LAKE HOSPITAL FOUNDATION INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- LAKE HOSPITAL FOUNDATION INC (EIN 34-1425872)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-15
- IRS object ID
- 202403209349310145
- Schema version
- 2023v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-15T11:36:30-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 4200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 462045108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341425872 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAKE | BusinessNameControlTxt |
| Phone | 2168441000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7590 AUBURN ROAD | AddressLine1Txt |
| City | CONCORD TOWNSHIP | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44077 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRADLEY C BOND | PersonNm |
| Person Title | CFO, UHHS | PersonTitleTxt |
| Phone | 2168441000 | PhoneNum |
| Signature | 2024-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHAWNA M JANSONS | PreparerPersonNm |
| PTIN | P01222873 | PTIN |
| Phone | 3174648600 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIMOTHY A CAHILL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7590 AUBURN ROAD | AddressLine1Txt |
| City | CONCORD TOWNSHIP | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44077 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $891,786 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.UHGIVING.ORG/WAYS-TO-GIVE/SUPPORTING- | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | SUPPORT AND ASSIST THE MISSION OF LAKE HOSPITAL SYSTEM, INC. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $457,980 | PYContributionsGrantsAmt |
| CY Contributions Grants | $500,058 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $235,648 | PYInvestmentIncomeAmt |
| CY Investment Income | $348,010 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$4,926 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $688,702 | PYTotalRevenueAmt |
| CY Total Revenue | $848,068 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $654,062 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $482,059 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $308,305 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $293,462 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $84,706 | PYOtherExpensesAmt |
| CY Other Expenses | $99,626 | CYOtherExpensesAmt |
| PY Total Expenses | $1,047,073 | PYTotalExpensesAmt |
| CY Total Expenses | $875,147 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$358,371 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$27,079 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $22,464,716 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,646,363 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,958,100 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,418,403 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,506,616 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $18,227,960 | NetAssetsOrFundBalancesEOYAmt |
| Mission | SUPPORT AND ASSIST LAKE HOSPITAL SYSTEM, INC. IN ITS EFFORTS TO SERVE THE NEEDS OF LAKE COUNTY RESIDENTS AND ITS SURROUNDING COMMUNITIES BY PROVIDING FUNDING FOR ENHANCED OR ADDITIONAL PROGRAMS THAT OTHERWISE MIGHT NOT BE AVAILABLE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $841,651 | ExpenseAmt |
| Grant | $482,059 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE FOUNDATION GRANTS ASSISTANCE TO LAKE HOSPITAL SYSTEM, INC. TO FURTHER ENHANCE THE HOSPITAL'S MISSION AND COMMUNITY BENEFIT. | Desc |
| Total Program Service Expenses | $841,651 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT GOEBEL | PersonNm |
| Phone | 2168441000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3605 WARRENSVILLE CENTER ROAD MSC | AddressLine1Txt |
| City | SHAKER HEIGHTS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44122 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| BAUMBERGER RONALD | |||||||
| TRUSTEE/VICE CHAIR (BEGIN 03/23) | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CAHILL TIMOTHY A | |||||||
