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      <Form990PartVIISectionAGrp>
        <PersonNm>O'Neal Stephen</PersonNm>
        <TitleTxt>Chief Nursing Officer KH MB</TitleTxt>
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        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>432253</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Thompson Jenny Lyn</PersonNm>
        <TitleTxt>Registered Nurse</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Brendel Michael</PersonNm>
        <TitleTxt>President KH Dayton</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>482563</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Tan Kristine E</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Brandstater Nate</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Satter Martin R</PersonNm>
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        <PersonNm>Merle Thomas J</PersonNm>
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        <PersonNm>Burns Terry</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Chanaga Luis</PersonNm>
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      <GrantsToDomesticIndividualsGrp>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>21370385</ProgramServicesAmt>
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      <AllOtherExpensesGrp>
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      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
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      <FederalGrantAuditPerformedInd>1</FederalGrantAuditPerformedInd>
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        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
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        <BookValueAmt>34107522</BookValueAmt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>Estimated amounts due to third-party payors</Desc>
        <Amt>27159304</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Finance lease liabilities</Desc>
        <Amt>1392005</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Interest rate swap agreements liability</Desc>
        <Amt>13089842</Amt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>Operating lease liabilities</Desc>
        <Amt>7616530</Amt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>Other long-term liabilities</Desc>
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      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Physician income guarantee commitments</Desc>
        <Amt>855000</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Professional self-insurance liability</Desc>
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      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>72645212</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The System completed an analysis of its certain and uncertain tax positions in accordance with applicable accounting guidance and determined that no amounts were required to be recognized in the consolidated financial statements at December 31, 2023 or 2022.</ExplanationTxt>
      </SupplementalInformationDetail>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Part V, Section A:</FormAndLineReferenceDesc>
        <ExplanationTxt>Each facility listed is required to be licensed, registered or recognized as a healthcare facility under state law.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Kettering Health Behavioral Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 5: The Health Collaborative (THC), in partnership with the Greater Dayton Area Hospital Association (GDAHA), facilitated the 2021 Regional Community Health Needs Assessment (CHNA). This Regional CHNA includes 36 hospitals, 22 health departments, across 26 counties in southwest Ohio and the Greater Dayton Area, southeast Indiana, and northern Kentucky.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Kettering Health Troy</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 5: The Health Collaborative (THC), in partnership with the Greater Dayton Area Hospital Association (GDAHA), facilitated the 2021 Regional Community Health Needs Assessment (CHNA). This Regional CHNA includes 36 hospitals, 22 health departments, across 26 counties in southwest Ohio and the Greater Dayton Area, southeast Indiana, and northern Kentucky.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Kettering Health Behavioral Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 6a: Bon Secours Mercy Health Clermont HospitalBon Secours Mercy Health Fairfield HospitalBon Secours Mercy Health Jewish HospitalBon Secours Mercy Health West HospitalCincinnati Children's HospitalCincinnati Children's Burnet CampusCincinnati Children's Liberty CampusCincinnati Children's College Hill CampusThe C&amp;F Lindner Center of HOPEThe Christ Hospital, Mt. AuburnTriHealth Good Samaritan HospitalTriHealth Good Samaritan Evendale HospitalTriHealth Bethesda North HospitalTriHealth Bethesda Butler HospitalTriHealth McCullough Hyde Memorial HospitalUC Health University of Cincinnati Medical CenterUC Health West Chester HospitalUC Health Drake Center for Post-Acute CareMiami Valley HospitalAtrium Medical CenterUpper Valley Medical CenterMiami Valley Hospital SouthMiami Valley Hospital NorthWilson Memorial HealthWayne HealthcareMercy Health Springfield Regional Medical CenterMercy Health Urbana HospitalAdams County Regional Medical CenterMargaret Mary