2018-11-07T08:37:27-06:00 2017-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2017-01-01 341935236 LIMA MEMORIAL PROFESSIONAL CORPORATION LIMA 4192283335 1001 BELLEFONTAINE AVENUE LIMA OH 45804 MICHAEL D SWICK PRESIDENT/CEO 4192283335 2018-10-29 1 BERNIE OSTROWSKI P00366367 6148493000 2018-10-17 74.113.40.52 2018-10-29 14:55:47 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CDA108602048A852A3C7A9C68094104E2D92ED46 2017 2019-02-21 02:37:17Z MICHAEL D SWICK 1001 BELLEFONTAINE AVENUE LIMA OH 45804 26331264 0 X WWW.LIMAMEMORIAL.ORG X 2000 OH WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 14 2 319 2 3344 -1511 0 0 22202811 26322098 388 686 5438 8480 22208637 26331264 10000 10000 0 0 26469186 31567020 0 0 0 8249905 8472447 34729091 40049467 -12520454 -13718203 6305101 5768388 104831132 118012604 -98526031 -112244216 X WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 0 0 38414196 10000 26327234 LIMA MEMORIAL PHYSICIANS IS AN EXTENDED NETWORK OF PRIMARY CARE, PEDIATRIC AND SPECIALIST PHYSICIANS. THE PRIMARY CARE SERVICE LINE IS THE PATIENT'S GATEWAY TO A WHOLE TEAM OF SPECIALTY PHYSICIANS. WITH AN EMPHASIS ON COLLABORATIVE, PATIENT-FOCUSED CARE, PATIENTS CAN TAKE GREAT COMFORT KNOWING AN ENTIRE TEAM IS WORKING TO PROVIDE YOU WITH THE VERY BEST CARE. THERE ARE 10 FAMILY MEDICINE LOCATIONS ACROSS LIMA AND THE SURROUNDING REGIONS, EXTENDED HOURS AND SAME-DAY APPOINTMENTS. LIMA MEMORIAL HAS THE TOP MEDICAL AND SURGICAL SPECIALISTS IN THE AREA WHO WORK COLLABORATIVELY WITH YOUR PRIMARY CARE PHYSICIAN. THE SPECIALTY SERVICES INCLUDES: CARDIAC SERVICES, DIABETES, EAR, NOSE & THROAT, GENERAL SURGERY, HEMATOLOGY / MEDICAL ONCOLOGY, INTERNAL MEDICINE, KIDNEY SERVICES, NEUROSURGERY & NEUROLOGY, NURSE-MIDWIFERY, OBSTETRICS / GYNECOLOGY, PALLIATIVE CARE, PEDIATRIC SERVICES, PODIATRY, PROCTOLOGY, PULMONARY MEDICINE, RADIATION ONCOLOGY, RHEUMATOLOGY, SLEEP DISORDERS, UROLOGY AND VEIN CARE. 38414196 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 48 0 1 319 1 1 1 0 0 0 0 0 0 0 0 0 X 14 2 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X MERI FOSTER 4192265197 1001 BELLEFONTAINE AVENUE LIMA OH 45804 FRANK BALDAUF MD THRU 617 CHAIRMAN (SEE SCH J) 40.00 0.00 X X 49405 0 0 KHA H TRAN MD THRU 917 VP/CMO/TREASURER (SEE SCH J) 20.00 20.00 X X 0 391383 93986 CHERYL WAYMAN PA-C SECRETARY (SEE SCH J) 40.00 0.00 X X 138474 0 21151 PRATAP BALUSU MD VP/CMO/TREASURER (SEE SCH J) 20.00 20.00 X X 0 68994 16730 G ALLEN BRYANT BOARD MEMBER (SEE SCH J) 40.00 0.00 X 332821 0 25077 JEREMY HEFFNER MD BOARD MEMBER (SEE SCH J) 40.00 0.00 X 1031432 0 41638 SUSAN KAUFMAN BOARD MEMBER (SEE SCH J) 40.00 0.00 X 346506 0 32475 JENNIFER MAAG BOARD MEMBER (SEE SCH J) 40.00 0.00 X 160091 0 35447 JOHN H JOHNSON THRU 617 BOARD MEMBER (SEE SCH J) 1.00 1.00 X 0 0 0 MASROOR ABRO MD BOARD MEMBER (SEE SCH J) 40.00 0.00 X 472852 0 49680 MICHAEL KERRIGAN CNP BOARD MEMBER 40.00 0.00 X 108337 0 33739 ERIC MILLER DPM BOARD MEMBER (SEE SCH J) 40.00 0.00 X 214040 0 30051 