KAITLYNS COTTAGE INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- KAITLYNS COTTAGE INC (EIN 45-4781053)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-12
- IRS object ID
- 202133169349310208
- Schema version
- 2020v4.1
- 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 | 2021-11-12T15:07:41-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 454781053 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KAITLYN'S COTTAGE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KAIT | BusinessNameControlTxt |
| Phone | 4192525772 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MADISON AVE ATTN TAX DEPARTM | AddressLine1Txt |
| City | TOLEDO | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43604 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEVEN M CAVANAUGH | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 4192525772 | PhoneNum |
| Signature | 2021-11-11 | SignatureDt |
| Discuss With Paid Preparer | 0 | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | STEVEN | PersonFirstNm |
| Person Last | CAVANAUGH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEVEN M CAVANAUGH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MADISON AVE | AddressLine1Txt |
| City | TOLEDO | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43604 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $312,834 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PROMEDICA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | LOCATED ON THE CAMPUS OF DEFIANCE HOSPITAL, INC., KAITLYN'S COTTAGE, INC. OFFERS RESPITE CARE TO INDIVIDUALS WITH DISABILTIES, AS WELL AS ASSISTANCE TO FAMILY MEMBERS AND OTHER CAREGIVERS OF YOUNG ADULTS WITH SPECIAL NEEDS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 22 | TotalEmployeeCnt |
| Total Volunteers | 300 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,205 | PYContributionsGrantsAmt |
| CY Contributions Grants | $266,747 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $47,911 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $43,006 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $8,485 | PYOtherRevenueAmt |
| CY Other Revenue | $3,081 | CYOtherRevenueAmt |
| PY Total Revenue | $62,601 | PYTotalRevenueAmt |
| CY Total Revenue | $312,834 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $214,928 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $235,724 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $196,503 | PYOtherExpensesAmt |
| CY Other Expenses | $198,138 | CYOtherExpensesAmt |
| PY Total Expenses | $411,431 | PYTotalExpensesAmt |
| CY Total Expenses | $433,862 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$348,830 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$121,028 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,075,601 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,106,103 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $21,644 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $137,848 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,053,957 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,968,255 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | KAITLYN'S COTTAGE, INC. IS A SAFE AND NURTURING COUNTRY COTTAGE GETAWAY WHERE PROFESSIONAL STAFF PROVIDE COMPASSIONATE CARE FOR PERSONS WITH COGNITIVE OR PHYSICAL DISABILITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $383,374 | ExpenseAmt |
| Revenue | $46,087 | RevenueAmt |
| Desc | KAITLYN'S COTTAGE, INC. IS A FACILITY WHICH PROVIDES SHORT-TERM RESPITE CARE SERVICES TO INDIVIDUALS WITH INTELLECTUAL AND PHYSICAL DISABILITIES. - SEE SCHEDULE O. | Desc |
| Total Program Service Expenses | $383,374 | 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 | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | 0 | 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 |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 22 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBERT SHARON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5675855652 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 MADISON AVE | AddressLine1Txt |
| City | TOLEDO | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43604 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| RANDALL OOSTRA | ||||||||
| PHS PRES. & CEO | 1.00 | 55.00 | Yes (X) | $0 | $3,971,638 | $136,986 | ||
| STEVEN M CAVANAUGH | ||||||||
| TREASURER | 1.00 | 55.00 | Yes (X) | $0 | $2,048,174 | $105,065 | ||
| JEFFREY C KUHN | ||||||||
| SECRETARY | 1.00 | 55.00 | Yes (X) | $0 | $1,123,411 | $62,157 | ||
| AMER ARSHAD MD | ||||||||
| TRUSTEE | 1.00 | 40.00 | $0 | $701,628 | $28,709 | Yes (X) | ||
| JORDAN W STUCKEY MD | ||||||||
| TRUSTEE | 1.00 | 40.00 | $0 | $566,389 | $29,509 | Yes (X) | ||
| HOLLY L BRISTOLL | ||||||||
| TRUSTEE | 1.00 | 40.00 | $0 | $523,344 | $46,484 | Yes (X) | ||
| GARY W AKENBERGER | ||||||||