Health</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Kettering Health Troy</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 6a: Bon Secours Mercy Health Clermont HospitalBon Secours Mercy Health Fairfield HospitalBon Secours Mercy Health Jewish HospitalBon Secours Mercy Health West HospitalCincinnati Children's HospitalCincinnati Children's Burnet CampusCincinnati Children's Liberty CampusCincinnati Children's College Hill CampusThe C&amp;F Lindner Center of HOPEThe Christ Hospital, Mt. AuburnTriHealth Good Samaritan HospitalTriHealth Good Samaritan Evendale HospitalTriHealth Bethesda North HospitalTriHealth Bethesda Butler HospitalTriHealth McCullough Hyde Memorial HospitalUC Health University of Cincinnati Medical CenterUC Health West Chester HospitalUC Health Drake Center for Post-Acute CareMiami Valley HospitalAtrium Medical CenterUpper Valley Medical CenterMiami Valley Hospital SouthMiami Valley Hospital NorthWilson Memorial HealthWayne HealthcareMercy Health Springfield Regional Medical CenterMercy Health Urbana HospitalAdams County Regional Medical CenterMargaret Mary Health</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Kettering Health Behavioral Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 6b: The Health CollaborativeGreater Dayton Area Hospital AssociationCity Health Departments:City: Cincinnati, Hamilton (City), Norwood, Piqua, SpringdaleCounty: Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Darke, Fayette,Greene, Hamilton, Highland, Miami, Montgomery, Preble, Shelby, WarrenCounty Health Departments:Indiana: Franklin, Dearborn, Ohio, Ripley, UnionKentucky: Campbell, Boone, Grant, KentonOhio: Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Darke, Greene,Hamilton, Highland, Miami, Montgomery, Preble, Shelby, Warren</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Kettering Health Troy</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 6b: The Health CollaborativeGreater Dayton Area Hospital AssociationCity Health Departments:City: Cincinnati, Hamilton (City), Norwood, Piqua, SpringdaleCounty: Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Darke, Fayette,Greene, Hamilton, Highland, Miami, Montgomery, Preble, Shelby, WarrenCounty Health Departments:Indiana: Franklin, Dearborn, Ohio, Ripley, UnionKentucky: Campbell, Boone, Grant, KentonOhio: Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Darke, Greene,Hamilton, Highland, Miami, Montgomery, Preble, Shelby, Warren</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Kettering Health Behavioral Medical Center</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 11: Kettering Health Behavioral Medical Center is addressing the significant needs identified in the Community Health Needs Assessment through support for Tobacco Cessation, OneFifteen, Behavioral Health Support Model, and Intensive Outpatient Program.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Kettering Health Troy</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 11: Kettering Health Troy is addressing the significant needs identified in the Community Health Needs Assessment through support for the Cancer Support Group, Tobacco Cessation, OneFifteen, Work Force Development, Kettering Health Community Outreach, Miami Valley Leadership Foundation, Behavioral Health Support Model and Intensive Outpatient Program.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Part V, Section B</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility Reporting Group A</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Facility Reporting Group A consists of:</FormAndLineReferenceDesc>
        <ExplanationTxt>- Facility 1: Kettering Health Main Campus, - Facility 2: Kettering Health Miamisburg</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group A-Facility 1 -- Kettering Health Main Campus Part V, Section B, line 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Health Collaborative (THC), in partnership with the Greater Dayton Area Hospital Association (GDAHA), facilitated the 2021 Regional Community Health Needs Assessment (CHNA). This Regional CHNA includes 36 hospitals, 22 health departments, across 26 counties in southwest Ohio and the Greater Dayton Area, southeast Indiana, and northern Kentucky.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group A-Facility 1 -- Kettering Health Main Campus Part V, Section B, line 6a:</FormAndLineReferenceDesc>
        <ExplanationTxt>Bon Secours Mercy Health Clermont HospitalBon Secours Mercy Health Fairfield HospitalBon Secours Mercy Health Jewish HospitalBon Secours Mercy Health West HospitalCincinnati Children's HospitalCincinnati Children's Burnet CampusCincinnati Children's Liberty CampusCincinnati Children's College Hill CampusThe C&amp;F Lindner Center of HOPEThe Christ Hospital, Mt. AuburnTriHealth Good Samaritan HospitalTriHealth Good Samaritan Evendale HospitalTriHealth Bethesda North HospitalTriHealth Bethesda Butler HospitalTriHealth McCullough Hyde Memorial HospitalUC Health University of Cincinnati Medical CenterUC Health West Chester HospitalUC Health Drake Center for Post-Acute CareMiami Valley HospitalAtrium Medical CenterUpper Valley Medical CenterMiami Valley Hospital SouthMiami Valley Hospital NorthWilson Memorial HealthWayne HealthcareMercy Health Springfield Regional Medical CenterMercy Health Urbana HospitalAdams County Regional Medical CenterMargaret Mary Health</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group A-Facility 1 -- Kettering Health Main Campus Part V, Section B, line 6b:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Health CollaborativeGreater Dayton Area Hospital AssociationCity Health Departments:City: Cincinnati, Hamilton (City), Norwood, Piqua, SpringdaleCounty: Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Darke, Fayette,Greene, Hamilton, Highland, Miami, Montgomery, Preble, Shelby, WarrenCounty Health Departments:Indiana: Franklin, Dearborn, Ohio, Ripley, UnionKentucky: Campbell, Boone, Grant, KentonOhio: Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Darke, Greene,Hamilton, Highland, Miami, Montgomery, Preble, Shelby, Warren</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group A-Facility 1 -- Kettering Health Main Campus Part V, Section B, line 11:</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering Medical Center is addressing the significant needs identified in the Community Health Needs Assessment through support for Good Neighbor House, Cancer Support Group, Infant Mortality Task Force, Tobacco Cessation, OneFifteen, Brigid's Path, Workforce Development, and Community Health Worker Training.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group A-Facility 2 -- Kettering Health Miamisburg Part V, Section B, line 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Health Collaborative (THC), in partnership with the Greater Dayton Area Hospital Association (GDAHA), facilitated the 2021 Regional Community Health Needs Assessment (CHNA). This Regional CHNA includes 36 hospitals, 22 health departments, across 26 counties in southwest Ohio and the Greater Dayton Area, southeast Indiana, and northern Kentucky.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group A-Facility 2 -- Kettering Health Miamisburg Part V, Section B, line 6a:</FormAndLineReferenceDesc>
        <ExplanationTxt>Bon Secours Mercy Health Clermont HospitalBon Secours Mercy Health Fairfield HospitalBon Secours Mercy Health Jewish HospitalBon Secours Mercy Health West HospitalCincinnati Children's HospitalCincinnati Children's Burnet CampusCincinnati Children's Liberty CampusCincinnati Children's College Hill CampusThe C&amp;F Lindner Center of HOPEThe Christ Hospital, Mt. AuburnTriHealth Good Samaritan HospitalTriHealth Good Samaritan Evendale HospitalTriHealth Bethesda North HospitalTriHealth Bethesda Butler HospitalTriHealth McCullough Hyde Memorial HospitalUC Health University of Cincinnati Medical CenterUC Health West Chester HospitalUC Health Drake Center for Post-Acute CareMiami Valley HospitalAtrium Medical CenterUpper Valley Medical CenterMiami Valley Hospital SouthMiami Valley Hospital NorthWilson Memorial HealthWayne HealthcareMercy Health Springfield Regional Medical CenterMercy Health Urbana HospitalAdams County Regional Medical CenterMargaret Mary Health</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group A-Facility 2 -- Kettering Health Miamisburg Part V, Section B, line 6b:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Health CollaborativeGreater Dayton Area Hospital AssociationCity Health Departments:City: Cincinnati, Hamilton (City), Norwood, Piqua, SpringdaleCounty: Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Darke, Fayette,Greene, Hamilton, Highland, Miami, Montgomery, Preble, Shelby, WarrenCounty Health Departments:Indiana: Franklin, Dearborn, Ohio, Ripley, UnionKentucky: Campbell, Boone, Grant, KentonOhio: Adams, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Darke, Greene,Hamilton, Highland, Miami, Montgomery, Preble, Shelby, Warren</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Group A-Facility 2 -- Kettering Health Miamisburg Part V, Section B, line 11:</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering Health Miamisburg is addressing the significant needs identified in the Community Health Needs Assessment through support for Primary Health Solutions FQHC, Good Neighbor House, Cancer Support Group, Tobacco Cessation, OneFifteen, Work Force Development, Kettering Health Community Outreach, Miami Valley Leadership Foundation, Behavioral Health Support Model and Intensive Outpatient Program.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>8</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>1 - Kettering Health Englewood</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>1250 National Road</AddressLine1Txt>
            <CityNm>Englewood</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45322</ZIPCd>
          </USAddress>
          <FacilityTxt>Outpatient Clinic &amp; Diagnostic Center</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>2 - Kettering Health Franklin</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>100 Kettering Way</AddressLine1Txt>
            <CityNm>Franklin</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45005</ZIPCd>
          </USAddress>
          <FacilityTxt>Emergency, Outpatient Clinic, and Diagnostic Center</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>3 - Kettering Health Middletown</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>6147 State Route 122</AddressLine1Txt>
            <CityNm>Middletown</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45005</ZIPCd>
          </USAddress>
          <FacilityTxt>Emergency, Outpatient Clinic, and Diagnostic Center</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>4 - Kettering Health Piqua</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>1 Kettering Way</AddressLine1Txt>