| TRUSTEE/TREASURER | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| COMBS BRIDGET MD | |||||||
| TRUSTEE/SECRETARY | 2.00 | 50.00 | Yes (X) | Yes (X) | $0 | $301,575 | $26,128 |
| GUBAN PHILIP | |||||||
| TRUSTEE/CHAIR (END 03/23) | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| THOMPSON KATHLEEN | |||||||
| TRUSTEE/CHAIR (BEGIN 03/23) | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BILECI-COCCA AMY | |||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CICERO RICHARD | |||||||
| TRUSTEE (EX-OFFICIO) | 2.00 | 54.00 | Yes (X) | $0 | $388,713 | $47,614 | |
| FLYNN OSCAR | |||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KOCHIK GEORGE | |||||||
| TRUSTEE (EX-OFFICIO) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| LINGENFELTER ANDREW | |||||||
| TRUSTEE (BEGIN 11/23) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| NEKIC JOHN | |||||||
| TRUSTEE (BEGIN 11/23) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| PAGANINI RAYMOND J | |||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| PATEL CHETAN P MD | |||||||
| TRUSTEE | 2.00 | 52.00 | Yes (X) | $0 | $697,196 | $36,026 | |
| PERRICO MICHAEL A | |||||||
| TRUSTEE | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SCHIEBLI ROBERT | |||||||
| TRUSTEE (END 02/23) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| STEIN NEIL | |||||||
| TRUSTEE (END 02/23) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TADESE TINU MD | |||||||
| TRUSTEE (EX-OFFICIO) | 2.00 | 50.00 | Yes (X) | $0 | $362,551 | $40,840 | |
| FLASH MARK | |||||||
| EXECUTIVE DIRECTOR | 40.00 | 10.00 | Yes (X) | $0 | $205,635 | $16,886 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,955,670 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $167,494 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $500,058 | RelatedOrganizationsAmt |
| Total Contributions | $500,058 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $335,115 | TotalRevenueColumnAmt |
| Exclusion | $335,115 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $56,613 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $43,718 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $12,895 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,895 | TotalRevenueColumnAmt |
| Exclusion | $12,895 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $848,068 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $348,010 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $482,059 | TotalAmt |
| Program Services | $482,059 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $277,622 | TotalAmt |
| Program Services | $260,965 | ProgramServicesAmt |
| Management And General | $16,657 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,289 | TotalAmt |
| Program Services | $3,092 | ProgramServicesAmt |
| Management And General | $197 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$4,706 | TotalAmt |
| Program Services | -$4,424 | ProgramServicesAmt |
| Management And General | -$282 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,257 | TotalAmt |
| Program Services | $16,222 | ProgramServicesAmt |
| Management And General | $1,035 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,000 | TotalAmt |
| Program Services | $5,640 | ProgramServicesAmt |
| Management And General | $360 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,848 | TotalAmt |
| Program Services | $4,557 | ProgramServicesAmt |
| Management And General | $291 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,668 | TotalAmt |
| Program Services | $2,508 | ProgramServicesAmt |
| Management And General | $160 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DONOR RECOGNITION | Desc |
| Total | $65,884 | TotalAmt |
| Program Services | $61,931 | ProgramServicesAmt |
| Management And General | $3,953 | ManagementAndGeneralAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,226 | TotalAmt |
| Program Services | $9,101 | ProgramServicesAmt |
| Management And General | $11,125 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $875,147 | TotalAmt |
| Program Services | $841,651 | ProgramServicesAmt |
