2019-11-15T08:04:05-06:00 2018-12-31 310800053 Clark Schaefer Hackett & Co 10100 Innovation Drive Suite 400 Dayton OH 45342 990 2018-01-01 270712680 Beavercreek Medical Center BEAV 9377621629 1 Prestige Place No 910 Miamisburg OH 45342 Steven Chavez KHN CFO 9377621629 2019-11-14 1 Herbert L Lemaster CPA P00039882 9372260070 2019-11-14 74.121.64.228 2019-11-14 08:19:31 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 E2C124E6C044DEA460B709D9705FB0CFF27D5D90 2018 2020-03-31 21:24:44Z The Indu and Raj Soin Medical Center Rick Dodds 1 Prestige Place Suite 910 Miamisburg OH 45342 180470733 0 X www.ketteringhealth.org X 2009 OH To provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner 13 4 0 388 13646 5098 1527638 2165319 158558499 178023592 196306 281822 0 0 160282443 180470733 14211 15108 0 0 55528299 64070643 0 0 0 89256613 98989679 144799123 163075430 15483320 17395303 190021962 193661008 128292133 122406451 61729829 71254557 To provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner 0 0 156996201 15108 176966565 Care was provided for 7,370 discharges, adult & ped days of 27,020, and 102,411 outpatient visits. 156996201 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Steven Chavez 9377621629 1 Prestige Place Suite 910 Miamisburg OH 45342 Manchur Fred CEO - KHN 1.00 50.00 X 0 2924891 38330 Chew Roy President - KHN 1.00 50.00 X 0 1469392 43380 Smith Robert T Physician 1.00 39.00 X 0 514946 33265 Dodds Rick President - GMH/SOIN 24.00 25.00 X X 0 513092 73475 Tyner Troy A Physician 1.00 9.00 X 0 281960 30499 Arnold Scott MD Physician (Jan-May 18) 1.00 X 0 40980 0 Weigley David Pres. Columbia Union Conference of SDA 1.00 6.00 X 0 12000 0 Halvorsen Ron Jr Pres. Ohio Conference of SDA 1.00 3.00 X 0 0 0 Harting Donald Community Volunteer 1.00 X 0 0 0 Peebles Thomas Community Volunteer 1.00 2.00 X 0 0 0 Parker Phillip Pres, Dayton Chamber of Commerce 1.00 X 0 0 0 Soin Amol MD Physician 1.00 X 0 0 0 Zimmer Stephen Community Volunteer (Jan-May 18) 1.00 X 0 0 0 Connovich Ron VP of Operations & Finance-GMH/SOIN until 10/18; P 0.00 49.00 X 0 463990 75428 King Peter VP of Operations & Finance-GMH/SOIN 24.00 25.00 X 0 175800 0 Jones Jeff Director HR 40.00 X 0 188260 29136 Gruia Ovidiu E Director Business Development 40.00 X 0 184739 29938 Hope Jill A Pharmacist 40.00 X 0 180486 28432 Morrison Brad Director Nursing Admin 40.00 X 0 172974 32052 Floro Mark Director - Transition 40.00 X 0 151319 22777 Mallett Belinda A Former Key Employee 0.00 40.00 X 0 181518 25710 Burns Terry Former Director/Officer 0.00 51.00 X 0 949664 113977 0 8406011 576399 0 1 1 0 0 2165319 2165319 Patient care services 622000 177173839 176130458 1043381 Rental income related to mission 531120 836107 836107 Catering 722320 13152 13152 Reference lab 621500 494 494 178023592 103 103 251424 251424 30295 0 30295 30295 30295 180470733 176966565 13646 1325203 X 15108 15108 2539226 2263297 275929 49280757 47835571 1445186 2758102 2677219 80883 5945091 5770748 174343 3547467 3443435 104032 467554 416747 50807 2380 2380 8646483 8055734 590749 1984710 1867980 116730 310649 274348 36301 2582595 2580607 1988 134038 106950 27088 85400 76596 8804 8326067 8319657 6410 11327783 11319061 8722 572200 426864 145336 Medical supplies 29603020 29600305 2715 Network services 18163170 16189441 1973729 Physician services 10659893 10659893 Cost of goods sold 1549502 1549502 4574235 3547138 1027097 163075430 156996201 6079229 0 57223 84840 18166998 21456236 3112321 2611850 754957 526765 233356053 75284361 155882674 158071692 11954456 10858494 93333 51131 190021962 193661008 12235217 11863827 100 109601391 109754433 32566 6455525 755525 128292133 122406451 X 61729829 71254557 61729829 71254557 190021962 193661008 X 17395303 -7870575 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 20671041 20671041 156382215 44147209 112235006 43381175 31137152 12244023 12921622 12921622 158071692 Professional self-insurance liability 2046670 Estimated amounts due to third-party payors -1291145 755525 X Part X, Line 2: The Network completed an analysis of its certain and uncertain tax positions in accordance with applicable accounting guidance and determined that no amounts were required to be recognized in the consolidated financial statements at December 31, 2018 or 2017. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 2837823 2462051 375772 0.00230 32432944 17849030 14583914 0.08940 35270767 20311081 14959686 0.09170 810021 3881 806140 0.00490 159287 159287 0.00100 2253180 764087 1489093 0.00910 32985 32985 0.00020 3255473 767968 2487505 0.01520 38526240 21079049 17447191 0.10690 1 19555534 469333 29809173 33830428 -4021255 X 1 1 1 1 Beavercreek Medical Center 3535 Pentagon Boulevard Beavercreek OH 45431 ketteringhealth.org/soin/ X X X X Beavercreek Medical Center 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X http://www.ketteringhealth.org/aboutus X 1 18 1 http://www.ketteringhealth.org/aboutus 0 1 X 250.000000000000 400.000000000000 X X X 1 1 X X X X 1 X http://www.ketteringhealth.org/financial/pdfs/PatientFinancialAssistancePol X http://www.ketteringhealth.org/financial/pdfs/HCAP.pdf X http://www.ketteringhealth.org/financial/pdfs/PLS1.pdf X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section A: The facility listed is required to be licensed, registered, or recognized as a healthcare facility under state law. Beavercreek Medical Center Part V, Section B, Line 5: Twelve hospitals came together to conduct a collaborative Community Health Needs Assessment(CHNA), organized by The Health Collaborative in Cincinnati, Ohio and the Greater Dayton AreaHospital Association in Dayton, Ohio. Primary data collection involved interviews of public health officials, online and paper surveys, and community focus groups. The Soin Medical Center committee received detailed information about the health issues identified in Clark, Greene, and Montgomery Counties. Hospital leaders prioritized and developed strategies to address these issues. This was performed during 2016. Beavercreek Medical Center Part V, Section B, Line 6a: Fort Hamilton HospitalGrandview Medical CenterGreene Memorial HospitalKettering Medical CenterSoin Medical CenterSouthview Medical CenterSycamore Medical CenterAtrium Medical CenterGood Samaritan HospitalMiami Valley HospitalUpper Valley Medical CenterWilson Health Beavercreek Medical Center Part V, Section B, Line 6b: Greater Dayton Area Hospital AssociationThe Health Collaborative Beavercreek Medical Center Part V, Section B, Line 11: The prioritized health needs are obesity, diabetes, heart disease, and mental health/substance abuse. For diabetes, heart disease and obesity, Soin will improve clinical outcomes through 1) PRIME training & certification of primary care physicians; and 2) partnership with diabetes prevention programs. For heart disease, Soin will provide access to preventive clinical services with CVD screening and education. For diabetes and heart disease Soin will address tobacco cessation through the creation of community partnerships (e.g., a hub model) to deliver and coordinate evidence-based tobacco cessation efforts through the community. For mental health/substance abuse Soin will provide evidence-based screening tools to PCPs to improve identification of mental health issues and clinical treatment planning and will improve integration of behavioral health services. 