ST LUKE'S HOSPITAL FOUNDATION: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- ST LUKE'S HOSPITAL FOUNDATION (EIN 34-1292849)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-13
- IRS object ID
- 201413179349305136
- Schema version
- 2013v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-13T15:39:53-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE STE 2000 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 462045108 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341292849 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST LUKE'S HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STLU | BusinessNameControlTxt |
| Phone | 4198935911 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5901 MONCLOVA ROAD | AddressLine1 |
| City | MAUMEE | City |
| State | OH | State |
| ZIP Code | 43537 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANIEL L WAKEMAN | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 4198935911 | PhoneNum |
| Signature | 2014-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SAMANTHA BOKORI | PreparerPersonNm |
| PTIN | P01057347 | PTIN |
| Phone | 3174648600 | PhoneNum |
| Preparation | 2014-10-27 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DANIEL L WAKEMAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5901 MONCLOVA ROAD | AddressLine1 |
| City | MAUMEE | City |
| State | OH | State |
| ZIP Code | 43537 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,306,867 | 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 | 1979 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO SUPPORT ST. LUKE'S HOSPITAL PROJECTS / PROGRAMS THAT IMPROVE PATIENT CARE OR SUPPORT THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 21 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $569,256 | PYContributionsGrantsAmt |
| CY Contributions Grants | $591,294 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $786,205 | PYInvestmentIncomeAmt |
| CY Investment Income | $468,150 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$8,742 | PYOtherRevenueAmt |
| CY Other Revenue | -$866 | CYOtherRevenueAmt |
| PY Total Revenue | $1,346,719 | PYTotalRevenueAmt |
| CY Total Revenue | $1,058,578 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $237,905 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $405,843 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $124,681 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $124,444 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $163,797 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $77,875 | PYOtherExpensesAmt |
| CY Other Expenses | $142,251 | CYOtherExpensesAmt |
| PY Total Expenses | $440,461 | PYTotalExpensesAmt |
| CY Total Expenses | $672,538 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $906,258 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $386,040 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $17,625,816 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,441,587 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $72,830 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $189,578 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,552,986 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,252,009 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE ST. LUKE'S HOSPITAL FOUNDATION IS DEDICATED TO SECURING RESOURCES TO SUPPORT THE HEALING AND CHARITABLE MISSION OF ST. LUKE'S HOSPITAL FOR THE COMMUNITIES IT SERVES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $405,843 | ExpenseAmt |
| Grant | $405,843 | GrantAmt |
| Desc | ST. LUKE'S HOSPITAL FOUNDATION, THROUGH ITS SUPPORT OF ST. LUKE'S HOSPITAL, CONTRIBUTES TO THE PROVISION OF HEALTH CARE AND ENHANCING THE QUALITY OF LIFE FOR PEOPLE IN OUR COMMUNITY. | Desc |
| Total Program Service Expenses | $405,843 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| 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 | 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | 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 |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARTIN DANSACK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4198918501 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5901 MONCLOVA ROAD | AddressLine1 |
