ST LUKE'S HOSPITAL FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ST LUKE'S HOSPITAL FOUNDATION (EIN 34-1292849)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-12
- IRS object ID
- 201303169349304030
- Schema version
- 2012v2.1
- 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
- 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) |
|---|---|---|
| Timestamp | 2013-11-12T14:21:56-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341292849 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST LUKE'S HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STLU | NameControl |
| Phone | 4198935911 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANIEL L WAKEMAN | Name |
| Title | PRESIDENT | Title |
| Phone | 4198935911 | Phone |
| Date Signed | 2013-11-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SHAWNA M JIMENEZ | Name |
| PTIN | P01222873 | PTIN |
| Phone | 3174648600 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DANIEL L WAKEMAN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 17818629 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PROMEDICA.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1979 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO SUPPORT ST. LUKE'S HOSPITAL PROJECTS / PROGRAMS THAT IMPROVE PATIENT CARE OR SUPPORT THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 557953 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 569256 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 828136 | InvestmentIncomePriorYear |
| Investment Income Current Year | 786205 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -7226 | OtherRevenuePriorYear |
| Other Revenue Current Year | -8742 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1378863 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1346719 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 280093 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 237905 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 108834 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 124681 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 157704 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 360751 | OtherExpensePriorYear |
| Other Expenses Current Year | 77875 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 749678 | TotalExpensesPriorYear |
| Total Expenses Current Year | 440461 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 629185 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 906258 | RevenuesLessExpensesCY |
| Total Assets BOY | 15677955 | TotalAssetsBOY |
| Total Assets EOY | 17625816 | TotalAssetsEOY |
| Total Liabilities BOY | 100947 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 72830 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 15577008 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 17552986 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 237905 | Expense |
| Grants | 237905 | Grants |
| Description | 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. | Description |
| Total Program Service Expense | 237905 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANNE ROSPO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4198918504 | TelephoneNumber |
Address US AddressUS
| 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 Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| JOHN BACHEY | |||||||||
| TRUSTEE | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| CHRISTINE BLACK | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| JAMES BLACK II | |||||||||
| EX OFFICIO | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| MEGAN COYLE-STAMOS | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| MICHAEL CZERNIAK | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| BARBARA DENNIS | |||||||||
| EX OFFICIO | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| JEAN EMERY | |||||||||
| EX OFFICIO | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| VALENTINA JINDAL MD | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| RICARDO KING | |||||||||
| TRUSTEE | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| CHRISTINA LAWLESS | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| BARB MANG | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| RANDALL OOSTRA | |||||||||
| TRUSTEE | 1.00 | 51.00 | X | 0 | 1309341 | 256213 | |||