| FORMER OFFICER | 0.00 | 40.00 | $0 | $483,424 | $41,276 | Yes (X) | ||
| GARY M CATES | ||||||||
| TRUSTEE | 1.00 | 41.00 | $0 | $485,715 | $32,373 | Yes (X) | ||
| JOSHUA M LUCAS MD | ||||||||
| TRUSTEE | 1.00 | 40.00 | $0 | $472,177 | $28,641 | Yes (X) | ||
| DARRIN ARQUETTE | ||||||||
| FORMER OFFICER | 0.00 | 43.00 | $0 | $391,028 | $40,287 | Yes (X) | ||
| PAMELA M JENSEN | ||||||||
| EX OFFICIO | 1.00 | 42.00 | $0 | $391,013 | $32,951 | Yes (X) | ||
| JULIE K YAROCH DO | ||||||||
| FORMER OFFICER | 0.00 | 41.00 | $0 | $358,522 | $26,934 | Yes (X) | ||
| NEERAJ K KANWAL MD | ||||||||
| FORMER OFFICER | 0.00 | 40.00 | $0 | $263,236 | $74,245 | Yes (X) | ||
| ALAN M SATTLER | ||||||||
| FORMER OFFICER | 0.00 | 40.00 | $0 | $249,480 | $36,266 | Yes (X) | ||
| DOUGLAS J BUSH | ||||||||
| PRES., TRUSTEE | 1.00 | 40.00 | Yes (X) | $0 | $231,482 | $33,838 | Yes (X) | |
| LAURA W KLINE | ||||||||
| CHAIRMAN | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| AMANDA K KISSNER | ||||||||
| VICE CHAIRMAN | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| ANDREW D SHINDLER | ||||||||
| TRUSTEE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| BRANDON M MCCANN | ||||||||
| TRUSTEE (PARTIAL YEAR) | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| CRYSTAL HORNISH | ||||||||
| TRUSTEE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| JENNIFER A BOYD | ||||||||
| TRUSTEE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| KATHRYN E GROFF | ||||||||
| TRUSTEE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| KENNETH EDWIN BOROFF | ||||||||
| TRUSTEE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| MICHELLE E STAHL CPA | ||||||||
| TRUSTEE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| RICHANNE C MANKEY EDD MSED BA | ||||||||
| TRUSTEE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| SUE A STRAUSBAUGH | ||||||||
| TRUSTEE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $12,260,661 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $755,721 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $266,747 | RelatedOrganizationsAmt |
| Total Contributions | $266,747 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RESPITE CARE SERVICES | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $43,006 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $43,006 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $43,006 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CAMPS/REC ACTIVITIES | 721210 | $2,178 | $2,178 |
| TRANSPORTATION | 480000 | $270 | $270 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $633 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $633 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,081 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $312,834 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $46,087 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,381 | TotalAmt |
| Program Services | $173,179 | ProgramServicesAmt |
| Management And General | $47,202 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,343 | TotalAmt |
| Program Services | $12,057 | ProgramServicesAmt |
| Management And General | $3,286 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,118 | TotalAmt |
| Program Services | $3,118 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $772 | TotalAmt |
| Program Services | $772 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,761 | TotalAmt |
| Program Services | $8,761 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,786 | TotalAmt |
| Program Services | $35,786 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,264 | TotalAmt |
| Program Services | $1,264 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,404 | TotalAmt |
| Program Services | $118,404 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| SPECIAL EVENTS | $15,985 | $15,985 |
| FOOD | $8,065 | $8,065 |
| MINOR EQUIPMENT | $1,448 | $1,448 |
| VEHICLE EXPENSE | $1,445 | $1,445 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,090 | TotalAmt |
| Program Services | $3,090 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $433,862 | TotalAmt |
| Program Services | $383,374 | ProgramServicesAmt |
| Management And General | $50,488 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200 | BOYAmt |
| EOY | $199 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,750,610 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $797,464 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,071,551 | BOYAmt |
| EOY | $1,953,146 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,850 | BOYAmt |
| EOY | $152,758 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,075,601 | BOYAmt |
| EOY | $2,106,103 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,243 | BOYAmt |
| EOY | $7,437 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,401 | BOYAmt |