| City | MAUMEE | City |
| State | OH | State |
| ZIP Code | 43537 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| JOHN BACHEY | |||||||||
| EX OFFICIO | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CHRISTINE C BLACK | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHELE G COOPER | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MEGAN COYLE-STAMOS | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL V CZERNIAK | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| BARBARA J DENNIS | |||||||||
| EX OFFICIO | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JEAN M EMERY | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| VALENTINA JINDAL MD | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RICARDO A KING | |||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TIMOTHY L LANGHORST | |||||||||
| TRUSTEE | 1.00 | 40.00 | Yes (X) | $0 | $143,391 | $17,250 | |||
| CHRISTINA L LAWLESS | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| GLENN L RAMBO | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID A REED | |||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SHEILA D SCHWARTZ | |||||||||
| EX OFFICIO | 1.00 | 41.00 | Yes (X) | $0 | $176,025 | $22,774 | |||
| DALE J SEYMOUR | |||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| EDWARD J SHULTZ | |||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BARBARA S STEELE | |||||||||
| EX OFFICIO | 1.00 | 41.00 | Yes (X) | $0 | $995,064 | $1,169,436 | |||
| KEVIN C WEBB PHD | |||||||||
| EX OFFICIO | 1.00 | 44.00 | Yes (X) | $0 | $483,405 | $52,701 | |||
| DANIEL L WAKEMAN | |||||||||
| PRESIDENT, EX OFFICIO | 1.00 | 42.00 | Yes (X) | $0 | $363,617 | $38,920 | Yes (X) | ||
| BARB A MANG | |||||||||
| CHAIRPERSON | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| KATHLEEN S HANLEY | |||||||||
| TREASURER | 0.50 | 51.50 | $0 | $700,133 | $104,802 | Yes (X) | |||
| JEFFREY C KUHN | |||||||||
| SECRETARY | 0.50 | 51.00 | $0 | $521,270 | $73,952 | Yes (X) | |||
| MARTIN DANSACK | |||||||||
| VP ACCTG & TAXATION, PHS | 0.50 | 41.00 | $0 | $191,469 | $35,079 | Yes (X) | |||
| LORI JOHNSTON | |||||||||
| VP FINANCE & OPS, SLH | 0.50 | 42.50 | $0 | $332,483 | $55,470 | Yes (X) | |||
| DAVID DEWEY | |||||||||
| FORMER OFFICER | 0.00 | 40.00 | $0 | $184,987 | $238,228 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,091,844 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,808,612 | 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 |
| Federated Campaigns | $5,532 | FederatedCampaignsAmt |
| Fundraising | $49,810 | FundraisingAmt |
| Related Organizations | $286,139 | RelatedOrganizationsAmt |
| All Other Contributions | $249,813 | AllOtherContributionsAmt |
| Noncash Contributions | $1,456 | NoncashContributionsAmt |
| Total Contributions | $591,294 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $303,588 | TotalRevenueColumnAmt |
| Exclusion | $303,588 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,243 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,739 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,504 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,504 | TotalRevenueColumnAmt |
| Exclusion | $6,504 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,380,779 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,216,217 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $164,562 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $164,562 | TotalRevenueColumnAmt |
| Exclusion | $164,562 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $20,963 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $49,810 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $28,333 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$7,370 | TotalRevenueColumnAmt |
| Exclusion | -$7,370 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,058,578 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $467,284 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $375,729 | TotalAmt |
| Program Services | $375,729 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,114 | TotalAmt |