| GLENN RAMBO | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| DAVID REED | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| SHEILA SCHWARTZ | |||||||||
| EX OFFICIO | 1.00 | 41.00 | X | 0 | 342495 | 49184 | |||
| EDWARD SHULTZ | |||||||||
| TRUSTEE | 1.00 | 1.00 | X | 0 | 0 | 0 | |||
| BARBARA STEELE | |||||||||
| EX OFFICIO | 1.00 | 50.00 | X | 0 | 845937 | 36826 | |||
| KEVIN WEBB | |||||||||
| EX OFFICIO | 1.00 | 43.00 | X | 0 | 453037 | 57666 | |||
| DANIEL WAKEMAN | |||||||||
| PRESIDENT, EX OFFICIO | 1.00 | 41.00 | X | 0 | 369481 | 37888 | X | ||
| DALE SEYMOUR | |||||||||
| CHAIRPERSON | 1.00 | 1.00 | X | 0 | 0 | 0 | X | ||
| KATHLEEN HANLEY | |||||||||
| TREASURER | 0.50 | 51.50 | 0 | 675864 | 105620 | X | |||
| JEFFREY KUHN | |||||||||
| SECRETARY | 0.50 | 51.00 | 0 | 531308 | 62161 | X | |||
| LORI JOHNSTON | |||||||||
| VP OPS & FINANCE, SLH | 0.50 | 40.50 | 0 | 336557 | 52567 | X | |||
| DAVID DEWEY | |||||||||
| FORMER OFFICER | 0.00 | 40.00 | 0 | 182390 | 36268 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 5046410 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 694393 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 5130 | FederatedCampaigns |
| Fundraising Events | 59745 | FundraisingEvents |
| Related Organizations | 271011 | RelatedOrganizations |
| All Other Contributions | 233370 | AllOtherContributions |
| Noncash Contributions | 1281 | NoncashContributions |
| Total Contributions | 569256 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 307069 | TotalRevenueColumn |
| Exclusion | $307,069 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 4162 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 6396 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -2234 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -2234 | TotalRevenueColumn |
| Exclusion | -$2,234 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 16914755 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 16435619 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 479136 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 479136 | TotalRevenueColumn |
| Exclusion | $479,136 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 23387 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 59745 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 29895 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -6508 | TotalRevenueColumn |
| Exclusion | -$6,508 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1346719 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $777,463 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 205051 | Total |
| Program Services | 205051 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32854 | Total |
| Program Services | 32854 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96652 | Total |
| Fundraising | 96652 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7201 | Total |
| Fundraising | 7201 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20828 | Total |
| Fundraising | 20828 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 367 | Total |
| Management And General | 367 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42278 | Total |
| Management And General | 42278 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2207 | Total |
| Management And General | 2207 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21263 | Total |
| Fundraising | 21263 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1225 | Total |
| Fundraising | 1225 | Fundraising |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| FOUNDATION ACTIVITIES | 6450 | 0 | 0 | 6450 |
| BAD DEBT | 2864 | 0 | 0 | 2864 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1221 | Total |
| Fundraising | 1221 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 440461 | Total |
| Program Services | 237905 | ProgramServices |
| Management And General | 44852 | ManagementAndGeneral |
| Fundraising | 157704 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 407870 | BOY |
| EOY | 787945 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 173779 | BOY |
| EOY | 132027 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 480000 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 480000 | BOY |
| EOY | 480000 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14611815 | BOY |
