BEAVERCREEK MEDICAL CENTER: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- BEAVERCREEK MEDICAL CENTER (EIN 27-0712680)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-14
- IRS object ID
- 201223199349305232
- Schema version
- 2011v1.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-14T14:05:48-08:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | MIAMISBURG | City |
| State | OH | State |
| ZIP Code | 45342 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | 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 | VP OF FINANCE & DECISION SUPPORT | Title |
| Phone | 9373844550 | Phone |
| Date Signed | 2012-11-12 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HERBERT L LEMASTER CPA | Name |
| Phone | 9372260070 | Phone |
| Date Prepared | 2012-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CLIFTON PATTEN | 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 | 1182360 | GrossReceipts |
| Group Return For Affiliates | false | 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 | Startup activities for new facility that will provide quality healthcare to individuals and the community as a whole in a Judeo-Christian manner | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 13000000 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 575500 | ContributionsGrantsCurrentYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1443535 | InvestmentIncomePriorYear |
| Investment Income Current Year | 606860 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 14443535 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1182360 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Current Year | 238340 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2720342 | OtherExpensePriorYear |
| Other Expenses Current Year | 2582628 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2720342 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2820968 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 11723193 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1638608 | RevenuesLessExpensesCY |
| Total Assets BOY | 167601243 | TotalAssetsBOY |
| Total Assets EOY | 135107554 | TotalAssetsEOY |
| Total Liabilities BOY | 104809113 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 100575898 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 62792130 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 34531656 | NetAssetsOrFundBalancesEOY |
| Mission Description | Startup activities for new facility | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 296687 | Expense |
| Description | SEE MISSION STATEMENT ABOVE. | Description |
| Total Program Service Expense | 296687 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTON PATTEN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| FRED MANCHUR | ||||||||
| KHN President | 1.00 | X | 0 | 1464243 | 391337 | |||
| GREG HENDERSON | ||||||||
| GMH/SOIN President | 40.00 | X | 0 | 955900 | 29254 | X | ||
| TROY TYNER DO | ||||||||
| Physician | 1.00 | X | 0 | 243396 | 0 | |||
| TERRY BURNS | ||||||||
| GMH/SOIN President | 40.00 | X | 0 | 189043 | 23640 | X | ||
| WM MICHAEL MCCULLOUGH MD | ||||||||
| Physician | 1.00 | X | 0 | 42052 | 0 | |||
| RAJ ATTIKEN | ||||||||
| Community Volunteer | 1.00 | X | 0 | 0 | 0 | |||
| DONALD HARTING | ||||||||
| Community Volunteer | 1.00 | X | 0 | 0 | 0 | |||
| PETER LUONGO | ||||||||
| Community Volunteer | 1.00 | X | 0 | 0 | 0 | |||
| ROBERT MILLS | ||||||||
| Community Volunteer | 1.00 | X | 0 | 0 | 0 | |||
| THOMAS PEEBLES | ||||||||
| Community Volunteer | 1.00 | X | 0 | 0 | 0 | |||
| PHILLIP PARKER | ||||||||
| Pres, Dayton Chamber of Commerce | 1.00 | X | 0 | 0 | 0 | |||
| SUSAN PHILLIPS | ||||||||
| Community Volunteer | 1.00 | X | 0 | 0 | 0 | |||
| SHAMIM SHAMSI MD | ||||||||
| Physician | 1.00 | X | 0 | 0 | 0 | |||
| AMOL SOIN MD | ||||||||
| Physician | 1.00 | X | 0 | 0 | 0 | |||
| DAVID WEIGLEY | ||||||||
| President Columbia Union Conf of SDA | 1 | X | ||||||
| STEPHEN ZIMMER | ||||||||
| Community Volunteer | 1 | X | ||||||
| MARK SMITH | ||||||||
| GMH CFO | 40 | 370066 | 23938 | X | ||||
| TIM KO | ||||||||
| GMH CFO | 40 | 195510 | 16313 | X | ||||
| BELINDA MALLETT | ||||||||
| VP of Patient Care Services | 40 | 270811 | 59210 | X | ||||
| FRANK PEREZ | ||||||||
| Former Director | 0 | 823860 | 21562 | X | ||||
| TIM POLLARD | ||||||||
| Former CFO | 0 | 141373 | X | |||||
| MICHAEL CACCAMO MD | ||||||||
| Physician | 0 | 24000 | X | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp Frm Rltd Orgs | 4720254 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 565254 | TotalOtherCompensation |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| All Other Contributions | 575500 | AllOtherContributions |
| Total Contributions | 575500 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 204581 | TotalRevenueColumn |
| Exclusion | $204,581 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -3 | TotalRevenueColumn |
| Exclusion | -$3 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 402282 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 402282 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 402282 | TotalRevenueColumn |
| Exclusion | $402,282 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1182360 | TotalRevenueColumn |
| Exclusion | $606,860 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 194000 | Total |
| Program Services | 174522 | ProgramServices |
| Management And General | 19478 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1691 | Total |
| Program Services | 1521 | ProgramServices |