            <CityNm>Piqua</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45356</ZIPCd>
          </USAddress>
          <FacilityTxt>Emergency, Outpatient Clinic, and Diagnostic Center</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>5 - Kettering Health Rehab and Therapy</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>70 Weller Drive Suite 120</AddressLine1Txt>
            <CityNm>Tipp City</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45371</ZIPCd>
          </USAddress>
          <FacilityTxt>Outpatient Clinic &amp; Diagnostic Center</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>6 - Kettering Health Sports Medicine</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>4403 Far Hills Avenue</AddressLine1Txt>
            <CityNm>Kettering</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45429</ZIPCd>
          </USAddress>
          <FacilityTxt>Outpatient Clinic &amp; Diagnostic Center</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>7 - Kettering Health Springboro Health Ctr</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>825 N Main Street</AddressLine1Txt>
            <CityNm>Springboro</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45066</ZIPCd>
          </USAddress>
          <FacilityTxt>Outpatient Clinic &amp; Diagnostic Center</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>8 - Kettering Health Sugarcreek Health Ctr</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>6438 Wilmington Pike</AddressLine1Txt>
            <CityNm>Sugarcreek Township</CityNm>
            <StateAbbreviationCd>OH</StateAbbreviationCd>
            <ZIPCd>45459</ZIPCd>
          </USAddress>
          <FacilityTxt>Outpatient Clinic &amp; Diagnostic Center</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7:</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7g:</FormAndLineReferenceDesc>
        <ExplanationTxt>Subsidized health services represent the non-needs based and non-Medicare program losses of services the hospital offers.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>An industry average was used to estimate this amount. It was not included as part of community benefit.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>Generally, patients who are covered by third-party payors are responsible for patient responsibility balances, including deductibles and coinsurance, which vary in amount. The System estimates the transaction price for patients with deductibles and coinsurance based on historical experience and current market conditions. The initial estimate of the transaction price is determined by reducing the standard charge by any explicit price concessions, discounts, and/or implicit price concessions. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to net patient service revenue in the period of change.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering Health Main Campus System, as part of Kettering Health, has dedicated an entire department to community health and wellness. The Community Outreach Department is comprised of coordinators who develop programs, screenings and other health related events. The department also has fitness specialists, nurses, dietitians, massage and behavioral therapists, a communication specialist, health coaches, a physician medical director, a full service call center, and many other resource personnel.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering Health Main Campus System 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 Kettering Health Main Campus System's charity care policy as follows:-Kettering Health Main Campus System 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.-Kettering Health Main Campus System has the reporting capability to review and screen any patient who may have been admitted during registration "off hours" for eligibility and assistance.-The Financial Assistance section on the back of patient statements contain the website associated to Financial Assistance, along with contact details for more information.-Kettering Health Main Campus System's patient account representatives in customer service screen patients that are unable to pay their bill for the various financial assistance programs.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering Health serves a population of approximately 1,635,000. The seven-county service area includes Butler, Clark, Greene, Miami, Montgomery, Preble, and Warren counties. The 88 counties in Ohio were ranked by County Health Rankings &amp; Road Maps in terms of health outcomes and health factors. A top-ranked county (rank=1) has the best health score. The counties served by Kettering Health have health outcome ranks from 2-80.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering Health Main Campus System 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, acquisition of the most advanced medical technology, upgrades of existing hospital structures, and construction of new facilities in order to provide accessible, efficient, quality care. -Medical and nursing education programs are also enhanced through purchase of state-of-the-art educational tools and dedicated learning centers of excellence. Medical research is supported through the Innovation Center, cultivating new technologies and fostering best practices among partners from industry, academia, and health care.