| EOY | $130,411 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,644 | BOYAmt |
| EOY | $137,848 | 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 | $2,053,957 | BOYAmt |
| EOY | $1,968,255 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,053,957 | BOYAmt |
| EOY | $1,968,255 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,075,601 | BOYAmt |
| EOY | $2,106,103 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$121,028 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $35,326 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | 0 | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $259,162 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,658 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $26,284 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,205 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $266,747 | CurrentTaxYearAmt |
| Total | $571,056 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $44,031 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $57,988 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $62,755 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $47,911 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $43,006 | CurrentTaxYearAmt |
| Total | $255,691 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $303,193 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $70,646 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $89,039 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $54,116 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $309,753 | CurrentTaxYearAmt |
| Total | $826,747 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $225,248 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,165 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $25,654 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,205 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $266,747 | CurrentTaxYearAmt |
| Total | $536,019 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $1,329 | CurrentTaxYearMinus3YearsAmt |
| Total | $1,329 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $225,248 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,494 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $25,654 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,205 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $266,747 | CurrentTaxYearAmt |
| Total | $537,348 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $289,399 | PublicSupportTotal509Amt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $801 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $926 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $941 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,485 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,081 | CurrentTaxYearAmt |
| Total | $14,234 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $303,994 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $71,572 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $89,980 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $62,601 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $312,834 | CurrentTaxYearAmt |
| Total | $840,981 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.34410 | PublicSupportCY509Pct |
| Public Support PY509 | 0.59910 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | RESIDENT CRAFT SALE - 2016 AMOUNT: $ 201. TRANSPORTATION - 2016 AMOUNT: $ 600. 2017 AMOUNT: $ 926. 2018 AMOUNT: $ 745. 2019 AMOUNT: $ 850. 2020 AMOUNT: $ 270. MISCELLANEOUS REVENUE - 2018 AMOUNT: $ 196. 2019 AMOUNT: $ 826. 2020 AMOUNT: $ 633. CAMPS/RECREATIONAL ACTIVITIES - 2019 AMOUNT: $ 6,809. 2020 AMOUNT: $ 2,178. | ExplanationTxt |
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
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,516,626 | OtherCostOrOtherBasisAmt |
| Depreciation | $615,213 | DepreciationAmt |
| Book Value | $1,901,413 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $218,339 | OtherCostOrOtherBasisAmt |
| Depreciation | $168,953 | DepreciationAmt |
| Book Value | $49,386 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,645 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,298 | DepreciationAmt |
| Book Value | $2,347 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,953,146 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM AFFILIATES | $150,100 |
| OTHER RECEIVABLES | $2,658 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $152,758 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $130,411 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $130,411 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | Yes (X) | FirstClassOrCharterTravelInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Severance Payment | Yes (1) | 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 (15 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RANDALL OOSTRA | ||||||||||||||