| Program Services | $30,114 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,468 | TotalAmt |
| Fundraising | $96,468 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,865 | TotalAmt |
| Fundraising | $5,865 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,111 | TotalAmt |
| Fundraising | $22,111 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,230 | TotalAmt |
| Management And General | $1,230 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,415 | TotalAmt |
| Management And General | $69,415 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,080 | TotalAmt |
| Fundraising | $6,080 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,358 | TotalAmt |
| Fundraising | $1,358 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| INTERCOMPANY SERVICES | $32,253 | $0 | $32,253 | $0 |
| FOUNDATION ACTIVITIES | $22,584 | $0 | $0 | $22,584 |
| BAD DEBT EXPENSE | $5,110 | $0 | $0 | $5,110 |
| DONOR CULTIVATION | $779 | $0 | $0 | $779 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,442 | TotalAmt |
| Fundraising | $3,442 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $672,538 | TotalAmt |
| Program Services | $405,843 | ProgramServicesAmt |
| Management And General | $102,898 | ManagementAndGeneralAmt |
| Fundraising | $163,797 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,727 | BOYAmt |
| EOY | $107,132 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $682,218 | BOYAmt |
| EOY | $990,362 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $132,027 | BOYAmt |
| EOY | $130,033 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $480,000 | LandBldgEquipCostOrOtherBssAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $480,000 | BOYAmt |
| EOY | $480,000 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,224,119 | BOYAmt |
| EOY | $18,727,616 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,725 | BOYAmt |
| EOY | $6,444 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,625,816 | BOYAmt |
| EOY | $20,441,587 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,523 | BOYAmt |
| EOY | $22,063 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,307 | BOYAmt |
| EOY | $167,515 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,830 | BOYAmt |
| EOY | $189,578 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,341,322 | BOYAmt |
| EOY | $19,077,671 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,211,664 | BOYAmt |
| EOY | $1,174,338 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,552,986 | BOYAmt |
| EOY | $20,252,009 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,625,816 | BOYAmt |
| EOY | $20,441,587 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $386,040 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,312,983 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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 | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Certification | Yes (X) | CertificationInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST LUKE'S HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344428232 | EIN |
| Organization Type | 3 | OrganizationTypeDesc |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $374,784 | SupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $374,784 | SupportSumAmt |
Form990 Schedule A Part IV Form990ScheduleAPartIVGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 11H: ST. LUKE'S HOSPITAL FOUNDATION PROVIDED TELEVISIONS TO | FormAndLineReferenceDesc |
| Explanation | ST. LUKE'S HOSPITAL. | 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $480,000 | InvestmentCostOrOtherBasisAmt |
