BEAVERCREEK MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- BEAVERCREEK MEDICAL CENTER (EIN 27-0712680)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201333199349302858
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T09:35:10-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310800053 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clark Schaefer Hackett & Co | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10100 Innovation Drive Suite 400 | AddressLine1 |
| City | Dayton | City |
| State | OH | State |
| ZIP Code | 45342 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 270712680 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Beavercreek Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BEAV | NameControl |
| Phone | 9373844550 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2110 Leiter Road | AddressLine1 |
| City | Miamisburg | City |
| State | OH | State |
| ZIP Code | 45342 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Clifton Patten | Name |
| Title | KHN CFO | Title |
| Phone | 9373844550 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Herbert L Lemaster CPA | Name |
| PTIN | P00039882 | PTIN |
| Phone | 9372260070 | Phone |
| Date Prepared | 2013-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Indu and Raj Soin Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Terry Burns | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2110 Leiter Road | AddressLine1 |
| City | Miamisburg | City |
| State | OH | State |
| ZIP Code | 45342 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 32103668 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.khnetwork.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2009 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | Provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 145 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 575500 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 14230 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 31892630 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 606860 | InvestmentIncomePriorYear |
| Investment Income Current Year | 195183 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1182360 | TotalRevenuePriorYear |
| Total Revenue Current Year | 32102043 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 238340 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 23145945 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2582628 | OtherExpensePriorYear |
| Other Expenses Current Year | 37041551 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2820968 | TotalExpensesPriorYear |
| Total Expenses Current Year | 60187496 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1638608 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -28085453 | RevenuesLessExpensesCY |
| Total Assets BOY | 135107554 | TotalAssetsBOY |
| Total Assets EOY | 168211497 | TotalAssetsEOY |
| Total Liabilities BOY | 100575898 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 106541394 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 34531656 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 61670103 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 51372599 | Expense |
| Revenue | 31695262 | Revenue |
| Description | Care was provided for 2,164 discharges, adult & ped days of 6,451, and 26,434 outpatient visits. | Description |
| Total Program Service Expense | 51372599 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Taxable Distributions | 0 | TaxableDistributions |
| Distribution To Donor | 0 | DistributionToDonor |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CLIFTON PATTEN | NamePerson |
| Telephone Number | 9373844550 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2110 LEITER ROAD | AddressLine1 |
| City | MIAMISBURG | City |
| State | OH | State |
| ZIP Code | 45342 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|---|
| Fred Manchur | ||||||||||
| KHN CEO | 1.00 | 39.00 | X | 0 | 1391797 | 390260 | ||||
| Terry Burns | ||||||||||
| GMH/SOIN President | 40.00 | X | 0 | 736819 | 40016 | X | ||||
| David Weigley | ||||||||||
| President Columbia Union C | 1.00 | X | 0 | 10000 | 0 | |||||
| Raj Attiken | ||||||||||
| Community Volunteer | 1.00 | X | 0 | 0 | 0 | |||||
| Donald Harting | ||||||||||
| Community Volunteer | 1.00 | X | 0 | 0 | 0 | |||||
| Michael McCullough MD | ||||||||||
| Physician | 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 | |||||
| Troy Tyner DO | ||||||||||
| Physician | 1.00 | X | 0 | 0 | 0 | |||||
| Stephen Zimmer | ||||||||||
| Community Volunteer | 1.00 | X | 0 | 0 | 0 | |||||
| Ronald Connovich | ||||||||||
| GMH/SOIN VP of Finance & Operations-3/12 to 9/12 | 40.00 | 0 | 221933 | 17507 | X | |||||
| Tim Ko | ||||||||||
| GMH/SOIN VP of Finance & Operations until 3/12 | 40.00 | 0 | 208927 | 27221 | X | |||||
| Steve Chavez | ||||||||||
| GMH/SOIN VP of Finance & Operations beginning 9/12 | 40.00 | 0 | 153117 | 17450 | X | |||||
| Belinda Mallett | ||||||||||
| GMH/SOIN VP of Patient Care Services | 40.00 | 0 | 350296 | 29042 | X | |||||
| James Porter | ||||||||||
| Director - Facility | 40.00 | 0 | 129317 | 20971 | X | |||||
| Jill Hope | ||||||||||
| Pharmacist | 40.00 | 0 | 122914 | 19945 | X | |||||
| Tim Garrity | ||||||||||
| Pharmacist | 40.00 | 0 | 121787 | 9266 | X | |||||
| Andrew Cain | ||||||||||
| Pharmacist | 40.00 | 0 | 115770 | 9655 | X | |||||
| Peggy Doyle | ||||||||||
| Director of Nursing | 40.00 | 0 | 115647 | 10437 | X | |||||
| Mark Smith | ||||||||||
| Former Officer | 0.00 | 40.00 | 0 | 433775 | 37812 | X | ||||