| PHS PRES. & CEO | $0 | $1,973,076 | $0 | $1,805,059 | $0 | $193,503 | $0 | $117,599 | $0 | $19,387 | $0 | $4,108,624 | $0 | $0 |
| STEVEN M CAVANAUGH | ||||||||||||||
| TREASURER | $0 | $1,330,912 | $0 | $710,821 | $0 | $6,441 | $0 | $82,144 | $0 | $22,921 | $0 | $2,153,239 | $0 | $0 |
| JEFFREY C KUHN | ||||||||||||||
| SECRETARY | $0 | $716,660 | $0 | $391,346 | $0 | $15,405 | $0 | $44,915 | $0 | $17,242 | $0 | $1,185,568 | $0 | $0 |
| AMER ARSHAD MD | ||||||||||||||
| TRUSTEE | $0 | $521,290 | $0 | $178,562 | $0 | $1,776 | $0 | $0 | $0 | $28,709 | $0 | $730,337 | $0 | $0 |
| JORDAN W STUCKEY MD | ||||||||||||||
| TRUSTEE | $0 | $565,175 | $0 | $0 | $0 | $1,214 | $0 | $0 | $0 | $29,509 | $0 | $595,898 | $0 | $0 |
| HOLLY L BRISTOLL | ||||||||||||||
| TRUSTEE | $0 | $331,217 | $0 | $183,179 | $0 | $8,948 | $0 | $21,127 | $0 | $25,357 | $0 | $569,828 | $0 | $0 |
| GARY W AKENBERGER | ||||||||||||||
| FORMER OFFICER | $0 | $390,451 | $0 | $88,180 | $0 | $4,793 | $0 | $19,393 | $0 | $21,883 | $0 | $524,700 | $0 | $0 |
| GARY M CATES | ||||||||||||||
| TRUSTEE | $0 | $376,904 | $0 | $98,080 | $0 | $10,731 | $0 | $14,575 | $0 | $17,798 | $0 | $518,088 | $0 | $0 |
| JOSHUA M LUCAS MD | ||||||||||||||
| TRUSTEE | $0 | $283,563 | $0 | $188,182 | $0 | $432 | $0 | $0 | $0 | $28,641 | $0 | $500,818 | $0 | $0 |
| DARRIN ARQUETTE | ||||||||||||||
| FORMER OFFICER | $0 | $324,493 | $0 | $63,579 | $0 | $2,956 | $0 | $11,877 | $0 | $28,410 | $0 | $431,315 | $0 | $0 |
| PAMELA M JENSEN | ||||||||||||||
| EX OFFICIO | $0 | $314,905 | $0 | $72,966 | $0 | $3,142 | $0 | $11,862 | $0 | $21,089 | $0 | $423,964 | $0 | $0 |
| JULIE K YAROCH DO | ||||||||||||||
| FORMER OFFICER | $0 | $292,648 | $0 | $64,622 | $0 | $1,252 | $0 | $10,818 | $0 | $16,116 | $0 | $385,456 | $0 | $0 |
| NEERAJ K KANWAL MD | ||||||||||||||
| FORMER OFFICER | $0 | $17,612 | $0 | $79,954 | $0 | $165,670 | $0 | $0 | $0 | $74,245 | $0 | $337,481 | $0 | $0 |
| ALAN M SATTLER | ||||||||||||||
| FORMER OFFICER | $0 | $210,691 | $0 | $35,926 | $0 | $2,863 | $0 | $10,110 | $0 | $26,156 | $0 | $285,746 | $0 | $0 |
| DOUGLAS J BUSH | ||||||||||||||
| PRES., TRUSTEE | $0 | $186,190 | $0 | $44,404 | $0 | $888 | $0 | $5,965 | $0 | $27,873 | $0 | $265,320 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | CHARTER TRAVEL: 2 OFFICERS- NOT INCLUDED IN TAXABLE COMPENSATION |
| PART I, LINE 1B | DUE TO EXTENUATING CIRCUMSTANCES RELATED TO THE COVID-19 PANDEMIC THAT LIMITED FLIGHT SCHEDULES AND ABILITY TO TRAVEL, CHARTERED FLIGHT SERVICES WERE UTILIZED WHEN NECESSARY AS THE ONLY FEASIBLE TRAVEL SOLUTION DURING TAX YEAR 2020. THIS WAS NECESSARY IN ORDER TO ENABLE EXECUTIVES TO BE ABLE TO CONTINUE TO CONDUCT BUSINESS WHEN COMMERCIAL FLIGHTS WERE NOT AVAILABLE TO MEET SCHEDULED MEETINGS AND DUE TO SCHEDULE CONSTRAINTS. DURING 2020 THERE WAS NOT A POLICY GOVERNING THIS TYPE OF TRAVEL IN PLACE AS IT WAS NOT FORESEEN IT WOULD BE NECESSARY. CURRENTLY A POLICY IS BEING DRAFTED TO ENSURE PROPER COMPLIANCE AND GOVERNANCE OF THESE EXPENDITURES IN THE FUTURE. |
| PART I, LINE 3 | PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF KAITLYN'S COTTAGE, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINES 4A-B | UNDER A VOLUNTARY TERMINATION AGREEMENT ENTERED INTO BY THE EMPLOYEE AND THE ORGANIZATION OR UPON A QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM PROMEDICA. SEVERANCE PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING LISTED PERSONS IN PART VII: NEERAJ K. KANWAL, M.D. $ 165,297.60 ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. |
| SCHEDULE J, SUPPLEMENTAL INFORMATION: | IN ADDITION, THE ORGANIZATION PROVIDES A SPLIT-DOLLAR LIFE INSURANCE PLAN TO ITS CHIEF EXECUTIVE OFFICER FROM WHICH NO CASH PAYMENTS WERE MADE DURING THE YEAR. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4: | KAITLYN'S COTTAGE, INC. - PROGRAM SERVICE ACCOMPLISHMENTS KAITLYN'S COTTAGE, INC. (KAITLYN'S) IS A MEMBER OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION-BASED, LOCALLY OWNED, NONPROFIT HEALTHCARE ORGANIZATION HIGHLY FOCUSED ON ACHIEVING CORE VALUES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA SERVES 28 STATES ACROSS THE COUNTRY AND IS ONE OF THE NATION'S LEADING HEALTH SYSTEMS. OUR STEWARDSHIP OF RESOURCES HAS ENABLED US TO WISELY INVEST IN PATIENT-CENTERED CARE, ADVANCED TECHNOLOGY, INNOVATIVE PROGRAMS, AND FAMILY-ORIENTED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF A PATIENT'S ABILITY TO PAY. WITH STRONG PHILANTHROPIC SUPPORT, KAITLYN'S OPENED ON THE CAMPUS OF DEFIANCE HOSPITAL, INC. IN 2012 FOR DAYTIME AND OVERNIGHT RESPITE CARE FOR INDIVIDUALS WITH INTELLECTUAL AND PHYSICAL DISABILITIES. AT THE TIME, IT WAS THOUGHT TO BE THE FIRST OF ITS KIND IN THE UNITED STATES. THE 5,000-SQUARE-FOOT FACILITY HAS FOUR PRIVATE BEDROOMS FOR OVERNIGHT GUESTS, A LIBRARY, AND ACTIVITY AND