PROCESS. THEY COUNTED EACH TAG AND SAVED THE COUNT, BUT NONE OF THESE TAGS REACHED HIGH ENOUGH NUMBERS (MORE THAN 5% OF MENTIONS) TO WARRANT ITS OWN CATEGORY IN THE FINAL ANALYSIS. SEE APPENDIX K FOR GUIDELINES USED TO ASSIGN CATEGORIES AND FOR SORTING AND TABULATING RESPONSES.7) SURVEYMONKEY'S FILTER OPTIONS FACILITATED THE PROCESS OF SORTING AND ANALYZING BY COUNTY, BY GROUPS OF COUNTIES, BY TYPE OF SURVEY, AND/OR BY SUB-POPULATION. THIS IS A USEFUL OPTION TO CONSIDER CONTEXT OR CULTURE, SUCH AS URBAN RESPONDENTS OR LATINO RESPONDENTS.
PART V, SECTION B, LINES 6A & 6B:	ATRIUM MEDICAL CENTER PARTNERED WITH MEMBER HOSPITALS OF THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, PUBLIC HEALTH DEPARTMENTS, THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO, ADAMS COUNTY HEALTH DEPARTMENT, BROWN COUNTY HEALTH DEPARTMENT, BUTLER COUNTY HEALTH DEPARTMENT, CHAMPAIGN-URBANA COUNTY DEPARTMENT, CINCINNATI HEALTH DEPARTMENT, CITYOF HAMILTON HEALTH DEPARTMENT, CLARK COUNTY COMBINED HEALTH DISTRICT, CLERMONT COUNTY PUBLIC HEALTH, CLINTON COUNTY HEALTH DEPARTMENT, DARKE COUNTY GENERAL HEALTH DISTRICT, FAYETTE COUNTY PUBLIC HEALTH, GREENE COUNTY PUBLIC HEALTH, HAMILTON COUNTY PUBLIC HEALTH, HIGHLAND COUNTY HEALTH DEPARTMENT, MIAMI COUNTY PUBLIC HEALTH, MIDDLETOWN CITY HEALTH DISTRICT, NORWOOD HEALTH DEPARTMENT, PIQUA CITY HEALTH DEPARTMENT, PREBLE COUNTY PUBLIC HEALTH, PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY, SIDNEY SHELBY COUNTY HEALTH DEPARTMENT, SPRINGDALE HEALTH DEPARTMENT & WARREN COUNTY COMBINED HEALTH DISTRICT.
PART V, SECTION B, LINES 7A & 10A:	THE WEBSITE ADDRESS WHERE THE 2019 CHNA AND THE 2020 COMMUNITY HEALTH IMPLEMENTATION PLAN CAN BE ACCESSED IS:HTTPS://WWW.PREMIERHEALTH.COM/ABOUT-PREMIER/COMMUNITY-INVOLVEMENT/COMMUNITY-HEALTH-IMPROVEMENT
PART V, SECTION B, LINE 11:	ATRIUM MEDICAL CENTER (AMC) ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE FOLLOWING PRIORITIZED NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA):* ACCESS TO CARE AND/OR SERVICES* CHRONIC DISEASE* HEALTHY BEHAVIORS* SUBSTANCE ABUSE AND MENTAL HEALTH.ACCESS TO CARE/SERVICESER VIRTUAL CAREMETRICS: NUMBER OF NEW SITES, NUMBER OF RESIDENTS SERVED, REASON FOR CONSULTATIONS, EMERGENCY DEPARTMENT TRANSFERS/HOSPITALIZATION RATES, AND PATIENT AND CLINICIAN SATISFACTION.HEALTH ISSUE: AS NURSING FACILITIES ARE CALLED UPON TO CARE FOR HIGHER-ACUITY PATIENTS AND DRIVE BETTER OUTCOMES AT A FRACTION OF THE COST OF A HOSPITALIZATION, SYSTEMS ARE REQUIRED THAT DELIVER QUALITY PHYSICIANS TO THE BEDSIDE AT TIMES OF CHANGE OF CONDITION.INTERVENTION'S GOAL: THE GOAL OF THE PROGRAM IS TO FACILITATE EARLY TREATMENT OF CONDITIONS, REDUCE EMERGENCY ROOM TRANSFERS AND HOSPITALIZATIONS, AND REDUCE CARE COSTS FOR RESIDENTS. THE LONG-TERM PLAN IS TO EXPAND ER VIRTUAL CARE TO NURSING FACILITIES ACROSS OUR MARKET AND EXPAND SERVICE OFFERINGS TO INCLUDE SPECIALTIES SUCH AS NEUROLOGY, WOUND CARE, AND BEHAVIORAL HEALTH.DESCRIPTION: VIDEO CONSULTATION WITH A DOCTOR CAN EXPEDITE EVALUATION OR TREATMENT FOR PATIENTS AT NURSING FACILITIES OR AT HOME. ER VIRTUAL CARE USES REAL-TIME VIDEO AND AUDIO FOR AN EMERGENCY MEDICINE PHYSICIAN TO TREAT A PATIENT REMOTELY. BY REMOVING GEOGRAPHICAL BOUNDARIES, THE HOSPITAL CAN LEVERAGE AVAILABLE PROVIDERS FROM A DISTANCE TO PROVIDE SUPPORT AND TREAT PATIENTS. THIS TELEMEDICINE SOLUTION CAN HELP ADDRESS UNNECESSARY TRANSFER OF NURSING HOME AND ASSISTED LIVING RESIDENTS TO HOSPITALS BY ALLOWING ACCESS TO EMERGENCY MEDICINE SPECIALISTS FOR AFTER HOUR AND WEEKEND COVERAGE.BACKGROUND: THE CLOSURE OF GOOD SAMARITAN HOSPITAL LED TO AN INCREASED DEMAND IN SERVICES AT MVH-NORTH. CLINICAL AND OPERATIONAL LEADERSHIP IDENTIFIED AN OPPORTUNITY TO LEVERAGE TELEMEDICINE AND HELP TREAT PATIENTS THAT PRESENT WITH LOW ACUITY SYMPTOMS TO EXPEDITE TREATMENT AND REDUCE WAIT TIMES. INITIAL RESULTS ON UTILIZATION AND PATIENT SATISFACTION WERE POSITIVE AND EXPANDED PREMIER HEALTH'S SCOPE FOR INCLUSION OF COMMUNITY PARTNER FACILITIES. NURSING FACILITIES ARE CHALLENGED WITH CARING FOR HIGHER ACUITY PATIENTS. THE SERVICE PROMOTES PREMIER HEALTH'S MISSION IN PROVIDING HIGHEST QUALITY OF CARE AT THE RIGHT TIME AND RIGHT PLACE. PARTNERS: MIAMI VALLEY EMERGENCY SPECIALISTS, SPRINGMEADE HEALTH CENTER, AND KOESTER PAVILIONACCESS TO CARE/SERVICESCOMMUNITY HEALTH MOBILE CLINICMETRICS: NUMBER OF PEOPLE SERVED. NUMBER OF PEOPLE CONNECTED TO RESOURCES. PERCENT OF PEOPLE IDENTIFIED AS 'AT RISK AND RECEIVING FOLLOW-UP.HEALTH ISSUE: BOTH URBAN AND RURAL RESIDENTS CAN EXPERIENCE OBSTACLES TO RECEIVING MEDICAL CARE. A MOBILE CLINIC CAN TRAVEL TO LOCATIONS CONVENIENT FOR RESIDENTS IN UNDERSERVED AREAS.INTERVENTION'S GOAL: THE GOAL IS TO BRING HEALTHCARE PROVIDERS AND SERVICES ON A ROUTINE BASIS TO UNDERSERVED COMMUNITIES THROUGH THE PREMIER COMMUNITY HEALTH MOBILE CLINIC PROGRAM. THE GOAL IS TO MAKE QUALITY HEALTHCARE ACCESSIBLE TO SUCH LOCATIONS AS PREBLE COUNTY AND WEST DAYTON BY UTILIZING SITES AT NONPROFIT ORGANIZATIONS, PARTICIPATING CVS PHARMACIES, AND LOCAL SCHOOLS.DESCRIPTION: THE PROGRAM UTILIZES MEDICAL PROVIDERS WHO OFFER PATIENTS ASSESSMENTS, COUNSELING, FOLLOW-UP CARE, AND REFERRALS THROUGH THE PREMIER HEALTH ONLINE SCHEDULING PORTAL. THE PATIENTS ARE PROVIDED BLOOD PRESSURE, CHOLESTEROL, BLOOD GLUCOSE, A1C SCREENINGS, (ALL WITH IMMEDIATE RESULTS) AS WELL AS FLU SHOTS ADMINISTERED BY PREMIER COMMUNITY HEALTH NURSES. THE CARE WILL BE DOCUMENTED IN EPIC ALLOWING TRACKING OF PROGRESS AND PROVIDING ACCESS OF THEIR MOBILE CLINIC'S VISITS TO OTHER PROVIDERS AS NEEDED. ALONG WITH THE HEALTH SCREENINGS RESULTS AND COUNSELING PROVIDED BY THE HEALTHCARE PROVIDER, THE PROGRAM ALSO PROVIDES EDUCATION THROUGH THE WELLNESS DEPARTMENT OF TAKE-HOME LITERATURE ABOUT CHRONIC DISEASE AND HEALTHY LIFESTYLE ALTERNATIVES. WITH THIS PARTNERSHIP, THE PROGRAM WILL PROVIDE APPROXIMATELY 700 HOURS OF SERVICE, BETWEEN NOVEMBER 2019 AND DECEMBER 2020 AND PROJECTED 700 HOURS OF SERVICE BETWEEN 2021 AND 2022, TO THE UNDERSERVED COMMUNITY.BACKGROUND: THE PREMIER COMMUNITY HEALTH