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ST LUKE'S HOSPITAL FOUNDATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ST LUKE'S HOSPITAL FOUNDATION (EIN 34-1292849)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-10
IRS object ID
201103149349303590
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-10T17:12:01-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1111 MONUMENT CIRCLE STE 2000AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code462045108ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN341292849EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST LUKE'S HOSPITAL FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTLUNameControl
Phone4198935900Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line15901 MONCLOVA ROADAddressLine1
CityMAUMEECity
StateOHState
ZIP Code43537ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDANIEL L WAKEMANName
TitlePRESIDENTTitle
Phone4198935900Phone
Date Signed2011-11-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSHAWNA M JIMENEZName
Phone3174648600Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDANIEL L WAKEMANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line15901 MONCLOVA ROADAddressLine1
CityMAUMEECity
StateOHState
ZIP Code43537ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16289819GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PROMEDICA.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1979YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionTO SUPPORT ST. LUKE'S HOSPITAL PROJECTS/PROGRAMS THAT IMPROVE PATIENT CARE OR SUPPORT THE COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers21TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1305100ContributionsGrantsPriorYear
Contributions Grants Current Year5708643ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year96946InvestmentIncomePriorYear
Investment Income Current Year1886764InvestmentIncomeCurrentYear
Other Revenue Prior Year13537OtherRevenuePriorYear
Other Revenue Current Year17798OtherRevenueCurrentYear
Total Revenue Prior Year1415583TotalRevenuePriorYear
Total Revenue Current Year7613205TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1257457GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY870023GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year174026SalariesEtcPriorYear
Salaries Etc Current Year152958SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year53009TotalFundrsngExpCurrentYear
Other Expense Prior Year121046OtherExpensePriorYear
Other Expenses Current Year118789OtherExpensesCurrentYear
Total Expenses Prior Year1552529TotalExpensesPriorYear
Total Expenses Current Year1141770TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-136946RevenuesLessExpensesPriorYear
Revenues Less Expenses CY6471435RevenuesLessExpensesCY
Total Assets BOY11141142TotalAssetsBOY
Total Assets EOY16091117TotalAssetsEOY
Total Liabilities BOY42984TotalLiabilitiesBOY
Total Liabilities EOY41798TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11098158NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY16049319NetAssetsOrFundBalancesEOY
Mission DescriptionTHE 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense870023Expense
Grants870023Grants
DescriptionTHE 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 Expense870023TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ANNE ROSPOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4198918504TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15901 MONCLOVA ROADAddressLine1
CityMAUMEECity
StateOHState
ZIP Code43537ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeFormerFormer
JAMIE BLACK
EX OFFICIO1.00X000
TINA BLACK
TRUSTEE1.00X000
JEAN EMERY
EX OFFICIO1.00X000
RICARDO KING
TRUSTEE1.00X000
CHRIS LAWLESS
TRUSTEE1.00X000
BARB MANG
TRUSTEE1.00X000
RANDALL OOSTRA
TRUSTEE1.00X01055080144585
SHEILA SCHWARTZ
EX OFFICIO1.00X032825852079
DALE SEYMOUR
TRUSTEE1.00X000
EDWARD SHULTZ
EX OFFICIO1.00X000
BARBARA STEELE
EX OFFICIO1.00X076750684913
STEPHEN BAZELEY MD
CHAIRMAN1.00X086752866X
MICHAEL CZERNIAK
CHAIRMAN1.00X000X
DANIEL WAKEMAN
PRESIDENT/EX OFFICIO1.00X026194014835X
STEPHEN STAELIN
EX OFFICIO1.00X000
KATHLEEN HANLEY
TREASURER1.00057158387366X
JEFFREY KUHN
SECRETARY1.00043395564541X
LORI JOHNSTON
SR VP FINANCE & OPS1.00031259449431X
DAVID DEWEY
FORMER VICE PRESIDENT1.00014382413432X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3961492TotalReportableCompFrmRltdOrgs
Total Other Compensation512048TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events26304FundraisingEvents
Related Organizations5115000RelatedOrganizations
All Other Contributions567339AllOtherContributions
Total Contributions5708643TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column196951TotalRevenueColumn
