Good Samaritan Hospital

Form 990, Part VI, Section A, Question 3:

“Premier Health (Premier), as the operator of Good Samaritan Hospital (GSH), develops and oversees the implementation of the strategic plan for GSH, which includes (but is not limited to) such matters as location of clinical and administrative expenses. GSH shall comply with and implement this plan and shall not take any action that materially departs from this plan without Premier's approval. GSH shall implement any capital and operating budget so approved and/or revised for it by Premier. GSH shall implement the business plan approved by Premier. Premier is the sole agent to negotiate all relationships with payors on behalf of GSH with all third party payors and alternative delivery systems including, but not limited to insurers. GSH 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. GSH must seek Premier's approval for any acquisitions, sale or transfer of any material asset used in Premier's activities. Form 990, Part VI, Section A Question 6: Good Samaritan Hospital has two corporate members. One member is Samaritan Health Partners, the parent company of the hospital. The second member is Premier Health (Premier), an Ohio non-profit corporation formed pursuant to the joint operating agreement. Samaritan Health Partners has the sole authority to elect the Board of Trustees of the corporation. Premier has the general authority to operate and manage the operational activities of the corporation. Form 990, Part VI, Section A, Question 7a: Samaritan Health Partners (SHP) has the sole authority to elect the Board of Trustees of Good Samaritan Hospital (GSH). SHP has the authority to remove trustees at any regular or special meeting or by written consent. Premier Health (Premier) has the right to request that SHP remove a trustee of GSH if Premier has determined that such trustee is frustrating the goals and purposes of Premier's network. Such removal shall not be unreasonably refused by SHP. Form 990, Part VI, Section A, Question 7b: See the response above for Form 990, Part VI, Section A, question 3. Form 990, Part VI, Section B, Question 11B: This 990 tax return and attached schedules (the return) are prepared by a staff member in the Tax Department of Premier Health (Premier), with which Good Samaritan Hospital is an affiliate. The return is reviewed by the Tax Manager and the 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 groups are made, the return is reviewed by the Vice President/Controller of Premier and the Chief Financial Officer of this entity. 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 the Board of Trustees meeting, the Vice President/Controller of Premier (or designee) shares detailed information on compensation and other key areas, as well as address any other questions from the Board of Trustees, pending their review. The 990 tax return is also shared with the Audit Committee of Premier. Form 990, Part VI, Section B, Question 12c: PREMIER HEALTH (PREMIER), WITH WHICH Good Samaritan HOSPITAL IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, OFFICERS, EXECUTIVE DIRECTORS, VICE PRESIDENTS, DIRECTORS, PURCHASING DEPARTMENT STAFF, AUTHORIZED PURCHASERS, MEDICAL DIRECTORS, DEPARTMENT AND SECTIONS CHAIRS, 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”