MOBILE CLINIC PROGRAM HAS PARTNERED WITH WRIGHT STATE PHYSICIAN RESIDENTS, PREMIER HEALTH URGENT CARE CENTERS, AND A PRIMARY CARE PHYSICIAN FROM ONEFIFTEEN TO PROVIDE ACCESSIBLE HEALTHCARE ASSESSMENTS, CONSULTATIONS AND REFERRALS TO PATIENTS IN THE TARGETED AREAS. A NEW PARTNERSHIP WITH CVS ENABLES THE MOBILE CLINIC TO PROVIDE SERVICES IN LOCATIONS WHERE THERE IS NOT A MINUTE CLINIC AVAILABLE. THERE WILL BE UP TO 10 CVS SITES IN DAYTON AND NEAR ATRIUM MEDICAL CENTER, WHERE THE MOBILE CLINIC CAN PARK AND SEE PATIENTS. SCHOOLS WILL ALSO OFFER A COMMUNITY LOCATION FOR THE PUBLIC AND SCHOOL STAFF.PARTNERS: CVS PHARMACY LOCATIONS IN GERMANTOWN, TROTWOOD, NEW LEBANON, EATON, AND MORE; DAYTON SALVATION ARMY-KROC CENTER; GRATIS FIRE DEPARTMENT; MADISON LOCAL SCHOOLS; PREBLE COUNTY CHAMBER OF COMMERCE; PREBLE COUNTY HEALTH DEPARTMENT; PREBLE SHAWNEE SCHOOLS; PREMIER HEALTH URGENT CARE CENTERS; SAMARITAN BEHAVIORAL HEALTH INC.; VALLEY VIEW LOCAL SCHOOLS; SOMERVILLE COMMUNITY CHURCH; WRIGHT STATE PHYSICIANS; HELP ME GROW; TRI-COUNTY NORTH; BROOKVILLE SCHOOLS; MAXON FOUNDATION; AND ATRIUM MEDICAL CENTER FOUNDATION.ACCESS TO CARE/SERVICES AND CHRONIC DISEASE COMMUNITY HEALTH VOUCHER PROGRAMMETRICS: FOR THE 3-YEAR PERIOD, A PROJECTED 275 WOMEN SYSTEM-WIDE WILL BE SERVED BY THE COMMUNITY HEALTH VOUCHER PROGRAM, WITH A GOAL TO INCREASE THE NUMBERS SERVED. AT ATRIUM MEDICAL CENTER, THE ANTICIPATED 50% INCREASE WOULD SERVE A TOTAL OF 70 WOMEN. IN 2019, THE ATRIUM MEDICAL CENTER FOUNDATION APPROVED A SECOND TYPE OF FUNDING FOR PREMIER COMMUNITY HEALTH CLIENTS THAT COVERS WOMEN RESIDING IN WARREN, BUTLER, PREBLE, AND HAMILTON COUNTIES. PRIOR TO THAT, THE ATRIUM MEDICAL CENTER FOUNDATION FUNDS WERE RESTRICTED TO WOMEN LIVING IN 5 ZIP CODES. IN 2019, 3 WOMEN OUT OF 7 WERE ABLE TO RECEIVE COVERAGE FROM ATRIUM MEDICAL CENTER FUNDS DUE TO THIS CHANGE. IT IS EXPECTED THAT THE NUMBER OF CLIENTS WHO ARE ELIGIBLE TO RECEIVE SERVICES COVERED BY THE ATRIUMMEDICAL CENTER FOUNDATION WILL CONTINUE TO RISE DUE TO THIS ELIGIBILITY EXPANSION. HEALTH ISSUE: THIS PROGRAM SUPPLEMENTS THE STATE OF OHIO'S FUNDING TO ENCOURAGE WOMEN TO BE SCREENED FOR BREAST CANCER AND CERVICAL CANCER. IT PROVIDES FINANCIAL ASSISTANCE TO WOMEN WHO ARE NOT ELIGIBLE FOR THE STATE PROGRAM, AND IT ALSO COVERS DIAGNOSTIC TESTING AND BIOPSIES.INTERVENTION'S GOAL: THE MISSION OF THE VOUCHER PROGRAM IS TO PROVIDE FINANCIAL ASSISTANCE TO DETECT BREAST AND CERVICAL CANCERS AT THE EARLIEST STAGE TO UNINSURED AND UNDER-INSURED COMMUNITY RESIDENTS. DESCRIPTION: THE FOLLOWING SERVICES ARE COVERED BY THIS PROGRAM: SCREENING MAMMOGRAMS; DIAGNOSTIC MAMMOGRAMS; BREAST ULTRASOUNDS; BREAST BIOPSY; SURGICAL CONSULT (BREAST); PAP TESTS; CLINICAL BREAST EXAMS; COLPOSCOPIES; AND EDUCATIONAL MATERIALS.BACKGROUND: THIS PROGRAM IS FUNDED THROUGH THE ATRIUM MEDICAL CENTER FOUNDATION AND OTHER COMMUNITY DONATIONS. CLIENTS MUST BE UNINSURED OR UNDERINSURED (COPAYMENT, DEDUCTIBLE, COINSURANCE) WITH INCOME AT OR BELOW 400% OF FEDERAL POVERTY LEVEL.PARTNERS: ATRIUM MEDICAL CENTER, GOOD SAMARITAN FOUNDATION-DAYTON, UPPER VALLEY MEDICAL CENTER FOUNDATIONS, MIAMI VALLEY HOSPITAL FOUNDATION (HELP HER FIGHT), KROGER, BREAST CANCER FOUNDATION, AND KUHNS BROTHERS.
PART V, SECTION B, LINE 11 (CONTINUED):	INFANT MORTALITYHEALTHCARE COPE (COST OF POVERTY EXPERIENCE) TRAINING METRICS: PRE-, POST- AND FOLLOW-ON-SURVEYS ARE ADMINISTERED TO PARTICIPANTS AND VOLUNTEERS TO EVALUATE THEIR PERCEPTIONS OF POVERTY. THE PRE- AND POST-SURVEYS OCCUR AS PEOPLE ENTER THE EVENT AND THEN FOLLOWING THE DEBRIEF. THE FOLLOW-ON SURVEY IS SENT LATER.HEALTH ISSUE: INFANT MORTALITY FOR BLACK INFANTS IN MONTGOMERY COUNTY IS DISPROPORTIONATELY HIGHER THAN FOR WHITE INFANTS. THIS IS THE FIFTH WORSE RATE IN OHIO. PREMATURITY ACCOUNTS FOR 50% OF THE DEATHS OF BLACK INFANTS. MATERNAL STRESS IS A SIGNIFICANT FACTOR IN PREMATURE LABOR, AND BLACK MOTHERS FACE MULTIPLE STRESSORS FROM DAILY ENCOUNTERS WITH RACISM. THE LACK OF PROGRESS IN THE REGION TO COMBAT INFANT MORTALITY LEADS TO THIS DEEPER LEVEL OF TRAINING FOR MATERNITY NURSING STAFF AND HOSPITAL LEADERS.INTERVENTION'S GOAL: THE GOAL IS TO IMPROVE INTERACTIONS WITH LOW-INCOME AND MINORITY FAMILIES TO ENSURE CULTURALLY APPROPRIATE AND TRAUMA-INFORMED CARE IS CONSISTENTLY DELIVERED.DESCRIPTION: PARTICIPATION DEEPENS THE UNDERSTANDING OF THE REALITIES OF POVERTY AND IMPLICIT BIAS; IMPROVES PROFESSIONAL APPROACH AND CONNECTIONS; DEVELOPS PRACTICES TO HELP BRIDGE THE HEALTH EQUITY GAP; AND BUILDS PARTNERSHIPS WITH THE COMMUNITY TO IMPROVE HEALTH OUTCOMES. TEN COPE TRAINING SESSIONS WILL INVOLVE 428 PARTICIPANTS, OF WHOM 85% WILL BE NURSES. THE PROGRAM STARTED IN JANUARY 2020 AND CONCLUDES IN APRIL 2020. PREMIER HEALTH CURRENTLY HAS TWO TRAINED COPE FACILITATORS AND THE NECESSARY EQUIPMENT. PART OF THE PROGRAM WILL BE TO TRAIN TWO MORE COPE FACILITATORS.BACKGROUND: COPE IS A TOOL THAT HELPS HOSPITALS BUILD A CULTURE AND INFRASTRUCTURE TO DELIVER CARE THAT IS EQUITABLE FOR ALL PATIENT POPULATIONS. A HEALTHCARE VERSION IS TARGETED FOR HEALTH PROFESSIONALS.PARTNERS: THINK TANK AND SAMARITAN BEHAVIORAL HEALTH INC.CHRONIC DISEASE AND HEALTHY BEHAVIORSBARBERSHOP PROGRAMMETRICS: EXPANSION TO TWO ADDITIONAL SITES: MIDDLETOWN AND MIAMI COUNTY HEALTH ISSUE: THERE ARE HEALTH DISPARITIES, ESPECIALLY FOR CHRONIC DISEASES, FOR THE AFRICAN-AMERICAN COMMUNITY. ACCORDING TO THE CDC, "NEW ANALYSIS SHOWS THAT YOUNGER AFRICAN-AMERICANS ARE LIVING WITH OR DYING OF MANY CONDITIONS TYPICALLY FOUND IN WHITE AMERICANS AT OLDER AGES. CHRONIC DISEASES AND SOME OF THEIR RISK FACTORS MAY BE SILENT OR NOT DIAGNOSED DURING THESE EARLY YEARS. HEALTH DIFFERENCES ARE OFTEN DUE TO ECONOMIC AND SOCIAL CONDITIONS THAT ARE MORE COMMON AMONG AFRICAN-AMERICANS THAN WHITES. FOR EXAMPLE, AFRICAN-AMERICAN ADULTS ARE MORE LIKELY TO REPORT THEY CANNOT SEE A DOCTOR BECAUSE OF COST."INTERVENTION'S GOAL: THE GOAL IS TO INCREASE AWARENESS OF CHRONIC HEALTH CONDITIONS AND TO PROMOTE HEALTHY LIFESTYLE CHOICES WITHIN THE AFRICAN-AMERICAN