Exclusion$196,951ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real3990Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2427Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real1563Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1563TotalRevenueColumn
Exclusion$1,563ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities10334489Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities8644676Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1689813Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1689813TotalRevenueColumn
Exclusion$1,689,813ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events45679GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events26304CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses29511FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column16168TotalRevenueColumn
Exclusion$16,168ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column67TotalRevenueColumn
Exclusion$67ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue67TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7613205TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,904,562ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total834699Total
Program Services834699ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total35324Total
Program Services35324ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total113602Total
Management And General113602ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total13405Total
Management And General13405ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total17632Total
Management And General17632ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total8319Total
Management And General8319ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total3100Total
Management And General3100ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total35964Total
Management And General35964ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total22489Total
Management And General22489ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total32338Total
Management And General2627ManagementAndGeneral
Fundraising29711Fundraising

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionBAD DEBTDescription
Total23298Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising23298Fundraising

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1600Total
Management And General1600ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1141770Total
Program Services870023ProgramServices
Management And General218738ManagementAndGeneral
Fundraising53009Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY254008BOY
EOY122769EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY167221BOY
EOY376904EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY400BOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis480000LandBuildingsEquipmentBasis

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1609694BOY
EOY480000EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY9109819BOY
EOY10111444EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY5000000EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11141142BOY
EOY16091117EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY42984BOY
EOY41798EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY42984BOY
EOY41798EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY10013425BOY
EOY15116785EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1084733BOY
EOY932534EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11098158BOY
EOY16049319EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11141142BOY
EOY16091117EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses6471435ReconcilationRevenueExpenses
Reconcilation Other Changes-1520274ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST LUKE'S HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
EIN344428232EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Amount$793,733Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts793733SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis480000InvestmentCostOrOtherBasis
Book Value480000BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings480000TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionINTERCOMPANY RECEIVABLEDescription
Book Value5000000BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets5000000TotalBookValueOtherAssets

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationST. LUKE'S HOSPITAL FOUNDATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES (PHS). THE FOLLOWING FOOTNOTE REFLECTS PHS'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740). PHS DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2010 AND 2009. IT IS PHS'S POLICY TO CLASSIFY THE EXPENSE RELATED TO INTEREST AND PENALTIES TO BE PAID ON UNDERPAYMENTS OF INCOME TAXES WITHIN GENERAL AND ADMINISTRATIVE EXPENSES. THERE ARE NO PENALTIES OR INTEREST ACCRUED IN THE STATEMENTS OF OPERATIONS.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF CLASSICNameOfEvent1
