2013-11-15T09:35:10-06:00 2012-12-31 310800053 Clark Schaefer Hackett & Co 10100 Innovation Drive Suite 400 Dayton OH 45342 990 2012-01-01 310564121 Dayton Osteopathic Hospital DAYT 9373844550 2110 Leiter Road Miamisburg OH 45342 Clifton Patten 9373844550 2013-11-14 1 Herbert L Lemaster CPA P00039882 9372260070 2013-11-13 2012 2016-02-25 16:41:14Z Grandview Hospital and Medical Center Richard Haas 2110 Leiter Road Miamisburg OH 45342 315550798 0 X www.khnetwork.org X 1939 OH To provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner 10 5 2400 167 123683 0 1385585 2813129 283198777 311598510 887686 137751 0 0 285472048 314549390 0 0 0 0 128519471 125486522 0 0 0 154006290 174044292 282525761 299530814 2946287 15018576 248003452 248822106 207260838 209248074 40742614 39574032 To provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner 0 0 252517057 310195512 Grandview Medical Center, Southview Medical Center, and other patient care related services provided care for 11,654 discharges, 50,355 adult & ped days, and 302,625 outpatient visits. 252517057 1 1 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 0 0 2400 1 1 1 0 0 0 0 0 0 0 0 0 X 10 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X Clifton Patten 9373844550 2110 Leiter Road Miamisburg OH 45342 Fred Manchur 1.00 39.00 X 0 1391797 390260 Richard Haas 40.00 0.00 X X 0 565914 54364 Dave Weigley 1.00 X 0 10000 0 John Sefton DO 1.00 X 0 2703 0 Kenneth Pugar DO 1.00 X 0 0 0 Shelia Burton 1.00 X 0 0 0 Gayle Johnson 1.00 X 0 0 0 Lyndell Dickerson 1.00 X 0 0 0 Les Neff 1.00 X 0 0 0 J Bradford Gamblin 1.00 X 0 0 0 Todd Anderson 40.00 X 0 309500 18938 Dave Seidel 40.00 X 0 476737 34970 Rita Pritchard 40.00 X 0 150774 24045 Robert Cain DO 40.00 X 230092 0 24811 Rebecca Lewis 40.00 X 217941 0 13799 Mike Sieving 40.00 X 191391 0 0 Linda McCall 40.00 X 150865 0 12479 Keith Achor 40.00 X 139918 0 11846 Russ Wetherell 0.00 40.00 X 0 599607 281605 Pete King 0.00 40.00 X 0 472068 65614 Thomas Hardy DO 0.00 0.00 X 0 296956 30069 Frank Perez 0.00 10.00 X 0 204000 0 930207 4480056 962800 39 1 1 0 0 2753596 59533 2813129 Patient care services 622000 311474827 310195512 1279315 Reference lab 621500 123683 123683 311598510 353978 353978 364 364 316352 468465 0 1001408 316352 -532943 -216591 -216591 314549390 310195512 123683 1417066 4669414 4669414 97738053 82725385 15012668 3854267 3262247 592020 12940263 10952625 1987638 6284525 5319215 965310 990482 990482 147650 40663 106987 53717 23333 30384 49526 49526 26788921 18909391 7879530 289393 113269 176124 6760981 6552193 208788 4544230 368923 4175307 5357183 3906463 1450720 274854 231076 43778 154347 154198 149 6174003 4502089 1671914 20635688 15047565 5588123 5286546 4969916 316630 Medical supplies 51622278 51588941 33337 Physician services 24447653 24447653 Cost of goods sold 6901023 6901023 Hospital assessment 4045539 4045539 9520278 8455350 1064928 299530814 252517057 47013757 0 2045378 3674499 72314 72394 43875983 36957948 308393 252237 4564019 4992413 891622 678965 307713309 132800687 174125361 174912622 15336145 21102069 4584148 4172348 2200089 2006611 248003452 248822106 20728796 25871423 224524 9395 97882256 93031156 209801 97746 15862700 14812648 72352761 75425706 207260838 209248074 X 40672391 39574032 70223 0 40742614 39574032 248003452 248822106 X 15018576 198897 -16386055 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 1 1.50 1 0 1 1 20.00 5670 0 14959707 14959707 653300 163125039 65228113 98550226 23563864 7601576 15962288 72852152 59970998 12881154 32559247 32559247 174912622 Accrued pension liability 22160206 Athletic sponsorship 688859 Due to affiliate 129290 Estimated amounts due to third-party payors -413053 Other long-term liabilities 125000 Physician income guarantee commitments 6250 Professional self-insurance liability 15575120 Synthetic lease obligations 37154034 75425706 X Explanation of Easements Enforcement Policies: Part II, Line 5: KHN does have a policy on conservation easements. The expense to monitor the conservation easement is recorded as incurred to the hospital There is no income from the easement and no asset has been recorded. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: 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. 1 1 X 1 X 1 X 1 1 0 1 1 14711085 6356872 8354213 0.02790 34614688 28126642 6488046 0.02170 49325773 34483514 14842259 0.04960 535488 535488 0.00180 13807499 7478201 6329298 0.02110 10621444 4513806 6107638 0.02040 130642 130642 0.00040 25095073 11992007 13103066 0.04370 74420846 46475521 27945325 0.09330 1 4736680 113680 50875366 52781556 -1906190 X 1 1 1 Grandview Associates Medical Office Building 0.92000 0.08000 2 Southview Orthopedic Center Medical Service Venture 0.51000 0.49000 2 1 Grandview Medical Center