DINING AREAS. GUESTS ARE OFFERED ACTIVITIES SUCH AS ARTS AND CRAFTS, COOKING, GARDENING, PLAYING MUSIC, PLAYING GAMES, OR MANY OTHER ACTIVITIES OF THEIR CHOOSING. FOUR, THREE-DAY SUMMER CAMPS ALSO ARE AVAILABLE, WITH SCHEDULING BASED UPON EACH CAMPERS' NEEDS FOR FULL OR PARTIAL DAYS. SPECIAL EVENTS SUCH AS A SPRING DANCE, HOLIDAY COOKOUTS, A FALL FESTIVAL, AND A NEW YEAR'S EVE PARTY ARE DESIGNED TO PROVIDE ADDITIONAL SOCIAL INTERACTION FOR GUESTS THROUGHOUT THE YEAR. IN 2020, KAITLYN'S RECEIVED A GENEROUS DONATION FROM THE SLEEPSAFE BED COMPANY TO HELP ACCOMMODATE A PATIENT WHO NEEDED A SPECIAL BED WITH ADDITIONAL SAFETY MEASURES IN PLACE. THE ADDITION GIVES THE FACILITY THREE SEPARATE OPTIONS FOR GUESTS REQUIRING UNIQUE SLEEP ACCOMMODATIONS. ADDITIONALLY, STAFF PROVIDES FAMILY AND CAREGIVER SUPPORT GROUPS, EDUCATION SESSIONS ON A VARIETY OF CAREGIVER TOPICS, AND OTHER TYPES OF SUPPORT. FURTHER, THERE IS A SLIDING-SCALE FEE (STARTING AT A NOMINAL AMOUNT) FOR PAYMENTS, AND AN ENDOWMENT HAS BEEN ESTABLISHED TO HELP ASSIST THOSE WHO CANNOT AFFORD SERVICES. AT KAITLYN'S, ALL STAFF MEMBERS ARE TRAINED IN MEDICATION ADMINISTRATION, CPR/FIRST AID CERTIFIED, AND CPI (NON-VIOLENT CRISIS INTERVENTION) TRAINED. TO HELP ENSURE THAT CARE AND SERVICES ARE PROVIDED APPROPRIATELY, KAITLYN'S HAS A PROFESSIONAL ADVISORY COUNCIL THAT CAN BE CONSULTED; MEMBERS INCLUDE A PHYSICIAN, CLERGY MEMBER, AN ATTORNEY, AND PATIENT FAMILY MEMBERS. IN SUMMARY, KAITLYN'S DEMONSTRATES PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING FAMILY EDUCATION, FOSTERING CONTINUED EXCELLENCE IN PROGRAMS AND SERVICES, AND OFFERING HIGH-QUALITY RESPITE CARE FOR THE BENEFIT OF ALL ITS GUESTS AND FAMILY CAREGIVERS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. PROMEDICA RECOGNIZES THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL CARE. THEREFORE, WE PROVIDE THESE HEALTHCARE SERVICES; RECRUIT AND TRAIN HEALTHCARE PROFESSIONALS TO SERVE THE BROADER COMMUNITY; PROVIDE APPROPRIATE FINANCIAL ASSISTANCE; OFFER SERVICES AND CONTRIBUTIONS TO OTHER NONPROFIT ORGANIZATIONS THAT ALLOW THEM TO PROVIDE KEY SERVICES TO THEIR CONSTITUENTS; AND PRESENT FREE EDUCATIONAL OFFERINGS AND OTHER OUTREACH ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE. |
| FORM 990, PART VI, SECTION A, LINE 6 | AS AN OHIO NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7A | PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE SOLE MEMBER OF DEFIANCE HOSPITAL, INC., WHICH IS THE SOLE MEMBER OF KAITLYN'S COTTAGE. PHS HAS THE RIGHT TO (A) NOMINATE AND ELECT A MINORITY OF THE MEMBERS AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF KAITLYN'S COTTAGE, AND (B) APPROVE THE NOMINEES TO FILL ANY VACANCIES ON THE BOARD OF TRUSTEES, A MAJORITY OF WHOM ARE NOMINATED BY DEFIANCE HOSPITAL, INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER AND (VI) ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR LIQUIDATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 RETURNS OF PROMEDICA HEALTH SYSTEM, INC. (PHS) AND ITS SUBSIDIARIES ARE PREPARED BY THE PHS TAX DEPARTMENT WITH THE ASSISTANCE OF FINANCE. THE RETURNS ARE REVIEWED BY THE AVP OF TAX BEFORE BEING PROVIDED TO THE RESPECTIVE COMPANY'S BOARD OF TRUSTEES PRIOR TO FILING. ANY COMMENTS OR QUESTIONS FROM THE BOARD ARE REVIEWED AND INCORPORATED INTO THE RETURN IF APPROPRIATE. FINAL RETURNS ARE PROVIDED TO A PRINCIPAL OFFICER FOR SIGNATURE PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER SOC SURVEY WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER SOC SURVEYS ARE REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER SOC SURVEYS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED, AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO COMPLETE THE SURVEY OR THE SUBMISSION OF A FALSE OR INCOMPLETE SURVEY, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S SURVEY RESULTS OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL BONUS-ELIGIBLE SENIOR LEADERSHIP AND SPECIFICALLY IDENTIFIED ADDITIONAL EMPLOYEES, ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE BY AN ESTABLISHED DEADLINE THAT IS COMMUNICATED TO THE EMPLOYEE. THE HUMAN RESOURCES DEPARTMENT ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND PROVIDES NOTIFICATION TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL EMPLOYEE CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT. ALL NEW EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYEE STANDARD OF CONDUCT AND THE EMPLOYEE CERTIFICATION STATEMENT WHICH THE NEW EMPLOYEE IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. THE AUDIT & COMPLIANCE DEPARTMENT HAS ACCESS TO A REPORT THAT IDENTIFIES ALL NEW HIRES. A SAMPLE OF EMPLOYEES IS IDENTIFIED AND AN AUDIT IS CONDUCTED TO ENSURE THAT REQUIRED DOCUMENTATION IS ON FILE. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE V.P., AUDIT & COMPLIANCE AND IF NECESSARY DISCUSSED WITH THE BUSINESS UNIT PRESIDENT IN WHICH THE EMPLOYEE WORKS, THE CHIEF HUMAN RESOURCE OFFICER, AND GENERAL COUNSEL. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL OF THE PHS PRESIDENT/CEO. RESULTS OF THE EMPLOYEE PROCESS AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FAILURE TO COMPLETE THE CERTIFICATION QUESTIONNAIRE, OR THE COMPLETION OF A FALSE OR INCOMPLETE CERTIFICATION QUESTIONNAIRE, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE EMPLOYEE'S CERTIFICATION QUESTIONNAIRE OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. ADDITIONALLY, AS PART OF THE ANNUAL MANDATORY COMPLIANCE TRAINING ASSIGNED TO ALL PROMEDICA EMPLOYEES, EACH EMPLOYEE IS REQUIRED TO ELECTRONICALLY ACKNOWLEDGE THAT THEY HAVE RECEIVED A COPY OF THE PROMEDICA STANDARDS OF CONDUCT, THAT THEY UNDERSTAND HOW THE STANDARDS APPLY TO THEM, ACKNOWLEDGE THEIR OBLIGATION TO FOLLOW THEM, THEIR OBLIGATION TO REPORT VIOLATIONS OF THE STANDARDS OR REQUESTS THAT WOULD RESULT IN VIOLATIONS OF THE STANDARDS TO APPROPRIATE COMPANY OFFICERS AND THAT THEY HAVE REPORTED ALL VIOLATIONS KNOWN TO THEM AS REQUIRED BY THE STANDARDS. IN ADDITION THE ATTESTATION STATES ANY CONFLICTS OF INTEREST OR OTHER MATTERS FOR WHICH THE STANDARDS REQUIRE WRITTEN DISCLOSURE TO THE COMPANY HAVE BEEN SO DISCLOSED BY THE EMPLOYEE AND THEY UNDERSTAND AND ACKNOWLEDGE THAT TO THE EXTENT THEY ARE AN AT-WILL EMPLOYEE, THE STANDARDS DO NOT AFFECT THE AT-WILL NATURE OF MY EMPLOYMENT RELATIONSHIP WITH THE COMPANY. |
| FORM 990, PART VI, SECTION B, LINE 15 | KAITLYN'S COTTAGE, INC.'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF PROMEDICA FOUNDATION'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE MADE BY A COMPENSATION COMMITTEE OF PHS. EACH YEAR INDEPENDENT CONSULTANTS CONDUCT AN ANNUAL SURVEY AND RECOMMEND EXECUTIVE PAYROLL BASE SALARY RANGES BASED UPON THE MARKET. THE DATA IS REVIEWED AND APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE EVERY OCTOBER. SALARY ADJUSTMENTS ARE DETERMINED AT THE DECEMBER MEETING OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES OTHER FORMS OF COMPENSATION BASED UPON THE PRIOR YEAR PERFORMANCE AT THE JANUARY MEETING EACH YEAR. |
| FORM 990, PART VI, SECTION C, LINE 19 | PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | TRANSFERS BETWEEN RELATED ENTITIES 35,326. |
| FORM 990, PART XII, LINE 2C | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990, PART XII, LINE 3B | THE REQUIRED SINGLE AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 HAS NOT YET BEEN COMPLETED. PLANS HAVE BEEN MADE TO HAVE THE REQUIRED SINGLE AUDIT COMPLETED BY THE EXTENDED DUE DATE AS ESTABLISHED IN OMB M-20-26. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (44 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 | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BAY PARK COMMUNITY HOSPITAL | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 341883132 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| COMMUNITY HEALTH CENTER OF BRANCH COUNTY | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 386108110 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| DEFIANCE HOSPITAL AUXILIARY | |||||||||||
| 1200 RALSTON | DEFIANCE | OH | 43512 | 510173779 | HOSPITAL / FOUNDATION SUPPORT | OH | 501(C)(3) | 10 | DEFIANCE HOSPITAL INC | Yes (1) | |
| DEFIANCE HOSPITAL INC | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 344446484 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| EMMA L BIXBY MEDICAL CENTER | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 382796005 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| EMMA L BIXBY MEDICAL CENTER AUXILIARY | |||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 43604 | 382149602 | HOSPITAL / FOUNDATION SUPPORT | MI | 501(C)(3) | 12B, II | EMMA L BIXBY MEDICAL CENTER | Yes (1) | |
| FOSTORIA HOSPITAL ASSOCIATION | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 340898745 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| FOSTORIA HOSPITAL AUXILIARY | |||||||||||
| PO BOX 907 | FOSTORIA | OH | 44830 | 346517634 | HOSPITAL / FOUNDATION SUPPORT | OH | 501(C)(3) | 10 | FOSTORIA HOSPITAL ASSOCIATION | Yes (1) | |
| HCR MANORCARE FOUNDATION INC | |||||||||||
| 444 N SUMMIT ST | TOLEDO | OH | 43604 | 522031975 | FOUNDATION | OH | 501(C)(3) | 12B, II | PROMEDICA FOUNDATION | Yes (1) | |
| HCR MANORCARE INC | |||||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43699 | 825373223 | SKILLED NURSING FACILITIES | OH | 501(C)(3) | 10 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| HEARTLAND HOSPICE MEMORIAL FUND INC | |||||||||||
| 444 N SUMMIT ST | TOLEDO | OH | 43604 | 270497199 | FOUNDATION | OH | 501(C)(3) | 12B, II | PROMEDICA FOUNDATION | Yes (1) | |
| HERRICK MEDICAL CENTER AUXILIARY | |||||||||||