Gross Receipts Event171983GrossReceiptsEvent1
Charitable Contributions Event126304CharitableContributionsEvent1
Gross Revenue Event145679GrossRevenueEvent1
Non Cash Prizes Event13061NonCashPrizesEvent1
Rent Facility Costs Event125960RentFacilityCostsEvent1
Other Direct Expenses Event1490OtherDirectExpensesEvent1
Gross Receipts Total71983GrossReceiptsTotal
Charitable Contributions Total26304CharitableContributionsTotal
Gross Revenue Total Events45679GrossRevenueTotalEvents
Non Cash Prizes Total Events3061NonCashPrizesTotalEvents
Rent Facility Costs Total Events25960RentFacilityCostsTotalEvents
Other Direct Expenses Total Events490OtherDirectExpensesTotalEvents
Direct Expense Summary Events29511DirectExpenseSummaryEvents
Net Income Summary16168NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1ST LUKE'S HOSPITALBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15901 MONCLOVA ROADAddressLine1
CityMAUMEECity
StateOHState
ZIP Code43537ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient344428232EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant793733AmountOfCashGrant
Purpose Of GrantOPERATING/CAPITAL SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients21NumberOfRecipients
Amount Of Cash Grant35324AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierOTHER INFORMATION:Identifier
Return ReferencePART IV:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: GRANTS MONITORING: SLH FOUNDATION REQUIRES WRITTEN REQUEST FOR GRANT FUNDS THAT INCLUDE SUPPORTING INFORMATION OF THE PURCHASE. THESE WRITTEN REQUESTS REQUIRE APPROVAL FROM THE UNIT DIRECTOR, RESPONSIBLE VICE PRESIDENT AND FOUNDATION DIRECTOR. THE FOUNDATION REGULARLY MONITORS GRANT ACTIVITY FOR PROPRIETY OF INTENDED GRANT PURPOSE AND EXPENDITURE LIMITS. SCHOLARSHIP APPLICATIONS: APPLICATIONS ARE MADE AVAILABLE EACH SPRING IN HUMAN RESOURCES. THE APPLICANT IS EXPECTED TO COMPLETE THE APPLICATION, HAVE RECOMMENDATIONS FROM THE DEPARTMENT AND GROUP HEADS, DOCUMENTATION OF ACCEPTANCE TO PROGRAMS OF STUDY THAT MEET THE CRITERIA FOR EDUCATION ASSISTANCE AND DOCUMENTATION OF CURRENT AND OVERALL GPA. THESE ARE THEN REVIEWED BY THE VICE PRESIDENT OF HUMAN RESOURCES AND THE MEDICAL STAFF COMMITTEE, WHO MAKE RECOMMENDATIONS TO THE VARIOUS SCHOLARSHIP COMMITTEES. THE FINAL APPROVAL IS MADE BY THE COMMITTEE FOR THE SPECIFIC SCHOLARSHIP (THERE ARE FOUR DIFFERENT TYPES OF SCHOLARSHIPS AVAILABLE). THE FOUNDATION DOES NOT PARTICIPATE IN SELECTION OF THE SCHOLARSHIP RECIPIENTS. CHECKS ARE THEN DISBURSED TO THE SCHOLARSHIP RECIPIENT AND THE COLLEGE BEING ATTENDED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RANDALL OOSTRA
0750000029007201500801261080184770119966500
SHEILA SCHWARTZ
0229500085658013100034749017330038033700
BARBARA STEELE
0554195020326501004607514409769085241900
DANIEL WAKEMAN
026194000000529609539027677500
KATHLEEN HANLEY
0414848015150405231069789017577065894900
JEFFREY KUHN
03093140113370011271046608017933049849600
LORI JOHNSTON
0236401062623013570034694014737036202500
DAVID DEWEY
0143824000002946010486015725600

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BALL 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.
PART I, LINE 7AN INCENTIVE BONUS IS PAID TO ALL EXECUTIVES BASED ON ATTAINMENT OF GOALS IN THE AREAS OF 1) INTEGRATED DELIVERY SYSTEM DEVELOPMENT; 2) COMMUNITY SERVICE; 3) QUALITY, SAFETY AND SERVICE; 4) FINANCIAL RESPONSIBILITY; AND 5) WORKFORCE DEVELOPMENT. THE BONUS IS A PERCENTAGE OF BASE PAY APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2JAMIE AND CHRISTINE BLACK HAVE A FAMILY RELATIONSHIP. THE FOLLOWING OFFICERS, BOARD MEMBERS AND KEY EMPLOYEES ARE EMPLOYEES OF PROMEDICA HEALTH SYSTEM OR ITS RELATED ORGANIZATIONS. MANY OF THESE EMPLOYEES ALSO SERVE ON OTHER RELATED PROMEDICA HEALTH SYSTEM BOARDS. RANDALL OOSTRA SHEILA SCHWARTZ BARBARA STEELE DANIEL WAKEMAN KATHLEEN HANLEY JEFFREY KUHN LORI JOHNSTON STEPHEN BAZELEY
FORM 990, PART VI, SECTION A, LINE 4EFFECTIVE SEPTEMBER 1, 2010, PROMEDICA HEALTH SYSTEM BECAME THE SOLE MEMBER OF ST. LUKE'S HOSPITAL FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 6AS AN OHIO NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7APROMEDICA 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 7BWHILE 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 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, AND (V) THE NON-BUDGETED 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 (VI) ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR LIQUIDATION.