| EOY | 16224119 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4491 | BOY |
| EOY | 1725 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15677955 | BOY |
| EOY | 17625816 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4822 | BOY |
| EOY | 10523 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 96125 | BOY |
| EOY | 62307 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100947 | BOY |
| EOY | 72830 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14430085 | BOY |
| EOY | 16341322 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1146923 | BOY |
| EOY | 1211664 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15577008 | BOY |
| EOY | 17552986 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15677955 | BOY |
| EOY | 17625816 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 906258 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 1069720 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST LUKE'S HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344428232 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Amount | $204,335 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 204335 | SumOfAmounts |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: PART I, LINE 11H: ST. LUKE'S HOSPITAL FOUNDATION PROVIDED NON-MONETARY SUPPORT, INCLUDING EQUIPMENT, TO ST. LUKE'S HOSPITAL. | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 480000 | InvestmentCostOrOtherBasis |
| Book Value | 480000 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 480000 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO AFFILIATES | Description |
| Amount | $62,307 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 62307 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| 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, 2012 AND 2011. FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, A TAXABLE SUBSIDIARY OF PHS RECOGNIZED A LIABILITY FOR UNCERTAIN TAX POSITIONS OF $1,552,000 AND $2,080,000, RESPECTIVELY. THE SUBSIDIARY RECOGNIZED A CREDIT FOR INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS OF ($117,000) AS OF DECEMBER 31, 2012 AND AN EXPENSE OF $308,000 AS OF DECEMBER 31, 2011 WITHIN THE INCOME TAX EXPENSE LINE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. ST. LUKE'S HOSPITAL FOUNDATION DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2012 AND 2011. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF OUTING | NameOfEvent1 |
| Gross Receipts Event1 | 83132 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 59745 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 23387 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 2231 | NonCashPrizesEvent1 |
| Food And Beverage Event1 | 10426 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 17238 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 83132 | GrossReceiptsTotal |
| Charitable Contributions Total | 59745 | CharitableContributionsTotal |
| Gross Revenue Total Events | 23387 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 2231 | NonCashPrizesTotalEvents |
| Food And Beverage Total Events | 10426 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 17238 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 29895 | DirectExpenseSummaryEvents |
| Net Income Summary | -6508 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST LUKE'S HOSPITAL | BusinessNameLine1 |
Address US AddressUS
| 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) |
|---|---|---|
| EIN Of Recipient | 344428232 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 204335 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 716 | AmountOfNonCashAssistance |
| Method Of Valuation | FMV | MethodOfValuation |
| Description Of Non Cash Assistance | LIGHTED STAR - BUSINESS CENTER | DescriptionOfNonCashAssistance |
| Purpose Of Grant | OPERATING/CAPITAL GRANT | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 22 | NumberOfRecipients |
| Amount Of Cash Grant | 32854 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RANDALL OOSTRA | ||||||||||||||
| TRUSTEE | 0 | 846000 | 0 | 433200 | 0 | 30141 | 0 | 244878 | 0 | 11335 | 0 | 1565554 | 0 | 0 |
| SHEILA SCHWARTZ | ||||||||||||||
| EX OFFICIO | 0 | 238772 | 0 | 97991 | 0 | 5732 | 0 | 37208 | 0 | 11976 | 0 | 391679 | 0 | 0 |
| BARBARA STEELE | ||||||||||||||