405 W Grand Avenue Dayton OH 45405

ketteringhealth.org X X X X A 2 Southview Medical Center

1997 Miamisburg Centerville Road Centerville OH 45459

ketteringhealth.org X X X X A Grandview Medical Center Group A 0 1 1 100.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X X 1 0 X X X 1 X 0 0 9 Yankee Medical Center

7677 Yankee Street Centerville OH 45459

Outpatient Clinic & Diag. Ctr Corwin M Nixon Health Center

1470 N Broadway Lebanon OH 45036

Circulatory & Wound Ctr Preble County Medical Ctr

450-B Washington Jackson Rd Eaton OH 45320

Outpatient Clinic & Diag. Ctr Beavercreek Health Center

2510 Commons Blvd Beavercreek OH 45431

Diagnostic Ctr and Rehab Clinic Charles H Huber Health Ctr

8701 Old Troy Pike Huber Heights OH 45424

Outpatient Clinic & Diag. Ctr Victor J Cassano Health Ctr

165 Edwin C Moses Blvd Dayton OH 45402

Diagnostic Ctr Cornerstone Medical Ctr

7740 Washington Village Dr Centerville OH 45459

Outpatient Clinic & Diag. Ctr Sugarcreek Health Ctr

6438 Wilmington Pike Dayton OH 45459

Outpatient Clinic & Diag. Ctr Englewood Health Center

1250 W National Road Suite 200500 Clayton OH 45315

Urgent Care & Diagnostic Ctr Part I, Line 6a: The organization provides an annual community benefit report that is made available to the public. Part I, Line 7: Charity care is calculated using a cost to charge ratio following the methodology of Worksheet 2. Medical costs are calculated using a cost accounting system that addresses all patient segments. Community health improvement services are calculated on the basis of direct expenditures. Health professions education is calculated based on the Medicare cost report. Subsidized health services is calculated based on the non-Medicare, Medicaid and charity care proportion of departmental losses for the specific programs. Cash and in-kind contributions are calculated on the basis of direct expenditures. Part I, Line 7g: Subsidized health services represent the non-needs based and non-Medicare program losses of services the hospital offers. Part III, Line 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 Medicare cost report. Medicare costs have not been included in Community Benefit in Part I. A reconciliation between Medicare program amounts reportable in Section B and the total Medicare program is below: Revenues Costs (Shortfall)SurplusMedicare Section B $50,875,366 $52,781,556 ($1,906,190) Other Programs $36,516,140 $29,290,367 $7,225,773Total Medicare Program $87,391,506 $82,071,923 $5,319,583Other Medicare Programs include Medicare Part C and Clinical laboratory and other therapy services not reportable in the Medicare Cost Report. 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 A: Each facility listed is required to be licensed, registered, or recognized as a healthcare facility under state law. Part VI, Line 2: Grandview, as a Christian organization,is charged with providing health education and screenings to look after those who cannot otherwise afford to do so. Programs and support groups that helped community members included childbirth education, infant CPR, stroke support, diabetes education, first aid, and more. These programs touched people from various age, gender, and socio-economic groups. Part VI, Line 3: Grandview 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 Grandview's charity care policy as follows:-Grandview has a financial assistance brochure that is included in all of the patient information kits given at the time of intake or registration into any facility or department.