2019-11-12T15:28:29-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2018-01-01 341707570 LIMA MEMORIAL FOUNDATION LIMA 4192265073 1001 BELLEFONTAINE AVENUE LIMA OH 45804 JOHN T FISCHBACH VICE-PRESIDENT/CFO 4192265073 2019-11-08 1 BERNIE OSTROWSKI P00366367 6148493000 2019-11-06 67.59.56.31 2019-11-08 14:55:45 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 47E4600F5136E639F21FA0FC9E647DE73F0A97F6 2018 2020-04-17 16:48:07Z MICHAEL D SWICK 1001 BELLEFONTAINE AVENUE LIMA OH 45804 2347118 0 X N/A X 1993 OH THE MISSION OF THE LIMA MEMORIAL FOUNDATION IS TO PROVIDE QUALITY HEALTH CARE THROUGH PHILANTHROPY TO THE COMMUNITIES WHICH LIMA MEMORIAL HEALTH SYSTEM SERVES. 14 12 0 75 0 0 2423293 1690055 0 0 46160 618788 -167074 -251183 2302379 2057660 0 45000 0 0 0 0 0 0 0 1142051 8556 1142051 53556 1160328 2004104 6438557 7679017 2294 1500 6436263 7677517 THE MISSION OF THE LIMA MEMORIAL FOUNDATION IS TO PROVIDE QUALITY HEALTH CARE THROUGH PHILANTHROPY TO THE COMMUNITIES WHICH LIMA MEMORIAL HEALTH SYSTEM SERVES. 0 0 45000 45000 0 THE CORPORATION WAS ORGANIZED TO OPERATE EXCLUSIVELY FOR CHARITABLE AND EDUCATIONAL PURPOSES. SPECIFICALLY, TO ASSIST LMH IN PROVIDING QUALITY HEALTH CARE TO THE COMMUNITY WHICH IT SERVES.FUNDS DESIGNATED TO THE INPATIENT REHABILITATION CENTER ARE BEING HELD WITHIN THE FOUNDATION UNTIL THE COMPLETION OF THE TWO-YEAR FUNDING PRIORITY. FUNDS WILL BE RELEASED AS THE PROJECT COMMENCES AND FUNDS ARE REQUESTED BY LIMA MEMORIAL HOSPITAL. 45000 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 5 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X MERI FOSTER 4192265197 1001 BELLEFONTAINE AVENUE LIMA OH 45804 SCOTT SHUTT CHAIRMAN 1.00 0.00 X X 0 0 0 STEVE ROMEY VICE-CHAIRMAN 1.00 0.00 X X 0 0 0 JANICE M VONDEREMBSE SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 ERIC WEICHART BOARD MEMBER 1.00 0.00 X 0 0 0 DR WALTER ELROD BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT ARMSTRONG BOARD MEMBER/LMH COO 1.00 39.00 X 0 352171 104116 DR RAFAEL NIVAR BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERTA BREWER BOARD MEMBER 1.00 0.00 X 0 0 0 KERMIT STROH BOARD MEMBER 1.00 1.00 X 0 0 0 BILL TIMMERMEISTER BOARD MEMBER 1.00 0.00 X 0 0 0 JIM MEREDITH BOARD MEMBER 1.00 0.00 X 0 0 0 ASHLEY COWAN-MEAS BOARD MEMBER 1.00 0.00 X 0 0 0 PRAVEEN MALHOTRA BOARD MEMBER 1.00 0.00 X 0 0 0 CLYDE RAUCH BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL SWICK BOARD MEMBER/LMH CEO 1.00 39.00 X 0 515025 172912 JOHN T FISCHBACH THRU 418 LMH CFO 0.50 40.00 X 0 357361 22201 BRAD SINCLAIR LMH CFO 0.50 40.00 X 0 60468 11548 LYNN CARPENTER EXECUTIVE DIRECTOR 20.00 20.00 X 0 161801 29488 0 1446826 340265 0 0 1 0 0 803974 331665 554416 295435 1690055 618788 618788 38275 803974 289458 -251183 -251183 2057660 0 0 367605 45000 45000 ADMIN AND GENERAL 8556 8556 53556 45000 8556 0 180943 367437 413 143923 704902 887578 5547104 6275106 5195 4973 6438557 7679017 2294 1500 2294 1500 X 5521358 5288436 705381 2179557 209524 209524 6436263 7677517 6438557 7679017 X 2004104 -868611 105761 X X 0 1 X 1 0 X X 1 LIMA MEMORIAL HOSPITAL 341883284 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 287783 -5675 282108 282762 5021 287783 278418 4344 282762 271649 6769 278418 262577 9072 271649 0.25000 0.75000 0.00000 0 0 0 MUTUAL FUNDS, BOND FUNDS 6275106 F 6275106 X PART V, LINE 4: AN ENDOWMENT FUND WAS ESTABLISHED ON JULY 2, 2009. THE INTENDED USE OF THE ENDOWMENT FUNDS ARE TO BENEFIT PERSONNEL OF AND SERVICES PROVIDED BY LMHS LABORATORY. IN ADDITION, NURSING PATHFINDER FUNDS WILL BE USED FOR SCHOLARSHIPS AT THE BOARD'S DISCRETION. PART X, LINE 2: THE HEALTH SYSTEM, LIMA MEMORIAL HOSPITAL, LIMA MEMORIAL PROFESSIONAL CORPORATION, LIMA MEMORIAL HOSPITAL FOUNDATION, AND LIMA MEMORIAL HOSPITAL AUXILIARY ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. ELM TREE FOUNDATION, THE FOR-PROFIT SUBSIDIARY, IS A TAXABLE CORPORATION. ELM TREE FOUNDATION HAD NET OPERATING LOSS CARRYFORWARDS OF $771,229 AND $853,131 ON ITS FILED INCOME TAX RETURNS IN 2018 AND 2017, RESPECTIVELY. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HEALTH SYSTEM AND TO RECOGNIZE A TAX LIABILITY IF THE HEALTH SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. JOURNEY TO REM 608726 589801 18925 179833 86441 GOLF EVENT 233523 214173 19350 23184 842249 803974 38275 179833 109625 289458 -251183 0 ASSOCIATE RELIEF FUND 63 45000 CASH VALUE THE ASSOCIATE RELIEF FUND WAS DEVELOPED TO PROVIDE ASSISTANCE TO LIMA MEMORIAL ASSOCIATES AND THEIR FAMILIES IN THE INSTANCE OF A HARDSHIP OR DISASTER. 1 1 0 0 0 0 0 0 0 ROBERT ARMSTRONG BOARD MEMBER/LMH COO 0 293140 0 51553 0 7478 0 79747 0 24369 0 456287 0 0 MICHAEL SWICK BOARD MEMBER/LMH CEO 0 393182 0 107014 0 14829 0 153988 0 18924 0 687937 0 0 JOHN T FISCHBACH THRU 418 LMH CFO 0 351254 0 0 0 6107 0 17666 0 4535 0 379562 0 0 LYNN CARPENTER EXECUTIVE DIRECTOR 0 144141 0 13000 0 4660 0 5119 0 24369 0 191289 0 0 PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS PARTICIPATED IN AN IRC 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN. THIS PLAN IS FUNDED BY THE HOSPITAL AND VESTS WITH SERVICE THEREFORE IS SUBJECT TO RISK OF FORFEITURE. ROBERT E. ARMSTRONG, JR.: $36,497 MICHAEL D. SWICK: $129,238 THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE YEAR: JOHN T. FISCHBACH: $130,713 PART 1, LINE 3: RELATED ORGANIZATION, LIMA MEMORIAL JOINT OPERATING COMPANY, DETERMINES THE COMPENSATION OF THE ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES BY 1)REVIEW AND APPROVAL OF THE COMPENSATION COMMITTEE; 2)UTILIZATION OF AN INDEPENDENT COMPENSATION CONSULTANT; 3)COMPARABLE DATA; AND 4) CONTEMPORANEOUS DOCUMENTATION. ADDITIONAL INFORMATION: COMPENSATION PRESENTED ON FORM 990, PART VII AND SCHEDULE J RELATED TO THE BOARD MEMBERS ARE FOR SERVICES PERFORMED FOR THE ORGANIZATION OUTSIDE THOSE SERVICES PERFORMED ON THE BOARD. THERE IS NO COMPENSATION PAID FOR BOARD SERVICES. X AUCTION ITEMS 34 179833 DONORS DETERMINATION 34 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER IS LIMA MEMORIAL JOINT OPERATING COMPANY. FORM 990, PART VI, SECTION A, LINE 7A LIMA MEMORIAL JOINT OPERATING COMPANY HAS THE POWER TO APPOINT BOARD MEMBERS FOR THE LIMA MEMORIAL HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS OF THE ARTICLES MUST BE APPROVED BY LIMA MEMORIAL JOINT OPERATING COMPANY. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WAS REVIEWED AND APPROVED BY THE EXECUTIVE DIRECTOR OF THE FOUNDATION. IN ADDITION, THE BOARD MEMBERS ARE GIVEN A COPY FOR THEIR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) HAS AGREED TO COMPLY WITH THE POLICY; AND 4) UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE TO THE PUBLIC FOR REVIEW ARE UPON REQUEST AND PROMOTED BY THE FOUNDATION IN WRITING. FORM 990, PART XI, LINE 9: CHANGE IN CHARITABLE REMAINDER TRUST -33,354. TRANSFER TO/FROM AFFILIATE 139,414. ADJUSTMENT TO UNRESTRICTED NET ASSETS PER AUDIT -299. FORM 990, PART XI, LINE 2C EXPLANATION: THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGE FROM THE PRIOR YEAR. LIMA MEMORIAL JOINT OPERATING COMPANY 1001 BELLEFONTAINE AVE LIMA OH 45804 341883028 HEALTHCARE OH 501(C)(3) LINE 3 N/A 0 LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVE LIMA OH 45804 344434676 HEALTHCARE OH 501(C)(3) LINE 3 LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL AUXILIARY 1001 BELLEFONTAINE AVE LIMA OH 45804 341694632 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) LINE 12B, II LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL PROFESSIONAL CORPORATION 1001 BELLEFONTAINE AVE LIMA OH 45804 341935236 HEALTHCARE OH 501(C)(3) LINE 3 LIMA MEMORIAL JOINT OPERATING COMPANY 1 LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLC 1001 BELLEFONTAINE AVE LIMA OH 45804 271023520 WOMEN'S HEALTH CO-MANAGEMENT OH N/A ELM TREE FOUNDATION 1220 EAST ELM STREET LIMA OH 45804 341417720 RENTAL REAL ESTATE OH N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 LIMA MEMORIAL JOINT OPERATING COMPANY S 138322 CASH