JOHN OEHLER DO BOARD MEMBER (SEE SCH J) 40.00 0.00 X 174195 0 5237 MELODY STEWART-CYRUS MD BOARD MEMBER (SEE SCH J) 40.00 0.00 X 178692 0 23844 RUTH WALL BOARD MEMBER (SEE SCH J) 1.00 1.00 X 0 11709 0 JAMES DOONE MD BOARD MEMBER (SEE SCH J) 40.00 0.00 X 193799 0 22854 PRAVEEN MALHOTRA BOARD MEMBER (SEE SCH J) 1.00 1.00 X 0 0 0 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 6.00 34.00 X 0 903103 255678 ROBERT E ARMSTRONG JR VICE PRESIDENT/COO (SEE SCH J) 10.00 30.00 X 0 487869 123727 JOHN T FISCHBACH VP OF FINANCE/CFO (SEE SCH J) 1.00 39.50 X 0 306883 111975 PIERRE BAMDAD MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 945170 0 21600 MEHRAN ARABPOUR MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 948845 0 63180 PAUL N ANIKE MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 1012798 0 56577 VENKAT R BATTULA MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 942554 0 63180 PAMELA R GARDNER PHYSICIAN (SEE SCH J) 40.00 0.00 X 808601 0 48498 8058612 2169941 1176324 62 0 1 0 VEIN CARE CONSULTANTS 229 S CHILLICOTHE STREET PLAIN CITY OH 43064 PHYSICIAN SERVICES 525303 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 LOCUM TENENS 428033 ECLINICALWORKS LLC 110 TURNPIKE ROAD SUITE 308 WESTBORO MA 01581 EMR SOFTWARE 280221 COMPHEALTH ASSOCIATES INC PO BOX 972670 DALLAS TX 75397 LOCUM TENENS 247647 INTEGRITY HEALTHCARE LOCUMS LLC 7501 VILLAGE SQUARE DRIVE SUITE 20 CASTLE PINES NORTH CO 80108 LOCUM TENENS 211782 9 PATIENT SERVICE REV 621110 26322098 26322098 26322098 686 686 PURCHASE DISCOUNTS 621110 5136 5136 BILLING SERVICES 561000 3344 3344 8480 26331264 26327234 3344 686 X 10000 10000 3400644 3400644 23093089 22172020 921069 527022 500115 26907 3188563 2925139 263424 1357702 1279248 78454 4349710 4185308 164402 19379 19379 442126 314431 127695 216618 201420 15198 97606 78820 18786 67352 61055 6297 250991 250991 MEDICAL SUPPLIES 1360072 1361485 -1413 BAD DEBT EXPENSE 1245019 1245019 EDUCATION & REWARDS 139712 132995 6717 MANAGED CARE ORG 2025 2025 281837 274102 7735 40049467 38414196 1635271 0 622515 1157094 1297767 785468 2426159 2874838 1090275 406368 538432 161400 1249938 866718 329953 383220 6305101 5768388 2964308 3183974 101866824 114828630 104831132 118012604 X -98526031 -112244216 -98526031 -112244216 6305101 5768388 X -13718203 18 X X 0 1 X 1 0 X 30476 30476 1219462 866718 352744 383220 ADVANCES FROM LIMA MEMORIAL JOINT OPERATING CO. 113886164 PENSION FUND 457B & F 785468 DEFERRED TAX LIABILITY 156998 114828630 X PART X, LINE 2: THE HEALTH SYSTEM, LIMA MEMORIAL HOSPITAL, LIMA MEMORIAL PROFESSIONAL CORPORATION, LIMA MEMORIAL HOSPITAL FOUNDATION, AND LIMA MEMORIAL HOSPITAL AUXILIARY ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. ELM TREE FOUNDATION, THE FOR-PROFIT SUBSIDIARY, IS A TAXABLE CORPORATION. ELM TREE FOUNDATION HAD NET OPERATING LOSS CARRYFORWARDS OF $853,131 AND $763,936 ON ITS FILED INCOME TAX RETURNS IN 2017 AND 2016, RESPECTIVELY. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HEALTH SYSTEM AND TO RECOGNIZE A TAX LIABILITY IF THE HEALTH SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. 1 LIMA MEMORIAL FOUNDATION 1001 BELLEFOUNTAINE AVENUE LIMA OH 45804 341707570 501(C)(3) 10000 CAPSTONE SPONSORSHIP 1 0 PART I, LINE 2: GRANTS WERE PAID TO RELATED TAX-EXEMPT ENTITY TO SUPPORT ITS MISSION. THIS IS MONITORED INTERNALLY. THE LIMA MEMORIAL HOSPITAL SYSTEM MONITORS BOTH LIMA MEMORIAL PROFESSIONAL CORPORATION AND LIMA MEMORIAL FOUNDATION. 0 1 0 0 0 0 0 0 0 KHA H TRAN MD THRU 917 VP/CMO/TREASURER (SEE SCH J) 0 242532 0 144167 0 4684 0 68754 0 25232 0 485369 0 54910 CHERYL WAYMAN PA-C SECRETARY (SEE SCH J) 120786 0 17688 0 0 0 4174 0 16977 0 159625 0 0 0 G ALLEN BRYANT BOARD MEMBER (SEE SCH J) 296770 0 36051 0 0 0 8100 0 16977 0 357898 0 0 0 JEREMY HEFFNER MD BOARD MEMBER (SEE SCH J) 412923 0 618509 0 0 0 18058 0 23580 0 1073070 0 0 0 SUSAN KAUFMAN BOARD MEMBER (SEE SCH J) 199296 0 147210 0 0 0 8100 0 24375 0 378981 0 0 0 JENNIFER MAAG BOARD MEMBER (SEE SCH J) 134890 0 25201 0 0 0 4978 0 30469 0 195538 0 0 0 MASROOR ABRO MD BOARD MEMBER (SEE SCH J) 452852 0 20000 0 0 0 26100 0 23580 0 522532 0 0 0 ERIC MILLER DPM BOARD MEMBER (SEE SCH J) 199336 0 14704 0 0 0 6471 0 23580 0 244091 0 0 0 JOHN OEHLER DO BOARD MEMBER (SEE SCH J) 165482 0 8713 0 0 0 5237 0 0 0 179432 0 0 0 MELODY STEWART-CYRUS MD BOARD MEMBER (SEE SCH J) 170192 0 8500 0 0 0 4980 0 18864 0 202536 0 0 0 JAMES DOONE MD BOARD MEMBER (SEE SCH J) 183596 0 10203 0 0 0 5877 0 16977 0 216653 0 0 0 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 0 359360 0 533372 0 10371 0 232478 0 23200 0 1158781 0 293973 ROBERT E ARMSTRONG JR VICE PRESIDENT/COO (SEE SCH J) 0 240588 0 240165 0 7116 0 98243 0 25484 0 611596 0 121178 JOHN T FISCHBACH VP OF FINANCE/CFO (SEE SCH J) 0 209058 0 91217 0 6608 0 92602 0 19373 0 418858 0 0 PIERRE BAMDAD MD PHYSICIAN (SEE SCH J) 685225 0 259945 0 0 0 21600 0 0 0 966770 0 204560 0 MEHRAN ARABPOUR MD PHYSICIAN (SEE SCH J) 679432 0 269413 0 0 0 39600 0 23580 0 1012025 0 209028 0 PAUL N ANIKE MD PHYSICIAN (SEE SCH J) 747600 0 265198 0 0 0 39600 0 16977 0 1069375 0 209813 0 VENKAT R BATTULA MD PHYSICIAN (SEE SCH J) 674944 0 267610 0 0 0 39600 0 23580 0 1005734 0 202225 0 PAMELA R GARDNER PHYSICIAN (SEE SCH J) 555803 0 252798 0 0 0 39600 0 8898 0 857099 0 197413 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN AN IRC 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN. THIS PLAN IS FUNDED BY THE HOSPITAL AND VESTS WITH SERVICE THEREFORE IS SUBJECT TO RISK OF FORFEITURE. ROBERT E. ARMSTRONG: $55,943 MICHAEL D. SWICK: $190,178 KHA H. TRAN: $27,534 JOHN FISCHBACH: $40,597 THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE YEAR: MARK RECKER: $45,734 KHA H. TRAN: $9,443 PART I, LINE 3: RELATED ORGANIZATION, LIMA MEMORIAL JOINT OPERATING COMPANY, DETERMINES THE COMPENSATION OF THE ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES BY 1)REVIEW AND APPROVAL OF THE COMPENSATION COMMITTEE; 2)UTILIZATION OF AN INDEPENDENT COMPENSATION CONSULTANT; 3)COMPARABLE DATA; AND 4) CONTEMPORANEOUS DOCUMENTATION. ADDITIONAL INFORMATION: COMPENSATION PRESENTED ON FORM 990, PART VII AND SCHEDULE J RELATED TO THE BOARD MEMBERS ARE FOR SERVICES PERFORMED FOR THE ORGANIZATION OUTSIDE THOSE SERVICES PERFORMED ON THE BOARD. THERE IS NO COMPENSATION PAID FOR BOARD SERVICES. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE IRS. THE AUDIT COMMITTEE OF THE BOARD REVIEWS AND APPROVES FORM 990. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) HAS AGREED TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE CURRENTLY NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 169,836. MANAGEMENT AND GENERAL EXPENSES 6,754. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 176,590. LOCUM TENENS FEE: PROGRAM SERVICE EXPENSES 1,029,295. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,029,295. COLLECTION FEES: PROGRAM SERVICE EXPENSES 564,826. MANAGEMENT AND GENERAL EXPENSES 29,034. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 593,860. EQUIPMENT RENTAL FEES: PROGRAM SERVICE EXPENSES 1,760,580. MANAGEMENT AND GENERAL EXPENSES 111,294. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,871,874. WASTE REMOVAL FEES: PROGRAM SERVICE EXPENSES 11,816. MANAGEMENT AND GENERAL EXPENSES 136. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,952. LAUNDRY FEES: PROGRAM SERVICE EXPENSES 15,735. MANAGEMENT AND GENERAL EXPENSES 787. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,522. CLEANING FEES: PROGRAM SERVICE EXPENSES 69,090. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 69,090. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 564,130. MANAGEMENT AND GENERAL EXPENSES 16,397. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 580,527. FORM 990, PART XI, LINE 9: INTERCOMPANY ALLOCATIONS 18. FORM 990, PART XI, LINE 2C EXPLANATION: THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVENUE LIMA OH 45804 344434676 HEALTHCARE OH 501(C)(3) LINE 3 LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL FOUNDATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341707570 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) LINE 12B, II LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL AUXILIARY 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341694632 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) LINE 12B, II LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL JOINT OPERATING COMPANY 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341883284 HEALTHCARE OH 501(C)(3) LINE 3 N/A 0 LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLC 1001 BELLEFONTAINE AVE LIMA OH 45804 271023520 WOMEN'S HEALTH CO-MANAGEMENT OH N/A ELM TREE FOUNDATION 1220 EAST ELM STREET LIMA OH 45804 341417720 RENTAL REAL ESTATE OH N/A C 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 1 LIMA MEMORIAL JOINT OPERATING COMPANY S 14282825 EQUITY TRANSFER LIMA MEMORIAL JOINT OPERATING COMPANY K 828198 LEASE CONTRACT ELM TREE FOUNDATION K 354592 LEASE CONTRACT