| Management And General | 170 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39284 | Total |
| Program Services | 35340 | ProgramServices |
| Management And General | 3944 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3365 | Total |
| Program Services | 3027 | ProgramServices |
| Management And General | 338 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2125 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 2125 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83361 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 83361 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 146623 | Total |
| Program Services | 66040 | ProgramServices |
| Management And General | 80583 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26267 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 26267 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15891 | Total |
| Program Services | 12782 | ProgramServices |
| Management And General | 3109 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31403 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 31403 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2616 | Total |
| Program Services | 2616 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187 | Total |
| Program Services | 187 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2161818 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 2161818 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22264 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 22264 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Minor miscellaneous expenses | Description |
| Total | 90073 | Total |
| Program Services | 652 | ProgramServices |
| Management And General | 89421 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2820968 | Total |
| Program Services | 296687 | ProgramServices |
| Management And General | 2524281 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7000000 | BOY |
| EOY | 4500000 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 832 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2500 | BOY |
| EOY | 3500 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 117638519 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75963221 | BOY |
| EOY | 117638519 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83105362 | BOY |
| EOY | 11505464 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1530160 | BOY |
| EOY | 1459239 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 167601243 | BOY |
| EOY | 135107554 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6772617 | BOY |
| EOY | 2448395 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98036496 | BOY |
| EOY | 98127503 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 104809113 | BOY |
| EOY | 100575898 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51831307 | BOY |
| EOY | 29456656 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10960823 | BOY |
| EOY | 5075000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62792130 | BOY |
| EOY | 34531656 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 167601243 | BOY |
| EOY | 135107554 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1638608 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -26621866 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| Public Support Total170 | 0 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Pertcentage170 | 0 | PublicSupportPertcentage170 |
| Public Support Total509 | 0 | PublicSupportTotal509 |
| Public Support Percentage509 | 0 | PublicSupportPercentage509 |
| Investment Income Percentage | 0 | InvestmentIncomePercentage |
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
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 117638519 | OtherCostOrOtherBasis |
| Book Value | 117638519 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 117638519 | TotalOfBookValueLandBuildings |
| Total Revenue | 1182360 | TotalRevenue |
| Total Expenses | 2820968 | TotalExpenses |
| Excess Or Deficit For Year | -1638608 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 376938 | NetUnrealizedGLOnInvestments |
| Other | -$26,998,804 | OtherAmount |
| Total Adjustments | -26621866 | TotalAdjustments |
| Excess Or Deficit Per FS | -28260474 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 7036823 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 7036823 | OtherRevenues |
| Revenue Not Rptd F990 | 7036823 | RevenueNotRptdF990 |
| Other Revenues Not Included | 1182360 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1182360 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1182360 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 35297297 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 32476329 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 32476329 | ExpensesNotRptdF990 |
| Expenses Subtotal | 2820968 | ExpensesSubtotal |
| Total Expenses Per Form990 | 2820968 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Pt X | The Network completed an analysis of its tax positions in accordance with applicable accounting guidance at December 31, 2011 and 2010, and determined that no amounts were required to be recognized in the consolidated financial statements at December 31, 2011 or 2010. |
| Pt XI Line 8 | Net transfers to affiliate (26,998,804) |
| Pt XII Line 2d | Net assets released from restrictions for capital 6,461,323 Contributions and investment income from restricted investments 575,500 |
| Pt XII Line 4b | Contributions 575,500 Investment income 606,860 |