FORM 990, PART VI, SECTION B, LINE 11UNDER THE GUIDANCE OF PROMEDICA HEALTH SYSTEM'S (PHS) TAX CONSULTANTS, FORM 990S ARE PREPARED BY THE RESPECTIVE ACCOUNTING DEPARTMENT OF EACH AFFILIATE AND REVIEWED BY THE APPROPRIATE DIRECTOR OF FINANCE. AFTER DIRECTOR OF FINANCE APPROVAL, COPIES OF THE FORM 990 FOR PHS AND THEIR SUBSIDIARIES ARE PROVIDED TO THE RESPECTIVE COMPANY'S BOARD OF DIRECTORS AND ARE REVIEWED AND SIGNED BY THE RESPECTIVE COMPANY'S PRESIDENT PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
THE FOUNDATION FOLLOWS THE POLICIES OF ST. LUKE'S HOSPITAL FOR CONFLICT OF INTEREST; CONFLICT OF INTEREST QUESTIONNAIRES ARE SENT TO THE BOARD MEMBERS, MEDICAL EXECUTIVE COMMITTEE, AND MEDICAL DIRECTORS. WHEN THE RESPONSES ARE RECEIVED, THEY ARE COMPILED IN A REPORT WHICH IS SUBMITTED TO THE HOSPITAL BOARD. THE BOARD THEN REVIEWS THE REPORT AND APPROVES IT. THIS IS PERFORMED ON AN ANNUAL BASIS.FORM 990, PART VI, SECTION B, LINE 12C
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 B, LINE 15
PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS DURING THE YEAR: RANDALL OOSTRA - 40 HOURS SHEILA SCHWARTZ - 40 HOURS BARBARA STEELE - 40 HOURS DANIEL WAKEMAN - 40 HOURS KATHLEEN HANLEY - 40 HOURS JEFFREY KUHN - 40 HOURS LORI JOHNSTON - 40 HOURS DAVID DEWEY - 40 HOURS STEPHEN BAZELEY - 40 HOURSFORM 990, PART VII:
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -390,580. JOINDER NET ASSET ADJUSTMENT PER ASC 958 -1,129,694. TOTAL TO FORM 990, PART XI, LINE 5: -1,520,274.FORM 990, PART XI, LINE 5:
ST. LUKE'S HOSPITAL FOUNDATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES (PHS) WHICH ARE PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE PHS AUDIT/COMPLIANCE COMMITTEE, WHICH PROVIDES ASSISTANCE TO THE PHS BOARD OF TRUSTEES IN FULFILLING ITS FIDUCIARY RESPONSIBILITIES AND MAINTAINS FREE AND OPEN COMMUNICATION BETWEEN THE COMMITTEE, THE DIRECTOR OF INTERNAL AUDIT/COMPLIANCE, THE INDEPENDENT AUDITORS AND MANAGEMENT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. MAJOR RESPONSIBILITIES OF THE AUDIT/COMPLIANCE COMMITTEE INCLUDE: - ANNUALLY, APPROVE THE ENGAGEMENT OF THE EXTERNAL AUDITOR, INCLUDING RELATED SCOPE, FEES AND REPORTS. - REVIEW WITH MANAGEMENT AND THE INDEPENDENT AUDITORS THE ANNUAL FINANCIAL STATEMENTS AND RESULTS OF THE AUDIT, INCLUDING REQUIRED MATTERS TO BE COMMUNICATED TO THE COMMITTEE BY THE INDEPENDENT AUDITORS UNDER GENERALLY ACCEPTED AUDITING STANDARDS. - DISCUSS WITH THE EXTERNAL AUDITORS THEIR INDEPENDENCE FROM MANAGEMENT AND THE ORGANIZATION AND THE MATTERS INCLUDED IN WRITTEN DISCLOSURE REQUIRED BY THE INDEPENDENCE STANDARDS BOARD. - OVERSEE MANAGEMENT ACTION PLANS RESULTING FROM EXTERNAL MANAGEMENT LETTER.FORM 990, PART XII, LINE 2A - 2D:

