2017-11-14T15:09:38-06:00 2016-12-31 310800053 Clark Schaefer Hackett & Co 10100 Innovation Drive Suite 400 Dayton OH 45342 990 2016-01-01 270712680 Beavercreek Medical Center BEAV 9377621629 1 Prestige Place No 910 Miamisburg OH 45342 Steven Chavez KHN CFO 9377621629 2017-11-14 1 Herbert L Lemaster CPA P00039882 9372260070 2017-11-14 24.142.191.122 2017-11-14 09:19:24 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FF1ADF7F950BE2AA8621E5D4B8A2222E21169A02 2016 2017-02-10 21:41:12Z The Indu and Raj Soin Medical Center Rick Dodds 1 Prestige Place Suite 910 Miamisburg OH 45342 128903318 0 X www.ketteringhealth.org X 2009 OH Provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner 13 5 0 351 12187 1013 562513 267135 113705188 128405620 121498 229077 0 0 114389199 128901832 9002 11528 0 0 49382582 56745341 0 0 0 63236442 73640847 112628026 130397716 1761173 -1495884 177226564 189907346 110987814 125697789 66238750 64209557 Provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner 0 0 111170244 11528 127560092 Care was provided for 6,685 discharges, adult & ped days of 23,265, and 73,325 outpatient visits. 111170244 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 1 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 X 13 5 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 Fred Manchur CEO - KHN 1.00 50.00 X 0 2915288 77467 Robert T Smith Physician 1.00 39.00 X 0 499855 29734 Rick Dodds Presdient - GMH/SOIN 24.00 25.00 X X 0 425599 18309 Troy A Tyner Physician 1.00 9.00 X 0 263090 24071 William M McCullough Jr Physician (Jan-Feb) 1.00 39.00 X 0 260447 26595 David Weigley Pres. Columbia Union Conference of SDA 1.00 X 0 12000 0 Francis Cortez DO Physician 1.00 39.00 X 0 0 0 Ron Halvorsen Jr Pres. Ohio Conference of SDA 1.00 X 0 0 0 Donald Harting Community Volunteer 1.00 X 0 0 0 Thomas Peebles Community Volunteer 1.00 X 0 0 0 Phillip Parker Pres, Dayton Chamber of Commerce 1.00 X 0 0 0 Amol Soin MD Physician 1.00 X 0 0 0 Stephen Zimmer Community Volunteer 1.00 X 0 0 0 Ron Connovich GMH VP of Finance & Operations 24.00 25.00 X 0 351325 32634 John L Weimer Pharmacist 40.00 X 0 204687 4880 Jill A Hope Pharmacist 40.00 X 0 188133 15192 Brad Morrison Pharmacist 40.00 X 0 185723 20182 Jeff Jones Pharmacist 40.00 X 0 181347 16209 Ovidiu E Gruia Pharmacist 40.00 X 0 170896 14813 Terri Day Former 0.00 0.00 X 0 833721 17663 Terry Burns Exec VP-KHN & VP of Oper/Finance-KMC 24.00 27.00 X 0 664679 53533 Mark Smith Former Officer 0.00 48.00 X 0 534508 32529 Tim Ko GMH VP of Finance & Operations 0.00 48.00 X 0 391403 31747 Steve Chavez GMH VP of Finance & Operations 0.00 48.00 X 0 373315 32640 Belinda Mallett Former 0.00 40.00 X 0 292206 17167 Richard Thomason Pharmacist 40.00 X 0 176154 19120 James B Porter Former 0.00 40.00 X 0 165447 16762 0 9089823 501247 0 1 1 0 0 267135 267135 Patient care services 622000 128346745 127513404 833341 Rental income from related medica 531120 46688 46688 Caterers 722320 12187 12187 128405620 22 22 153010 153010 5497 72034 0 1486 5497 70548 76045 76045 128901832 127560092 12187 1062418 X 11528 11528 1871020 1652213 218807 44546349 36617798 7928551 1733958 1425341 308617 5851965 4810407 1041558 2742049 2254007 488042 305597 269859 35738 19314 6848 12466 7076 7076 7632424 5411384 2221040 529421 408 529013 1682735 1524589 158146 2195084 128264 2066820 1671154 1481162 189992 70903 65686 5217 51184 34014 17170 9683111 8582245 1100866 15088224 13372855 1715369 865426 748550 116876 Medical supplies 23487426 23488965 -1539 Physician services 5977940 5977940 Hospital assessment 1557298 1557298 Cost of goods sold 1145279 1145279 1671251 603604 1067647 130397716 111170244 19227472 0 18667851 18423302 2332574 2607471 177870 679709 210176415 53697092 143700638 156479323 12347631 11589208 128333 177226564 189907346 10284065 10367322 97315978 109448350 3387771 5882117 110987814 125697789 X 65663750 64209557 575000 0 66238750 64209557 177226564 189907346 X -1495884 -21988 -511321 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 20671041 20671041 149300422 29933676 119366746 39074724 23763416 15311308 1130228 1130228 156479323 Professional self-insurance liability 1608157 Estimated amounts due to third-party payors 4230127 Physician income guarantee commitments 43833 5882117 X Part X, Line 2: The Network completed an analysis of its 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, 2016 or 2015. 1 1 X 1 X 1 X 1 1 1 0 1 1 2302775 2836831 0 0.00000 28377746 14814037 13563709 0.10400 30680521 17650868 13563709 0.10400 126925 126925 0.00100 1562155 549785 1012370 0.00780 107964 107964 0.00080 1797044 549785 1247259 0.00960 32477565 18200653 14810968 0.11360 1 2026660 48640 24125520 29850235 -5724715 X 1 1 1 1 Beavercreek Medical Center 3535 Pentagon Boulevard Beavercreek OH 45431 ketteringhealth.org/soin/ 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 16 1 http://www.ketteringhealth.org/aboutus 0 1 X 100.000000000000 300.000000000000 X X X 1 1 X X X X 1 X http://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: The Soin Medical Center committee received detailed information about the health issues identified in Clark, Greene, and Montgomery Counties by Health Commissioners, individual consumers, nonprofit agencies serving vulnerable populations, and focus group participants. This was performed during the fall of 2015. 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. 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. 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: A cost to charge ratio was applied to uncollectible patient charges. Part III, Line 3: An industry average was used to compute the above amount. It is not included in 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. Text of footnote describing bad debt expense is as follows:"Based on historical experience, a significant portion of the Network's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Network records a significant provision for bad debts related to uninsured patients in the period the services are provided." Part III, Line 8: The costing methodology used to determine Medicare costs is the 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 is done regardless of insured or uninsured status. 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 1,670,000 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 12.6% of area households have income below $15,000. 11.1% have income between $15,000 and $24,999 and 24.7% have income between $25,000 and $49,000. Portions of each county except 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 and establishment of new programs. 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, 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, cultivating new technologies and fostering 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 10 7416 FMV Scholarship awards 3 4112 FMV Part I, Line 2: Funds are monitored and use is determined by board members. Scholarship awards are given to students pursuing a career in a healthcare field. Volunteers raise funds to award these scholarships and use is monitored and determined by the Volunteer board members. 1 1 0 0 0 0 0 0 0 Fred Manchur CEO - KHN 0 1329739 0 455301 0 1130248 0 54187 0 23280 0 2992755 0 0 Robert T Smith Physician 0 376358 0 120195 0 3302 0 14887 0 14847 0 529589 0 0 Rick Dodds Presdient - GMH/SOIN 0 334205 0 90000 0 1394 0 0 0 18309 0 443908 0 0 Troy A Tyner Physician 0 263090 0 0 0 0 0 14887 0 9184 0 287161 0 0 William M McCullough Jr Physician (Jan-Feb) 0 260447 0 0 0 0 0 12237 0 14358 0 287042 0 0 Ron Connovich GMH VP of Finance & Operations 0 279253 0 69497 0 2575 0 14887 0 17747 0 383959 0 0 John L Weimer Pharmacist 0 167504 0 36102 0 1081 0 0 0 4880 0 209567 0 0 Jill A Hope Pharmacist 0 156680 0 28775 0 2678 0 0 0 15192 0 203325 0 0 Brad Morrison Pharmacist 0 177590 0 4545 0 3588 0 475 0 19707 0 205905 0 0 Jeff Jones Pharmacist 0 154397 0 24272 0 2678 0 1017 0 15192 0 197556 0 0 Ovidiu E Gruia Pharmacist 0 126010 0 42402 0 2484 0 1339 0 13474 0 185709 0 0 Terri Day Former 0 833721 0 0 0 0 0 0 0 17663 0 851384 0 0 Terry Burns Exec VP-KHN & VP of Oper/Finance-KM 0 501937 0 144000 0 18742 0 14887 0 38646 0 718212 0 0 Mark Smith Former Officer 0 411796 0 122712 0 0 0 14887 0 17642 0 567037 0 0 Tim Ko GMH VP of Finance & Operations 0 307320 0 82735 0 1348 0 14887 0 16860 0 423150 0 0 Steve Chavez GMH VP of Finance & Operations 0 294385 0 76274 0 2656 0 14887 0 17753 0 405955 0 0 Belinda Mallett Former 0 226720 0 65486 0 0 0 14887 0 2280 0 309373 0 0 Richard Thomason Pharmacist 0 147390 0 24526 0 4238 0 0 0 19120 0 195274 0 0 James B Porter Former 0 88833 0 24886 0 51728 0 3707 0 13055 0 182209 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, Lines 4a-b Terri Day received a severance payment of $833,721. 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 100664666 10260823 2633592 1612304 85213731 944216 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 Andrew Day Son of Terri Day, former director 56800 Compensation 0 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 -511,321. 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 Memorial Hospital Services Inc 1 Prestige Place Suite 910 Miamisburg OH 45342 311358549 Physician Services OH 501(c)(3) 509(a)(3) 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 267135 FMV Alliance Physicians Inc J 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 511321 FMV Part V, Line 2 Kettering Medical Center is a conduit through which revenue is received and expenses are paid.