| Greg Henderson | ||||||||||
| Former Director & Officer | 0.00 | 0 | 372384 | 12029 | X | |||||
| Frank Perez | ||||||||||
| Former Director | 0.00 | 10.00 | 0 | 204000 | 0 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4688483 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 641611 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Government Grants | 14171 | GovernmentGrants |
| All Other Contributions | 59 | AllOtherContributions |
| Total Contributions | 14230 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient care services | Description |
| Business Code | 622000 | BusinessCode |
| Total Revenue Column | 31892630 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31695262 | RelatedOrExemptFunctionIncome |
| Exclusion | $197,368 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 31892630 | TotalProgramServiceRevenue |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 196808 | TotalRevenueColumn |
| Exclusion | $196,808 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1625 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -1625 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1625 | TotalRevenueColumn |
| Exclusion | -$1,625 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32102043 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31695262 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $392,551 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1174510 | Total |
| Management And General | 1174510 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18005243 | Total |
| Program Services | 15665480 | ProgramServices |
| Management And General | 2339763 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 749829 | Total |
| Program Services | 652389 | ProgramServices |
| Management And General | 97440 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2104502 | Total |
| Program Services | 1831024 | ProgramServices |
| Management And General | 273478 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1111861 | Total |
| Program Services | 967376 | ProgramServices |
| Management And General | 144485 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 249138 | Total |
| Management And General | 249138 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62648 | Total |
| Program Services | 1836 | ProgramServices |
| Management And General | 60812 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1870 | Total |
| Management And General | 1870 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3333746 | Total |
| Program Services | 2077517 | ProgramServices |
| Management And General | 1256229 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 302554 | Total |
| Program Services | 12893 | ProgramServices |
| Management And General | 289661 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1236218 | Total |
| Program Services | 1086554 | ProgramServices |
| Management And General | 149664 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 626438 | Total |
| Program Services | 31851 | ProgramServices |
| Management And General | 594587 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3335648 | Total |
| Program Services | 3051146 | ProgramServices |
| Management And General | 284502 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45625 | Total |
| Program Services | 42296 | ProgramServices |
| Management And General | 3329 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72387 | Total |
| Program Services | 72287 | ProgramServices |
| Management And General | 100 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6517250 | Total |
| Program Services | 5961383 | ProgramServices |
| Management And General | 555867 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8970515 | Total |
| Program Services | 8205406 | ProgramServices |
| Management And General | 765109 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 884375 | Total |
| Program Services | 811668 | ProgramServices |
| Management And General | 72707 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical supplies | 7440637 | 7423862 | 16775 |
| Physician services | 2856547 | 2856547 | |
| Cost of goods sold | 330761 | 330761 | |
| Minor equipment | 183239 | 182383 | 856 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 591955 | Total |
| Program Services | 107940 | ProgramServices |
| Management And General | 484015 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60187496 | Total |
| Program Services | 51372599 | ProgramServices |
| Management And General | 8814897 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4500000 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 6124841 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 832 | BOY |
| EOY | 1446264 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3500 | BOY |
| EOY | 57567 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 155593772 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8248597 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 117638519 | BOY |
| EOY | 147345175 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11505464 | BOY |
| EOY | 11849333 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1459239 | BOY |
| EOY | 1388317 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 135107554 | BOY |
| EOY | 168211497 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2448395 | BOY |
| EOY | 7856450 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98127503 | BOY |
| EOY | 98218510 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 466434 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100575898 | BOY |
