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 341935236 LIMA MEMORIAL PROFESSIONAL CORPORATION LIMA 4192283335 1001 BELLEFONTAINE AVENUE LIMA OH 45804 ERIC D POHJALA VICE-PRESIDENT/CFO 4192283335 2019-11-08 1 BERNIE OSTROWSKI P00366367 6148493000 2019-11-08 67.59.56.31 2019-11-08 14:45:33 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 47E4600F5136E639F21FA0FC9E647DE73F0A97F6 2018 2020-01-14 16:20:31Z MICHAEL D SWICK 1001 BELLEFONTAINE AVENUE LIMA OH 45804 31621295 0 X WWW.LIMAMEMORIAL.ORG X 2000 OH WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 12 1 346 2 207 -2855 0 0 26322098 31616790 686 742 8480 3763 26331264 31621295 10000 10000 0 0 31567020 38206132 0 0 0 8472447 11173972 40049467 49390104 -13718203 -17768809 5768388 6935396 118012604 136948421 -112244216 -130013025 X WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 0 0 47741765 10000 31620346 LIMA MEMORIAL PHYSICIANS IS AN EXTENDED NETWORK OF PRIMARY CARE, PEDIATRIC AND SPECIALIST PHYSICIANS. THE PRIMARY CARE SERVICE LINE IS THE PATIENT'S GATEWAY TO A WHOLE TEAM OF SPECIALTY PHYSICIANS. WITH AN EMPHASIS ON COLLABORATIVE, PATIENT-FOCUSED CARE, PATIENTS CAN TAKE GREAT COMFORT KNOWING AN ENTIRE TEAM IS WORKING TO PROVIDE YOU WITH THE VERY BEST CARE. THERE ARE 10 FAMILY MEDICINE LOCATIONS ACROSS LIMA AND THE SURROUNDING REGIONS, EXTENDED HOURS AND SAME-DAY APPOINTMENTS. LIMA MEMORIAL HAS THE TOP MEDICAL AND SURGICAL SPECIALISTS IN THE AREA WHO WORK COLLABORATIVELY WITH YOUR PRIMARY CARE PHYSICIAN. THE SPECIALTY SERVICES INCLUDES: CARDIAC SERVICES, DIABETES, EAR, NOSE & THROAT, GENERAL SURGERY, HEMATOLOGY / MEDICAL ONCOLOGY, INTERNAL MEDICINE, KIDNEY SERVICES, NEUROSURGERY & NEUROLOGY, NURSE-MIDWIFERY, OBSTETRICS / GYNECOLOGY, PALLIATIVE CARE, PEDIATRIC SERVICES, PODIATRY, PROCTOLOGY, PULMONARY MEDICINE, RADIATION ONCOLOGY, RHEUMATOLOGY, SLEEP DISORDERS, UROLOGY AND VEIN CARE. 47741765 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 46 0 1 346 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X MERI FOSTER 4192265197 1001 BELLEFONTAINE AVENUE LIMA OH 45804 CHERYL WAYMAN PA-C SECRETARY (SEE SCH J) 40.00 0.00 X X 139586 0 21175 PRATAP BALUSU MD VP/CMO/TREASURER (SEE SCH J) 20.00 20.00 X X 0 297085 72877 G ALLEN BRYANT CHAIRMAN (SEE SCH J) 40.00 0.00 X X 315331 0 26525 JEREMY HEFFNER MD BOARD MEMBER (SEE SCH J) 40.00 0.00 X 919790 0 50038 SUSAN KAUFMAN BOARD MEMBER (SEE SCH J) 40.00 0.00 X 270431 0 32502 JENNIFER MAAG BOARD MEMBER (SEE SCH J) 40.00 0.00 X 151683 0 35239 MASROOR ABRO MD BOARD MEMBER (SEE SCH J) 40.00 0.00 X 606133 0 56561 MICHAEL KERRIGAN CNP BOARD MEMBER (SEE SCH J) 40.00 0.00 X 111440 0 33822 ERIC MILLER DPM BOARD MEMBER (SEE SCH J) 40.00 0.00 X 257087 0 31332 MELODY STEWART-CYRUS MD BOARD MEMBER (SEE SCH J) 40.00 0.00 X 179146 0 24246 RUTH WALL BOARD MEMBER (SEE SCH J) 1.00 1.00 X 0 11308 0 JAMES DOONE MD BOARD MEMBER (SEE SCH J) 40.00 0.00 X 193579 0 22824 PRAVEEN MALHOTRA BOARD MEMBER (SEE SCH J) 1.00 1.00 X 0 0 0 JON OEHLER DO THRU 618 BOARD MEMBER (SEE SCH J) 40.00 0.00 X 78746 0 2367 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 6.00 34.00 X 0 515025 172912 ROBERT E ARMSTRONG JR VP/COO (SEE SCH J) 10.00 30.00 X 0 352171 104116 JOHN T FISCHBACH THRU 418 FORMER VP/CFO (SEE