| EX OFFICIO | 0 | 565279 | 0 | 231321 | 0 | 49337 | 0 | 31364 | 0 | 5462 | 0 | 882763 | 0 | 0 |
| KEVIN WEBB | ||||||||||||||
| EX OFFICIO | 0 | 342770 | 0 | 107032 | 0 | 3235 | 0 | 41789 | 0 | 15877 | 0 | 510703 | 0 | 0 |
| DANIEL WAKEMAN | ||||||||||||||
| PRESIDENT, EX OFFICIO | 0 | 280935 | 0 | 88546 | 0 | 0 | 0 | 25734 | 0 | 12154 | 0 | 407369 | 0 | 0 |
| KATHLEEN HANLEY | ||||||||||||||
| TREASURER | 0 | 473484 | 0 | 195800 | 0 | 6580 | 0 | 88731 | 0 | 16889 | 0 | 781484 | 0 | 0 |
| JEFFREY KUHN | ||||||||||||||
| SECRETARY | 0 | 353206 | 0 | 170216 | 0 | 7886 | 0 | 46771 | 0 | 15390 | 0 | 593469 | 0 | 0 |
| LORI JOHNSTON | ||||||||||||||
| VP OPS & FINANCE, SLH | 0 | 245952 | 0 | 90605 | 0 | 0 | 0 | 35988 | 0 | 16579 | 0 | 389124 | 0 | 0 |
| DAVID DEWEY | ||||||||||||||
| FORMER OFFICER | 0 | 150356 | 0 | 28966 | 0 | 3068 | 0 | 26345 | 0 | 9923 | 0 | 218658 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | JAMES AND CHRISTINE BLACK HAVE A FAMILY RELATIONSHIP. |
| 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, AS WELL AS AN ATTACHMENT WITH A FULL LISTING OF THE BOARD MEMBER'S DISCLOSURES AND THE TOTAL AMOUNT OF FINANCIAL ACTIVITY IN THE PRECEDING 12 MONTHS BETWEEN PHS AND THE BOARD MEMBERS/AFFILIATES. 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 THE CHIEF HUMAN RESOURCES OFFICER 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. |
| 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
Form990 Schedule R Part I Form990ScheduleRPartI (28 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| COBRA VENTURES LLC | |||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 204671613 | LAND LEASING | OH | 4162 | 84060 | ST LUKE'S HOSPITAL FOUNDATION |
| MIDWEST CARDIOVASCULAR CONSULTANTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 611448753 | EMPLOYS PHYSICIANS | OH | 2620101 | 257761 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA CENTRAL PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341881137 | EMPLOYS PHYSICIANS | OH | 110286329 | 22013362 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA EAST PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341881145 | EMPLOYS PHYSICIANS | OH | 5321776 | 2132911 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA ORTHOPEDIC PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 208050622 | EMPLOYS PHYSICIANS | OH | 2738752 | 1006774 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA SOUTH PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341898679 | EMPLOYS PHYSICIANS | OH | 3040985 | 1949844 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA WEST PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341893773 | EMPLOYS PHYSICIANS | OH | 12489882 | 4770917 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 263888045 | EMPLOYS PHYSICIANS | OH | 28134855 | 5464173 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA GI PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 263015991 | EMPLOYS PHYSICIANS | OH | 7894231 | 1049190 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA CARDIOTHORACIC PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 270978204 | EMPLOYS PHYSICIANS | OH | 5501987 | 664108 | PROMEDICA PHYSICIAN GROUP |
| WELLCARE PHYSICIANS LLC | |||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 611528443 | EMPLOYS PHYSICIANS | OH | 13614704 | 2510023 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA HEMATOLOGY-ONCOLOGY PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 271401750 | EMPLOYS PHYSICIANS | OH | 3890340 | 198396 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA ENT LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 272404505 | EMPLOYS PHYSICIANS | OH | 3582772 | 593090 | PROMEDICA PHYSICIAN GROUP |
| THE PHARMACY COUNTER LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 271325141 | MEDICAL EQUIPMENT & PHARMACY | OH | 37999387 | 11039701 | PROMEDICA PHYSICIAN GROUP |
| WOLF CREEK ASSOCIATES LLC | |||||||||
| 901 KIMOLE LN | ADRIAN | MI | 49221 | 383164818 | FACILITY LEASING | MI | 286755 | 1140448 | EMMA L BIXBY MEDICAL CENTER |
| PROMEDICA MONROE CARDIOLOGY PLLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 272920342 | EMPLOYS PHYSICIANS | MI | 2778419 | 599851 | PROMEDICA PHYSICIAN GROUP |