| EOY | 106541394 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29456656 | BOY |
| EOY | 61095103 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5075000 | BOY |
| EOY | 575000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34531656 | BOY |
| EOY | 61670103 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 135107554 | BOY |
| EOY | 168211497 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -28085453 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 7750 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 55216150 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 122722048 | OtherCostOrOtherBasis |
| Depreciation | 4429016 | Depreciation |
| Book Value | 118293032 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 31350486 | OtherCostOrOtherBasis |
| Depreciation | 3819581 | Depreciation |
| Book Value | 27530905 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1521238 | OtherCostOrOtherBasis |
| Book Value | 1521238 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 147345175 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Estimated amounts due to third-party payors | -$279,000 |
| Professional self-insurance liability | $745,434 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 466434 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X, Line 2: | ReturnReference |
| Explanation | The Network completed an analysis of its tax positions in accordance with applicable accounting guidance at December 31, 2012 and 2011 and determined that no amounts were required to be recognized in the consolidated financial statements at December 31, 2012 or 2011. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6069647 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6069647 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10080 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4251592 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3245028 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1006564 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01670 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10321239 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3245028 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7076211 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11750 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1635984 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 836912 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 799072 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01330 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 36391 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 36391 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1672375 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 836912 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 835463 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01390 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11993614 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4081940 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7911674 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13140 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,624,904 | BadDebtExpenseAmount |
| Amount Attributable To | 38998 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8337768 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12107363 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3769595 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Beavercreek Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3535 Pentagon Boulevard | AddressLine1 |
| City | Beavercreek | City |
| State | OH | State |
| ZIP Code | 45431 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | ketteringhealth.org/soin/ | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Beavercreek Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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. A reconciliation between Medicare program amounts reported in Section B and the total Medicare program is below: Revenues Costs (Shortfall)SurplusMedicare Section B $ 8,337,768 $12,107,363 ($3,769,595) Other Medicare Programs $ 2,160,062 ($135,824) $2,295,887Total Medicare Programs $10,497,830 $11,971,539 ($1,473,708)Other Medicare programs include Medicare Part C and clinical laboratory and therapy programs not reportable in the Medicare Cost Report. Revenues and Costs for these programs are offset by differences in estimates of costs per the Medicare Cost Report and estimated total program costs during the hospital's first year of operations. | ||
| 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 V, Section B, Line 20d: 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 22: The hospital charged patients an amount equal to gross charges in select circumstances. This includes, for example, claims with insurance denials for non-cooperation. | Beavercreek Medical Center | |
| 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 1,631,000 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, 11.2% of area residents have income below $15,000. 10.3% have income between $15,000 and $24,000 and 27.3% have income between $25,000 and $49,000. Portions of Darke and Montgomery counties 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. | ||
| OH | Reports Filed With States | Part VI, Line 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Fred Manchur | ||||||||||||||
| KHN CEO | 0 | 1115235 | 0 | 191039 | 0 | 85523 | 0 | 373845 | 0 | 16415 | 0 | 1782057 | 0 | 0 |
| Terry Burns | ||||||||||||||
| GMH/SOIN President | 0 | 366858 | 0 | 0 | 0 | 369961 | 0 | 10550 | 0 | 29466 | 0 | 776835 | 0 | 0 |