SCH J) 1.00 39.00 X 0 357361 22201 ANN POHL VP/CNO (SEE SCH J) 1.00 39.00 X 0 218880 49197 PAUL N ANIKE MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 999692 0 50189 JABER ALANZI MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 950087 0 38437 VENKAT R BATTULA MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 947805 0 50330 MEHRAN ARABPOUR MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 906889 0 50330 PAMELA R GARDNER PHYSICIAN (SEE SCH J) 40.00 0.00 X 714921 0 35648 7742346 1751830 982868 80 0 1 0 NATIONAL ANESTHESIA SERVICES INC 31040 LAHSER ROAD BEVERLEY HILLS MI 48025 LOCUM TENEMS 649541 INTEGRITY HEALTHCARE LOCUMS LLC 7501 VILLAGE SQUARE DRIVE SUITE 20 CASTLE PINES NORTH CO 80108 LOCUM TENEMS 547279 VEIN CARE CONSULTANTS LLC 229 S CHILLICOTHE STREET PLAIN CITY OH 43064 PHYSICIAN SERVICES 526346 COMPHEALTH ASSOCIATES INC PO BOX 972670 DALLAS TX 75397 LOCUM TENEMS 349796 KEYBRIDGE MEDICAL REVENUE MGMT 2348 BATON ROUGE AVE LIMA OH 45802 COLLECTIONS 179940 46 PATIENT SERVICE REV 621110 31616790 31616790 31616790 742 742 PURCHASE DISCOUNTS 621110 3556 3556 BILLING SERVICES 561000 207 207 3763 31621295 31620346 207 742 X 10000 10000 32332911 31525675 807236 649474 616246 33228 3604672 3404057 200615 1619075 1522552 96523 5951953 5604168 347785 16653 16653 550777 433744 117033 223578 209902 13676 102924 89418 13506 2471 2471 90488 86162 4326 338364 338364 BAD DEBT EXPENSE 2151723 2151723 DRUGS 844369 844369 MEDICAL SUPPLIES 412902 412156 746 EDUCATION & REWARDS 150224 145938 4286 337546 328167 9379 49390104 47741765 1648339 0 1157094 1578991 785468 784090 2874838 3478684 406368 399993 0 108786 161400 150049 775270 340467 383220 434803 5768388 6935396 3183974 3781350 0 80564 114828630 133086507 118012604 136948421 X -112244216 -130013025 -112244216 -130013025 5768388 6935396 -17768809 0 X X 0 1 X 1 0 X 30476 30476 744794 340467 404327 434803 ADVANCES FROM LIMA MEMORIAL JOINT OPERATING CO. 132091413 PENSION FUND 457B & F 784090 LONG TERM PROFESSIONAL LIABILITY RESERVE 211004 133086507 X 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. 1 LIMA MEMORIAL FOUNDATION 1001 BELLEFOUNTAINE AVENUE LIMA OH 45804 341707570 501(C)(3) 10000 CAPSTONE SPONSORSHIP 1 0 PART I, LINE 2: GRANTS WERE PAID TO RELATED TAX-EXEMPT ENTITY TO SUPPORT ITS MISSION. THIS IS MONITORED INTERNALLY. THE LIMA MEMORIAL HOSPITAL SYSTEM MONITORS BOTH LIMA MEMORIAL PROFESSIONAL CORPORATION AND LIMA MEMORIAL FOUNDATION. 1 1 0 0 0 0 0 0 0 CHERYL WAYMAN PA-C SECRETARY (SEE SCH J) 122784 0 16440 0 362 0 4198 0 16977 0 160761 0 0 0 PRATAP BALUSU MD VP/CMO/TREASURER (SEE SCH J) 0 292523 0 0 0 4562 0 54760 0 18117 0 369962 0 0 G ALLEN BRYANT CHAIRMAN (SEE SCH J) 296723 0 18246 0 362 0 9548 0 16977 0 341856 0 0 0 JEREMY HEFFNER MD BOARD MEMBER (SEE SCH J) 413307 0 506121 0 362 0 26458 0 23580 0 969828 0 0 0 SUSAN KAUFMAN BOARD MEMBER (SEE SCH J) 185541 0 84528 0 362 0 8127 0 24375 0 302933 0 0 0 JENNIFER MAAG BOARD MEMBER (SEE SCH J) 130293 0 21028 0 362 0 4771 0 30468 0 186922 0 0 0 MASROOR ABRO MD BOARD MEMBER (SEE SCH J) 479281 0 126490 0 362 0 32981 0 23580 0 662694 0 0 0 ERIC MILLER DPM BOARD MEMBER (SEE SCH J) 199067 0 57658 0 362 0 7752 0 23580 0 288419 0 0 0 MELODY STEWART-CYRUS MD BOARD MEMBER (SEE