| Book Value | $480,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $480,000 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $167,515 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $167,515 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ST. LUKE'S HOSPITAL FOUNDATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES (PHS). THE FOLLOWING REFLECTS PHS'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740. EXCEPT AS NOTED BELOW, PHS DID NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2013 AND 2012. FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2012, A TAXABLE SUBSIDIARY OF PHS RECOGNIZED A LIABILITY FOR UNCERTAIN TAX POSITIONS OF $1,059,000 AND $1,552,000, RESPECTIVELY. THE SUBSIDIARY RECOGNIZED A CREDIT FOR INTEREST AND PENALTIES WITHIN THE INCOME TAX EXPENSE LINE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS RELATED TO UNRECOGNIZED TAX BENEFITS OF $20,000 AND $117,000 AS OF DECEMBER 31, 2013 AND 2012, RESPECTIVELY. ST. LUKE'S HOSPITAL FOUNDATION DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2013 AND 2012. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF OUTING | NameOfEvent1Amt |
| Gross Receipts Event1 | $70,773 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $49,810 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $20,963 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $1,515 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $10,422 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $16,396 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $70,773 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $49,810 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $20,963 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $1,515 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $10,422 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $16,396 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $28,333 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$7,370 | NetIncomeSummaryAmt |
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 | ST LUKE'S HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5901 MONCLOVA ROAD | AddressLine1 |
| City | MAUMEE | City |
| State | OH | State |
| ZIP Code | 43537 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 344428232 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $374,784 | CashGrantAmt |
| Non Cash Assistance | $945 | NonCashAssistanceAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Non Cash Assistance | TELEVISIONS | NonCashAssistanceDesc |
| Purpose Of Grant | OPERATING/CAPITAL GRANT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 18 | RecipientCnt |
| Cash Grant | $30,114 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | AS AN AFFILIATE OF PROMEDICA HEALTH SYSTEM, INC. (PHS) CORPORATE POLICIES EXIST TO ENSURE THAT THE APPROVAL AND DISTRIBUTION OF FOUNDATION FUNDS ARE CONSISTENT WITH THE APPROVED SUPPORTED ORGANIZATION STRATEGIC PLAN AND DOCUMENTED DONOR INTENT. ALL REQUESTS FOR FUNDS MUST BE SUBMITTED ON THE "FUND UTILIZATION REQUEST" FORM AND INCLUDE WRITTEN SUPPORTING DOCUMENTATION AND APPROPRIATE APPROVALS DEPENDING ON THE DOLLAR AMOUNT OF THE REQUEST. ON A MONTHLY BASIS A REPORT LISTING ALL FUND DISTRIBUTIONS IS DISTRIBUTED TO THE PHS PRESIDENT/CHIEF EXECUTIVE OFFICER AND CHIEF PHILANTHROPIC OFFICER. | 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 (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIMOTHY L LANGHORST | ||||||||||||||
| TRUSTEE | $0 | $115,184 | $0 | $26,852 | $0 | $1,355 | $0 | $9,973 | $0 | $7,277 | $0 | $160,641 | $0 | $0 |
| SHEILA D SCHWARTZ | ||||||||||||||
| EX OFFICIO | $0 | $50,590 | $0 | $105,509 | $0 | $19,926 | $0 | $22,134 | $0 | $640 | $0 | $198,799 | $0 | $0 |
| BARBARA S STEELE | ||||||||||||||
| EX OFFICIO | $0 | $699,260 | $0 | $228,373 | $0 | $67,431 | $0 | $1,162,120 | $0 | $7,316 | $0 | $2,164,500 | $0 | $0 |
| KEVIN C WEBB PHD | ||||||||||||||
| EX OFFICIO | $0 | $375,870 | $0 | $97,758 | $0 | $9,777 | $0 | $40,158 | $0 | $12,543 | $0 | $536,106 | $0 | $0 |
| DANIEL L WAKEMAN | ||||||||||||||
| PRESIDENT, EX OFFICIO | $0 | $277,038 | $0 | $83,578 | $0 | $3,001 | $0 | $24,522 | $0 | $14,398 | $0 | $402,537 | $0 | $0 |
| KATHLEEN S HANLEY | ||||||||||||||
| TREASURER | $0 | $460,254 | $0 | $196,212 | $0 | $43,667 | $0 | $89,856 | $0 | $14,946 | $0 | $804,935 | $0 | $0 |
| JEFFREY C KUHN | ||||||||||||||
| SECRETARY | $0 | $355,991 | $0 | $144,956 | $0 | $20,323 | $0 | $52,946 | $0 | $21,006 | $0 | $595,222 | $0 | $0 |
| MARTIN DANSACK | ||||||||||||||
| VP ACCTG & TAXATION, PHS | $0 | $148,893 | $0 | $33,835 | $0 | $8,741 | $0 | $21,888 | $0 | $13,191 | $0 | $226,548 | $0 | $0 |
| LORI JOHNSTON | ||||||||||||||