COMMUNITY.DESCRIPTION: PARTNERING WITH THE LOCAL HEALTH DEPARTMENT, PUBLIC HEALTH-DAYTON & MONTGOMERY COUNTY, WILL HELP TO FURTHER EXPAND SERVICES FOR THE COMMUNITY. BARBERS (AND SALON OWNERS) HAVE A CLOSE BOND WITH THEIR CLIENTS. THEY CAN SERVE AS MODELS OF GOOD HEALTH AND/OR HELP CONNECT THEIR CLIENTS TO HEALTH SERVICES. THE PROGRAM PROVIDES FREE, VOLUNTARY, AND CONVENIENT HEALTH SCREENINGS ON SATURDAYS AT THE SHOPS. HEALTH FAIRS, EVENTS, AND FUN CHALLENGES ALSO OCCUR.BACKGROUND: PREMIER HEALTH DEVELOPED THE BARBERSHOP HEALTH PROGRAM, WHICH. NOW HAS 5 LOCATIONS. ATRIUM MEDICAL CENTER IS INTERESTED IN EXPANDING TO INCLUDE ONE OR MORE LOCATIONS IN THE HAMILTON AND MIDDLETOWN AREAS, ALONG WITH EXPANSION TO MIAMI COUNTY FOR THE UPPER VALLEY MEDICAL CENTER. THE ORIGINAL 3 BARBERSHOPS RESULTED IN 249 SCREENINGS.PARTNERS: DEEEZ CUTTZ, SERENITY SALON, MAN UPCHRONIC DISEASE AND HEALTHY BEHAVIORSTHE DAILY MILEMETRICS: EXPANSION TO AT LEAST TWO MORE SCHOOL DISTRICTS IN THE REGION HEALTH ISSUE: HEALTHY BEHAVIORSINTERVENTION'S GOALS: THE GOAL IS TO PRESENT PHYSICAL ACTIVITY AS AN IMPORTANT OPPORTUNITY THAT SHAPES HEALTH, DEVELOPMENT AND FUTURE PHYSICAL ACTIVITY BEHAVIOR IN CHILDREN. CHILDREN WILL EXPERIENCE HIGHER LEVELS OF FITNESS, LOWER BODY FAT, AND STRONGER BONES AND MUSCLES WITH AN INCREASE IN PHYSICAL ACTIVITY LEVELS.DESCRIPTION: REGULAR PHYSICAL ACTIVITY ALSO BENEFITS THE MENTAL AND SOCIAL HEALTH OF CHILDREN. THE DAILY MILE IS A WELLNESS INTERVENTION DEVELOPED IN SCOTLAND, DESIGNED TO INCREASE PHYSICAL ACTIVITY LEVELS DURING THE SCHOOL DAY BY ENCOURAGING CHILDREN TO PARTICIPATE IN A JOG OR RUN, AT THEIR OWN PACE - WITH WALKING KEPT TO A MINIMUM. THE DAILY MILE OBJECTIVES COINCIDE WITH HEALTHY PEOPLE 2020 OBJECTIVES TO TARGET YOUNGER CHILDREN THROUGH PHYSICAL ACTIVITY IN CHILDCARE SETTINGS.BACKGROUND: THE DAILY MILE CURRENTLY INFLUENCES PHYSICAL ACTIVITY BEHAVIOR AT FOUR SCHOOLS, POSITIVELY AFFECTING 340 STUDENTS DURING THE 2019-2020 SCHOOL YEAR. THE DAILY MILE WAS DEVELOPED IN 2012 AND FEATURED IN SCOTLAND AND ENGLAND SCHOOLS; HOWEVER, ITSPOSITIVE IMPACT ON THE CHILDREN RESULTED IN PARTICIPATION FROM OVER 10,943 SCHOOLS AND NURSERIES WORLDWIDE AND 2,309,784 STUDENTS. PREMIER HEALTH AND THE INVOLVED PARTNERS INTRODUCED THE FIRST DAILY MILE PILOT PROGRAM IN 2018. THE PILOT PROGRAM RESULTED IN A 52.7% PARTICIPATION RATE IN WHICH 80% (OF THE STUDENTS PARTICIPATING) DEMONSTRATED GROWTH IN THEIR LEVEL OF ENDURANCE. THE SUCCESS OF THE DAILY MILE CAN BE CREDITED TO THE PARTNERSHIP BETWEEN THE ORGANIZATIONS AND THE SCHOOL'S EDUCATORS. PREMIER AND THE COMMUNITY AGENCIES INVOLVED WITH THE PROJECT CONTINUE TO WORK TO EXPAND THE PROGRAM WITHIN LOCAL SCHOOL DISTRICTS. PARTNERS: DAYTON CHILDREN'S HOSPITAL; PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY; FIVE RIVERS METROPARKS; CENTERVILLE CITY SCHOOL DISTRICT; MIAMISBURG CITY SCHOOL DISTRICT; AND CENTERVILLE-WASHINGTON PARK DISTRICT
PART V, SECTION B, LINE 11 (CONTINUED):	SUBSTANCE ABUSE AND MENTAL HEALTH PRESTO (PROMOTING ENGAGEMENT FOR SAFE TRAINING OF OPIOIDS)METRICS: ATTRACT AT LEAST 38 PRIMARY CARE PROVIDERS TO PARTICIPATE IN THE RESEARCH STUDY. THEIR PARTICIPATION WILL HELP THE RESEARCHERS TEST AND DEVELOP AN EFFICIENT AND EFFECTIVE PROTOCOL TO GUIDE OTHER PROVIDERS.HEALTH ISSUE: OHIO IS ONE OF THE STATES HARDEST HIT BY THE NATION'S OPIOID CRISIS. OHIO'S RATE OF UNINTENTIONAL OPIOID OVERDOSE RATE WAS NEARLY THREE TIMES THE U.S. AVERAGE IN 2017. ACCORDING TO THE OHIO DEPARTMENT OF HEALTH, 80% OF OHIOANS WHO DIED FROM AN OVERDOSE IN 2016 HAD A HISTORY OF OPIOID PRESCRIPTIONS.INTERVENTION'S GOAL: PREMIER HEALTH WILL RECRUIT SYSTEM-WIDE TO ATTRACT AT LEAST 38 OF THE 150 PRIMARY CARE PROVIDERS THAT WRIGHT STATE UNIVERSITY WILL TRAIN IN HOW TO ENGAGE PATIENTS TO TAPER DOWN THEIR OPIOID PRESCRIPTION USE.DESCRIPTION: THE PRESTO PROTOCOL IS MODELED ON THE SBIRT APPROACH OF SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT. IT INCORPORATES CDC OPIOID PRESCRIBING GUIDELINES, USE OF OHIO'S PRESCRIPTION DRUG MONITORING PROGRAM, AND MOTIVATIONAL INTERVIEWING. PARTICIPATING PROVIDERS WILL AGREE TO PARTICIPATE IN THE OHIO AUTOMATED RX REPORTING SYSTEM (OARRS) AND HAVE DE-IDENTIFIED PRESCRIBING DATA SHARED WITH INVESTIGATORS. THEY WILL PARTICIPATE IN A 3-HOUR IN-PERSON TRAINING EVENT AS WELL AS A 1-HOUR FOLLOW-UP TRAINING ABOUT 4-6 WEEKS LATER. THEY WILL BE ENCOURAGED TO USE THE PRESTO PROTOCOL AND MOTIVATIONAL INTERVIEWING WITH APPROPRIATE PATIENTS. EACH PROVIDER WILL RECEIVE $1,000 FOR COMPLETION OF THE TWO TRAINING EVENTS TO ASSIST WITH THE COST OF ATTENDING. THEY WILL ALSO RECEIVE 3 HOURS OF CONTINUING EDUCATION CREDITS. FULL IMPLEMENTATION IS EXPECTED IN LATE 2020 OR EARLY 2021.BACKGROUND: THE OHIO DEPARTMENT OF HIGHER EDUCATION AWARDED FUNDING TO RESEARCH SUBSTANCE USE DISORDERS. WRIGHT STATE UNIVERSITY RECEIVED AN AWARD TO TRAIN PRIMARY CARE PROVIDERS IN A PRESCRIPTION-TAPERING PROTOCOL KNOWN AS PRESTO.PARTNERS: MERCY HEALTH, WRIGHT STATE UNIVERSITY
PART V, SECTION B, LINES 16 A, B, AND C:	THE DIRECT WEBSITE ADDRESS WHERE A COPY OF THE FINANCIAL ASSISTANCE POLICY, THE APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY CAN BE ACCESSED IS:HTTPS://WWW.PREMIERHEALTH.COM/PATIENT-AND-VISITOR-GUIDE/PATIENT-GUIDE/COSTS-AND-INSURANCE/BILLING/FINANCIAL-ASSISTANCE
PART V, SECTION B, LINE 16J:	THE HOSPITAL WIDELY DISTRIBUTES INFORMATION ABOUT ITS FINANCIAL ASSISTANCE POLICY WITHIN THE AREA THAT IT SERVES. THIS INFORMATION INCLUDES THE METHOD OF APPLYING FOR AND ACCESSING FINANCIAL ASSISTANCE. NOTICES ARE PUBLICIZED IN PATIENTS' BILLS AND ARE POSTED IN THE EMERGENCY ROOM, ADMITTING AND REGISTRATION AREAS, AS WELL AS OTHER PUBLIC AREAS. THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FINANCIAL COUNSELORS, PATIENT ADVOCATES, AND CUSTOMER SERVICE REPRESENTATIVES DISCUSS THE FINANCIAL ASSISTANCE POLICY WITH ALL UNINSURED PATIENTS, AND ANY PATIENT WHO EXPRESSES FINANCIAL HARDSHIP WITH PAYING THEIR BILL. APPLICATIONS FOR FINANCIAL ASSISTANCE POLICY ARE AVAILABLE IN BOTH ENGLISH AND SPANISH.