1 1 - Springfield Health Center 2100 Emmanuel Way Springfield OH 45502 Outpatient Clinic & Diagnostic Center Part I, Line 6a: The organization provides an annual community benefit report that is made available to the public. Part I, Line 7: Charity care is calculated using a cost to charge ratio following the methodology of Worksheet 2. Medical costs are calculated using a cost accounting system that addresses all patient segments. Community health improvement services are calculated on the basis of direct expenditures. Health professions education is calculated based on Medicare cost report. Subsidized health services is calculated based on the non-Medicare, Medicaid, and charity care proportion of departmental losses for the specific programs. Cash and in-kind contributions are calculated on the basis of direct expenditures. Part I, Line 7g: Subsidized health services represent the non-needs based and non-Medicare program losses of services the hospital offers. Part III, Line 2: The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. Part III, Line 3: An industry average was used to estimate this amount. It was not included as part of community benefit. Part III, Line 4: A cost to charge ratio was used to determine the amount reported in Part III, Line 2. An industry average was used to compute the amount on Line 3. Discounts and payments on patient accounts reduce bad debt expense. No portion of bad debt expense is reported as community benefit. Text of footnote describing bad debt expense is as follows:"The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful receivables based upon historical write-off experience by payor category. The results of this review are then used to make modifications to the provision for bad debts to establish an appropriate allowance for doubtful accounts." Part III, Line 8: The costing methodology used to determine Medicare costs is the Medicare cost report. Medicare costs have not been included in community benefit in Part I. Part III, Line 9b: Financial counselors work out a payment program for any amount due after the Charity Sliding Scale Discounts are applied. Collection procedures consistent with self-pay accounts are applied to these balances. Part VI, Line 3: Soin informs and educates patients or persons who may be billed for patient care about their eligibility for assistance under federal, state or local government programs or under Soin's charity care policy as follows:-Soin has a financial assistance brochure that is included in all of the patient information kits given at the time of intake or registration into any facility or department.-There is information posted in all of the admitting and registration areas about charity care and financial assistance.-During the registration process there is specific scripting to ask patients if they would like to disclose family size and income to screen them for federal/state/local and hospital based charity/assistance programs. This data is available for future visits as well.-Soin has the reporting capability to review and screen any patient who may have been admitted during registration "off hours" for eligibility and assistance.-Soin contracts with an outside agency for patient assistance in the application process.-The back of the patient statement shows the current and prior year Federal Poverty Guidelines and has the Financial Assistance Form to complete and mail in for consideration for Soin's HCAP or Charity Sliding Scale program. -Soin's patient account representatives in customer service screen patients that are unable to pay their bill for the various financial assistance programs. Part VI, Line 4: KHN serves a population of approximately 1,690,000 in its primary and secondary service area. The nine-county service area includes Butler, Clark, Clinton, Darke, Greene, Miami, Montgomery, Preble and Warren counties. Out of this service area, approximately 11.4% of area households have income below $15,000. 10.1% have income between $15,000 and $24,999 and 23.5% have income between $25,000 and $49,000. Portions of each county except Clinton and Preble have been identified as medically underserved by the Health Resources and Services Administration. This nine-county area is served by 15 hospitals, 8 of which are part of Kettering Health Network. Part VI, Line 5: Soin furthers its exempt purpose by promoting the health of the community by:-Retaining a Board of Directors with a majority (excluding employees and contractors) living in the primary service area;-Extending medical staff privileges to all qualified physicians in its community for a majority of its departments.