| VP FINANCE & OPS, SLH | $0 | $243,222 | $0 | $74,193 | $0 | $15,068 | $0 | $36,630 | $0 | $18,840 | $0 | $387,953 | $0 | $0 |
| DAVID DEWEY | ||||||||||||||
| FORMER OFFICER | $0 | $150,819 | $0 | $32,327 | $0 | $1,841 | $0 | $226,057 | $0 | $12,171 | $0 | $423,215 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF ST. LUKE'S HOSPITAL FOUNDATION, 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, LINE 4B | ALL EMPLOYEES AND AMOUNTS LISTED ARE VOLUNTARY DEFERRALS OR COMPANY CONTRIBUTIONS TO VARIOUS NON-QUALIFIED 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. NO PAYMENTS WERE MADE TO LISTED PERSONS IN PART VII UNDER THE VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS DURING THE YEAR. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 PARENT CORPORATION AND SOLE MEMBER OF ST. LUKE'S HOSPITAL FOUNDATION OR IS THE SOLE MEMBER OF THE SOLE MEMBER OF ST. LUKE'S HOSPITAL FOUNDATION. AS THE MEMBER, PHS HAS THE RIGHT TO (A) NOMINATE AND ELECT A MINORITY OF THE MEMBERS AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF ST. LUKE'S HOSPITAL FOUNDATION, AND (B) APPROVE THE NOMINEES TO FILL ANY VACANCIES ON THE BOARD OF TRUSTEES, A MAJORITY OF WHOM ARE NOMINATED BY ST. LUKE'S HOSPITAL FOUNDATION. |
| 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 11 | UNDER THE GUIDANCE OF PROMEDICA HEALTH SYSTEM, INC.'S (PHS) TAX CONSULTANTS, FORM 990S ARE PREPARED BY THE RESPECTIVE ACCOUNTING DEPARTMENT OF EACH AFFILIATE AND REVIEWED BY THE AFFILIATE'S FINANCE LEADERSHIP. AFTER AFFILIATE'S FINANCE LEADERSHIP APPROVAL, COPIES OF THE FORM 990 FOR PHS AND THEIR SUBSIDIARIES ARE PROVIDED TO THE RESPECTIVE COMPANY'S BOARD OF TRUSTEES AND ARE REVIEWED AND SIGNED BY THE RESPECTIVE COMPANY'S PRESIDENT 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 CERTIFICATION STATEMENT WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER CERTIFICATION STATEMENTS ARE COMPILED AND 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 CERTIFICATION STATEMENTS (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 FILE THE CERTIFICATION STATEMENT, OR THE FILING OF A FALSE OR INCOMPLETE CERTIFICATION STATEMENT, 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 CERTIFICATION STATEMENT 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 SALARIED EMPLOYEES ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE WITHIN 30 DAYS OF NOTIFICATION. 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, COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT, AND A LIST OF ALL NEW EMPLOYEES HIRED DURING THE PREVIOUS 12 MONTHS. 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, 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. |
| FORM 990, PART VI, SECTION B, LINE 15 | ST. LUKE'S HOSPITAL FOUNDATION'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF ST. LUKE'S HOSPITAL 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. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (28 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| COBRA VENTURES LLC | |||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 204671613 | LAND LEASING | OH | $10,243 | $91,159 | ST LUKE'S HOSPITAL FOUNDATION |
| MIDWEST CARDIOVASCULAR CONSULTANTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 611448753 | EMPLOYS PHYSICIANS | OH | $0 | $585,466 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA CENTRAL PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341881137 | EMPLOYS PHYSICIANS | OH | $123,454,721 | $107,979,144 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA EAST PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341881145 | EMPLOYS PHYSICIANS | OH | $5,723,952 | $1,859,699 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA ORTHOPEDIC PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 208050622 | EMPLOYS PHYSICIANS | OH | $3,421,359 | $720,044 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA SOUTH PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341898679 | EMPLOYS PHYSICIANS | OH | $2,877,606 | $2,239,631 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA WEST PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341893773 | EMPLOYS PHYSICIANS | OH | $12,634,300 | $3,120,379 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 263888045 | EMPLOYS PHYSICIANS | OH | $32,620,946 | -$5,312,940 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA GI PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 263015991 | EMPLOYS PHYSICIANS | OH | $8,901,260 | -$2,506,912 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA CARDIOTHORACIC PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 270978204 | EMPLOYS PHYSICIANS | OH | $5,256,798 | -$173,251 | PROMEDICA PHYSICIAN GROUP |