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?9
Name and address		Type of Facility (describe)
1	1 - ATRIUM HEALTH CENTER TRENTON 3590 BUSENBARK RD TRENTON,OH45067	CARIDIOLOGY, VASCULAR, SPORTS MED & PHYSICAL THERAPY, DIAGNOSTICS & IMAGING
2	2 - MEDICAL IMAGING IN MIDDLETOWN 4214 GRAND AVE MIDDLETOWN,OH45044	IMAGING AND RADIOLOGY
3	3 - RALPH J STOLLE COUNTRYSIDE YMCA 1697 DEERFIELD RD LEBANON,OH45036	SPORTS MEDICINE & PHYSICAL THERAPY
4	4 - SPORTS MEDICINE AND PHYSICAL THERAPY IN 4859 NIXON PARK DR SUITE B MASON,OH45040	SPORTS MEDICINE & PHYSICAL THERAPY
5	5 - ATRIUM FAMILY YMCA 5750 INNOVATION DR MIDDLETOWN,OH45005	SPORTS MEDICINE & PHYSICAL THERAPY
6	6 - SPORTS MEDICINE AND PHYSICAL THERAPY IN 909 E SECOND ST FRANKLIN,OH45005	SPORTS MEDICINE & PHYSICAL THERAPY
7	7 - OCCUPATIONAL HEALTH IN MIDDLETOWN 4220 GRAND AVE MIDDLETOWN,OH45044	OCCUPATIONAL HEALTH
8	8 - SOUTHWEST OHIO SURGERY CENTER 295 N BREIEL BLVD MIDDLETOWN,OH45042	GENERAL SURGERY
9	9 - UNION VILLAGE 580 N ST ROUTE 741 LEBANON,OH45036	DIAGNOSTICS, IMAGING, HEALTH CENTER, AND OCCUPATIONAL HEALTH
10

