2014-11-13T15:39:53-06:00 2013-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE STE 2000 INDIANAPOLIS IN 462045108 990 2013-01-01 341292849 ST LUKE'S HOSPITAL FOUNDATION STLU 4198935911 5901 MONCLOVA ROAD MAUMEE OH 43537 DANIEL L WAKEMAN PRESIDENT 4198935911 2014-11-13 1 SAMANTHA BOKORI P01057347 3174648600 2014-10-27 2013 2015-11-30 17:44:51Z DANIEL L WAKEMAN 5901 MONCLOVA ROAD MAUMEE OH 43537 6306867 0 X WWW.PROMEDICA.ORG X 1979 OH TO SUPPORT ST. LUKE'S HOSPITAL PROJECTS / PROGRAMS THAT IMPROVE PATIENT CARE OR SUPPORT THE COMMUNITY. 18 14 0 21 0 0 569256 591294 0 0 786205 468150 -8742 -866 1346719 1058578 237905 405843 0 0 124681 124444 0 0 163797 77875 142251 440461 672538 906258 386040 17625816 20441587 72830 189578 17552986 20252009 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. 0 0 405843 405843 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. 405843 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 18 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X MARTIN DANSACK 4198918501 5901 MONCLOVA ROAD MAUMEE OH 43537 JOHN BACHEY EX OFFICIO 1.00 1.00 X 0 0 0 CHRISTINE C BLACK TRUSTEE 1.00 0.00 X 0 0 0 MICHELE G COOPER TRUSTEE 1.00 0.00 X 0 0 0 MEGAN COYLE-STAMOS TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL V CZERNIAK TRUSTEE 1.00 0.00 X 0 0 0 BARBARA J DENNIS EX OFFICIO 1.00 0.00 X 0 0 0 JEAN M EMERY TRUSTEE 1.00 0.00 X 0 0 0 VALENTINA JINDAL MD TRUSTEE 1.00 0.00 X 0 0 0 RICARDO A KING TRUSTEE 1.00 1.00 X 0 0 0 TIMOTHY L LANGHORST TRUSTEE 1.00 40.00 X 0 143391 17250 CHRISTINA L LAWLESS TRUSTEE 1.00 0.00 X 0 0 0 GLENN L RAMBO TRUSTEE 1.00 0.00 X 0 0 0 DAVID A REED TRUSTEE 1.00 0.00 X 0 0 0 SHEILA D SCHWARTZ EX OFFICIO 1.00 41.00 X 0 176025 22774 DALE J SEYMOUR TRUSTEE 1.00 1.00 X 0 0 0 EDWARD J SHULTZ TRUSTEE 1.00 1.00 X 0 0 0 BARBARA S STEELE EX OFFICIO 1.00 41.00 X 0 995064 1169436 KEVIN C WEBB PHD EX OFFICIO 1.00 44.00 X 0 483405 52701 DANIEL L WAKEMAN PRESIDENT, EX OFFICIO 1.00 42.00 X X 0 363617 38920 BARB A MANG CHAIRPERSON 1.00 1.00 X X 0 0 0 KATHLEEN S HANLEY TREASURER 0.50 51.50 X 0 700133 104802 JEFFREY C KUHN SECRETARY 0.50 51.00 X 0 521270 73952 MARTIN DANSACK VP ACCTG & TAXATION, PHS 0.50 41.00 X 0 191469 35079 LORI JOHNSTON VP FINANCE & OPS, SLH 0.50 42.50 X 0 332483 55470 DAVID DEWEY FORMER OFFICER 0.00 40.00 X 0 184987 238228 0 4091844 1808612 0 1 1 0 0 5532 49810 286139 249813 1456 591294 303588 303588 10243 3739 6504 6504 6504 5380779 5216217 164562 164562 164562 20963 49810 28333 -7370 -7370 1058578 0 0 467284 375729 375729 30114 30114 96468 96468 5865 5865 22111 22111 1230 1230 69415 69415 6080 6080 1358 1358 INTERCOMPANY SERVICES 32253 0 32253 0 FOUNDATION ACTIVITIES 22584 0 0 22584 BAD DEBT EXPENSE 5110 0 0 5110 DONOR CULTIVATION 779 0 0 779 3442 3442 672538 405843 102898 163797 105727 107132 682218 990362 132027 130033 480000 480000 480000 16224119 18727616 1725 6444 17625816 20441587 10523 22063 62307 167515 72830 189578 X 16341322 19077671 1211664 1174338 0 17552986 20252009 17625816 20441587 386040 2312983 0 X 0 1 X 1 0 X X X 0 0 0 ST LUKE'S HOSPITAL 344428232 3 1 374784 1 374784 PART I, LINE 11H: ST. LUKE'S HOSPITAL FOUNDATION PROVIDED TELEVISIONS TO ST. LUKE'S HOSPITAL. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 480000 480000 480000 DUE TO AFFILIATES 167515 167515 X PART X, LINE 2: 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. GOLF OUTING 70773 49810 20963 1515 10422 16396 70773 49810 20963 1515 10422 16396 28333 -7370 1 ST LUKE'S HOSPITAL 5901 MONCLOVA ROAD MAUMEE OH 43537 344428232 501(C)(3) 374784 945 FMV TELEVISIONS OPERATING/CAPITAL GRANT 1 0 SCHOLARSHIPS 18 30114 0 PART I, LINE 2: 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. 0 1 0 0 0 0 0 0 0 TIMOTHY L LANGHORST TRUSTEE 0 115184 0 26852 0 1355 0 9973 0 7277 0 160641 0 0 SHEILA D SCHWARTZ EX OFFICIO 0 50590 0 105509 0 19926 0 22134 0 640 0 198799 0 0 BARBARA S STEELE EX OFFICIO 0 699260 0 228373 0 67431 0 1162120 0 7316 0 2164500 0 0 KEVIN C WEBB PHD EX OFFICIO 0 375870 0 97758 0 9777 0 40158 0 12543 0 536106 0 0 DANIEL L WAKEMAN PRESIDENT, EX OFFICIO 0 277038 0 83578 0 3001 0 24522 0 14398 0 402537 0 0 KATHLEEN S HANLEY TREASURER 0 460254 0 196212 0 43667 0 89856 0 14946 0 804935 0 0 JEFFREY C KUHN SECRETARY 0 355991 0 144956 0 20323 0 52946 0 21006 0 595222 0 0 MARTIN DANSACK VP ACCTG & TAXATION, PHS 0 148893 0 33835 0 8741 0 21888 0 13191 0 226548 0 0 LORI JOHNSTON VP FINANCE & OPS, SLH 0 243222 0 74193 0 15068 0 36630 0 18840 0 387953 0 0 DAVID DEWEY FORMER OFFICER 0 150819 0 32327 0 1841 0 226057 0 12171 0 423215 0 0 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. 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. 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