| Management And General | $33,496 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $970,464 | BOYAmt |
| EOY | $267,955 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $455,292 | BOYAmt |
| EOY | $593,043 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $294,953 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,650 | BOYAmt |
| EOY | $1,649 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,078 | BOYAmt |
| EOY | $5,078 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,071,975 | BOYAmt |
| EOY | $21,693,489 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $479,957 | BOYAmt |
| EOY | $525,669 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $480,300 | BOYAmt |
| EOY | $264,527 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,464,716 | BOYAmt |
| EOY | $23,646,363 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,996 | BOYAmt |
| EOY | $5,355,112 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,500 | BOYAmt |
| EOY | $7,500 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,869,604 | BOYAmt |
| EOY | $55,791 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,958,100 | BOYAmt |
| EOY | $5,418,403 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,156,109 | BOYAmt |
| EOY | $10,483,433 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,350,507 | BOYAmt |
| EOY | $7,744,527 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,506,616 | BOYAmt |
| EOY | $18,227,960 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,464,716 | BOYAmt |
| EOY | $23,646,363 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$27,079 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,726,221 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $22,202 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE HOSPITAL SYSTEM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341425870 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $482,059 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $482,059 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,350,507 | BeginningYearBalanceAmt |
| Contributions | $202,983 | ContributionsAmt |
| Investment Earnings Or Losses | $490,439 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $299,402 | OtherExpendituresAmt |
| End Year Balance | $7,744,527 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,817,807 | BeginningYearBalanceAmt |
| Contributions | $457,981 | ContributionsAmt |
| Investment Earnings Or Losses | -$99,652 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $825,629 | OtherExpendituresAmt |
| End Year Balance | $7,350,507 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,186,654 | BeginningYearBalanceAmt |
| Contributions | $474,754 | ContributionsAmt |
| Investment Earnings Or Losses | $582,521 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $89,913 | GrantsOrScholarshipsAmt |
| Other Expenditures | $336,209 | OtherExpendituresAmt |
| End Year Balance | $7,817,807 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,503,815 | BeginningYearBalanceAmt |
| Contributions | $1,793,553 | ContributionsAmt |
| Investment Earnings Or Losses | $402,960 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $43,639 | GrantsOrScholarshipsAmt |
| Other Expenditures | $1,470,035 | OtherExpendituresAmt |
| End Year Balance | $7,186,654 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,272,122 | BeginningYearBalanceAmt |
| Contributions | $541,913 | ContributionsAmt |
| Investment Earnings Or Losses | $606,520 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $87,443 | GrantsOrScholarshipsAmt |
| Other Expenditures | $829,297 | OtherExpendituresAmt |
| End Year Balance | $6,503,815 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.46370 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.53630 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PAYABLE TO LAKE HOSPITAL | Desc |