| WELLCARE PHYSICIANS LLC | |||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 611528443 | EMPLOYS PHYSICIANS | OH | $15,374,731 | $2,903,032 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA HEMATOLOGY-ONCOLOGY PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 271401750 | EMPLOYS PHYSICIANS | OH | $4,275,009 | -$2,016,759 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA ENT LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 272404505 | EMPLOYS PHYSICIANS | OH | $2,846,948 | $255,567 | PROMEDICA PHYSICIAN GROUP |
| THE PHARMACY COUNTER LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 271325141 | MEDICAL EQUIPMENT & PHARMACY | OH | $47,035,814 | $16,743,293 | PROMEDICA PHYSICIAN GROUP |
| WOLF CREEK ASSOCIATES LLC | |||||||||
| 901 KIMOLE LN | ADRIAN | MI | 49221 | 383164818 | FACILITY LEASING | MI | $131,512 | $1,118,636 | EMMA L BIXBY MEDICAL CENTER |
| PROMEDICA MONROE CARDIOLOGY PLLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 272920342 | EMPLOYS PHYSICIANS | MI | $2,694,521 | -$445,866 | PROMEDICA PHYSICIAN GROUP |
| ERIE WEST HOSPICE & PALLIATIVE CARE LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 205752995 | PROVIDES HOSPICE CARE | OH | $2,710,535 | $8,545,046 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES |
| PROMEDICA ANESTHESIA CONSULTANTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 453251737 | EMPLOYS PHYSICIANS | OH | $30,039,933 | $3,690,549 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA CRITICAL CARE LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 275165922 | EMPLOYS PHYSICIANS | OH | $4,291,585 | -$829,757 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA PHYSICIANS MANAGEMENT SERVICES LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 453230331 | PRACTICE MANAGEMENT | OH | $81,676 | $1,625,759 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA SURGICAL SERVICES LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | EMPLOYS PHYSICIANS | OH | $0 | $0 | PROMEDICA PHYSICIAN GROUP | |
| MISSION POINTE GOLF COURSE LLC | |||||||||
| 2142 NORTH COVE | TOLEDO | OH | 43606 | GOLF COURSE | OH | $0 | $493,717 | PROMEDICA FOUNDATION | |
| PROMEDICA INNOVATIONS LLC | |||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | INVESTMENT COMPANY | OH | -$69,166 | $464,347 | PROMEDICA HEALTH SYSTEM INC | |
| PROMEDICA GENITO-URINARY SURGEONS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 461120436 | EMPLOYS PHYSICIANS | OH | $12,617,702 | $2,080,190 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA MONROE PHYSICIANS PLLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 461111822 | EMPLOYS PHYSICIANS | MI | $726,713 | $31,358 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA MULTI-SPECIALTY PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 454976786 | EMPLOYS PHYSICIANS | OH | $0 | $160,552 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA HOSPITALISTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | EMPLOYS PHYSICIANS | OH | $0 | $0 | PROMEDICA PHYSICIAN GROUP | |
| PROMEDICA HOSPITALISTS PLLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | EMPLOYS PHYSICIANS | MI | $0 | $0 | PROMEDICA PHYSICIAN GROUP | |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BAY PARK COMMUNITY HOSPITAL | |||||||||||
| 2801 BAY PARK DR | OREGON | OH | 43616 | 341883132 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| CARE ENTERPRISES INC | |||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 341366709 | FACILITY LEASING | OH | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| DEFIANCE HOSPITAL AUXILIARY | |||||||||||