Schedule H (Form 990) 2021

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 6A:	THE COMMUNITY BENEFIT REPORT FOR ATRIUM MEDICAL CENTER IS PART OF THE PREMIER HEALTH (PREMIER) REPORT (EIN# 31-1446699).
PART I, LINE 7:	A COST TO CHARGE RATIO WAS USED TO CALCULATE THIS FINANCIAL ASSISTANCE AT COST. THIS CALCULATION TAKES TOTAL OPERATING EXPENSES LESS OTHER OPERATING REVENUES DIVIDED BY TOTAL GROSS REVENUES. UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENTAL PROGRAMS WERE CALCULATED USING A COST ACCOUNTING SYSTEM. THIS SYSTEM ADDRESSES ALL PATIENT SEGMENTS AND INCLUDES FULLY LOADED COSTS. FOR THE REMAINING ITEMS, THE ORGANIZATION USED SPECIFIC NUMBERS FOR EXPENSE PAID DIRECTLY FOR THESE SERVICES.
PART I, LINE 7G:	ATRIUM MEDICAL CENTER (AMC) PROVIDES SUBSIDIZED EMERGENCY SERVICES BY OPERATING A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THIS EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL INCURS EXPENSES RELATED TO CALL TIME AND PHYSICIAN SUBSIDIES DUE TO THE LARGE NUMBER OF INDIGENT PATIENTS COMING THROUGH THE EMERGENCY ROOM. FOR 2021, THE AMOUNT PAID FOR CALL AND SUBSIDIES WAS $6,843,000.
PART III, LINES 2 & 3:	BAD DEBT EXPENSE IS INCURRED WHEN AN ACCOUNT IS TAKEN OUT OF ACCOUNTS RECEIVABLE AND TURNED OVER TO A COLLECTION AGENCY. THIS ACTION MAY OCCUR IF A PATIENT REFUSES PAYMENT ARRANGEMENTS, REFUSES TO APPLY FOR FINANCIAL ASSISTANCE, AND THERE IS NOT AN INSURANCE BALANCE BEING CONTENDED. AN ACCOUNT IS WRITTEN OFF TO BAD DEBT AFTER 130 DAYS IF AN ATTEMPT TO COLLECT FROM THE PATIENT IS MADE WITHIN OUR COLLECTION POLICY. THE COLLECTION AGENCY ATTEMPTS TO COLLECT THE ACCOUNT IN ACCORDANCE WITH ESTABLISHED GUIDELINES. COLLECTION ATTEMPTS ARE CEASED AND THE ACCOUNT RETURNED TO THE ORGANIZATION IF THE PATIENT APPLIES FOR FINANCIAL ASSISTANCE. ANY AMOUNTS COLLECTED FROM THESE ACCOUNTS ARE CREDITED BACK AGAINST BAD DEBT EXPENSE. THE ORGANIZATION RECOGNIZES THERE ARE ACCOUNTS WRITTEN OFF TO BAD DEBT THAT MAY HAVE QUALIFIED FOR CHARITY CARE IF THE PATIENT HAD PROVIDED THE NECESSARY FINANCIAL INFORMATION. TO RESOLVE THIS, THE ORGANIZATION HAS ENGAGED A THIRD-PARTY VENDOR TO ANALYZE DATA BASED ON CREDIT SCORES TO REALLOCATE SOME OF THIS EXPENSE TO CHARITY CARE. A REPRESENTATIVE SAMPLE OF THESE ACCOUNTS IS THEN SENT TO OUR THIRD-PARTY VENDOR WHO GATHERS EXTERNAL CREDIT DATA THAT PRESENTS THE ACCOUNT AS LESS THAN 100% FEDERAL POVERTY LEVEL OR NOT ENOUGH INFORMATION (TYPICALLY INDICATIVE OF INDIGENT). THESE ACCOUNTS ARE RECLASSED FROM BAD DEBT EXPENSE TO CHARITY EXPENSE ON OUR INCOME STATEMENT. ANY CREDIT SCORE THAT PRESENTS THE ACCOUNTS AS GREATER THAN 100% FEDERAL POVERTY LEVEL REMAINS IN BAD DEBT EXPENSE. DUE TO THIS PROCESS, THE ORGANIZATION HAS USED BEST EFFORTS TO NOT REPORT BAD DEBT EXPENSE FOR PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY.
PART III, LINE 4:	THE ORGANIZATION DOES NOT HAVE A FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS WHICH DISCUSSES THIS CALCULATION.
PART III, SECTION B, LINES 5, 6, AND 7:	THE AMOUNTS REPORTED ON LINES 5, 6, AND 7 DO NOT INCLUDE CERTAIN MEDICARE PROGRAM REVENUES AND COSTS, AND THUS DO NOT REFLECT ALL OF THE ORGANIZATION'S REVENUES AND COSTS ASSOCIATED WITH ITS PARTICIPATION IN MEDICARE PROGRAMS. IN ADDITION TO THE AMOUNTS REPORTED ON LINE 5, 6, AND 7, THE ORGANIZATION RECEIVED REVENUE OF $51,095,000 AND INCURRED COST OF $74,061,000 FOR AN ADDITIONAL NET SHORTFALL OF $22,966,000 ASSOCIATED WITH THESE PROGRAMS. BELOW IS A RECONCILIATION OF THE AMOUNTS ASSOCIATED WITH MEDICARE PROGRAMS.ALLOWABLE MEDICARE REVENUE PER MEDICARE COST REPORT IN PART III, SECTION B $44,652,000MEDICARE REVENUE NOT REPORTED IN PART III, SECTION B $51,095,000TOTAL MEDICARE ASSOCIATED REVENUE $95,747,000ALLOWABLE MEDICARE COST PER MEDICARE COST REPORT IN PART III, SECTION B $47,852,000MEDICARE COST NOT REPORTED IN PART III, SECTION B $74,061,000TOTAL MEDICARE ASSOCIATED COST $121,913,000ALLOWABLE MEDICARE SHORTFALL IN PART III, SECTION B $3,200,000ADDITIONAL SHORTFALL NOT INCLUDED IN PART III, SECTION B $22,966,000TOTAL MEDICARE SHORTFALL $26,166,000
PART III, LINE 8:	THE ORGANIZATION'S SHORTFALL SHOULD BE CONSIDERED CHARITY CARE BECAUSE IT IS PROVIDING HIGH-QUALITY CARE, IN EXCESS OF COST, TO OUR COMMUNITY RESIDENTS THAT NEED CARE. THE MEDICARE POPULATION AT THE ORGANIZATION IS IN EXCESS OF 52% OF NET PATIENT REVENUE. THE ORGANIZATION USED A COST ACCOUNTING SYSTEM TO CALCULATE THE MEDICARE ALLOWABLE COSTS.
PART III, LINE 9B:	THE ORGANIZATION MAKES REASONABLE EFFORTS TO DETERMINE WHETHER OR NOT AN INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THE STATE OR HOSPITAL FINANCIAL ASSISTANCE POLICY BEFORE ENGAGING IN EXTRAORDINARY COLLECTIVE ACTIONS AGAINST THAT INDIVIDUAL. PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE OFFERED REASONABLE PAYMENT PLAN ARRANGEMENTS FOR ANY REMAINING BALANCES. ANY THIRD-PARTY COLLECTING SELF-PAY RECEIVABLES ON OUR BEHALF IS REQUIRED TO MAKE REASONABLE EFFORTS TO DETERMINE IF THE INDIVIDUAL MEETS THE QUALIFICATIONS OF THE STATE OR OF OUR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS.REASONABLE EFFORTS INCLUDE:A. VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENT HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL.B. DOCUMENTING THAT THE ORGANIZATION HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE UNDER ITS FINANCIALASSISTANCE POLICY.C. DOCUMENT THAT THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE.D. DOCUMENT THAT THE PATIENT HAS BEEN OFFERED AND ACCEPTED TERMS FOR A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN.THE FINANCIAL COUNSELORS MEET WITH INPATIENT, OUTPATIENT, SELF-PAY, AND OTHER PATIENTS UPON REQUEST WHO MAY NEED FINANCIAL ASSISTANCE. IN ADDITION TO ASSISTING PATIENTS WHO WANT TO APPLY FOR ASSISTANCE THROUGH THE MEDICAID PROGRAM, THE FINANCIAL COUNSELOR WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION.
PART VI, LINE 2:	THE ORGANIZATION WORKS WITH THE COMMUNITY ON PROGRAMS THAT ADDRESS THE UNDERLYING CAUSES OF PERSISTENT HEALTH PROBLEMS AS PART OF A COMPREHENSIVE STRATEGY TO IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE FOR IDENTIFIED MEMBERS OF THE COMMUNITY WHO ARE ECONOMICALLY DISADVANTAGED, DISENFRANCHISED AND/OR WHO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE ORGANIZATION STRIVES TO WORK WITH PREMIER, THE HOSPITAL BOARD OF TRUSTEES, EXECUTIVE MANAGEMENT, MANAGERS, STAFF MEMBERS, COMMUNITY GROUPS, AND INDIVIDUALS TO PROVIDE A COLLABORATIVE APPROACH TO THE GOVERNANCE AND MANAGEMENT OF COMMUNITY BENEFIT ACTIVITIES.
PART VI, LINE 3:	THERE ARE SEVERAL WAYS IN WHICH OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR SERVICES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FIRST, NOTIFICATION OF SUCH AVAILABLE ASSISTANCE IS CLEARLY POSTED IN REGISTRATION AREAS, AS WELL AS MATERNITY AND EMERGENCY DEPARTMENTS. NEXT, PATIENT ADVOCATES, PATIENT ACCESS STAFF MEMBERS, AND FINANCIAL COUNSELORS IN THE INPATIENT AND EMERGENCY DEPARTMENTS MEET WITH UNINSURED AND UNDERINSURED PATIENTS, AND THOSE WITH ONLY MEDICARE COVERAGE TO DISCUSS ELIGIBILITY FOR ASSISTANCE. FINANCIAL COUNSELORS ALSO DISCUSS OPTIONS TO RESOLVE UNPAID ACCOUNT BALANCES WITH UNINSURED AND UNDERINSURED PATIENTS. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE, ALONG WITH INFORMATION ON HOW TO OBTAIN AN APPLICATION. WHEN A PATIENT RECEIVES A BILL, THE REVERSE SIDE OF THE BILL CONTAINS INFORMATION ABOUT THE STATE OF OHIO FREE CARE PROGRAM (CARE ASSURANCE) AND A FINANCIAL ASSISTANCE APPLICATION. THE BILLING STATEMENTS OFFER THE FINANCIAL ASSISTANCE OPTIONS AVAILABLE, AND THE CONTACT INFORMATION FOR ASSISTANCE.
PART VI, LINE 4:	ATRIUM MEDICAL CENTER IS LOCATED IN MIDDLETOWN OHIO, SERVICING BUTLER AND WARREN COUNTIES. THE POPULATION OF ATRIUM MEDICAL CENTER'S SERVICE AREA IS APPROXIMATELY 581,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME OF WARREN COUNTY IS $89,410 PER YEAR, WITH APPROXIMATELY 5.2% OF ITS CITIZENS LIVING BELOW THE FEDERAL POVERTY LEVEL. THE MEDIAN HOUSEHOLD INCOME OF BUTLER COUNTY IS $69,023 PER YEAR, WITH APPROXIMATELY 10.1% OF ITS CITIZENS LIVING BELOW THE FEDERAL POVERTY LEVEL. FOR 2021, MEDICARE PATIENTS REPRESENTED 50.4% OF GROSS PATIENT REVENUE AND MEDICAID REPRESENTED 18.8% OF GROSS PATIENT REVENUE.PART VI, LINE 5:ATRIUM MEDICAL CENTER'S (AMC) MOST VISIBLE CONTRIBUTION TO THE COMMUNITY IS IN THE FORM OF PROVIDING HIGH-QUALITY INPATIENT AND OUTPATIENT CARE TO OUR PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. OUR MISSION INCLUDES CONTINUALLY STRIVING TO ENRICH THE COMMUNITY BY TRAINING AND EDUCATING FUTURE HEALTHCARE WORKERS, OFFERING HEALTH AWARENESS AND EDUCATION TO THE COMMUNITY, SUCH AS PROMOTION OF BREAST CANCER SCREENINGS, WOMEN AND INFANT HEALTH, DIABETIC WELLNESS AND DRIVER SAFETY AWARENESS FOR HIGH-SCHOOL STUDENTS. AMC PARTNERS WITH THE LOCAL YMCA TO CO-HOST A FREE, PUBLIC ANNUAL DIABETES WELLNESS FAIR. ORGANIZATIONS SPECIALIZING IN DIABETIC CARE AND HOSPITAL REPRESENTATIVES ARE ON HAND TO OFFER HEALTH SCREENINGS AND DISCUSS AVAILABLE SERVICES. FREE DIAPERS, BOTTLES, WIPES AND OTHER ESSENTIAL SUPPLIES ARE PROVIDED TO LOCAL PARENTS IN NEED THROUGH A COLLABORATION WITH ANOTHER LOCAL NON-PROFIT ORGANIZATION. THE HOSPITAL ALSO PROVIDES RELEVANT EDUCATION FOR EMS AND PRE-HOSPITAL CARE PROVIDERS THROUGHOUT THE REGION. THE TRAINING INCLUDES LOCAL CASE REVIEWS, LECTURES, HANDS-ON SIMULATION AND PANEL DISCUSSIONS PERTAINING TO THE EDUCATION ON USE OF TOOLS, PRIORITIES OF PATIENT CARE AND OTHER CRITICAL INFORMATION. AMC PARTNERS WITH MANY OF THE LOCAL SCHOOLS TO PROVIDE CERTIFIED AND LICENSED ATHLETIC TRAINERS AT THEIR CAMPUSES TO AID IN INJURY PREVENTION, RECOGNITION AND TREATMENT OF SPORTS-RELATED INJURIES. THE HOSPITAL ALSO SUPPORTS THE COMMUNITY THROUGH SPONSORSHIPS AND PARTICIPATION IN LOCAL FUNDRAISING EVENTS THAT PROMOTE HEALTHY LIFESTYLE CHOICES, PREVENTATIVE CARE, CHRONIC DISEASE MANAGEMENT AND GENERAL HEALTH EDUCATION. WITHIN THE HOSPITAL, INTERPRETERS ARE OFFERED TO PATIENTS AT NO COST AS A RESULT OF INCREASED VOLUMES OF NON-ENGLISH-SPEAKING PATIENTS. AMC PROVIDES DIRECT PASTORAL SUPPORT ANDCOUNSELING SERVICES TO PATIENTS AND FAMILY MEMBERS BY 4 TRAINED PROFESSIONALS, IN-HOUSE 13 HOURS A DAY MONDAY THROUGH FRIDAY, 8 HOURS ON SATURDAY, AND ON CALL 24 HOURS A DAY, 7 DAYS A WEEK. THEY ALSO PROVIDE BEREAVEMENT SUPPORT.THE HOSPITAL HAS AN OPEN MEDICAL STAFF, PARTICIPATES IN MEDICAID AND MEDICARE, AND HAS AN ACTIVE CHARITY CARE PROGRAM. AMC'S MISSION REFLECTS A COMMITMENT TO PROVIDE HIGH-QUALITY COST-EFFECTIVE HEALTH SERVICES TO THE DIVERSE COMMUNITIES THAT IT SERVES. AT THE CORE OF THE COMMITMENT IS THE BELIEF THAT IN ORDER TO MEET OUR PATIENTS' EXPECTATIONS AND TO IMPROVE TREATMENT OUTCOMES, IT IS NECESSARY FOR US TO UNDERSTAND THE PATIENT'S FRAME OF REFERENCE. A DIVERSE WORKFORCE ALLOWS US TO DRAW UPON THE RICHNESS OF OUR HUMAN RESOURCES, CREATE A POSITIVE WORK ENVIRONMENT, AND MEET THE EXPECTATIONS OF THOSE WE SERVE. AMC'S COMMITMENT TO DIVERSITY IS ACCOMPLISHED BY:* TAKING A LEADERSHIP ROLE IN CREATING AND SUSTAINING AN ORGANIZATIONAL ENVIRONMENT THAT ACTIVELY SUPPORTS DIVERSITY,* POSITIONING DIVERSITY AS A LONG-TERM COMPREHENSIVE ORGANIZATIONAL STRATEGY,* ESTABLISHING AND SUPPORTING RELATIONSHIPS WITH MINORITY AND DIVERSITY FOCUSED ORGANIZATIONS AND* PROVIDING EMPLOYMENT AND EDUCATION OPPORTUNITIES FOR INDIVIDUALS WITH SIGNIFICANT DISABILITIES.
PART VI, LINE 6:	PREMIER HEALTH (PREMIER) IS THE SOLE MEMBER OF ATRIUM MEDICAL CENTER, TWO OTHER HOSPITAL ENTITIES (FIVE TOTAL LOCATIONS), AND SEVERAL OTHER HEALTH CARE SERVICE SUBSIDIARIES. PREMIER HAS THE AUTHORITY TO OPERATE EACH HOSPITAL WITH RESPECT TO MATTERS SUCH AS BUDGETING, STRATEGIC PLANNING, MANAGED CARE CONTRACTING, EMPLOYEE COMPENSATION, TRANSFER/SALE OF MATERIAL ASSETS, ETC. AS AN INTEGRATED HEALTHCARE SYSTEM, PREMIER PROVIDES A CONTINUUM OF CARE FOR THE RESIDENTS OF SOUTHWEST OHIO. AS A SYSTEM, PREMIER IS A COMMUNITY LEADER IN SUPPORTING VARIOUS COMMUNITY BENEFIT PROGRAMS THAT ALIGN WITH ITS CURRENT CHNA. RESOURCES ARE LEVERAGED IN EACH ENTITY WITHIN THE PREMIER SYSTEM TO SUPPORT THESE PROGRAMS IDENTIFIED AT THE PREMIER SYSTEM LEVEL. THE POLICIES FOR BAD DEBT AND CHARITY COLLECTIONS ARE ESTABLISHED BY PREMIER.
PART VI, LINE 7:	OHIO