-There is information posted in all of the admitting and registration areas about charity care and financial assistance.-During the registration process there is specific scripting to ask patients if they would like to disclose family size and income to screen them for federal/state/local and hospital based charity/assistance programs. This data is available for future visits as well.-Grandview has the reporting capability to review and screen any patient who may have been admitted during registration "off hours" for eligibility and assistance.-Grandview 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 Grandview's HCAP or Charity Sliding Scale program.-Grandview'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 services 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: Grandview 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, acquistion of the most-advanced medical technology, upgrades of existing hospital structures and construction of new facilities in order to provide accessible, efficient, quality care. As a nationally-recognized osteopathic teaching hospital, Grandview partners with the Ohio University College of Osteopathic Medicine to enhance state-of-the-art medical education tools and programs. Medical research is supported through the Innovation Center, cultivating new technologies and fostering best practices among partners from industry, academia, and healthcare. Part VI, Line 6: The following describes the respective roles of Grandview and its affiliates in promoting the health of the communities served by the system:-Grandview is dedicated to the creation and maintenance of community wellness programs, support groups and health education programs. Grandview provides numerous screenings, family-focused classes, health fairs, conferences, donations and education programs to ensure the long-term well-being of people living in the community.-Grandview is affiliated with the Ohio University College of Osteopathic Medicine. The teaching programs have been an integral part of Grandview's emergence as one of the nation's leading Osteopathic hospitals for clinical quality.-The Grandview Foundation is the philanthropic arm of Grandview Medical Center and supports the education of future osteopathic physicians.-Kettering Affiliated Health Services, Inc. includes Sycamore Glen Health Center, Sycamore Glen Retirement Community, and Kettering Mobile Imaging. These health care areas provide services to the surrounding communities which complement those services provided by Grandview 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 healthcare. Reports Filed With States Part VI, Line 7 OH Part V, Line 8 Facility Reporting Group A See below Facility 1 -- Grandview Medical Center 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. Facility 1 -- Grandview 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. Facility 2 -- Southview Medical Center 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. Facility 2 -- Southview 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. 