| Amt | $55,791 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $55,791 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | THE ENDOWMENT FUNDS SUPPORT THE IMMEDIATE NEEDS IDENTIFIED BY UNIVERSITY HOSPITALS LAKE HOSPITAL SYSTEM SUCH AS INDIGENT PROGRAMS, INCLUDING HOSPICE, AS WELL AS OTHER PROGRAMS PROVIDING HEALTH, WELLNESS AND OVERALL COMMUNITY BENEFIT. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE HOSPITAL SYSTEM INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3605 WARRENSVILLE CTR RD MSC 9155 | AddressLine1Txt |
| City | SHAKER HEIGHTS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44122 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 341425870 | RecipientEIN |
| IRC Section | 501 (C)(3) | IRCSectionDesc |
| Cash Grant | $482,059 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | GENERAL SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE I, PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | LAKE HOSPITAL FOUNDATION, INC. HAS A PROCESS WHERE WE RECEIVE AND REVIEW REQUESTS FOR FUNDING, WHICH INCLUDES OUR SENIOR LEADERS. IN THAT REVIEW PROCESS WE CHECK TO BE SURE THE ORGANIZATION IS MISSION ALIGNED TO LAKE HOSPITAL FOUNDATION, INC. AND REVIEW HISTORICAL GIVING. MUCH OF OUR SUPPORT IS REVIEWED BOTH INTERNALLY AND WITH THE EXTERNAL GROUP ON AN ANNUAL BASIS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PATEL CHETAN P MD | ||||||||||||||
| TRUSTEE | $0 | $690,211 | $0 | $14 | $0 | $6,971 | $0 | $13,200 | $0 | $22,826 | $0 | $733,222 | $0 | $0 |
| CICERO RICHARD | ||||||||||||||
| TRUSTEE (EX-OFFICIO) | $0 | $312,709 | $0 | $47,616 | $0 | $28,388 | $0 | $29,196 | $0 | $18,418 | $0 | $436,327 | $0 | $0 |
| TADESE TINU MD | ||||||||||||||
| TRUSTEE (EX-OFFICIO) | $0 | $323,052 | $0 | $20,265 | $0 | $19,234 | $0 | $6,539 | $0 | $34,301 | $0 | $403,391 | $0 | $0 |
| COMBS BRIDGET MD | ||||||||||||||
| TRUSTEE/SECRETARY | $0 | $260,980 | $0 | $40,000 | $0 | $595 | $0 | $17,435 | $0 | $8,693 | $0 | $327,703 | $0 | $0 |
| FLASH MARK | ||||||||||||||
| EXECUTIVE DIRECTOR | $0 | $174,606 | $0 | $14,067 | $0 | $16,962 | $0 | $5,713 | $0 | $11,173 | $0 | $222,521 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM, INC., A RELATED ORGANIZATION, USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINE 4B | ELIGIBLE EMPLOYEES PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN UNDER CODE 457(F). ANY AMOUNTS ULTIMATELY PAID UNDER THE PLAN TO AN ELIGIBLE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B (III) IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | LAKE HOSPITAL SYSTEM, INC. IS THE SOLE MEMBER OF LAKE HOSPITAL FOUNDATION, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | LAKE HOSPITAL SYSTEM, INC. HAS THE POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | WHILE THE BOARD OF TRUSTEES IS GRANTED CERTAIN POWERS WITH RESPECT TO OPERATIONS, AS THE MEMBER, LAKE HOSPITAL SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) FINANCES AND FINANCING, (II) INVESTMENTS, (III) LEGAL MATTERS, (IV) MATERIAL ASSET SALES AND TRANSFERS, AND (V) STRATEGIC PLANNING. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN INDEPENDENT THIRD-PARTY PUBLIC ACCOUNTING FIRM. MANAGEMENT REVIEWS THE 990 BEFORE THE COMPLETE COPY IS MADE AVAILABLE TO THE FOUNDATION BOARD BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE SYSTEM HAS ADOPTED SIX CONFLICT OF INTEREST POLICIES THAT SET FORTH GUIDELINES RELATED TO TRANSACTIONS WITH DISQUALIFIED PERSONS (AS DEFINED IN APPLICABLE FEDERAL REGULATION). THESE POLICIES APPLY TO ALL EMPLOYEES, EMPLOYED PHYSICIANS AND OTHER LICENSED PRACTITIONERS (EXCLUDING PHYSICIAN TRAINEES), DIRECTORS, OFFICERS, AND RELATED PARTIES TO UH AND ITS WHOLLY-OWNED SUBSIDIARIES. UH REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICIES. DESIGNATED INDIVIDUALS, (E.G., UH MANAGEMENT, DIRECTORS, EMPLOYED PHYSICIANS, AND ADVANCED PRACTICE PROFESSIONALS), ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE AND PROVIDE INFORMATION REGARDING ANY INTERESTS THAT MAY BE POTENTIAL CONFLICTS PURSUANT TO THE CONFLICT OF INTEREST POLICIES. THEY ARE REQUIRED TO PROVIDE ANY CHANGES OR NEW DISCLOSURES SHOULD THEY OCCUR. ALL DISCLOSURES AND SUBSEQUENT UPDATES TO DISCLOSURES ARE REVIEWED BY THE UH COMPLIANCE AND ETHICS DEPARTMENT. BOARD-LEVEL AND KEY PERSONNEL CONFLICTS ARE