| Ronald Connovich | ||||||||||||||
| GMH/SOIN VP of Finance & Operations- | 0 | 221267 | 0 | 0 | 0 | 666 | 0 | 0 | 0 | 17507 | 0 | 239440 | 0 | 0 |
| Tim Ko | ||||||||||||||
| GMH/SOIN VP of Finance & Operations | 0 | 206481 | 0 | 0 | 0 | 2446 | 0 | 10891 | 0 | 16330 | 0 | 236148 | 0 | 0 |
| Steve Chavez | ||||||||||||||
| GMH/SOIN VP of Finance & Operations | 0 | 152417 | 0 | 0 | 0 | 700 | 0 | 0 | 0 | 17450 | 0 | 170567 | 0 | 0 |
| Belinda Mallett | ||||||||||||||
| GMH/SOIN VP of Patient Care Services | 0 | 235350 | 0 | 0 | 0 | 114946 | 0 | 13687 | 0 | 15355 | 0 | 379338 | 0 | 77973 |
| James Porter | ||||||||||||||
| Director - Facility | 0 | 125076 | 0 | 81 | 0 | 4160 | 0 | 5821 | 0 | 15150 | 0 | 150288 | 0 | 0 |
| Mark Smith | ||||||||||||||
| Former Officer | 0 | 379840 | 0 | 50985 | 0 | 2950 | 0 | 13687 | 0 | 24125 | 0 | 471587 | 0 | 0 |
| Greg Henderson | ||||||||||||||
| Former Director & Officer | 0 | 372384 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 12029 | 0 | 384413 | 0 | 0 |
| Frank Perez | ||||||||||||||
| Former Director | 0 | 204000 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 204000 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | County of Greene Ohio | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 316000271 | IssuerEIN |
| CUSIP Number | 394650BV6 | CUSIPNumber |
| Date Issued | 2009-11-03 | DateIssued |
| Issue Price | 97931091 | IssuePrice |
| Description Of Purpose | Construct and equip a hospital | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 100032163 | TotalProceeds |
| Amount In Reserve Fund | 10520948 | AmountInReserveFund |
| Capitalized Interest | 2633592 | CapitalizedInterest |
| Issuance Costs From Proceeds | 1612304 | IssuanceCostsFromProceeds |
| Capital Expenditures | 85213731 | CapitalExpenditures |
| Other Spent Proceeds | 51588 | OtherSpentProceeds |
| Year Of Subst Completion | 2012 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 1 | MngmentCntrctBondFinancdPrprty |
| Engage Bond Counsel Contracts | 1 | EngageBondCounselContracts |
| Any Research Agreements | 1 | AnyResearchAgreements |
| Engage Bond Counsel Research | 1 | EngageBondCounselResearch |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 1 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 1 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 1 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 1 | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II, Line 3, Column A | Identifier |
| Explanation | Includes investment earnings of $2,101,072 | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| New Program Services | Form 990, Part III, line 2 | Beavercreek Medical Center officially opened in 2012. This is the first year with patient revenue. |
| 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. | |
| Officers Compensation | Part VII; Section A | Tim Ko was the financial officer until March 2012. Ron Connovich was the financial officer from March 2012 to August 2012 and November 2012 to present. Steve Chavez was the financial officer from September 2012 to November 2012. |
| Changes in Net Assets or Fund Balances: | Form 990, Part XI, line 9: | Net transfers from affiliate 55,216,150. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Alliance Physicians Inc | ||||||||||
| 2110 Leiter Road | Miamisburg | OH | 45342 | 311175717 | Physician Services | OH | 501(c)(3) | 509(a)(3) | Kettering Adventist Healthcare | 0 |
| Dayton Osteopathic Hospital | ||||||||||
| 2110 Leiter Road | Miamisburg | OH | 45342 | 310564121 | Hopsital | OH | 501(c)(3) | 509(a)(1) | Kettering Adventist Healthcare | 0 |
| The Fort Hamilton Hospital | ||||||||||
| 2110 Leiter Road | Miamisburg | OH | 45342 | 310536662 | Hopsital | OH | 501(c)(3) | 509(a)(1) | Kettering Adventist Healthcare | 0 |
| Greene Foundation | ||||||||||
| 2110 Leiter Road | Miamisburg | OH | 45342 | 310886949 | Fundraising | OH | 501(c)(3) | 509(a)(1) | Greene Memorial Hospital | 0 |
| Greene Memorial Hospital | ||||||||||
| 2110 Leiter Road | Miamisburg | OH | 45342 | 310809436 | Hopsital | OH | 501(c)(3) | 509(a)(1) | Kettering Adventist Healthcare | 0 |
| Greene Memorial Hospital Services Inc | ||||||||||
| 2110 Leiter Road | Miamisburg | OH | 45342 | 311358549 | Physician Services | OH | 501(c)(3) | 509(a)(3) | Kettering Adventist Healthcare | 0 |
| Kettering Adventist Healthcare | ||||||||||
| 2110 Leiter Road | Miamisburg | OH | 45342 | 311051688 | Management | OH | 501(c)(3) | 509(a)(3) | Kettering Adventist Healthcare | 0 |
| Kettering Medical Center | ||||||||||
| 2110 Leiter Road | Miamisburg | OH | 45342 | 310621866 | Hospital | OH | 501(c)(3) | 509(a)(1) | Kettering Adventist Healthcare | 0 |
| Kettering Medical Center Foundation | ||||||||||
| 2110 Leiter Road | Miamisburg | OH | 45342 | 237419897 | Fundraising | OH | 501(c)(3) | 509(a)(3) | Kettering Medical Center | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Alliance Physicians Inc | ||
| M | 0 | FMV |
| Kettering Medical Center | ||
| M | 0 | FMV |
| Kettering Medical Center | ||
| N | 0 | FMV |
| Kettering Medical Center | ||
| O | 0 | FMV |
| Kettering Medical Center | ||
| P | 0 | FMV |
| Kettering Medical Center | ||
| S | 55216150 | FMV |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Transactions with Related Organizations | Identifier |
| Return Reference | Part V; Line 2 | ReturnReference |
| Explanation | Kettering Medical Center is the conduit through which revenue is received and expenses are paid. | Explanation |
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