| Pt XIII Line 2d | Contributions (575,500) Investment income (606,860) Transfers for PP&E 6,461,323 Transfers to net assets (5,885,823) Net unrealized gains on investments (376,938) Net transfers to affiliate 26,998,804 Temporarily restricted net assets released from restrictions for capital 6,461,323 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | false | CharityCarePolicy |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Written Debt Collection Policy | false | WrittenDebtCollectionPolicy |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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) |
|---|---|---|
| Other | Under Construction | Other |
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 |
| Eligibility Criteria Explained | false | EligibilityCriteriaExplained |
| Uses FPG Free | false | UsesFPGFree |
| Uses FPG Discounted | false | UsesFPGDiscounted |
| Explains Basis | false | ExplainsBasis |
| Explains Application Method | false | ExplainsApplicationMethod |
| Includes Publicity Measures | false | IncludesPublicityMeasures |
| Actions On Nonpayment | false | ActionsOnNonpayment |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | false | CollectionActivities |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | false | NondiscrimEmergencyCarePolicy |
| Other Reason | X | OtherReason |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (3 entries)
| ExplanationExplanation |
|---|
| BEAVERCREEK MEDICAL CENTER IS STILL UNDER CONSTRUCTION. |
| THE ORGANIZATION IS CURRENTLY ADDRESSING THE POLICIES |
| CONCERNING THE PROVISIONS OF HEALTH CARE FOR 2011 AND 2012. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|
| FRED MANCHUR | ||||||
| 1100401 | 268335 | 95507 | 373845 | 17492 | 1855580 | |
| GREG HENDERSON | ||||||
| 431860 | 93147 | 430893 | 13687 | 15567 | 985154 | 193030 |
| TROY TYNER DO | ||||||
| 243396 | 243396 | |||||
| TERRY BURNS | ||||||
| 182282 | 6761 | 23640 | 212683 | |||
| MARK SMITH | ||||||
| 330507 | 37620 | 1939 | 23938 | 394004 | ||
| TIM KO | ||||||
| 178244 | 16854 | 412 | 16313 | 211823 | ||
| BELINDA MALLETT | ||||||
| 222837 | 44827 | 3147 | 43884 | 15326 | 330021 | |
| FRANK PEREZ | ||||||
| 575282 | 238197 | 10381 | 13687 | 7875 | 845422 | |
| TIM POLLARD | ||||||
| 141373 | 141373 | |||||
| MICHAEL CACCAMO MD | ||||||
| 24000 | 24000 | |||||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Pt I Line 4b | Identifier |
| Explanation | The Network has a Supplemental Executive Retirement Plan available only to a certain class of management. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (34 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Pt VI, Line 11a | 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). | |
| Pt VI, 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. | |
| Pt VI, 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. | |
| Pt VI, Line 19 | The KHN Conflict of Interest policy is available on the KHN intranet. The |
| organization's governing documents and financial statements | |
| are available upon request. | |
| Pt XI | Line 5: Net unrealized gains on investments 376,938 |
| Pt XI | Line 5: Net transfers to affiliate (26,998,804) |
| Pt XII, Line 2c | KHN has an audit committee that meets regularly throughout the year |
| to review issues that are brought to it by the internal auditor. This | |
| committee is also responsible for the financial audit. | |
| Part IX, Lines 7,8,9,10 | Salaries, pension plan, other benefits, and payroll taxes |
| Part IX, Lines 7,8,9,10 | are paid by and allocated from Kettering Medical Center. |
| Part IV, Line 24 | Line 24a should be "Yes" and 24b,c,d should be "No". |
| Part IV, Line 24 | The organization does have tax-exempt bonds but the software |
| Part IV, Line 24 | converts Schedule K with an error. This caused the |
| Part IV, Line 24 | return to be rejected by the agency. |
| Part IV, Line 24 | Schedule K has been attached as a .pdf file as a workaround. |
| Part IV, Line 24 | We've also attached the rejection notice. |
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 | false |
| DAYTON OSTEOPATHIC HOSPITAL | ||||||||||
| 2110 LEITER ROAD | MIAMISBURG | OH | 45342 | 310564121 | HOSPITAL | OH | 501(c)(3) | 509(a)(1) | KETTERING ADVENTIST HEALTHCARE | false |
| THE FORT HAMILTON HOSPITAL | ||||||||||
| 2110 LEITER ROAD | MIAMISBURG | OH | 45342 | 310536662 | HOSPITAL | OH | 501(c)(3) | 509(a)(1) | KETTERING ADVENTIST HEALTHCARE | false |
| GREENE FOUNDATION | ||||||||||
| 2110 LEITER ROAD | MIAMISBURG | OH | 45342 | 310886949 | FUNDRAISING | OH | 501(c)(3) | 509(a)(1) | GREENE MEMORIAL HOSPITAL | false |
| GREENE MEMORIAL HOSPITAL | ||||||||||
| 2110 LEITER ROAD | MIAMISBURG | OH | 45342 | 310809436 | HOSPITAL | OH | 501(c)(3) | 509(a)(1) | KETTERING ADVENTIST HEALTHCARE | false |
| GREENE MEMORIAL HOSPITAL SERVICES INC | ||||||||||
| 2110 LEITER ROAD | MIAMISBURG | OH | 45342 | 311358549 | PHYSICIAN SERVICES | OH | 501(c)(3) | 509(a)(3) | KETTERING ADVENTIST HEALTHCARE | false |
| KETTERING ADVENTIST HEALTHCARE | ||||||||||
| 2110 LEITER ROAD | MIAMISBURG | OH | 45342 | 311051688 | MANAGEMENT | OH | 501(c)(3) | 509(a)(3) | NA | false |
| KETTERING MEDICAL CENTER | ||||||||||
| 2110 LEITER ROAD | MIAMISBURG | OH | 45342 | 310621866 | HOSPITAL | OH | 501(c)(3) | 509(a)(1) | KETTERING ADVENTIST HEALTHCARE | false |
| KETTERING MEDICAL CENTER FOUNDATION | ||||||||||
| 2110 LEITER ROAD | MIAMISBURG | OH | 45342 | 237419897 | FUNDRAISING | OH | 501(c)(3) | 509(a)(3) | KETTERING MEDICAL CENTER | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|
| KETTERING MEDICAL CENTER IS A CONDUIT THROUGH WHICH REVENUE | |
| lmnor | FMV |
| IS RECEIVED AND EXPENSES ARE PAID | |
Comments