-Utilizing surplus funds to help support ongoing improvements in patient care through equipment upgrades, acquisition of the most advanced medical technology, upgrades of existing hospital structures, and construction of new facilities in order to provide accessible, efficient, quality care. Part VI, Line 6: Soin promotes the health of the communities served as described below:-Soin, a part of the Kettering Health Network, is dedicated to the creation and maintenance of community wellness programs, support groups, and health education programs. Soin provides numerous screenings, family-focused classes, health fairs, conferences, donations, and education programs to ensure the long-term well-being of people living in the community.-Kettering Affiliated Health Services, Inc includes Sycamore Glen Health Center and Sycamore Glen Retirement Community. These healthcare areas provide services to the surrounding communities which complement those services provided by Soin as part of the Kettering Health Network.-Medical research is supported through the Innovation Center, which cultivates new technologies and fosters best practices among partners from industry, academia and health care. Part VI, Line 7, Reports Filed With States OH 1 Assistance to employees for hardship 16 13108 FMV Scholarship award 1 2000 FMV Part I, Line 2: Funds are monitored and use is determined by board members. 0 1 0 0 0 0 0 0 0 Manchur Fred CEO - KHN 0 1448991 0 443167 0 1032733 0 15487 0 22843 0 2963221 0 0 Chew Roy President - KHN 0 1117310 0 304332 0 47750 0 15487 0 27893 0 1512772 0 0 Smith Robert T Physician 0 514946 0 0 0 0 0 15487 0 17778 0 548211 0 0 Dodds Rick President - GMH/SOIN 0 412693 0 98804 0 1595 0 49607 0 23868 0 586567 0 0 Tyner Troy A Physician 0 281960 0 0 0 0 0 15487 0 15012 0 312459 0 0 Connovich Ron VP of Operations & Finance-GMH/SOIN 0 379621 0 81000 0 3369 0 51022 0 24406 0 539418 0 0 King Peter VP of Operations & Finance-GMH/SOIN 0 165000 0 10800 0 0 0 0 0 0 0 175800 0 0 Jones Jeff Director HR 0 188215 0 45 0 0 0 10885 0 18251 0 217396 0 0 Gruia Ovidiu E Director Business Development 0 184484 0 170 0 85 0 8445 0 21493 0 214677 0 0 Hope Jill A Pharmacist 0 176468 0 1010 0 3008 0 10883 0 17549 0 208918 0 0 Morrison Brad Director Nursing Admin 0 168908 0 1988 0 2078 0 10559 0 21493 0 205026 0 0 Floro Mark Director - Transition 0 101942 0 6847 0 42530 0 8665 0 14112 0 174096 0 0 Mallett Belinda A Former Key Employee 0 157663 0 19929 0 3926 0 11471 0 14239 0 207228 0 0 Burns Terry Former Director/Officer 0 733966 0 176185 0 39513 0 75487 0 38490 0 1063641 0 0 Part I, Line 3 Compensation is established by a related organization. The process of determining compensation of CEO's, executive directors, officers, and key employees is to have an independent board approve the compensation. The compensation is determined to be reasonable compared to independent comparability data. The approval of the amounts is documented in the Board minutes within the appropriate time frame. At year end the organization reviews executive compensation by comparing the amounts approved to the amounts paid. Part I, Line 4b The network has a supplemental executive retirement plan available only to a certain class of management. Part II, Col Biii Column Biii includes compensation reported on the W-2 that may or may not have gone through the current year Statement of Operations and Changes in Net Assets. A County of Greene Ohio 316000271 394650BV6 2009-11-03 97931091 Construct and equip a hospital 0 0 0 B County of Montgomery Ohio 316000271 613520LA1 2016-05-04 12087009 Hospital building improvements and equipment 0 0 0 A 100867503 9296792 2633592 1612304 85213731 2111084 2012 0 0 1 1 B 12087009 110713 11976296 2016 0 0 1 1 A 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 Form 990, Part VI, Section B, line 11b A tax specialist is engaged to review the 990. The 990 is reviewed and accepted by the audit committee which reports this to the governing body (board). Form 990, Part VI, Section B, line 12c The Network regularly and consistently monitors and enforces compliance with the conflict of interest policy by making it part of the employees' annual reviews. Employees must certify that they have read the conflict of interest policy and have disclosed any potential conflicts and agree to immediately notify Corporate Integrity if one should arise. Board members are required to annually review the Network's policy, sign a conflict of interest statement, and notify the Network if a conflict should arise. Form 990, Part VI, Section B, line 15 The process of determining compensation of CEO's, executive directors, officers, and key employees is to have an independent board approve the compensation. The compensation is determined to be reasonable compared to independent comparability data. The approval of the amounts is documented in the Board minutes within the appropriate time frame. At year end the organization reviews executive compensation by comparing the amounts approved to the amounts paid. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are available upon request. Part IX, Lines 5, 7, 8, 9, & 10 Salaries, retirement plan contributions, other benefits, and payroll taxes are paid by and allocated from Kettering Medical Center. Form 990, Part XI, line 9: Net transfers to affiliate -7,870,575. Part XII, Line 2c Neither the oversight process nor the selection process changed during the tax year. Alliance Physicians Inc 1 Prestige Place Suite 910 Miamisburg OH 45342 311175717 Physician Services OH 501(c)(3) 509(a)(3) Kettering Adventist Healthcare 0 Dayton Osteopathic Hospital 1 Prestige Place Suite 910 Miamisburg OH 45342 310564121 Hospital OH 501(c)(3) 509(a)(1) Kettering Adventist Healthcare 0 The Fort Hamilton Hospital 1 Prestige Place Suite 910 Miamisburg OH 45342 310536662 Hospital OH 501(c)(3) 509(a)(1) Kettering Adventist Healthcare 0 Fort Hamilton Hospital Foundation 1 Prestige Place Suite 910 Miamisburg OH 45342 452036966 Fundraising OH 501(c)(3) 509(a)(3) The Fort Hamilton Hospital 0 Greene Foundation 1 Prestige Place Suite 910 Miamisburg OH 45342 310886949 Fundraising OH 501(c)(3) 509(a)(3) Greene Memorial Hospital 0 Greene Memorial Hospital 1 Prestige Place Suite 910 Miamisburg OH 45342 310809436 Hospital OH 501(c)(3) 509(a)(1) Kettering Adventist Healthcare 0 Greene Oaks 1 Prestige Place Suite 910 Miamisburg OH 45342 310999724 Senior Healthcare Facilities OH 501(c)(3) 509(a)(2) Kettering Affiliated Health Services Inc 0 Kettering Adventist Healthcare 1 Prestige Place Suite 910 Miamisburg OH 45342 311051688 Management OH 501(c)(3) 509(a)(3) N/A 0 Kettering Affiliated Health Services Inc 1 Prestige Place Suite 910 Miamisburg OH 45342 311127485 Health Services OH 501(c)(3) 509(a)(3) Kettering Adventist Healthcare 0 Kettering Medical Center 1 Prestige Place Suite 910 Miamisburg OH 45342 310621866 Hospital OH 501(c)(3) 509(a)(1) Kettering Adventist Healthcare 0 Kettering Medical Center Foundation 1 Prestige Place Suite 910 Miamisburg OH 45342 237419897 Fundraising OH 501(c)(3) 509(a)(3) Kettering Medical Center 0 Kettcor 1 Prestige Place Suite 910 Miamisburg OH 45342 311078381 Health Services OH N/A C 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 1 0 Greene Foundation C 2165319 FMV Alliance Physicians Inc J 385250 FMV Dayton Osteopathic Hospital J 300861 FMV Alliance Physicians Inc M FMV Greene Foundation M FMV Kettering Adventist Healthcare M FMV Kettering Medical Center M FMV Kettering Medical Center N FMV Greene Memorial Hospital O FMV Kettering Medical Center O FMV Kettering Medical Center P FMV Kettering Medical Center R 7870575 FMV Part V, Line 2 Kettering Medical Center is a conduit through which revenue is received and expenses are paid.