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (16 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
COBRA VENTURES LLC
5901 MONCLOVA RDMAUMEEOH43537204671613LAND LEASINGOH377681368ST LUKE'S HOSPITAL FOUNDATION
MIDWEST CARDIOVASCULAR CONSULTANTS LLC
5855 MONROE STSYLVANIAOH43560611448753EMPLOYS PHYSICIANSOH2656840849076PROMEDICA PHYSICIAN GROUP
PROMEDICA CENTRAL PHYSICIANS LLC
5855 MONROE STSYLVANIAOH43560341881137EMPLOYS PHYSICIANSOH7839452212670114PROMEDICA PHYSICIAN GROUP
PROMEDICA EAST PHYSICIANS LLC
5855 MONROE STSYLVANIAOH43560341881145EMPLOYS PHYSICIANSOH47867081701245PROMEDICA PHYSICIAN GROUP
PROMEDICA ORTHOPEDIC PHYSICIANS LLC
5855 MONROE STSYLVANIAOH43560208050622EMPLOYS PHYSICIANSOH27725272500589PROMEDICA PHYSICIAN GROUP
PROMEDICA SOUTH PHYSICIANS LLC
5855 MONROE STSYLVANIAOH43560341898679EMPLOYS PHYSICIANSOH30268171374952PROMEDICA PHYSICIAN GROUP
PROMEDICA WEST PHYSICIANS LLC
5855 MONROE STSYLVANIAOH43560341893773EMPLOYS PHYSICIANSOH106043275384008PROMEDICA PHYSICIAN GROUP
PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS LLC
5855 MONROE STSYLVANIAOH43560263888045EMPLOYS PHYSICIANSOH269137155413477PROMEDICA PHYSICIAN GROUP
PROMEDICA GI PHYSICIANS LLC
5855 MONROE STSYLVANIAOH43560263015991EMPLOYS PHYSICIANSOH49385961761225PROMEDICA PHYSICIAN GROUP
PROMEDICA CARDIOTHORACIC PHYSICIANS LLC
5855 MONROE STSYLVANIAOH43560270978204EMPLOYS PHYSICIANSOH4231885-131431PROMEDICA PHYSICIAN GROUP
WELLCARE PHYSICIANS LLC
5901 MONCLOVA RDMAUMEEOH43537611528443PHYSICIAN PRACTICESOH52449902590295PROMEDICA PHYSICIAN GROUP
PROMEDICA HEMATOLOGY-ONCOLOGY PHYSICIANS LLC
5855 MONROE STSYLVANIAOH43560271401750EMPLOYS PHYSICIANSOH147077941682PROMEDICA PHYSICIAN GROUP
PROMEDICA ENT LLC
5855 MONROE STSYLVANIAOH43560272404505EMPLOYS PHYSICIANSOH016163PROMEDICA PHYSICIAN GROUP
THE PHARMACY COUNTER LLC
5855 MONROE STSYLVANIAOH43560271325141MEDICAL EQUIPMENT & PHARMACYOH3076366912690612PROMEDICA CONTINUING CARE SERVICES CORP
WOLF CREEK ASSOCIATES LLC
901 KIMOLE LNADRIANMI49221383164818FACILITY LEASINGMI2878581252203EMMA L BIXBY MEDICAL CENTER
PROMEDICA MONROE CARDIOLOGY PLLC
5855 MONROE STSYLVANIAOH43560272920342EMPLOYS PHYSICIANSMI00PROMEDICA PHYSICIAN GROUP

Form990 Schedule R Part II Form990ScheduleRPartII (34 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
BAY PARK COMMUNITY HOSPITAL
2801 BAY PARK DROREGONOH43616341883132HOSPITALOH501(C)(3)3PROMEDICA HEALTH SYSTEM1