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 6:</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering Health Main Campus System and its affiliates promote the health of the communities served by the system as described below: -Kettering Health Main Campus System, as part of Kettering Health, is dedicated to the creation and maintenance of community wellness programs, support groups and health education programs. Kettering Health Main Campus System provides numerous screenings, family-focused classes, health fairs, conferences, donations, and education programs to ensure the long-term wellbeing of people living in the community.-Kettering Health Foundation serves donors by providing assistance in fulfilling philanthropic wishes and maintaining an efficient conduit for gifts to benefit Kettering Health and its affiliated programs and facilities. Kettering Health Foundation manages over 140 funds in support of programs, offering donors the confidence that their donations will meaningfully influence the program they choose to support.-Kettering College is a doctorate, master's, and bachelor's degree-granting college with programs in human biology, nursing, medical sonography, physician assistant studies, occupational therapy, radiology technology, respiratory therapy, and health sciences. Associate degree options are available for some programs of study. The college is owned by Kettering Health Main Campus System and is chartered by the Seventh-day Adventist Church, for whom health care has always been a key ministry to the wider public.-Kettering Affiliated Health Services Inc provides Senior Living services to the surrounding communities which complement those services provided by Soin Medical Center as part of Kettering Health.-Medical research is supported through the Innovation Center which cultivates new technologies and fosters best practices among partners from industry, academia, and health care.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 7, Reports Filed With States</FormAndLineReferenceDesc>
        <ExplanationTxt>OH</ExplanationTxt>
      </SupplementalInformationDetail>
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      <GrantRecordsMaintainedInd>1</GrantRecordsMaintainedInd>
      <GrantsOtherAsstToIndivInUSGrp>
        <GrantTypeTxt>Scholarships, grants, and other assistance to Kettering College students</GrantTypeTxt>
        <RecipientCnt>121</RecipientCnt>
        <CashGrantAmt>306966</CashGrantAmt>
      </GrantsOtherAsstToIndivInUSGrp>
      <GrantsOtherAsstToIndivInUSGrp>
        <GrantTypeTxt>Assistance to employees for hardship</GrantTypeTxt>
        <RecipientCnt>231</RecipientCnt>
        <CashGrantAmt>250996</CashGrantAmt>
      </GrantsOtherAsstToIndivInUSGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering College maintains the criteria used for awarding institutional scholarships. Some of the scholarships awarded by Kettering College are based on need, others are awarded strictly based on merit, and others are awarded based on both need and merit. Kettering Medical Center employees may apply for up to $1,000 per qualifying hardship event. The lifetime maximum for an employee is capped at $2,000.</ExplanationTxt>
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        <PersonNm>Hoeprich Mark R</PersonNm>
        <TitleTxt>Physician</TitleTxt>
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        <PersonNm>Mewhirter Michael</PersonNm>
        <TitleTxt>Interim CEO until July 23, CAO</TitleTxt>
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        <PersonNm>Briggs Sharlet</PersonNm>
        <TitleTxt>President KH Main Campus</TitleTxt>
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        <PersonNm>Ko Timothy</PersonNm>
        <TitleTxt>CFO KH</TitleTxt>
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        <NontaxableBenefitsRltdOrgsAmt>24248</NontaxableBenefitsRltdOrgsAmt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Velasco Jonathan E</PersonNm>
        <TitleTxt>Physician</TitleTxt>
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        <NontaxableBenefitsRltdOrgsAmt>12367</NontaxableBenefitsRltdOrgsAmt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Sawyer Robert J</PersonNm>
        <TitleTxt>Physician</TitleTxt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Perez Shelley</PersonNm>
        <TitleTxt>Physician</TitleTxt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
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        <TitleTxt>KH Acute Care CFO</TitleTxt>
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        <TotalCompensationRltdOrgsAmt>793871</TotalCompensationRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Schneider Erica</PersonNm>
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        <CompensationBasedOnRltdOrgsAmt>506923</CompensationBasedOnRltdOrgsAmt>
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        <DeferredCompRltdOrgsAmt>129074</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>24875</NontaxableBenefitsRltdOrgsAmt>
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        <TotalCompensationRltdOrgsAmt>684707</TotalCompensationRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>O'Neal Stephen</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Thompson Jenny Lyn</PersonNm>
        <TitleTxt>Registered Nurse</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Brendel Michael</PersonNm>