| ERIE WEST HOSPICE & PALLIATIVE CARE LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 205752995 | PROVIDES HOSPICE CARE | OH | 3599956 | 8545277 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES |
| PROMEDICA ANESTHESIA CONSULTANTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 453251737 | EMPLOYS PHYSICIANS | OH | 26293050 | 3615082 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA CRITICAL CARE LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 275165922 | EMPLOYS PHYSICIANS | OH | 4122931 | 413886 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA PHYSICIANS MANAGEMENT SERVICES LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 453230331 | PRACTICE MANAGEMENT | OH | 252770 | 2572026 | 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 | 677873 | 533145 | PROMEDICA FOUNDATION | |
| PROMEDICA INNOVATIONS LLC | |||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | INVESTMENT COMPANY | OH | -23486 | 476514 | PROMEDICA HEALTH SYSTEM INC | |
| PROMEDICA GENITO-URINARY SURGEONS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 461120436 | EMPLOYS PHYSICIANS | OH | 4043138 | 3525183 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA MONROE PHYSICIANS PLLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 461111822 | EMPLOYS PHYSICIANS | MI | 185307 | 112852 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA MULTI-SPECIALTY PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 454976786 | EMPLOYS PHYSICIANS | OH | 532097 | 204610 | 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 | |
Form990 Schedule R Part II Form990ScheduleRPartII (26 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BAY PARK COMMUNITY HOSPITAL | |||||||||||
| 2801 BAY PARK DR | OREGON | OH | 43616 | 341883132 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | 1 | |
| CARE ENTERPRISES | |||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 341366709 | FACILITY LEASING | OH | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | 1 | |
| DEFIANCE HOSPITAL AUXILIARY | |||||||||||
| 1200 RALSTON | DEFIANCE | OH | 43512 | 510173779 | HOSPITAL / FOUNDATION SUPPORT | OH | 501(C)(3) | 11D, III-O | DEFIANCE HOSPITAL INC | 1 | |
| DEFIANCE HOSPITAL INC | |||||||||||
| 1200 RALSTON | DEFIANCE | OH | 43512 | 344446484 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | 1 | |
| EMMA L BIXBY MEDICAL CENTER | |||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 382796005 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | 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 | 1 | |
| FLOWER HOSPITAL | |||||||||||
| 5200 HARROUN RD | SYLVANIA | OH | 43560 | 344428794 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | 1 | |
| FOSTORIA HOSPITAL ASSOCIATION | |||||||||||
| 501 VAN BUREN STREET | FOSTORIA | OH | 44830 | 340898745 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | 1 | |
| FOSTORIA HOSPITAL AUXILIARY | |||||||||||
| PO BOX 907 | FOSTORIA | OH | 44830 | 346517634 | HOSPITAL / FOUNDATION SUPPORT | OH | 501(C)(3) | 11A, I | FOSTORIA HOSPITAL ASSOCIATION | 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 | 1 | |
| HERRICK MEMORIAL HOSPITAL INC | |||||||||||
| 500 E POTTAWATAMIE ST | TECUMSEH | MI | 49286 | 383049015 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | 1 | |
| LENAWEE LONG TERM CARE | |||||||||||
| 700 LAKESHORE TR | ADRIAN | MI | 49221 | 382879330 | LONG TERM CARE | MI | 501(C)(3) | 9 | EMMA L BIXBY MEDICAL CENTER | 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 & CONTINUUM SERVICES | 1 | |
| PROMEDICA COURIER SERVICES INC | |||||||||||
| 3170 W CENTRAL AVE | TOLEDO | OH | 43606 | 260324790 | COURIER SERVICE | OH | 501(C)(3) | 11B, II | PROMEDICA PHYSICIANS & CONTINUUM SERVICES | 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 | 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 | 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 | 1 | |
| PROMEDICA PHYSICIANS & CONTINUUM SERVICES | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341880767 | PHYSICIAN MANAGEMENT SERVICES | OH | 501(C)(3) | 11C, III-FI | PROMEDICA HEALTH SYSTEM INC | 1 | |
| PROMEDICA PHYSICIAN GROUP | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341899439 | PHYSICIAN HEALTH CARE SERVICES | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS & CONTINUUM SERVICES | 1 | |