BAY PARK COMMUNITY HOSPITAL FOUNDATION
2801 BAY PARK DROREGONOH43616341901462FOUNDATIONOH501(C)(3)11B, IIPROMEDICA HEALTH SYSTEM1
BIXBY COMMUNITY HEALTH FOUNDATION
818 RIVERSIDE AVEADRIANMI49221382691494FOUNDATIONMI501(C)(3)11B, IIEMMA L BIXBY MEDICAL CENTER1
CARE ENTERPRISES INC
5901 MONCLOVA RDMAUMEEOH43537341366709FACILITY LEASINGOH501(C)(3)11B, IIPROMEDICA HEALTH SYSTEM1
DEFIANCE HOSPITAL AUXILIARY
1200 RALSTONDEFIANCEOH43512510173779HOSPITAL / FOUNDATION SUPPORTOH501(C)(3)11D, III-ODEFIANCE HOSPITAL INC DBA DEFIANCE REGIONAL HOSPITAL1
DEFIANCE HOSPITAL FOUNDATION INC
1200 RALSTONDEFIANCEOH43512341559647FOUNDATIONOH501(C)(3)11B, IIPROMEDICA HEALTH SYSTEM1
DEFIANCE HOSPITAL INC DBA DEFIANCE REGIONAL MEDICAL CENTER
1200 RALSTONDEFIANCEOH43512344446484HOSPITALOH501(C)(3)3PROMEDICA HEALTH SYSTEM1
EMMA L BIXBY MEDICAL CENTER
818 RIVERSIDE AVEADRIANMI49221382796005HOSPITALMI501(C)(3)3PROMEDICA NORTH REGION1
EMMA L BIXBY MEDICAL CENTER AUXILIARY
818 RIVERSIDE AVEADRIANMI49221382149602HOSPITAL / FOUNDATION SUPPORTMI501(C)(3)11B, IIEMMA L BIXBY MEDICAL CENTER1
FLOWER HOSPITAL
5200 HARROUN RDSYLVANIAOH43560344428794HOSPITALOH501(C)(3)3PROMEDICA HEALTH SYSTEM1
FLOWER HOSPITAL FOUNDATION
2142 N COVE BLVDTOLEDOOH43606341556730FOUNDATIONOH501(C)(3)7PROMEDICA HEALTH SYSTEM1
FOSTORIA COMMUNITY HOSPITAL FOUNDATION
PO BOX 907FOSTORIAOH44830341805993FOUNDATIONOH501(C)(3)11A, IFOSTORIA HOSPITAL ASSOC DBA FOSTORIA COMMUNITY HOSPITAL1
FOSTORIA HOSPITAL ASSOC DBA FOSTORIA COMMUNITY HOSPITAL
PO BOX 907FOSTORIAOH44830340898745HOSPITALOH501(C)(3)3PROMEDICA HEALTH SYSTEM1
FOSTORIA HOSPITAL AUXILIARY
PO BOX 907FOSTORIAOH44830346517634HOSPITAL / FOUNDATION SUPPORTOH501(C)(3)11A, IFOSTORIA HOSPITAL ASSOC DBA FOSTORIA COMMUNITY HOSPITAL1
HERRICK MEDICAL CENTER AUXILIARY
500 E POTTAWATAMIE STTECUMSEHMI49286383076105HOSPITAL / FOUNDATION SUPPORTMI501(C)(3)11B, IIHERRICK MEMORIAL HOSPITAL DBA HERRICK MEDICAL CENTER1
HERRICK MEDICAL CENTER FOUNDATION
500 E POTTAWATAMIE STTECUMSEHMI49286383076106FOUNDATIONMI501(C)(3)11B, IIHERRICK MEMORIAL HOSPITAL DBA HERRICK MEDICAL CENTER1
HERRICK MEMORIAL HOSPITAL INC DBA HERRICK MEDICAL CENTER
500 E POTTAWATAMIE STTECUMSEHMI49286383049015HOSPITALMI501(C)(3)3PROMEDICA NORTH REGION1
LENAWEE LONG TERM CARE DBA PROVINCIAL HOUSE OF ADRIAN
700 LAKESHORE TRADRIANMI49221382879330LONG TERM CAREMI501(C)(3)9PROMEDICA NORTH REGION1
PROMEDICA CONTINUING CARE SERVICES CORP
5855 MONROE STSYLVANIAOH43560344492440LONG TERM AND HOME HEALTH CAREOH501(C)(3)9PROMEDICA HEALTH SYSTEM1
PROMEDICA CONTINUING CARE SERVICES CORP FOUNDATION