| 500 E POTTAWATAMIE ST | TECUMSEH | MI | 49286 | 383076105 | HOSPITAL / FOUNDATION SUPPORT | MI | 501(C)(3) | 12B, II | HERRICK MEMORIAL HOSPITAL INC | Yes (1) | |
| HERRICK MEMORIAL HOSPITAL INC | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 383049015 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| LENAWEE LONG TERM CARE | |||||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43699 | 382879330 | LONG TERM CARE | MI | 501(C)(3) | 10 | HCR MANORCARE INC | Yes (1) | |
| MANOR CARE OF GIG HARBOR WA ASSOCIATION | |||||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43699 | 260624719 | SKILLED NURSING FACILITY | DE | 501(C)(3) | 10 | HCR MANORCARE INC | Yes (1) | |
| MANOR CARE OF LACEY WA ASSOCIATION | |||||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43699 | 260624391 | SKILLED NURSING FACILITY | DE | 501(C)(3) | 10 | HCR MANORCARE INC | Yes (1) | |
| MANOR CARE OF LYNNWOOD WA ASSOCIATION | |||||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43699 | 260624675 | SKILLED NURSING FACILITY | DE | 501(C)(3) | 10 | HCR MANORCARE INC | Yes (1) | |
| MANOR CARE OF SALMON CREEK WA ASSOCIATION | |||||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43699 | 260624375 | SKILLED NURSING FACILITY | DE | 501(C)(3) | 10 | HCR MANORCARE INC | Yes (1) | |
| MANOR CARE OF SPOKANE WA ASSOCIATION | |||||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43699 | 260624687 | SKILLED NURSING FACILITY | DE | 501(C)(3) | 10 | HCR MANORCARE INC | Yes (1) | |
| MANOR CARE OF TACOMA WA ASSOCIATION | |||||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43699 | 260624696 | SKILLED NURSING FACILITY | DE | 501(C)(3) | 10 | HCR MANORCARE INC | Yes (1) | |
| MEMORIAL HOSPITAL | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 344430849 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| MEMORIAL PROFESSIONAL SERVICES | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 273763993 | PHYSICIAN HEALTH CARE SERVICES | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| MERCY MEMORIAL HOSPITAL CORPORATION | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 381984289 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| MONROE COMMUNITY HEALTH SERVICES | |||||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43699 | 382934134 | LONG TERM CARE | MI | 501(C)(3) | 10 | HCR MANORCARE INC | Yes (1) | |
| PARAMOUNT ADVANTAGE | |||||||||||
| 1901 INDIAN WOOD CIR | MAUMEE | OH | 43537 | 203376102 | HEALTH INSURANCE | OH | 501(C)(3) | 10 | PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES | Yes (1) | |
| PROMEDICA AT HOME INC | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 852320857 | PHYSICIAN SUPPORT | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| PROMEDICA CENTRAL PHYSICIANS | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 341881137 | PHYSICIAN HEALTH CARE SERVICES | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| PROMEDICA CHILDRENS SPECIALISTS | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 208734161 | PHYSICIAN HEALTH CARE SERVICES | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| PROMEDICA CONTINUING CARE SERVICES CORP | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 344492440 | LONG TERM AND HOME HEALTH CARE | OH | 501(C)(3) | 10 | PROMEDICA CONTINUUM SERVICES | Yes (1) | |
| PROMEDICA CONTINUUM SERVICES | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 341880767 | PHYSICIAN MANAGEMENT SERVICES | OH | 501(C)(3) | 12B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA COURIER SERVICES INC | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 260324790 | COURIER SERVICE | OH | 501(C)(3) | 12B, II | PROMEDICA CONTINUUM SERVICES | Yes (1) | |
| PROMEDICA FOUNDATION | |||||||||||
| 444 N SUMMIT ST | TOLEDO | OH | 43604 | 341517672 | FOUNDATION | OH | 501(C)(3) | 12B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA GENITO-URINARY SURGEONS | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 461120436 | PHYSICIAN HEALTH CARE SERVICES | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| PROMEDICA HEALTH SYSTEM INC | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 341517671 | PARENT COMPANY OF HEALTH SYSTEM | OH | 501(C)(3) | 12B, II | 0 | N/A | |
| PROMEDICA INDEMNITY CORP | |||||||||||
| ONE CHURCH ST 5TH FLOOR | BURLINGTON | VT | 05401 | 341931936 | PROFESSIONAL & GENERAL LIABILITY | VT | 501(C)(3) | 12B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA MONROE CARDIOLOGY | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 272920342 | PHYSICIAN HEALTH CARE SERVICES | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| PROMEDICA MONROE PHYSICIANS | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 461111822 | PHYSICIAN HEALTH CARE SERVICES | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 263888045 | PHYSICIAN HEALTH CARE SERVICES | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| PROMEDICA PHYSICIAN GROUP INC | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 341899439 | PHYSICIAN HEALTH CARE SERVICES | OH | 501(C)(3) | 10 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA PHYSICIANS AT HOME INC | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 852181349 | PHYSICIAN HEALTH CARE SERVICES | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| PROMEDICA PRIMARY CARE PROVIDERS | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 831731861 | PHYSICIAN HEALTH CARE SERVICES | MI | 501(C)(3) | 10 | PROMEDICA PHYSICIAN GROUP INC | Yes (1) | |