| 1200 RALSTON | DEFIANCE | OH | 43512 | 510173779 | HOSPITAL / FOUNDATION SUPPORT | OH | 501(C)(3) | 11D, III-O | DEFIANCE HOSPITAL INC | Yes (1) | |
| DEFIANCE HOSPITAL INC | |||||||||||
| 1200 RALSTON | DEFIANCE | OH | 43512 | 344446484 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| EMMA L BIXBY MEDICAL CENTER | |||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 382796005 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| EMMA L BIXBY MEDICAL CENTER AUXILIARY | |||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 382149602 | HOSPITAL / FOUNDATION SUPPORT | MI | 501(C)(3) | 11B, II | EMMA L BIXBY MEDICAL CENTER | Yes (1) | |
| FLOWER HOSPITAL | |||||||||||
| 5200 HARROUN RD | SYLVANIA | OH | 43560 | 344428794 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| FOSTORIA HOSPITAL ASSOCIATION | |||||||||||
| 501 VAN BUREN STREET | FOSTORIA | OH | 44830 | 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) | 11A, I | FOSTORIA HOSPITAL ASSOCIATION | Yes (1) | |
| HERRICK MEDICAL CENTER AUXILIARY | |||||||||||
| 500 E POTTAWATAMIE ST | TECUMSEH | MI | 49286 | 383076105 | HOSPITAL / FOUNDATION SUPPORT | MI | 501(C)(3) | 11B, II | HERRICK MEMORIAL HOSPITAL INC | Yes (1) | |
| HERRICK MEMORIAL HOSPITAL INC | |||||||||||
| 500 E POTTAWATAMIE ST | TECUMSEH | MI | 49286 | 383049015 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| LENAWEE LONG TERM CARE | |||||||||||
| 700 LAKESHIRE TR | ADRIAN | MI | 49221 | 382879330 | LONG TERM CARE | MI | 501(C)(3) | 9 | EMMA L BIXBY MEDICAL CENTER | Yes (1) | |
| PROMEDICA CONTINUING CARE SERVICES CORP | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 344492440 | LONG TERM AND HOME HEALTH CARE | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| PROMEDICA COURIER SERVICES INC | |||||||||||
| 3170 W CENTRAL AVE | TOLEDO | OH | 43606 | 260324790 | COURIER SERVICE | OH | 501(C)(3) | 11B, II | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| PROMEDICA HEALTH SYSTEM INC | |||||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | 341517671 | PARENT COMPANY OF HEALTH SYSTEM | OH | 501(C)(3) | 11C, III-FI | 0 | N/A | |
| PHS VENTURES | |||||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | 341880473 | HEALTH CARE MANAGEMENT SERVICES | OH | 501(C)(3) | 11C, III-FI | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| ACADEMIC HEALTH CENTER CORPORATION | |||||||||||
| 2142 N COVE BLVD | TOLEDO | OH | 43606 | 341887062 | MEDICAL EDUCATION & RESEARCH | OH | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA INDEMNITY CORP | |||||||||||
| ONE CHURCH ST 5TH FLOOR | BURLINGTON | VT | 05401 | 341931936 | PROFESSIONAL & GENERAL LIABILITY | VT | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341880767 | PHYSICIAN MANAGEMENT SERVICES | OH | 501(C)(3) | 11C, III-FI | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA PHYSICIAN GROUP | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341899439 | PHYSICIAN HEALTH CARE SERVICES | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| ST LUKE'S HOSPITAL | |||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 344428232 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA FOUNDATION | |||||||||||
| 2142 N COVE BLVD | TOLEDO | OH | 43606 | 341517672 | FOUNDATION | OH | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| THE TOLEDO HOSPITAL | |||||||||||
| 2142 N COVE BLVD | TOLEDO | OH | 43606 | 344428256 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| TOLEDO DISTRICT NURSE ASSOCIATION | |||||||||||
| 1946 N 13TH STREET | TOLEDO | OH | 43624 | 344427949 | SKILLED HOME CARE | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| VISITING NURSE HOSPICE AND HEALTH CARE | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341831624 | HOSPICE HOME CARE | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| KAITLYN'S COTTAGE INC | |||||||||||
| 1260 RALSTON AVE | DEFIANCE | OH | 43512 | 454781053 | RESPITE CARE | OH | 501(C)(3) | 9 | DEFIANCE HOSPITAL INC | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (8 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BIXBY MEDICAL OFFICE LIMITED PARTNERSHIP | |||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 382972398 | FACILITY LEASING | MI | EMMA L BIXBY MEDICAL CENTER | RELATED | $5,040 | $1,191,758 | 0 | Yes (1) | 0.64600 |