0 1 0 0 0 0 0 0 0 Fred Manchur 0 1115235 0 191039 0 85523 0 373845 0 16415 0 1782057 0 0 Richard Haas 0 542896 0 0 0 23018 0 33482 0 20882 0 620278 0 0 Todd Anderson 0 307573 0 0 0 1927 0 8501 0 10437 0 328438 0 0 Dave Seidel 0 201848 0 0 0 274889 0 13687 0 21283 0 511707 0 200190 Rita Pritchard 0 148776 0 0 0 1998 0 10228 0 13817 0 174819 0 0 Robert Cain DO 226917 0 81 0 3094 0 13245 0 11566 0 254903 0 0 0 Rebecca Lewis 213518 0 0 0 4423 0 0 0 13799 0 231740 0 0 0 Mike Sieving 191350 0 41 0 0 0 0 0 0 0 191391 0 0 0 Linda McCall 149614 0 81 0 1170 0 8096 0 4383 0 163344 0 0 0 Keith Achor 123641 0 15107 0 1170 0 7463 0 4383 0 151764 0 0 0 Russ Wetherell 0 574902 0 0 0 24705 0 276177 0 5428 0 881212 0 0 Pete King 0 377146 0 0 0 94922 0 38408 0 27206 0 537682 0 59110 Thomas Hardy DO 0 296956 0 0 0 0 0 13687 0 16382 0 327025 0 0 Frank Perez 0 204000 0 0 0 0 0 0 0 0 0 204000 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. Supplemental Information Part III 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 Montgomery Ohio 316000172 2011-12-10 77819579 Current refund 0 0 0 B County of Montgomery Ohio 316000172 2012-05-01 15952311 Current refund 0 0 0 A 77819579 69874 77749705 2011 1 0 1 1 B 15952311 83606 15868705 2012 1 0 1 1 A 0 0 1 1 1 1 0.00000 0.00000 0.00000 1 0 0 B 0 0 1 1 1 1 0.00000 0.00000 0.00000 1 0 0 A 0 0 1 0 1 1 Merrill Lynch Capital Services 16.200000000000 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 Richard Manchur Family of Director Fred Manchur 96351 Compensation 0 Argo LLC Director John Sefton is 20% owner 154410 Property rental 0 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Net transfers to affiliate -10,745,672. Change in plan assets and benefit obligation of pension plan -5,640,383. Alliance Physicians Inc 2210 Leiter Road Miamisburg OH 45342 311175717 Physician Services OH 501(c)(3) 509(a)(3) Kettering Adventist Healthcare 0 Beavercreek Medical Center 2210 Leiter Road Miamisburg OH 45342 270712680 Hospital OH 501(c)(3) 509(a)(1) Kettering Adventist Healthcare 0 The Fort Hamilton Hospital 2210 Leiter Road Miamisburg OH 45342 310536662 Hospital OH 501(c)(3) 509(a)(1) Kettering Adventist Healthcare 0 Grandview Foundation 405 W Grand Avenue Dayton OH 45405 311649591 Fundraising OH 501(c)(3) 509(a)(3) N/A 0 Greene Memorial Hospital 2210 Leiter Road Miamisburg OH 45342 310809436 Hospital OH 501(c)(3) 509(a)(1) Kettering Adventist Healthcare 0 Greene Memorial Hospital Services Inc 2210 Leiter Road Miamisburg OH 45342 311358549 Physician Services OH 501(c)(3) 509(a)(3) Kettering Adventist Healthcare 0 Kettering Adventist Healthcare 2210 Leiter Road Miamisburg OH 45342 311051688 Management OH 501(c)(3) 509(a)(3) N/A 0 Kettering Affiliated Health Services Inc 2210 Leiter Road Miamisburg OH 45342 311127485 Health Services OH 501(c)(3) 509(a)(3) Kettering Adventist Healthcare 0 Kettering Medical Center 2210 Leiter Road Miamisburg OH 45342 310621866 Hospital OH 501(c)(3) 509(a)(1) Kettering Adventist Healthcare 0 Grandview Associates 405 W Grand Avenue Dayton OH 45405 311427280 Building Management OH Dayton Osteopathic Hospital Inc Related -8650 1433605 0 1 0.92000 Southview Orthopedic Center Management Company LLC 1997 Miamisburg-Centerville Road Dayton OH 45459 262040203 Medical Services OH Dayton Osteopathic Hospital Inc Related 4326553 2048225 0 41 1 0.51000 Kettcor 2110 Leiter Road Miamisburg OH 45342 311078381 Health Services OH Kettering Adventist Healthcare C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 Grandview Foundation C 2753596 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 R 10745672 FMV Transactions With Related Organizations PART V; LINE 2 Kettering Medical Center is the conduit through which revenue is received and expenses are paid.