        <TitleTxt>President KH Dayton</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Tan Kristine E</PersonNm>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Brandstater Nate</PersonNm>
        <TitleTxt>President Kettering College</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Satter Martin R</PersonNm>
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        <PersonNm>Merle Thomas J</PersonNm>
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        <PersonNm>Sackett Walter</PersonNm>
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        <PersonNm>Burns Terry</PersonNm>
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        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Chanaga Luis</PersonNm>
        <TitleTxt>President - KH Miamisburg &amp; KH Middl</TitleTxt>
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        <OtherCompensationRltdOrgsAmt>215017</OtherCompensationRltdOrgsAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>An independent executive compensation committee reviews an independent consultant's report that identifies the current and proposed compensation for the CEO, officers, and key employees. Compensation is determined to be reasonable, and the approval amount is documented in the minutes of the committee meeting. At year end, the actual compensation is compared to approved compensation by the executive compensation committee.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Lines 4a-b</FormAndLineReferenceDesc>
        <ExplanationTxt>Walter Sackett received a severance payment of $772,744. Terry Burns received a severance payment of $733,073. Kettering Health has a supplemental executive retirement plan available only to a certain class of management.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
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      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
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        <BondIssuedDt>2012-05-01</BondIssuedDt>
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        <PurposeDesc>Current refund</PurposeDesc>
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        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
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      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>C</BondReferenceCd>
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        <BondReferenceCd>C</BondReferenceCd>
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        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>1</ProceduresCorrectiveActionInd>
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      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
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    </IRS990ScheduleK>
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        <BondReferenceCd>A</BondReferenceCd>
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        <BondReferenceCd>A</BondReferenceCd>
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    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering Adventist Healthcare is the sole member.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>The Members of Kettering Adventist Healthcare have the power to elect or appoint members of the governing body.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>A tax specialist is engaged to review the 990, and a copy of the completed Form 990 is provided to all members of the Board of Directors before filing.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Kettering Health 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 Kettering Health's policy, sign a conflict of interest statement, and notify Kettering Health if a conflict should arise.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>An independent executive compensation committee reviews an independent consultant's report that identifies the current and proposed compensation for the CEO, officers, and key employees. Compensation is determined to be reasonable, and the approval amount is documented in the minutes of the committee meeting. At year end, the actual compensation is compared to approved compensation by the executive compensation committee.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's governing documents, conflict of interest policy, and financial statements are available upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Net transfers to affiliate -100,115,232. Other changes, net 131,116.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2c</FormAndLineReferenceDesc>
        <ExplanationTxt>Neither the oversight process nor the selection process changed during the tax year.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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        <DisregardedEntityName>
          <BusinessNameLine1Txt>Alliance Physicians Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
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          <AddressLine1Txt>1 Prestige Place Suite 910</AddressLine1Txt>
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          <BusinessNameLine1Txt>Greene Foundation</BusinessNameLine1Txt>
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          <AddressLine1Txt>1 Prestige Place Suite 910</AddressLine1Txt>
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        <FormAndLineReferenceDesc>Part V, Line 2</FormAndLineReferenceDesc>
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</Return>