REVIEWED AND APPROVED, IF APPROPRIATE, BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE UH BOARD AND/OR THE UH BOARD. IF A CONFLICT EXISTS WITH A DIRECTOR, CERTAIN RESTRICTIONS MAY BE IMPOSED, SUCH AS EXCUSING THE DIRECTOR FROM THE ROOM DURING DISCUSSION AND/OR VOTING WITH REGARD TO A PROPOSED TRANSACTION. EDUCATION REGARDING CONFLICTS OF INTEREST IS INCLUDED IN THE ANNUAL COMPLIANCE TRAINING THAT INCLUDES ALL DIRECTORS, EMPLOYEES, PHYSICIANS AND LICENSED PRACTITIONERS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY FOR LAKE HOSPITAL FOUNDATION, INC. ARE AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 5805 EUCLID INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 814962989 | SUPPORT HOSPITAL | OH | 501(C)(3) | LINE 12B, II | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| ELYRIA MEDICAL CENTER FOUNDATION | |||||||||||
| 630 EAST RIVER STREET | ELYRIA | OH | 44035 | 611579760 | SUPPORT HOSPITAL | OH | 501(C)(3) | LINE 12A, I | EMH REGIONAL MEDICAL CENTER | 0 | |
| FUND FOR CURES UK LTD | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | GRANT FUNDING | N/A | N/A | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | UK | ||
| KETTERING MOHICAN AREA MEDICAL CENTER INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 340823455 | INACTIVE | OH | 501(C)(3) | SAMARITAN REGIONAL HEALTH SYSTEM | 0 | ||
| LHS LEGACY | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 862916134 | MANAGEMENT | OH | 501(C)(3) | LINE 12C, III-FI | LAKE HOSPITAL SYSTEM INC | 0 | |
| PARMA HOSPITAL HEALTH CARE FOUNDATION | |||||||||||
| 7007 POWERS BLVD | PARMA | OH | 44129 | 341626664 | SUPPORT HOSPITAL | OH | 501(C)(3) | LINE 12A, I | PARMA COMMUNITY MEDICAL CENTER | 0 | |
| ROBINSON MEMORIAL HOSPITAL FOUNDATION | |||||||||||
| 6847 N CHESTNUT STREET PO BOX | RAVENNA | OH | 44266 | 341510544 | SUPPORT HOSPITAL | OH | 501(C)(3) | LINE 12A, I | ROBINSON HEALTH SYSTEM INC | 0 | |
| SAMARITAN HOSPITAL FOUNDATION | |||||||||||
| 663 EAST MAIN STREET | ASHLAND | OH | 44805 | 341783215 | SUPPORT HOSPITAL | OH | 501(C)(3) | LINE 12C, III-FI | SAMARITAN REGIONAL MEDICAL CENTER | 0 | |
| THE AUXILLARY OF LAKE HOSPITAL SYSTEM INC | |||||||||||
| 7590 AUBURN ROAD | CONCORD TOWNSHIP | OH | 44077 | 341605226 | PATIENT NEEDS AND PHYSICIAN EQUIPMENT | OH | 501(C)(3) | LINE 3 | LAKE HOSPITAL SYSTEM INC | 0 | |
| COMPREHENSIVE HEALTH CARE OF OHIO INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341492733 | HEALTHCARE | OH | 501(C)(3) | LINE 12B, II | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| EMH REGIONAL MEDICAL CENTER | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 340714612 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | COMPREHENSIVE HEALTHCARE OF OHIO INC | 0 | |
| LAKE HOSPITAL SYSTEM INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341425870 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| PARMA COMMUNITY GENERAL HOSPITAL | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 340827442 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| PRIMEHEALTH INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341778204 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | LAKE HOSPITAL SYSTEM INC | 0 | |
| ROBINSON HEALTH SYSTEM INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 461382538 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| SAMARITAN REGIONAL HEALTH SYSTEM | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 340714535 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UH REGIONAL HOSPITALS | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341924226 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS AHUJA MEDICAL CENTER INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 264827222 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341567805 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 340714550 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS COORDINATED CARE ORGANIZATION | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 900794903 | HEALTHCARE | OH | 501(C)(3) | LINE 10 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 