5855 MONROE STSYLVANIAOH43560341901457FOUNDATIONOH501(C)(3)11B, IIPROMEDICA HEALTH SYSTEM1
PROMEDICA COURIER SERVICES INC
3170 W CENTRAL AVETOLEDOOH43606260324790COURIER SERVICEOH501(C)(3)11B, IIPROMEDICA CONTINUING CARE SERVICES CORP1
PROMEDICA HEALTH SYSTEM INC
1801 RICHARDS RDTOLEDOOH43607341517671PARENT COMPANY OF HEALTH SYSTEMOH501(C)(3)11C, III-FI0N/A
PHS VENTURES FKA BVPH VENTURES INC
1801 RICHARDS RDTOLEDOOH43607341880473HEALTH CARE MANAGEMENT SERVICESOH501(C)(3)11C, III-FIPROMEDICA HEALTH SYSTEM1
ACADEMIC HEALTH CENTER CORPORATION
2142 N COVE BLVDTOLEDOOH43606341887062MEDICAL EDUCATION & RESEARCHOH501(C)(3)11B, IIPROMEDICA HEALTH SYSTEM1
PROMEDICA INDEMNITY CORP
ONE CHURCH ST 5TH FLOORBURLINGTONVT05401341931936PROFESSIONAL & GENERAL LIABILITYVT501(C)(3)11B, IIPROMEDICA HEALTH SYSTEM1
PROMEDICA NORTH REGION INC
818 RIVERSIDE AVEADRIANMI49221383307345MANAGES DELIVERY OF HEALTH SYSTEMMI501(C)(3)11B, IIPROMEDICA HEALTH SYSTEM1
PROMEDICA PHYSICIANS & CONTINUUM SERVICES
5855 MONROE STSYLVANIAOH43560341880767MANAGES PHYSICIAN SERVICESOH501(C)(3)11C, III-FIPROMEDICA HEALTH SYSTEM1
PROMEDICA PHYSICIAN GROUP
5855 MONROE STSYLVANIAOH43560341899439PHYSICIAN HEALTH CARE SERVICESOH501(C)(3)9PROMEDICA PHYSICIANS & CONTINUUM SERVICES1
ST LUKE'S HOSPITAL
5901 MONCLOVA RDMAUMEEOH43537344428232HOSPITALOH501(C)(3)3PROMEDICA HEALTH SYSTEM1
THE TOLEDO HOSPITAL
2142 N COVE BLVDTOLEDOOH43606344428256HOSPITALOH501(C)(3)3PROMEDICA HEALTH SYSTEM1
THE TOLEDO HOSPITAL FOUNDATION
2142 N COVE BLVDTOLEDOOH43606341517672FOUNDATIONOH501(C)(3)11B, IIPROMEDICA HEALTH SYSTEM1
TOLEDO CHILDREN'S HOSPITAL FOUNDATION
2142 N COVE BLVDTOLEDOOH43606341901463FOUNDATIONOH501(C)(3)11B, IIPROMEDICA HEALTH SYSTEM1
TOLEDO DISTRICT NURSE ASSOCIATION
1946 N 13TH STREETTOLEDOOH43624344427949SKILLED HOME CAREOH501(C)(3)7PROMEDICA CONTINUING CARE SERVICES CORP1
VISITING NURSE HOSPICE AND HEALTH CARE
383 W DUSSEL DRIVEMAUMEEOH43537341831624HOSPICE HOME CAREOH501(C)(3)9PROMEDICA CONTINUING CARE SERVICES CORP1

Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
BIXBY MEDICAL OFFICE LIMITED PARTNERSHIP
818 RIVERSIDE AVEADRIANMI49221382972398FACILITY LEASINGMIEMMA L BIXBY MEDICAL CENTERRELATED378631303421010.64600
REYNOLDS RD SURGICAL CENTER LLC
2865 N REYNOLDS RDTOLEDOOH43615311569454FREESTANDING AMBULATORY SURGICAL CENTEROHTHE TOLEDO HOSPITALRELATED7890082760995000.64960
WATERVILLE MEDICAL CENTER LLC
5901 MONCLOVA RDMAUMEEOH43537320160784FACILITY LEASINGOHCARE ENTERPRISES INCRELATED6045921810000.70000
WEST CENTRAL SURGICAL CENTER