| ST LUKE'S HOSPITAL | |||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 344428232 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | 1 | |
| THE TOLEDO HOSPITAL | |||||||||||
| 2142 N COVE BLVD | TOLEDO | OH | 43606 | 344428256 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | 1 | |
| PROMEDICA FOUNDATION | |||||||||||
| 2142 N COVE BLVD | TOLEDO | OH | 43606 | 341517672 | FOUNDATION | OH | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | 1 | |
| TOLEDO DISTRICT NURSE ASSOCIATION | |||||||||||
| 1946 N 13TH STREET | TOLEDO | OH | 43624 | 344427949 | SKILLED HOME CARE | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS & CONTINUUM SERVICES | 1 | |
| VISITING NURSE HOSPICE AND HEALTH CARE | |||||||||||
| 383 W DUSSEL DRIVE | MAUMEE | OH | 43537 | 341831624 | HOSPICE HOME CARE | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS & CONTINUUM SERVICES | 1 | |
| KAITLYN'S COTTAGE INC | |||||||||||
| 1260 RALSTON AVE | DEFIANCE | OH | 43512 | 454781053 | RESPITE CARE | OH | 501(C)(3) | 9 | DEFIANCE HOSPITAL INC | 1 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BIXBY MEDICAL OFFICE LIMITED PARTNERSHIP | |||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 382972398 | FACILITY LEASING | MI | EMMA L BIXBY MEDICAL CENTER | RELATED | -3045 | 1215277 | 0 | 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 | 849171 | 2428028 | 0 | 0 | 0.67000 |
| WATERVILLE MEDICAL CENTER LLC | |||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 320160784 | FACILITY LEASING | OH | CARE ENTERPRISES INC | RELATED | 9151 | 804239 | 0 | 0 | 0.70000 |
| NORTHWEST OHIO DEDICATED BREAST MRI LLC | |||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 260679898 | MEDICAL DIAGNOSTICS | OH | THE TOLEDO HOSPITAL | RELATED | 10503 | 398666 | 0 | 0 | 0.50000 |
| WEST CENTRAL SURGICAL CENTER LLC | |||||||||||||
| 7055 W CENTRAL | TOLEDO | OH | 43617 | 200088459 | AMBULATORY SURGICAL CENTER | OH | THE TOLEDO HOSPITAL | RELATED | 574701 | 2954296 | 0 | 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 | 61341 | 840248 | 0 | 0 | 0.59400 |
| LENAWEE PHYSICIAN HOSPITAL ORGANIZATION LLC | |||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 383605511 | PHYSICIAN MANAGEMENT SERVICES | MI | EMMA L BIXBY MEDICAL CENTER | RELATED | 12696 | 121447 | 0 | 1 | 0.50000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARE HOLDINGS | ||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 341796790 | HOLDING COMPANY | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | 1 | ||
| HERRICK MEMORIAL DEVELOPMENT CORP | ||||||||||||
| 500 E POTTAWATAMIE TR | ADRIAN | MI | 49221 | 383146907 | FACILITY LEASING | MI | EMMA L BIXBY MEDICAL CENTER | C | 1.00000 | 1 | 1557 | 545721 |
| LHA PHYSICIAN SERVICES CORPORATION | ||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 611451576 | PHYSICIAN BILLING | MI | EMMA L BIXBY MEDICAL CENTER | C | 1.00000 | 1 | -72654 | 189096 |
| PHYSICIANS ADVANTAGE MSO | ||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 061811760 | PHYSICIAN MANAGEMENT SERVICES | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | 1 | -952 | 24835 |
| PROMEDICA CENTRAL CORPORATION OF MI INC | ||||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 383322278 | PHYSICIAN HEALTH CARE SERVICES | OH | PROMEDICA PHYSICIAN GROUP | C | 1.00000 | 1 | 411900 | 12952564 |
| 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 | 1 | -6220000 | 247313000 |
| PROMEDICA NORTH PHYSICIAN CORPORATION | ||||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 383482148 | PHYSICIAN HEALTH CARE SERVICES | OH | PROMEDICA PHYSICIAN GROUP | C | 1.00000 | 1 | 203340 | |
| PROMEDICA PHYSICIAN HOSPITAL ORGANIZATION | ||||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341887065 | PHYSICIAN MANAGEMENT SERVICES | OH | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | C | 1.00000 | 1 | 404501 | |
| PROMEDICA RETAIL GROUP INC | ||||||||||||
| 3890 MONROE ST | TOLEDO | OH | 43606 | 341159928 | FLORIST | OH | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | C | 1.00000 | 1 | 22296 | 1421714 |
| TOLEDO HOSPITAL LOCAL PROVIDER UNIT | ||||||||||||
| 2142 N COVE BLVD | TOLEDO | OH | 43606 | 341586739 | PHYSICIAN SERVICES | OH | THE TOLEDO HOSPITAL | C | 1.00000 | 1 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| ST LUKE'S HOSPITAL | ||
| B | 205051 | FMV |
| ST LUKE'S HOSPITAL | ||
| C | 269661 | FMV |