340714461 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS HEALTH SYSTEM - HEATHER HILL INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 340771884 | INACTIVE | OH | 501(C)(3) | LINE 12B, II | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS HOME CARE SERVICES INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341527536 | HOME CARE | OH | 501(C)(3) | LINE 12B, II | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341720429 | LAB SERVICES | OH | 501(C)(3) | LINE 12B, II | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS MEDICAL GROUP INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 204881619 | PHYSICIANS GROUP | OH | 501(C)(3) | LINE 12B, II | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS ST JOHN MEDICAL CENTER | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341260978 | HEALTHCARE | OH | 501(C)(3) | LINE 3 | UNIVERSITY HOSPITALS HEALTH SYSTEM INC | 0 | |
| UNIVERSITY HOSPITALS HEALTH SYSTEM INC | |||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 340714775 | SUPPORT SYSTEM | OH | 501(C)(3) | LINE 3 | 0 | ||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC | |||||||||
| 7580 AUBURN RD | CONCORD | OH | 44077 | 260550261 | OFFICE SPACE | OH | N/A | 0 | 0 |
| NEW MANNA CLG LLC | |||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 371848577 | MEDICAL SERVICES | OH | N/A | 0 | 0 |
| SAMARITAN REGIONAL PAIN MANAGEMENT LLC | |||||||||
| 1025 CENTER STREET | ASHLAND | OH | 44805 | 462286785 | MEDICAL SERVICES | OH | N/A | 0 | 0 |
| UH VALUEHEALTH HOLDINGS LLC | |||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 853503184 | HOLDING COMPANY | OH | N/A | 0 | 0 |
| UHHS ENDOSCOPY HOLDINGS LLC | |||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 831284090 | MEDICAL SERVICES | OH | N/A | 0 | 0 |
| UNIVERSITY SUBURBAN REAL ESTATE LTD | |||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341397180 | REAL ESTATE | OH | N/A | 0 | 0 |
| UNIVERSITY HOSPITALS URGENT CARE BY WELLSTREET LLC | |||||||||
| 3330 CUMBERLAND BLVD STE 825 | ATLANTA | GA | 30339 | 921031874 | MEDICAL SERVICES | GA | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COMPREHENSIVE VENTURES UNLIMITED INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341596060 | PHYSICIAN ADMINISTRATION | OH | N/A | C | 0 | ||||
| EMH MEDICAL OFFICE BUILDING IN AVON INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341935407 | REAL ESTATE | OH | N/A | C | 0 | ||||
| EMH PROFESSIONAL SERVICES INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341778419 | PHYSICIANS GROUP | OH | N/A | C | 0 | ||||
| NORTH OHIO HEART INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 272574020 | PHYSICIANS GROUP | OH | N/A | C | 0 | ||||
| PRL CORPORATION | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341499245 | PHYSICIANS GROUP | OH | N/A | C | 0 | ||||
| QUALITY CARE NETWORK INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 811081563 | MEDICAL MANAGEMENT | OH | N/A | C | 0 | ||||
| USHC MANAGEMENT INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341395971 | HOLDING COMPANY | OH | N/A | C | 0 | ||||
| UHHS PROVIDER AND CENTRAL VERIFICATION ORGANIZATION INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341908517 | MEDICAL MANAGEMENT | OH | N/A | C | 0 | ||||
| UNIVERSITY HOSPITALS ACCOUNTABLE CARE ORGANIZATION INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 813836118 | ACCOUNT CARE | OH | N/A | C | 0 | ||||
| UNIVERSITY HOSPITALS HOLDINGS INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341768931 | HOLDING COMPANY | OH | N/A | C | 0 | ||||
| UNIVERSITY HOSPITALS PHYSICIAN SERVICES INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341768929 | PHYSICIAN ADMINISTRATION | OH | N/A | C | 0 | ||||
| UNIVERSITY PRIMARY CARE PRACTICES INC | |||||||||||||
| 3605 WARRENSVILLE CENTER ROAD-MSC 9 | SHAKER HEIGHTS | OH | 44122 | 341768928 | PHYSICIAN GROUP | OH | N/A | C | 0 | ||||
| WESTERN RESERVE ASSURANCE CO LTD SPC | |||||||||||||
| 980462740 | INSURANCE | N/A | C | 0 | PO BOX 1051 GT KY1 | GRAND CAYMAN | CJ | CJ | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |