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OHIOCARE HEALTH SYSTEMS INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
OHIOCARE HEALTH SYSTEMS INC (EIN 34-1366258)
Tax period
2010-01-01 to 2010-08-31
Filed
2011-12-08
IRS object ID
201103429349300610
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)
Timestamp2011-12-08T09:50:33-06:00Timestamp
Tax Period End Date2010-08-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line165 EAST STATE ST STE 600AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN341366258EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1OHIOCARE HEALTH SYSTEMS INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlOHIONameControl
Phone4198935994Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameLORI JOHNSTONName
TitleCOO/CFOTitle
Phone4198935994Phone
Date Signed2011-11-16DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBERNIE OSTROWSKIName
Phone6148493000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line15901 MONCLOVA ROADAddressLine1
CityMAUMEECity
StateOHState
ZIP Code43537ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9928967GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1981YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE SUPPORT TO RELATED EXEMPT ORGANIZATIONS.ActivityOrMissionDescription
Termination Or ContractionXTerminationOrContraction
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees147TotalNbrEmployees
Total Nbr Volunteers6TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4465505ContributionsGrantsPriorYear
Contributions Grants Current Year2685000ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3302012ProgramServiceRevenuePriorYear
Program Service Revenue CY7243967ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year-6338InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year7767517TotalRevenuePriorYear
Total Revenue Current Year9922629TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1371954GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY109924GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8312455SalariesEtcPriorYear
Salaries Etc Current Year8057312SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3632524OtherExpensePriorYear
Other Expenses Current Year3988536OtherExpensesCurrentYear
Total Expenses Prior Year13316933TotalExpensesPriorYear
Total Expenses Current Year12155772TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-5549416RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2233143RevenuesLessExpensesCY
Total Assets BOY14433933TotalAssetsBOY
Total Assets EOY0TotalAssetsEOY
Total Liabilities BOY3218125TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11215808NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY0NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionNONEMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change1SignificantChange
Expense9790357Expense
Grants0Grants
Revenue7243967Revenue
DescriptionTO PROVIDE SUPPORT TO RELATED EXEMPT ORGANIZATIONS.Description
Total Program Service Expense9790357TotalProgramServiceExpense
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 Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
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
Terminated1Terminated
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 With109630NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees147NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address1OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
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 Line1LORI JOHNSTONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4198247440TelephoneNumber

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 (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
WILLIAM R AMMANN
CHAIRMAN0.50XX000
DALE SEYMOUR
VICE CHAIRMAN0.50XX000
DANIEL WAKEMAN
PRESIDENT0.50XX026667036832
DENNIS WAGNER
TREASURER0.50XX010486136381
PHYLLIS MARKS
SECRETARY0.50XX05013719618
ALLAN BROGAN
TRUSTEE0.30X000
BARBARA MACHIN
TRUSTEE0.30X000
DAVID DEWEY
TRUSTEE0.30X014924344478
DEBRA BALL
TRUSTEE0.30X012397031110
DOUGLAS DEACON
TRUSTEE0.30X012799042249
JOHN BEARSS
TRUSTEE0.30X000
THERESA KONWINSKI
TRUSTEE0.30X012799047613
THOMAS FAIRHURST
TRUSTEE0.30X000
WENDY CEDOZ
VP OF LEGAL COUNSEL0.30X000
MICHAEL HOEFLINGER
PHYSICIAN40.00492439027499X
BENJAMIN SALPIETRO JR
PHYSICIAN40.00494426022519X
THOMAS HOUSTON
PHYSICIAN40.00335080027389X
RICHARD MARKWOOD
PHYSICIAN40.00237625010331X
SHANNON LUCENTE
PHYSICIAN40.0020169005745X
DAVID OPPENLANDER
TREASURER (FORMER)0.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1761260TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs950861TotalReportableCompFrmRltdOrgs
Total Other Compensation351764TotalOtherCompensation
Number Individuals GT100 K28NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations2685000RelatedOrganizations
Total Contributions2685000TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PROGRAM SERVICES90009971021507102150
INVESTMENT-SURGICARE900099144118144118
INVESTMENT-ST LUKE PHO900099-2301-2301
FieldValueIRS element (for citing)
Total Program Service Revenue7243967TotalProgramServiceRevenue

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other6338Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-6338Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-6338TotalRevenueColumn
Exclusion-$6,338ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9922629TotalRevenueColumn
Related Or Exempt Function Income7243967RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$6,338ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total109924Total
Program Services109924ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6894608Total
Program Services6067255ProgramServices
Management And General827353ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1162704Total
Program Services1023180ProgramServices
Management And General139524ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total316194Total
Management And General316194ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total949995Total
Management And General949995ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total24000Total
Management And General24000ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total204718Total
Program Services137161ProgramServices
Management And General67557ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1023871Total
Program Services1003394ProgramServices
Management And General20477ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total567518Total
Program Services556168ProgramServices
Management And General11350ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total87990Total
Program Services87990ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total448243Total
Program Services439278ProgramServices
Management And General8965ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
BAD DEBT EXPENSE324565324565
BANK SERVICE FEES4144241442

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12155772Total
Program Services9790357ProgramServices
Management And General2365415ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY233328BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1265029BOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY171614BOY

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY397066BOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY234751BOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY12132145BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY14433933BOY
EOY0EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3107825BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY110300BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3218125BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY11215808BOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11215808BOY
EOY0EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14433933BOY
EOY0EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-2233143ReconcilationRevenueExpenses
Reconcilation Other Changes-8982665ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
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 Doc0ListedInGoverningDoc
Supported Organization Notified0SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

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

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Total Revenue9922629TotalRevenue
Total Expenses12155772TotalExpenses
Excess Or Deficit For Year-2233143ExcessOrDeficitForYear
Other-$8,982,665OtherAmount
Total Adjustments-8982665TotalAdjustments
Excess Or Deficit Per FS-11215808ExcessOrDeficitPerFS

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPART XI, LINE 8 - OTHER ADJUSTMENTS:Identifier
ExplanationBOOK-TAX DIFFERENCE FROM SURGICARE K-1 156,784. BOOK VALUE OF NET ASSETS TRANSFER--SEE SCHEDULE N -9,139,449.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

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 Grant109924AmountOfCashGrant
Method Of ValuationN/AMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance
Purpose Of GrantGENERAL SUPPORTPurposeOfGrant

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
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 Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 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
DANIEL WAKEMAN
0266670000002729309539030350200
DAVID DEWEY
0149243000003529209186019372100
DEBRA BALL
0123970000002204409066015508000
DOUGLAS DEACON
0127990000003314709102017023900
THERESA KONWINSKI
0127990000003850209111017560300
MICHAEL HOEFLINGER
4924390000021174063250519938000
BENJAMIN SALPIETRO JR
4944260000016194063250516945000
THOMAS HOUSTON
3350800000021064063250362469000
RICHARD MARKWOOD
237625000005296050350247956000
SHANNON LUCENTE
20169000000529604490207435000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationPART I, LINE 3: COMPENSATION FOR THE ORGANIZATION'S PRESIDENT IS DETERMINED BY A RELATED ORGANIZATION, ST. LUKE'S HOSPITAL, UTILIZING A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD AND COMPENSATION COMMITTEE.Explanation

Schedule N IRS990ScheduleN

Liquidation Table LiquidationTable

Liquidation Detail LiquidationDetail (6 entries)

Description Of AssetDescriptionOfAssetDate Of DistributionDateOfDistributionFMV Of AssetFMVOfAssetMethod Of FMV DeterminationMethodOfFMVDeterminationEINEINAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeIRC SectionIRCSection
ST LUKE'S HOSPITAL
CASH2010-09-0120591BOOK VALUE3444282325901 MONCLOVA ROADMAUMEEOH43537501(C)(3)
PROMEDICA HEALTH SYSTEM
INVESTMENT IN CARE ENTERPRISES2010-09-0112645762BOOK VALUE3415176711801 RICHARDS ROADTOLEDOOH43607501(C)(3)
ST LUKE'S HOSPITAL
INVESTMENT IN ST. LUKE'S PHYSICIAN HOSPITAL ORGANIZATION2010-09-01-8398BOOK VALUE3444282325901 MONCLOVA ROADMAUMEEOH43537501(C)(3)
PROMEDICA HEALTH SYSTEM
INVESTMENT IN CARE HOLDINGS2010-09-01100BOOK VALUE3415176711801 RICHARDS ROADTOLEDOOH43607501(C)(3)
PROMEDICA HEALTH SYSTEM
INVESTMENT IN PHYSICIAN'S ADVANTAGE MSO2010-09-01100BOOK VALUE3415176711801 RICHARDS ROADTOLEDOOH43607501(C)(3)
ST LUKE'S HOSPITAL
INVESTMENT IN OHIOCARE AMBULATORY SURGERY CENTER LLC2010-09-01937159BOOK VALUE3444282325901 MONCLOVA ROADMAUMEEOH43537501(C)(3)
FieldValueIRS element (for citing)
Director Of Successor1DirectorOfSuccessor
Employee Of Successor1EmployeeOfSuccessor
Owner Of Successor0OwnerOfSuccessor
Receive Compensation0ReceiveCompensation
Assets Distributed1AssetsDistributed
Required To Notify AG1RequiredToNotifyAG
AG Notified1AGNotified
Liabilities Paid1LiabilitiesPaid
Bonds Outstanding0BondsOutstanding
Bond Liabilities Discharged0BondLiabilitiesDischarged

Form990 Schedule N Part III Form990ScheduleNPartIII (2 entries)

ExplanationExplanation
PART I, LINE 2E: BARB MACHIN, ESQDANIEL WAKEMANDAVID DEWEYDOUGLAS DEACONTHERESA KONWINSKI
PART I, LINE 2E: BARB MACHIN, ESQ, BECAME A MEMBER OF THE BOARD OF ST. LUKE'S HOSPITAL.DANIEL WAKEMAN, DAVID DEWEY, DOUGLAS DEACON, AND THERESA KONWINSKI WILL BECOME EMPLOYEES OF PROMEDICA HEALTH SYSTEM AS OF 01/01/11.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
CHANGES IN PROGRAM SERVICESFORM 990, PART III, LINE 3OHIOCARE HEALTH SYSTEMS, INC. WAS DISSOLVED ON SEPTEMBER 1, 2010.
FORM 990, PART VI, SECTION B, LINE 11UPON RECEIPT OF THE COMPLETED 990 FROM THE INDEPENDENT ACCOUNTING FIRM, THE ACTING TREASURER REVIEWS THE 990. ANY ADJUSTMENTS THAT NEED TO BE MADE ARE REQUESTED PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12COHIOCARE HEALTH SYSTEMS FOLLOWS THE POLICIES OF ST. LUKE'S HOSPITAL FOR CONFLICT OF INTEREST, WHISTLEBLOWER, AND RECORD AND RETENTION AND DESTRUCTION. EVERY YEAR, CERTAIN EMPLOYEES (INCLUDING OFFICERS, DIRECTORS, AND TRUSTEES) ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT.
FORM 990, PART VI, SECTION B, LINE 15THE ST LUKE'S HOSPITAL BOARD OF DIRECTORS DELEGATES RESPONSIBILITY TO THE EXECUTIVE COMPENSATION COMMITTEE FOR OVERSEEING THE ST. LUKE'S HOSPITAL EXECUTIVE TOTAL COMPENSATION PROGRAM AND APPROVING ALL COMPENSATION BENEFITS ARRANGEMENTS FOR THE PRESIDENT, CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND ANY OTHER EXECUTIVES WHO MAY BE "DISQUALIFIED INDIVIDUALS" SUBJECT TO INTERMEDIATE SANCTIONS AS DEFINED BY THE INTERNAL REVENUE CODE 4958. THE EXECUTIVE COMPENSATION COMMITTEE RECOMMENDS TO THE BOARD A TOTAL COMPENSATION PHILOSOPHY FOR SENIOR EXECUTIVES AND ASSURES THAT THE TOTAL COMPENSATION PROGRAM IS ADMINISTERED CONSISTENT WITH THAT PHILOSOPHY. COMPENSATION IS DETERMINED THROUGH AN INDEPENDENT COMPENSATION CONSULTANT AND A COMPENSATION SURVEY OR STUDY. THE EXECUTIVE COMPENSATION COMMITTEE WILL ALSO BE RESPONSIBLE FOR PERIODICALLY REVIEWING TOTAL COMPENSATION POLICIES FOR NON-EXECUTIVE STAFF.
FORM 990, PART VI, SECTION C, LINE 18FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART VIIESTIMATE OF OFFICERS' ALLOCATION OF HOURS WORKED FOR OHIOCARE HEALTH SYSTEMS, INC. RELATED ENTITIES: ST. LUKE'S HOSPITAL: -DANIEL WAKEMAN: 40 -DENNIS WAGNER: 40 -PHYLLIS MARKS: 40 -DAVID DEWEY: 40 -DEBRA BALL: 40 -DOUGLAS DEACON: 40 -THERESA KONWINSKI: 40
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:BOOK-TAX DIFFERENCE FROM SURGICARE K-1 156,784. BOOK VALUE OF NET ASSETS TRANSFER--SEE SCHEDULE N -9,139,449. TOTAL TO FORM 990, PART XI, LINE 5: -8,982,665.
FORM 990, PART XI, LINE 2C: THE AUDIT COMMITTEE OF ST. LUKE'S HOSPITAL IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTS THE INDEPENDENT ACCOUNTANT WHO WILL PERFORM THE AUDIT AND COMPLETION OF ANY TAX RETURNS FOR ALL OHIOCARE HEALTH SYSTEM ENTITIES. THE AUDIT IS COMPLETED ON A CONSOLIDATED BASIS.
FORM 990, PART VI, SECTION A, LINE 9: DAVID M OPPENLANDER, SENIOR VICE PRESIDENT & CHIEF FINANCIAL OFFICER, CAN BE REACHED AT: DECATUR MEMORIAL HOSPITAL 2300 NORTH EDWARD STREET DECATUR, IL 62526
FORM 990, PART III, LINE 3THE ORGANIZATION WAS DISSOLVED AS OF SEPTEMBER 1, 2010, DUE TO ITS SUBSIDIARY ORGANIZATIONS SOLE MEMBERS BEING SUBSTITUTED BY PROMEDICA HEALTH SYSTEM.
FORM 990, PART VI, SECTION B, LINE 16B: THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY REGARDING JOINT VENTURES. HOWEVER, OHIOCARE DOES SAFEGUARD ITS EXEMPT STATUS WITHIN ITS JOINT VENTURE AGREEMENTS.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1WELLCARE PHYSICIANS GROUP LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15901 MONCLOVA RDAddressLine1
CityMAUMEECity
StateOHState
ZIP Code43537ZIPCode
FieldValueIRS element (for citing)
EIN611528443EIN
Primary ActivitiesPHYSICIAN PRACTICESPrimaryActivities
Legal Domicile StateOHLegalDomicileState
Total Income7095817TotalIncome
EOY Assets2144737EOYAssets
Direct Controlling Entity NAN/ADirectControllingEntityNA

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
ST LUKE'S HOSPITAL
5901 MONCLOVA ROADMAUMEEOH43537344428232PROVIDING HEALTHCARE SERVICESOH501C(3)3N/A1
ST LUKE'S HOSPITAL FOUNDATION
5901 MONCLOVA ROADMAUMEEOH43537341292849SUPPORTING PROJECTS TO ASSIST ST. LUKE'S HOSPITAL AND THE COMMUNITYOH501C(3)11BN/A1
CARE ENTERPRISES
5901 MONCLOVA ROADMAUMEEOH43537341366709LEASE OF MEDICAL OFFICE SPACEOH501C(3)11BN/A1

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1WATERVILLE MEDICAL CENTER LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15901 MONCLOVA ROADAddressLine1
CityMAUMEECity
StateOHState
ZIP Code43537ZIPCode
FieldValueIRS element (for citing)
EIN320160784EIN
Primary ActivityLEASE OF MEDICAL OFFICE SPACEPrimaryActivity
Legal Domicile StateOHLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
CARE HOLDINGS
5901 MONCLOVA ROADMAUMEEOH43537341796790HOLDING COMPANYOHN/AC1000.50000
PHYSICIANS ADVANTAGE MSO
5901 MONCLOVA ROADMAUMEEOH43537061811760PHYSICIAN PRACTICE MANAGEMENTOHN/AC100
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 Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
ST LUKE'S HOSPITAL
B109924CASH TRANSACTION
ST LUKE'S HOSPITAL
C2685000CASH TRANSACTION