Schedule H (Form 990) 2021

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
ATRIUM MEDICAL CENTER

Employer identification number
31-1079309

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) ONEFIFTEEN RECOVERY 6636 LONGSHORE ST 200 DUBLIN,OH43017	83-3504845	501(C)(3)	140,004	SUPPORT
(2) MIAMI VALLEY HOSPITAL 110 N MAIN ST 500 DAYTON,OH45402	31-0537504	501(C)(3)	71,754	SUPPORT
(3) REACH OUT MONTGOMERY COUNTY PO BOX 718 OAKWOOD,OH45409	31-1434282	501(C)(3)	9,538	SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2021

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	SCHEDULE I, PART I, LINE 2: 1) DISBURSEMENTS ARE ANALYZED MONTHLY THROUGH VARIOUS REPORTS AND COMMITTEE MEETINGS. 2) INVOICES ARE RECEIVED IN ACCOUNTS PAYABLE AND APPROVED AND DISBURSED PER ORGANIZATIONAL POLICY. 3) GRANT SPENDING IS MONITORED AGAINST BUDGETED AMOUNTS ON AN ONGOING BASIS.

Schedule I (Form 990) 2021

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1MARY H BOOSALIS TRUSTEE / PREMIER PRESIDENT & CEO	(i) (ii)	0 ------------- 1,231,550	0 ------------- 1,757,745	0 ------------- 41,161	0 ------------- 19,976	0 ------------- 20,539	0 ------------- 3,070,971	0 ------------- 0
2BARBARA A JOHNSON FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 748,165	0 ------------- 279,876	0 ------------- 81,631	0 ------------- 14,445	0 ------------- 11,644	0 ------------- 1,135,761	0 ------------- 0
3MICHAEL R UHL FORMER OFFICER	(i) (ii)	0 ------------- 668,884	0 ------------- 218,074	0 ------------- 21,925	0 ------------- 118,454	0 ------------- 29,900	0 ------------- 1,057,237	0 ------------- 0
4GEOFFREY P WALKER SYSTEM VP - CHIEF LEGAL OFFICER	(i) (ii)	0 ------------- 462,192	0 ------------- 149,483	0 ------------- 312,717	0 ------------- 20,762	0 ------------- 27,111	0 ------------- 972,265	0 ------------- 0
5JENNIFER J HAULER DO FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 558,282	0 ------------- 237,009	0 ------------- 22,553	0 ------------- 97,662	0 ------------- 2,415	0 ------------- 917,921	0 ------------- 0
6SCOTT A SHELTON FORMER OFFICER	(i) (ii)	0 ------------- 19,025	0 ------------- 249,130	0 ------------- 618,596	0 ------------- 8,827	0 ------------- 1,860	0 ------------- 897,438	0 ------------- 0
7MARC R BELCASTRO DO VP MEDICAL AFFAIRS & PREMIER CMO	(i) (ii)	0 ------------- 552,833	0 ------------- 168,313	0 ------------- 79,026	0 ------------- 10,837	0 ------------- 24,565	0 ------------- 835,574	0 ------------- 32,810
8KEITH D BRICKING MD PRESIDENT & CEO	(i) (ii)	526,752 ------------- 0	176,449 ------------- 0	8,479 ------------- 0	54,635 ------------- 0	31,234 ------------- 0	797,549 ------------- 0	0 ------------- 0
9JOHN M MILLER MD TRUSTEE	(i) (ii)	0 ------------- 690,569	0 ------------- 0	0 ------------- 55,548	0 ------------- 13,538	0 ------------- 27,912	0 ------------- 787,567	0 ------------- 0
10MARY M CLANCY CHIEF DIGITAL OFFICER	(i) (ii)	0 ------------- 461,421	0 ------------- 141,346	0 ------------- 57,405	0 ------------- 100,824	0 ------------- 26,265	0 ------------- 787,261	0 ------------- 0
11JOSHUA J ORDWAY MD TRUSTEE	(i) (ii)	0 ------------- 401,875	0 ------------- 244,813	0 ------------- 1,170	0 ------------- 11,965	0 ------------- 26,826	0 ------------- 686,649	0 ------------- 0
12J MICHAEL SIMS SYS VP & CORPORATE CONTROLLER	(i) (ii)	0 ------------- 350,568	0 ------------- 129,225	0 ------------- 143,453	0 ------------- 20,415	0 ------------- 28,425	0 ------------- 672,086	0 ------------- 0
13GARY G GINTER FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 434,057	0 ------------- 125,396	0 ------------- 6,646	0 ------------- 71,972	0 ------------- 28,691	0 ------------- 666,762	0 ------------- 0
14MARGARET PEGGY W MARK VP NURSING / CNO / PATIENT EXP	(i) (ii)	0 ------------- 385,838	0 ------------- 129,004	0 ------------- 72,047	0 ------------- 11,301	0 ------------- 28,359	0 ------------- 626,549	0 ------------- 28,507
15ELAINE LAINIE M DEAN FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 372,434	0 ------------- 117,644	0 ------------- 21,559	0 ------------- 12,298	0 ------------- 14,277	0 ------------- 538,212	0 ------------- 0
16THOMAS R CURTIN SYSTEM VP REVENUE CYCLE	(i) (ii)	0 ------------- 252,198	0 ------------- 131,008	0 ------------- 2,660	0 ------------- 47,677	0 ------------- 19,566	0 ------------- 453,109	0 ------------- 0
17MARQUITA L TURNER FORMER OFFICER	(i) (ii)	11,355 ------------- 283,865	0 ------------- 86,280	218 ------------- 2,619	890 ------------- 22,110	517 ------------- 12,916	12,980 ------------- 407,790	0 ------------- 0
18ANDRE T HARRIS MD TRUSTEE / VP OPERATIONS & CMO	(i) (ii)	258,838 ------------- 0	101,216 ------------- 0	1,257 ------------- 0	12,073 ------------- 0	27,219 ------------- 0	400,603 ------------- 0	0 ------------- 0
19KIMBERLY A HENSLEY TRUSTEE / COO & CNO	(i) (ii)	277,361 ------------- 9,813	73,915 ------------- 0	2,544 ------------- 184	20,581 ------------- 803	10,117 ------------- 405	384,518 ------------- 11,205	0 ------------- 0
20BILLIE L LUCENTE-BAKER FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 240,558	0 ------------- 79,314	0 ------------- 778	0 ------------- 19,990	0 ------------- 14,606	0 ------------- 355,246	0 ------------- 0
21JOANNE R MORGAN SYSTEM VP - PHARMACY OPERATIONS	(i) (ii)	216,159 ------------- 0	67,586 ------------- 0	21,955 ------------- 0	10,455 ------------- 0	13,843 ------------- 0	329,998 ------------- 0	0 ------------- 0
22THOMAS R PARKER FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 0	0 ------------- 79,628	0 ------------- 208,983	0 ------------- 20,942	0 ------------- 2,624	0 ------------- 312,177	0 ------------- 126,836
23RHONDA L SEIDENSCHMIDT TRUSTEE & VP OPERATIONS	(i) (ii)	192,014 ------------- 0	56,082 ------------- 0	909 ------------- 0	10,506 ------------- 0	28,957 ------------- 0	288,468 ------------- 0	0 ------------- 0
24JEANNA R SEVERT DIRECTOR - HUMAN RESOURCES	(i) (ii)	184,864 ------------- 0	40,550 ------------- 0	572 ------------- 0	16,570 ------------- 0	19,157 ------------- 0	261,713 ------------- 0	0 ------------- 0
25KIM K STRAHL FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 119,293	0 ------------- 86,212	0 ------------- 2,100	0 ------------- 18,470	0 ------------- 5,254	0 ------------- 231,329	0 ------------- 0
26AMANDA K RICCI SYSTEM VP REVENUE CYCLE	(i) (ii)	177,857 ------------- 0	30,845 ------------- 0	394 ------------- 0	8,194 ------------- 0	10,452 ------------- 0	227,742 ------------- 0	0 ------------- 0
27BENJAMIN A WATSON ESQ DIRECTOR - LEGAL SERVICES	(i) (ii)	0 ------------- 168,035	0 ------------- 41,023	0 ------------- 450	0 ------------- 7,467	0 ------------- 9,757	0 ------------- 226,732	0 ------------- 0
28ROBYN S MYERS DIRECTOR - QUALITY, SYS PATIENT SAFE	(i) (ii)	163,122 ------------- 0	36,238 ------------- 0	3,017 ------------- 0	5,486 ------------- 0	12,864 ------------- 0	220,727 ------------- 0	0 ------------- 0
29WENDY H PARKS DIR - MARKETING	(i) (ii)	159,453 ------------- 0	33,865 ------------- 0	486 ------------- 0	8,088 ------------- 0	2,222 ------------- 0	204,114 ------------- 0	0 ------------- 0
30WILLIAM ANDREW MD TRUSTEE	(i) (ii)	0 ------------- 188,000	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 188,000	0 ------------- 0
31LYNDSEY A PITTMAN BOARD TREASURER / DIRECTOR FINANCE &	(i) (ii)	138,221 ------------- 0	28,902 ------------- 0	302 ------------- 0	5,673 ------------- 0	2,168 ------------- 0	175,266 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	COMPENSATION FOR ATRIUM MEDICAL CENTER'S (AMC) CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH AMC IS AN AFFILIATE. SEE EXPLANATION ON SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINE 15.
PART I, LINE 4A:	THOMAS PARKER RECEIVED $49,154 SEVERANCE IN 2021.
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, ATRIUM MEDICAL CENTER (AMC) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. AMC 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 2021. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN RECEIVED THE ASSOCIATED PAYMENT IN 2021: MARY CLANCY $52,772; SCOTT SHELTON $614,357; J. MICHAEL SIMS $117,016; GEOFFREY WALKER $305,647. THE INDIVIDUALS LISTED BELOW HAVE MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE SERP AND RECEIVED THE ASSOCIATED PLAN PAYMENT 2021: MARK BELCASTRO, M.D. $68,706; BARBARA JOHNSON $67,504; MARGARET MARK $45,747; THOMAS PARKER $159,829. IN ADDITION, THE FOLLOWING SERP AMOUNTS WERE DEFERRED ON THE PARTICIPANTS' BEHALF DURING THE YEAR AND WILL BE HELD UNTIL THE INCREMENTAL AMOUNTS ARE VESTED: MARC BELCASTRO M.D. $1,364; KEITH BRICKING, M.D. $44,845; THOMAS CURTIN $29,333; GARY GINTER $50,882; ANDRE HARRIS, M.D. $4,131; JENNIFER HAULER, D.O. $87,168; KIMBERLY HENSLEY $4,995; BILLIE LUCENTE-BAKER, $1,377; MARGARET MARK $1,038; THOMAS PARKER $5,272; MARQUITA TURNER $9,412, MICHAEL UHL $106,501. 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.