7055 W CENTRAL AVETOLEDOOH43617200088459FREESTANDING AMBULATORY SURGICAL CENTEROHTHE TOLEDO HOSPITALRELATED-62312773150010.50000

Form990 Schedule R Part IV Form990ScheduleRPartIV (15 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityPercentage OwnershipPercentageOwnershipShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssets
CARE HOLDINGS
5901 MONCLOVA RDMAUMEEOH43537341796790HOLDING COMPANYOHPROMEDICA HEALTH SYSTEMC1.00000
CENTRAL REGION PROPERTIES INC
2142 N COVE BLVDTOLEDOOH43606341059809FACILITY LEASINGOHTHE TOLEDO HOSPITALC1.0000087993718524765
HERRICK MEMORIAL DEVELOPMENT CORP
500 E POTTAWATAMIE TRADRIANMI49221383146907FACILITY LEASINGMIPROMEDICA NORTH REGIONC1.0000013359600657
LHA PHYSICIAN SERVICES CORPORATION
818 RIVERSIDE AVEADRIANMI49221611451576PHYSICIAN BILLINGMIEMMA L BIXBY MEDICAL CENTERC1.00000-13972386789
PHYSICIANS ADVANTAGE MSO
5901 MONCLOVA RDMAUMEEOH43537061811760PHYSICIAN PRACTICE MANAGEMENTOHPROMEDICA HEALTH SYSTEMC1.00000-92928949
PROMEDICA CENTRAL CORPORATION OF MI INC
5855 MONROE STSYLVANIAOH43560383322278PHYSICIAN HEALTH CARE SERVICESOHPROMEDICA PHYSICIAN GROUPC1.000001040755664567
PROMEDICA FOUNDATION
1801 RICHARDS RDTOLEDOOH43607341901465FOUNDATIONOHPROMEDICA HEALTH SYSTEMC1.00000
PROMEDICA HEALTH EDUCATION & RESEARCH FOUNDATION
2142 N COVE BLVDTOLEDOOH43606341930876FOUNDATIONOHPROMEDICA HEALTH SYSTEMC1.00000
PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES
1901 INDIAN WOOD CIRMAUMEEOH43537341570675HEALTH CARE INSURANCEOHPROMEDICA HEALTH SYSTEMC1.000003509000230740000
PROMEDICA NORTH PHYSICIAN CORPORATION
5855 MONROE STSYLVANIAOH43560383482148PHYSICIAN HEALTH CARE SERVICESOHPROMEDICA PHYSICIAN GROUPC1.00000203340
PROMEDICA PHYSICIAN HOSPITAL ORGANIZATION
5855 MONROE STSYLVANIAOH43560341887065PHYSICIAN MANAGEMENT SERVICESOHPROMEDICA PHYSICIANS & CONTINUUM SERVICESC1.00000404501
PROMEDICA PHYSICIAN CORPORATION
5855 MONROE STSYLVANIAOH43560341757084PHYSICIAN MANAGEMENT SERVICESOHPROMEDICA HEALTH SYSTEMC1.00000
PROMEDICA RETAIL GROUP INC
3890 MONROE STTOLEDOOH43606341159928FLORISTOHPROMEDICA CONTINUING CARE SERVICES CORPC1.00000-94251929550
TOLEDO HOSPITAL LOCAL PROVIDER UNIT
2142 N COVE BLVDTOLEDOOH43606341586739PHYSICIAN SERVICESOHTHE TOLEDO HOSPITALC1.00000
ST LUKE'S PHYSICIAN HOSPITAL ORGANIZATION
5901 MONCLOVA RDMAUMEEOH43537341781420PHYSICIAN MANAGEMENT SERVICESOHST LUKE'S HOSPITALC0.50000-34306732
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
ST LUKE'S HOSPITAL
B793733FMV
PROMEDICA HEALTH SYSTEM
C5000000FMV
ST LUKE'S HOSPITAL
O113602FMV
ST LUKE'S HOSPITAL
C115000FMV