| REYNOLDS RD SURGICAL CENTER LLC | |||||||||||||
| 2865 N REYNOLDS RD | TOLEDO | OH | 43615 | 311569454 | FREESTANDING AMBULATORY SURGICAL CENTER | OH | THE TOLEDO HOSPITAL | RELATED | $625,202 | $2,576,269 | 0 | 0 | 0.69340 |
| WATERVILLE MEDICAL CENTER LLC | |||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 320160784 | FACILITY LEASING | OH | CARE ENTERPRISES INC | RELATED | $17,500 | $792,802 | 0 | 0 | 0.70000 |
| NORTHWEST OHIO DEDICATED BREAST MRI LLC | |||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 260679898 | MEDICAL DIAGNOSTICS | OH | THE TOLEDO HOSPITAL | RELATED | $51,989 | $367,075 | 0 | 0 | 0.50000 |
| WEST CENTRAL SURGICAL CENTER LLC | |||||||||||||
| 7055 W CENTRAL | TOLEDO | OH | 43617 | 200088459 | AMBULATORY SURGICAL CENTER | OH | THE TOLEDO HOSPITAL | RELATED | $138,512 | $3,011,429 | 0 | Yes (1) | 0.50000 |
| OHIO CARE AMBULATORY SURGICAL CENTER LLC | |||||||||||||
| 5959 MONCLOVA RD | MAUMEE | OH | 43537 | 341863472 | AMBULATORY SURGICAL CENTER | OH | ST LUKE'S HOSPITAL | RELATED | $72,709 | $943,946 | 0 | 0 | 0.60320 |
| LENAWEE PHYSICIAN HOSPITAL ORGANIZATION LLC | |||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 383605511 | PHYSICIAN MANAGEMENT SERVICES | MI | EMMA L BIXBY MEDICAL CENTER | RELATED | $90,413 | $182,244 | 0 | Yes (1) | 0.50000 |
| PROMEDICA SURGICAL SERVICES CO-MANAGEMENT CO LLC | |||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 461989695 | PHYSICIAN MANAGEMENT SERVICES | OH | PROMEDICA HEALTH SYSTEM INC | RELATED | $552,421 | $590,193 | 0 | 0 | 0.50940 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (10 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Entity TypeEntityTypeTxt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARE HOLDINGS | ||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 341796790 | HOLDING COMPANY | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | Yes (1) | ||
| HERRICK MEMORIAL DEVELOPMENT CORP | ||||||||||||
| 500 E POTTAWATAMIE TR | ADRIAN | MI | 49221 | 383146907 | FACILITY LEASING | MI | EMMA L BIXBY MEDICAL CENTER | C | 1.00000 | Yes (1) | $54,728 | $1,021,086 |
| LHA PHYSICIAN SERVICES CORPORATION | ||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 611451576 | PHYSICIAN BILLING | MI | EMMA L BIXBY MEDICAL CENTER | C | 1.00000 | Yes (1) | -$103,722 | $85,903 |
| PHYSICIANS ADVANTAGE MSO | ||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 061811760 | PHYSICIAN MANAGEMENT SERVICES | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | Yes (1) | -$24,835 | |
| PROMEDICA CENTRAL CORPORATION OF MICHIGAN | ||||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 383322278 | PHYSICIAN HEALTH CARE SERVICES | OH | PROMEDICA PHYSICIAN GROUP | C | 1.00000 | Yes (1) | -$299,008 | $11,176,039 |
| PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES | ||||||||||||
| 1901 INDIAN WOOD CIR | MAUMEE | OH | 43537 | 341570675 | HEALTH CARE INSURANCE | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | Yes (1) | $14,873,000 | $286,849,000 |
| PROMEDICA NORTH PHYSICIAN CORPORATION | ||||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 383482148 | PHYSICIAN HEALTH CARE SERVICES | OH | PROMEDICA PHYSICIAN GROUP | C | 1.00000 | Yes (1) | $203,340 | |
| PROMEDICA PHYSICIAN HOSPITAL ORGANIZATION | ||||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341887065 | PHYSICIAN MANAGEMENT SERVICES | OH | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | C | 1.00000 | Yes (1) | $404,501 | |
| PROMEDICA RETAIL GROUP INC | ||||||||||||
| 3890 MONROE ST | TOLEDO | OH | 43606 | 341159928 | FLORIST | OH | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | C | 1.00000 | Yes (1) | $29,726 | $1,690,747 |
| HERRICK MEMORIAL OFFICE PLAZA CONDOMINIUM ASSOCIATION | ||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 383639616 | FACILITY MANAGEMENT | MI | HERRICK MEMORIAL DEVELOPMENT CORP | C | 0.71800 | Yes (1) | $26 | $51,070 |
| 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 | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ST LUKE'S HOSPITAL | ||
| B | $375,729 | FMV |
| ST LUKE'S HOSPITAL | ||
| C | $278,806 | FMV |