Schedule J (Form 990) 2021

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
ATRIUM MEDICAL CENTER

Employer identification number
31-1079309

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	COUNTY OF MONTGOMERY OHIO	31-6000172	613520LO6	09-24-2019	83,203,105	REFUND SERIES 2008 A & B		X		X		X
B	CITY OF MIDDLETOWN OHIO	31-6000139	597146AP4	08-31-2016	86,392,792	REFUND SERIES 2010		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................			3,452,792
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	83,203,105		86,392,792
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	766,203		400,067
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............	82,436,902		85,992,725
12 Other unspent proceeds .............
13 Year of substantial completion .............	2019		2006
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X			X
b Exception to rebate? ........		X		X
c No rebate due? .........		X	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X
b Name of provider ..........			BARCLAYS PNC BANK
c Term of hedge .........			2380.0000000000 %
d Was the hedge superintegrated? ......				X
e Was the hedge terminated? ........				X
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
NOTE A PART I, LINE A, COLUMN E:	ISSUE PRICE IS NOT IDENTICAL TO THE ISSUE PRICE LISTED ON FORM 8038 DUE TO THE SERIES 2019A BONDS' PROCEEDS BEING SPLIT BETWEEN MIAMI VALLEY HOSPITAL, ATRIUM MEDICAL CENTER, AND UPPER VALLEY MEDICAL CENTER
NOTE A PART I, LINE A, COLUMN F:	REFUNDED THE FOLLOWING SERIES BONDS: SERIES 2008A BONDS - ISSUE DATE 11/21/2008 SERIES 2008B BONDS - ISSUE DATE 11/21/2008
NOTE B PART IV, LINE 2C	COMPUTATION DATE IS OCTOBER 1, 2019

Schedule K (Form 990) 2021

Additional Data

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....	X	2	480	FMV
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......	X		200	FMV
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( GIFT SHOP INVENTORY )	X	1	84,193	FMV
26 Other ( EMPLOYEE FOOD )	X	39	38,189	FMV
27 Other ( COVID-19 PPE )	X	18	23,467	FMV
28 Other ( SUPPLIES/PRIZES )	X	41	20,262	FMV
Other ( CAPITAL EQUIPMENT )	X	1	1,738	FMV

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2021)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation

Schedule M (Form 990) (2021)

Additional Data

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Software Version:

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SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

Return Reference	Explanation
FORM 990, PART V, LINE 1A:	PART V, LINE 1A IS SUBSTANTIALLY LOWER THAN PREVIOUS YEARS. PREMIER HEALTH MAKES PAYMENTS ON BEHALF OF THE OTHER ENTITIES IN THE PREMIER HEALTH NETWORK. TREAS. REG. 1.6041-1(E) DEEMS A PERSON THAT MAKES A PAYMENT IN THE COURSE OF ITS TRADE OR BUSINESS ON BEHALF OF ANOTHER PERSON AS THE PAYOR THAT MUST ISSUE FORMS 1099. AS SUCH, BEGINNING WITH THE 2021 YEAR, ACCOUNTS PAYABLE FORMS 1099 FROM THE NETWORK WILL BE ISSUED BY PREMIER HEALTH.
FORM 990, PART VI, SECTION A, LINE 3	PREMIER HEALTH (PREMIER) AS THE OPERATOR OF ATRIUM MEDICAL CENTER (AMC) DEVELOPS AND OVERSEES THE IMPLEMENTATION OF THE STRATEGIC PLAN FOR AMC, WHICH INCLUDES (BUT IS NOT LIMITED TO) SUCH MATTERS AS LOCATION OF CLINICAL AND ADMINISTRATIVE EXPENSES AND THE CONSOLIDATION OF SUCH SERVICES. AMC SHALL COMPLY WITH AND IMPLEMENT THIS PLAN AND SHALL NOT TAKE ANY ACTION THAT MATERIALLY DEPARTS FROM THIS PLAN WITHOUT PREMIER'S APPROVAL. AMC SHALL IMPLEMENT ANY CAPITAL AND OPERATING BUDGET SO APPROVED AND/OR REVISED FOR IT BY PREMIER. AMC SHALL IMPLEMENT THE BUSINESS PLAN APPROVED BY PREMIER. PREMIER IS THE SOLE AGENT TO NEGOTIATE ALL RELATIONSHIPS WITH PAYORS ON BEHALF OF AMC WITH ALL THIRD-PARTY PAYORS AND ALTERNATIVE DELIVERY SYSTEMS INCLUDING, BUT NOT LIMITED TO, INSURERS. AMC MUST HAVE APPROVAL FROM PREMIER TO BORROW IN ANY FISCAL YEAR, GUARANTEE IN ANY YEAR, OR INCUR ANY LIEN OR OTHER ENCUMBRANCE ON ANY PROPERTY IN AN AMOUNT EQUAL TO OR GREATER THAN $1,000,000. AMC MUST SEEK PREMIER'S APPROVAL FOR ANY ACQUISITIONS, SALE OR TRANSFER OF ANY MATERIAL ASSET USED IN AMC'S ACTIVITIES.
FORM 990, PART VI, SECTION A, LINE 6	ATRIUM MEDICAL CENTER HAS ONE CORPORATE MEMBER: 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 ATRIUM MEDICAL CENTER (AMC). 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 EXPLANATION FOR LINE 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, OF WHICH ATRIUM MEDICAL CENTER IS AN AFFILIATE. THE RETURN IS REVIEWED BY THE MANAGER AND DIRECTOR OF TAX COMPLIANCE OF PREMIER. THE RETURN IS CONCURRENTLY SENT TO ERNST & YOUNG U.S. LLP FOR THEIR REVIEW. AFTER ALL CHANGES FROM THE ABOVE PERSONS ARE MADE, THE RETURN IS REVIEWED BY THE VICE PRESIDENT/CONTROLLER OF PREMIER. A FINAL VERSION OF THE RETURN IS SENT TO ERNST & YOUNG U.S. LLP FOR A FINAL REVIEW AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. AT A BOARD OF TRUSTEES MEETING, THE VICE PRESIDENT/CONTROLLER OF PREMIER (OR DESIGNEE) SHARES DETAILED INFORMATION ON COMPENSATION AND OTHER KEY AREAS, AS WELL AS ADDRESSES ANY OTHER QUESTIONS FROM THE BOARD OF TRUSTEES, PENDING THEIR REVIEW. THE 990 FILING IS ALSO SHARED WITH THE AUDIT COMMITTEE OF PREMIER.
FORM 990, PART VI, SECTION B, LINE 12C	PREMIER, WITH WHICH ATRIUM MEDICAL CENTER 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 B, LINE 15	COMPENSATION FOR ATRIUM MEDICAL CENTER'S (AMC) CEO IS REVIEWED AND APPROVED BY PREMIER, WITH WHICH AMC IS AN AFFILIATE, ON AN ANNUAL BASIS. THE REVIEW PROCESS PERFORMED BY PREMIER FOLLOWS A MARKET BASED COMPENSATION PHILOSOPHY DESIGNED TO ATTRACT AND RETAIN THE EXECUTIVE TALENT REQUIRED TO MEET THE HIGH-PERFORMANCE STANDARDS OF OUR BOARD AND OUR COMMUNITY. PREMIER ANNUALLY REVIEWS EXECUTIVE COMPENSATION SURVEY DATA FOR A REGIONAL PEER GROUP OF SYSTEMS AND HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO PREMIER AND ITS AFFILIATES. THE DATA FOR THE SURVEY IS PROVIDED BY A THIRD-PARTY CONSULTANT GROUP THAT IS INDEPENDENT OF PREMIER. THIS REPORT INCLUDES COMPARABILITY DATA FOR KEY EXECUTIVES, VICE PRESIDENTS, AND DIRECTOR LEVEL POSITIONS. THE INDEPENDENT COMPARABILITY DATA IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THIS COMMITTEE CONTAINS THREE MEMBERS, ALL OF WHOM ARE INDEPENDENT. THIS COMMITTEE REVIEWS IN DETAIL THE COMPENSATION FOR THE PREMIER CEO, COO, CFO, CHIEF INTEGRATION OFFICER, CHIEF STRATEGY OFFICER, AND THE HOSPITAL CEOS. OTHER POSITIONS ARE REVIEWED AT A HIGH LEVEL FOR REASONABLENESS. ALL THE MEETING MINUTES ARE DOCUMENTED AND KEPT ON FILE ALONG WITH ANY COMPARABILITY DATA AND THE CONSULTANT REPORT. AFTER THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION ACTIONS, THE PROCESS IS AUDITED BY THE INTERNAL AUDIT DEPARTMENT. THE EXECUTIVE COMPENSATION COMMITTEE PRESENTS THE COMPENSATION ACTIONS TO THE PREMIER BOARD ANNUALLY.
FORM 990, PART VI, SECTION C, 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 VII, SECTION B, LINES 1 & 2:	THERE ARE NO REPORTABLE INDEPENDENT CONTRACTORS PAID BY THIS ENTITY DURING 2021. PREMIER HEALTH MAKES PAYMENTS ON BEHALF OF THE OTHER ENTITIES IN THE PREMIER HEALTH NETWORK. TREAS. REG. 1.6041-1(E) DEEMS A PERSON THAT MAKES A PAYMENT IN THE COURSE OF ITS TRADE OR BUSINESS ON BEHALF OF ANOTHER PERSON AS THE PAYOR THAT MUST ISSUE FORMS 1099. AS SUCH, BEGINNING WITH THE 2021 YEAR, ALL FORMS 1099 FROM THE NETWORK WILL BE ISSUED BY PREMIER HEALTH.
FORM 990, PART IX, LINE 11G	OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 16,467,289. MANAGEMENT AND GENERAL EXPENSES 309,214. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,776,503. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 9,107,535. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,107,535. PURCHASED LABOR: PROGRAM SERVICE EXPENSES 8,095,601. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,095,601. CHI C/E DIRECT CHARGE: PROGRAM SERVICE EXPENSES 2,400,553. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,400,553. COLLECTION COSTS: PROGRAM SERVICE EXPENSES 803,986. MANAGEMENT AND GENERAL EXPENSES 60,654. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 864,640. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 592,606. MANAGEMENT AND GENERAL EXPENSES 63,960. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 656,566. RESIDENTS: PROGRAM SERVICE EXPENSES 164,471. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 164,471. PHYSICIAN RECRUITMENT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 133,990. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,990. OTHER FEES: PROGRAM SERVICE EXPENSES 69,116. MANAGEMENT AND GENERAL EXPENSES 81,849. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 150,965.
FORM 990, PART XI, LINE 9:	EQUITY TRANSFERS -58,879,742. FUNDING FROM AFFILIATES -351,294. CAPTIVE INSURANCE ADJUSTMENT 486,099. CAPITAL DONATIONS 552,963. PENSION ADJUSTMENT 4,614,554.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

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.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

ATRIUM MEDICAL CENTER

Employer identification number

31-1079309

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?
(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	Yes	No
(1)PREMIER HEALTH 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-1446699	PARENT	OH	501(C)(3)	12B	N/A		No
(2)MEDAMERICA HEALTH SYSTEMS CO 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-1040228	SUPPORT ORG	OH	501(C)(3)	12B	N/A		No
(3)MIAMI VALLEY HOSPITAL 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-0537504	HOSPITAL	OH	501(C)(3)	3	PREMIER HEALTH		No
(4)MIAMI VALLEY HOSPITAL FOUNDATION 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-1040231	FOUNDATION	OH	501(C)(3)	7	PREMIER HEALTH		No
(5)FIDELITY HEALTH CARE INC 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-1075381	HOME HEALTH	OH	501(C)(3)	10	PREMIER HEALTH		No
(6)PREMIER COMMUNITY HEALTH 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-1122883	HEALTH EDUCATION	OH	501(C)(3)	10	FIDELITY HEALTH CARE		No
(7)GOOD SAMARITAN FOUNDATION - DAYTON 110 MAIN STREET SUITE 500 DAYTON,OH45402 23-7296923	FOUNDATION	OH	501(C)(3)	7	PREMIER HEALTH		No
(8)ATRIUM HEALTH SYSTEM 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-0537492	SUPPORT ORG	OH	501(C)(3)	12B	N/A		No
(9)UVMC 110 MAIN STREET SUITE 500 DAYTON,OH45402 34-1850683	SUPPORT ORG	OH	501(C)(3)	12B	N/A		No
(10)UPPER VALLEY MEDICAL CENTER 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-0537095	HOSPITAL	OH	501(C)(3)	3	PREMIER HEALTH		No
(11)UPPER VALLEY PROFESSIONAL CORP 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-1400963	HEALTH CARE	OH	501(C)(3)	10	PREMIER HEALTH HOLDING CO		No
(12)UVPC SPECIALISTS 110 MAIN STREET SUITE 500 DAYTON,OH45402 20-3687536	HEALTH CARE	OH	501(C)(3)	10	PREMIER HEALTH HOLDING CO		No
(13)UVMC NURSING CARE INC 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-1224064	NURSING HOME	OH	501(C)(3)	10	PREMIER HEALTH		No
(14)COMPUNET CLINICAL LABORATORIES LLC 110 MAIN STREET SUITE 500 DAYTON,OH45402 31-1258010	LAB	OH	501(C)(3)	12B	PREMIER HEALTH		No
(15)SAMARITAN BEHAVIORAL HEALTH INC 110 MAIN STREET SUITE 500 DAYTON,OH45402 02-0633634	BEHAVIORAL HEALTH	OH	501(C)(3)	7	PREMIER HEALTH		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) SWEITZER STREET LLC 110 N MAIN STREET SUITE 500 DAYTON,OH45402 45-4700417	REAL ESTATE	OH	MVHE INC	EXCLUDED				No			No
(2) SWEITZER MOB LLC 110 N MAIN STREET SUITE 500 DAYTON,OH45402 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?
(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	Yes	No
(1) MVHE INC 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 31-1185270	PHYSICIAN SVCS	OH	PREMIER HEALTH HOLDING CO	C					No
(2) PREMIER HEALTH SPECIALISTS 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 06-1744704	PHYSICIAN SVCS	OH	PREMIER HEALTH HOLDING CO	C					No
(3) SAMARITAN FAMILY CARE 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 31-1299450	PHYSICIAN SVCS	OH	PREMIER HEALTH HOLDING CO	C					No
(4) AFTER HOURS FAMILY CARE 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 31-1269483	HEALTH CARE	OH	UPPER VALLEY PROFESSIONAL CORP	C					No
(5) UVMC MANAGEMENT CORP 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 31-1360489	MANAGEMENT COMPANY	OH	PREMIER HEALTH	C					No
(6) PREMIER HEALTH URGENT CARE INC 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 82-2079409	URGENT CARE	OH	PREMIER HEALTH HOLDING CO	C					No
(7) PREMIER HEALTH PLAN INC 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 46-3024049	HEALTH INSURANCE	OH	PREMIER HEALTH INSURING CO	C					No
(8) GOOD SAMARITAN HOSPITAL 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 31-0536981	HOSPITAL	OH	PREMIER HEALTH	C					No
(9) PREMIER HEALTH ACO OF OHIO 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 47-4049773	MEDICARE ACO	OH	PREMIER HEALTH	C					No
(10) PREMIER HEALTH HOLDING CO 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 81-2419110	HOLDING CO	OH	PREMIER HEALTH	C					No
(11) PREMIER HEALTH INSURING CO 110 NORTH MAIN STREET SUITE 500 DAYTON,OH45402 46-4766841	HEALTH INSURANCE	OH	PREMIER HEALTH	C					No

Schedule R (Form 990) 2021

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

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) 2021

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)	(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
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: WE WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE WITH OTHERS WHO SHARE OUR COMMITMENT TO PROVIDE HIGH-QUALITY, COST-COMPETITIVE HEALTHCARE SERVICES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	1
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	1,819
6	Total number of volunteers (estimate if necessary) .............	6	127
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,809,941	1,328,057
9	Program service revenue (Part VIII, line 2g) .........	211,282,080	249,150,191
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	9,944,035	11,016,649
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,222,948	7,412,802
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	228,259,004	268,907,699
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	566,457	276,899
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	87,752,896	86,967,033
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	112,147,396	123,277,016
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	200,466,749	210,520,948
19	Revenue less expenses. Subtract line 18 from line 12.......	27,792,255	58,386,751
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	352,578,494	360,404,055
21	Total liabilities (Part X, line 26).............	300,202,229	301,004,057
22	Net assets or fund balances. Subtract line 21 from line 20.....	52,376,265	59,399,998

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 203,409,510 including grants of $ 276,899 ) (Revenue $ 249,150,191 )
	THE PRIMARY EXEMPT PURPOSE OF ATRIUM MEDICAL CENTER IS TO PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES TO THE RESIDENTS OF BUTLER AND WARREN COUNTIES. THE HOSPITAL FURTHERS ITS TAX-EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN MANY WAYS. SEE SCHEDULE H FOR MORE INFORMATION.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses203,409,510

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,991,777	14,872,039	1,346,553

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	29,675
e	Government grants (contributions)		1e	890,832

f	All other contributions, gifts, grants, and similar amounts not included above		1f	407,550

g	Noncash contributions included in lines 1a - 1f:$		1g	168,529

h Total. Add lines 1a-1f.......		1,328,057

		Business Code
2a	NET PATIENT SERVICE REVENUE	900099	129,895,212	129,895,212
b	MEDICARE/MEDICAID PAYMENTS	900099	118,470,394	118,470,394
c	HOSPITAL FRANCHISE TAX RECOVERIES	900099	751,094	751,094
d	ATHLETIC TRAINING	900099	20,908	20,908
e	MEDICAL RECORDS	900099	12,583	12,583
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		249,150,191

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,473,856			1,473,856
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		2,198,826	6a
b	Less: rental expenses		2,060,812	6b
c	Rental income or (loss)		138,014	6c
d	Net rental income or (loss).......			138,014			138,014
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	297,713	152,749,230	7a
b	Less: cost or other basis and sales expenses	683,113	142,821,037	7b
c	Gain or (loss)	-385,400	9,928,193	7c
d	Net gain or (loss).........			9,542,793			9,542,793
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	88,955
b	Less: cost of goods sold ..		10b	54,483
c	Net income or (loss) from sales of inventory..			34,472			34,472
Business Code			Miscellaneous Revenue
11a	GAIN ON INTEREST SWAP ADJ		900099	6,263,078			6,263,078
b	FEMA REVENUE		900099	830,892			830,892
c	CAFETERIA SALES		900099	32,309			32,309
d	All other revenue ....			114,037			114,037
e	Total. Add lines 11a–11d ......			7,240,316
12	Total revenue. See instructions.....			268,907,699	249,150,191	0	18,429,451

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	276,899	276,899
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	2,046,404	1,073,589	972,815
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	67,062,354	64,197,275	2,865,079
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,713,037	3,506,837	206,200
9	Other employee benefits .......	9,387,954	8,866,602	521,352
10	Payroll taxes ...........	4,757,284	4,703,708	53,576
11	Fees for services (non-employees):
a	Management ......	41,818	41,818
b	Legal .........	13,873		13,873
c	Accounting ...........
d	Lobbying ...........	4,421		4,421
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	263,772		263,772
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	38,350,824	37,701,157	649,667
12	Advertising and promotion ....	331,127	3,829	327,298
13	Office expenses .......	741,151	397,429	343,722
14	Information technology ......	1,714,709	1,592,903	121,806
15	Royalties ..
16	Occupancy ...........	6,674,151	6,570,374	103,777
17	Travel ............	20,556	18,543	2,013
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	8,270,204	8,270,204
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	16,545,827	16,109,287	436,540
23	Insurance ...	16,042		16,042
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	OPERATING SUPPLIES	42,394,629	42,394,629
b	HOSPITAL FRANCHISE TAX	6,038,700	6,038,700
c	REPAIRS AND MAINTENANCE	667,563	667,563
d	EQUIPMENT RENTAL	446,101	446,101
e	All other expenses	741,548	532,063	209,485
25	Total functional expenses. Add lines 1 through 24e	210,520,948	203,409,510	7,111,438	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			9,720	1	6,205
2	Savings and temporary cash investments .........			9,940,311	2	9,496,978
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			30,943,123	4	38,963,434
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			795,247	7	59,751
8	Inventories for sale or use ............			2,554,550	8	2,110,347
9	Prepaid expenses and deferred charges ......			1,752,497	9	3,653,492
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	405,916,404
b	Less: accumulated depreciation	10b	248,936,369	162,474,168	10c	156,980,035
11	Investments—publicly traded securities .			117,137,231	11	101,701,620
12	Investments—other securities. See Part IV, line 11 .....			8,957,943	12	37,342,288
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			8,657,463	14	8,657,463
15	Other assets. See Part IV, line 11 ...........			9,356,241	15	1,432,442
16	Total assets. Add lines 1 through 15 (must equal line 33)...			352,578,494	16	360,404,055

17	Accounts payable and accrued expenses .....	18,356,191	17	19,951,170
18	Grants payable ...	2,090,240	18	1,801,945
19	Deferred revenue .........	218,798	19	218,798
20	Tax-exempt bond liabilities .........	187,194,888	20	186,295,962
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	16,883,914	23	25,023,766
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	75,458,198	25	67,712,416
26	Total liabilities. Add lines 17 through 25..	300,202,229	26	301,004,057

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	52,244,925	27	59,268,658
28	Net assets with donor restrictions ...........	131,340	28	131,340
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	52,376,265	32	59,399,998
33	Total liabilities and net assets/fund balances ........	352,578,494	33	360,404,055

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No