| THE HUG FUND | |||||||||||
| 444 N SUMMIT ST | TOLEDO | OH | 43604 | 202272848 | FOUNDATION | OH | 501(C)(3) | 12B, II | PROMEDICA FOUNDATION | Yes (1) | |
| THE TOLEDO HOSPITAL | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 344428256 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| VISITING NURSE HOSPICE AND HEALTH CARE | |||||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 341831624 | HOSPICE HOME CARE | OH | 501(C)(3) | 10 | HCR MANORCARE INC | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (13 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 |
|---|---|---|---|---|---|---|---|---|---|
| EAST-WEST HOLDINGS LTD | |||||||||
| 715 SOUTH TAFT AVE | FREMONT | OH | 43420 | 204066818 | REAL ESTATE | OH | N/A | 0 | 0 |
| MERCYMANOR PARTNERSHIP | |||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43604 | 521931012 | SKILLED NURSING | PA | N/A | 0 | Yes (1) |
| NORMAN SPECIALTY HOSPITAL LLC | |||||||||
| PO BOX 10086 ATTN TAX-5 | TOLEDO | OH | 43604 | 421627672 | HEALTH CARE | DE | N/A | 0 | Yes (1) |
| NORTHWEST OHIO DEDICATED BREAST MRI LLC | |||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 260679898 | MEDICAL DIAGNOSTICS | OH | N/A | 0 | 0 |
| PROMEDICA DOWNTOWN CAMPUS LANDLORD LLC | |||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 473163945 | REAL ESTATE | OH | N/A | 0 | Yes (1) |
| PROMEDICA MASTER TENANT LLC | |||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 475288490 | REAL ESTATE | OH | N/A | 0 | Yes (1) |
| PROMEDICA PATHOLOGY LABORATORIES LLC | |||||||||
| 2130 W CENTRAL AVE STE 300 | TOLEDO | OH | 43606 | 831022842 | CLINICAL LABORATORY | DE | N/A | 0 | 0 |
| PROMEDICA SURGICAL SERVICES CO-MANAGEMENT CO LLC | |||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 461989695 | PHYSICIAN MANAGEMENT SERVICES | OH | N/A | 0 | 0 |
| REYNOLDS ROAD SURGICAL CENTER LTD | |||||||||
| 2865 N REYNOLDS RD | TOLEDO | OH | 43615 | 311569454 | FREESTANDING AMBULATORY SURGICAL CENTER | OH | N/A | 0 | 0 |
| ROCKET VENTURE FUND II LLC | |||||||||
| 2865 N REYNOLDS RD STE 220 | TOLEDO | OH | 43615 | 475603627 | INVESTMENT FUND | OH | N/A | 0 | 0 |
| SENIOR & REHAB CARE AT METROHEALTH LLC | |||||||||
| 100 MADISON AVE ATTN TAX DEPT | TOLEDO | OH | 43604 | 872465544 | SKILLED NURSING | OH | N/A | 0 | Yes (1) |
| THE SURGICAL INSTITUTE OF MONROE AMBULATORY SURGERY CENTER LLC | |||||||||
| 1051 S TELEGRAPH RD | MONROE | MI | 48161 | 270843485 | AMBULATORY SURGICAL CENTER | MI | N/A | 0 | 0 |
| WEST CENTRAL SURGICAL CENTER LLC | |||||||||
| 7055 W CENTRAL | TOLEDO | OH | 43617 | 200088459 | AMBULATORY SURGICAL CENTER | OH | N/A | 0 | Yes (1) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| HERRICK MEMORIAL DEVELOPMENT CORP | |||||||||
| 500 E POTTAWATAMIE TR | ADRIAN | MI | 49221 | 383146907 | FACILITY LEASING | MI | N/A | C | 0 |
| HERRICK MEMORIAL OFFICE PLAZA CONDOMINIUM ASSOCIATION | |||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 383639616 | FACILITY MANAGEMENT | MI | N/A | C | 0 |
| MONROE HEALTH VENTURES INC | |||||||||
| 718 N MACOMB | MONROE | MI | 48164 | 382704426 | PHARMACY | MI | N/A | C | 0 |
| PROMEDICA CENTRAL CORPORATION OF MICHIGAN | |||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 383322278 | PHYSICIAN HEALTH CARE SERVICES | OH | N/A | C | 0 |
| PROMEDICA HEALTH NETWORK INC | |||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 474006496 | PHYSICIAN MANAGEMENT SERVICES | OH | N/A | C | 0 |
| PROMEDICA INNOVATIONS LLC | |||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 301221601 | INVESTMENT COMPANY | OH | N/A | C | 0 |
| PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES | |||||||||
| 1901 INDIAN WOOD CIR | MAUMEE | OH | 43537 | 341570675 | HEALTH CARE INSURANCE | OH | N/A | C | 0 |
| PROMEDICA MANAGER MEMBER LLC | |||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 475168737 | REAL ESTATE | OH | N/A | C | 0 |
| PROMEDICA NORTH PHYSICIAN CORPORATION | |||||||||
| 100 MADISON AVE | TOLEDO | OH | 43604 | 383482148 | PHYSICIAN HEALTH CARE SERVICES | OH | N/A | C | 0 |
| PROMEDICA RETAIL GROUP INC | |||||||||
| 3890 MONROE ST | TOLEDO | OH | 43606 | 341159928 | FLORIST | OH | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | 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 | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |