2016-11-15T09:47:16-06:00 2015-12-31 310800053 Clark Schaefer Hackett & Co 10100 Innovation Drive Suite 400 Dayton OH 45342 990 2015-01-01 270712680 Beavercreek Medical Center BEAV 9377621629 1 Prestige Place No 910 Miamisburg OH 45342 Clifton Patten KHN CFO 9377621629 2016-11-14 1 Herbert L Lemaster CPA P00039882 9372260070 2016-11-14 2015 2017-02-10 21:41:12Z The Indu and Raj Soin Medical Center Rick Dodds 1 Prestige Place Suite 910 Miamisburg OH 45342 114428929 0 X www.ketteringhealth.org X 2009 OH Provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner 12 4 0 306 8119 2226 52521 562513 100635191 113705188 240286 121498 0 0 100927998 114389199 8121 9002 0 0 41407875 49382582 0 0 0 57476525 63236442 98892521 112628026 2035477 1761173 167058317 177226564 108237220 110987814 58821097 66238750 Provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner 0 0 95887521 9002 112938370 Care was provided for 5,403 discharges, adult & ped days of 18,038, and 65,948 outpatient visits. 95887521 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 X 12 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Clifton Patten 9377621629 1 Prestige Place Suite 910 Miamisburg OH 45342 Terri Day President - KHN (until Nov 2015) 1.00 50.00 X 0 4447732 51435 Fred Manchur CEO - KHN 1.00 50.00 X 0 3794331 73757 Terry Burns President GMH/SOIN (until Nov 2015) 24.00 27.00 X X 0 530800 48287 Jarrod McNaughton President KMC (Nov-Dec) 1.00 50.00 X 0 399047 31295 Troy Tyner DO Physician 1.00 9.00 X 0 390236 4484 Michael McCullough MD Physician 1.00 39.00 X 0 290152 33572 Rick Dodds Presisdent - GMH/SOIN (Nov-Dec) 24.00 27.00 X X 0 284866 4437 David Weigley Pres. Columbia Union Conference of SDA 1.00 5.00 X 0 10000 0 Ron Halvorsen Jr Pres. Ohio Conference of SDA 1.00 3.00 X 0 0 0 Donald Harting Community Volunteer 1.00 1.00 X 0 0 0 Thomas Peebles Community Volunteer 1.00 2.00 X 0 0 0 Phillip Parker Pres. Dayton Chamber of Commerce 1.00 1.00 X 0 0 0 Amol Soin MD Physician 1.00 1.00 X 0 0 0 Stephen Zimmer Community Volunteer 1.00 1.00 X 0 0 0 Ronald Connovich GMH/SOIN VP of Oper/Finance 24.00 25.00 X 0 289431 35717 Belinda Mallett GMH/SOIN VP of Patient Care 24.00 24.00 X 0 286435 33260 Jill Hope Pharmacist 40.00 0.00 X 0 156698 26586 Richard Thomason Pharmacist 40.00 0.00 X 0 135918 26888 Tim Garrity Pharmacist 40.00 0.00 X 0 122299 13215 Grant Warren Pharmacist 40.00 0.00 X 0 122289 12243 Peggy Doyle Director of Nursing (until Nov 2015) 40.00 0.00 X 0 121538 1974 Mark Smith Former Officer 0.00 48.00 X 0 546299 43292 Steve Chavez Former Officer 0.00 48.00 X 0 334458 35774 Tim Ko Former Officer 0.00 48.00 X 0 300970 35138 0 12563499 511354 0 1 1 0 0 562513 562513 Patient care services 622000 113647040 112888341 758699 Rental income from related medica 531120 50029 50029 Reference lab 621500 8119 8119 113705188 17 17 138035 138035 23176 11821 27909 -11821 -4733 -16554 -16554 114389199 112938370 8119 880197 X 9002 9002 1453025 1267708 185317 38815457 32436996 6378461 1568003 1310336 257667 5179954 4328743 851211 2366143 1977320 388823 243047 212049 30998 18075 8241 9834 1600 1600 6950794 4200520 2750274 405352 34 405318 1516847 1397302 119545 1769443 166356 1603087 1039811 920170 119641 101120 68946 32174 50146 45334 4812 9165215 8110663 1054552 13951955 12346639 1605316 401625 289956 111669 Medical supplies 19372581 19371405 1176 Physician services 4841419 4841419 Hospital assessment 1138871 1138871 Cost of goods sold 891217 891217 1377324 548294 829030 112628026 95887521 16740505 0 13840 12897418 18667851 1725553 2332574 146103 177870 185420469 41719831 140103979 143700638 10924950 12347631 1246474 167058317 177226564 8732390 10284065 98400524 97315978 1104306 3387771 108237220 110987814 X 58246097 65663750 575000 575000 58821097 66238750 167058317 177226564 X 1761173 -31825 5688305 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 140357259 22736808 117620451 36552694 18983023 17569671 8510516 8510516 143700638 Professional self-insurance liability 1099427 Estimated amounts due to third-party payors 2288344 3387771 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, 2015 or 2014. 1 1 X 1 X 1 X 1 1 0 1 1 3096149 2035943 1060206 0.00940 26762293 14091836 12670457 0.11250 29858442 16127779 13730663 0.12190 102519 102519 0.00090 1192249 214818 977431 0.00870 115733 115733 0.00100 1410501 214818 1195683 0.01060 31268943 16342597 14926346 0.13250 1 1509137 36219 17906638 23942961 -6036323 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 13 1 1 1 1 X http://www.ketteringhealth.org/aboutus X 1 14 1 http://www.ketteringhealth.org/aboutus 0 0 1 X 100.000000000000 300.000000000000 X X X X 1 1 X X X 1 X http://www.ketteringhealth.org/financial X http://www.ketteringhealth.org/financial X X 1 X 0 X X X 1 X 0 1 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: Partners in the data review process and in the process for identifying and prioritizing community health needs and services are the Board of Trustees and executive leadership of Soin Medical Center, community health collaboratives featuring community, health, and business stakeholders/advocates organized by both Soin Medical Center, and the Greater Dayton Area Hospital Association with its member hospitals. These partners were consulted through the use of focus groups.To prepare the CHNA, primary and secondary data were collected in order to paint a detailed picture of the Soin Medical Center Service Area. Primary data is collected directly from first-hand experience and secondary data is data that has already been collected and archived by other organizations.For Soin's Community Health Needs Assessment, primary data were collected by surveying 975 Greene County adults using the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS). Secondary data were collected from sources such as the Ohio Hospital Association via the Greater Dayton Area Hospital Association, the Ohio Department of Health, the Health Resources and Services Administration(HRSA), the Bureau of the Census, and the Robert Wood Johnson Foundation, among others. Beavercreek Medical Center Part V, Section B, Line 6a: Soin Medical Center partnered with member hospitals of the Greater Dayton Area Hospital Association to prepare the Community Health Needs Assessment (CHNA) for the hospital's service area. Beavercreek Medical Center Part V, Section B, Line 6b: Soin Medical Center also partnered with Wright State University to prepare the Community Health Needs Assessment (CHNA) for the hospital's service area. Beavercreek Medical Center Part V, Section B, Line 11: Five health priorities were identified for adults in the service area: heart disease, breast cancer, diabetes, chronic lower respiratory disease, and unintentional injury. Two of these, heart disease and diabetes, will be addressed by the Soin Medical Center. Greene Memorial Hospital will address Breast Cancer in its Hospital Implementation Strategy. The remaining health priorities will be addressed by other organizations within the service area. Beavercreek Medical Center Part V, Section B, Line 22d: The hospital provided a discount on medically necessary hospital services to uninsured patients who do not qualify under the charity care policy. Beavercreek Medical Center Part V, Section B, Line 24: The hospital charged patients an amount equal to gross charges in select circumstances. This includes, for example, claims with insurance denials for non-cooperation. 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 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 1,656,000 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, Sycamore Glen Retirement Community, and Kettering Breast Evaluation Centers. These health care 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 13 9002 FMV Part I, Line 2: Funds are monitored and use is determined by board members. 0 1 0 0 0 0 0 0 0 Terri Day President - KHN (until Nov 2015) 0 968409 0 262893 0 3216430 0 14587 0 36848 0 4499167 0 1925976 Fred Manchur CEO - KHN 0 1261849 0 390258 0 2142224 0 53887 0 19870 0 3868088 0 1027903 Terry Burns President GMH/SOIN (until Nov 2015) 0 407358 0 105182 0 18260 0 14587 0 33700 0 579087 0 0 Jarrod McNaughton President KMC (Nov-Dec) 0 326266 0 70916 0 1865 0 14587 0 16708 0 430342 0 0 Troy Tyner DO Physician 0 390236 0 0 0 0 0 0 0 4484 0 394720 0 0 Michael McCullough MD Physician 0 290152 0 0 0 0 0 14587 0 18985 0 323724 0 0 Rick Dodds Presisdent - GMH/SOIN (Nov-Dec) 0 259026 0 25205 0 635 0 0 0 4437 0 289303 0 0 Ronald Connovich GMH/SOIN VP of Oper/Finance 0 227819 0 59569 0 2043 0 14587 0 21130 0 325148 0 0 Belinda Mallett GMH/SOIN VP of Patient Care 0 222350 0 57781 0 6304 0 14587 0 18673 0 319695 0 0 Jill Hope Pharmacist 0 141293 0 11464 0 3941 0 9375 0 17211 0 183284 0 0 Richard Thomason Pharmacist 0 113081 0 18755 0 4082 0 6051 0 20837 0 162806 0 0 Mark Smith Former Officer 0 438754 0 105182 0 2363 0 14537 0 28755 0 589591 0 0 Steve Chavez Former Officer 0 269986 0 62406 0 2066 0 14587 0 21187 0 370232 0 0 Tim Ko Former Officer 0 240251 0 59569 0 1150 0 14587 0 20551 0 336108 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 A 100530461 10126618 2633592 1612304 85213731 944216 2012 0 0 1 1 A 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 Form 990, Part VI, Section B, line 11 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 from affiliate 5,688,305. 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 0 1 Greene Foundation C 562513 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 S 5688305 FMV Part V, Line 2 Kettering Medical Center is a conduit through which revenue is received and expenses are paid.