SCH J) 170284 0 8500 0 362 0 5382 0 18864 0 203392 0 0 0 JAMES DOONE MD BOARD MEMBER (SEE SCH J) 183422 0 9795 0 362 0 5847 0 16977 0 216403 0 0 0 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 0 393182 0 107014 0 14829 0 153988 0 18924 0 687937 0 0 ROBERT E ARMSTRONG JR VP/COO (SEE SCH J) 0 293140 0 51553 0 7478 0 79747 0 24369 0 456287 0 0 JOHN T FISCHBACH THRU 418 FORMER VP/CFO (SEE SCH J) 0 204042 0 0 0 153319 0 17666 0 4535 0 379562 0 0 ANN POHL VP/CNO (SEE SCH J) 0 179317 0 34029 0 5534 0 49197 0 0 0 268077 0 0 PAUL N ANIKE MD PHYSICIAN (SEE SCH J) 800792 0 198538 0 362 0 33212 0 16977 0 1049881 0 0 0 JABER ALANZI MD PHYSICIAN (SEE SCH J) 651701 0 298024 0 362 0 16500 0 21937 0 988524 0 0 0 VENKAT R BATTULA MD PHYSICIAN (SEE SCH J) 707868 0 239575 0 362 0 26750 0 23580 0 998135 0 0 0 MEHRAN ARABPOUR MD PHYSICIAN (SEE SCH J) 693978 0 212549 0 362 0 26750 0 23580 0 957219 0 0 0 PAMELA R GARDNER PHYSICIAN (SEE SCH J) 556697 0 157862 0 362 0 26750 0 8898 0 750569 0 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: $36,497 MICHAEL D. SWICK: $129,238 ANN POHL: $10,352 THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE YEAR: JOHN T. FISCHBACH: $147,212 PART I, 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. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING WITH THE IRS. THE AUDIT COMMITTEE OF THE BOARD REVIEWS AND APPROVES FORM 990. 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 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE CURRENTLY NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 96,993. MANAGEMENT AND GENERAL EXPENSES 22,844. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 119,837. LOCUM TENENS FEE: PROGRAM SERVICE EXPENSES 2,162,407. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,162,407. COLLECTION FEES: PROGRAM SERVICE EXPENSES 789,754. MANAGEMENT AND GENERAL EXPENSES 16,012. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 805,766. EQUIPMENT RENTAL FEES: PROGRAM SERVICE EXPENSES 1,875,654. MANAGEMENT AND GENERAL EXPENSES 151,601. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,027,255. WASTE REMOVAL FEES: PROGRAM SERVICE EXPENSES 14,936. MANAGEMENT AND GENERAL EXPENSES 731. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,667. LAUNDRY FEES: PROGRAM SERVICE EXPENSES 16,124. MANAGEMENT AND GENERAL EXPENSES 74. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,198. CLEANING FEES: PROGRAM SERVICE EXPENSES 64,438. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,438. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 583,862. MANAGEMENT AND GENERAL EXPENSES 156,523. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 740,385. 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 CHANGED FROM THE PRIOR YEAR. LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVENUE LIMA OH 45804 344434676 HEALTHCARE OH 501(C)(3) LINE 3 LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL FOUNDATION 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341707570 SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITAL OH 501(C)(3) LINE 12B, II LIMA MEMORIAL JOINT OPERATING COMPANY 1 LIMA MEMORIAL HOSPITAL AUXILIARY 1001 BELLEFONTAINE AVENUE 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 JOINT OPERATING COMPANY 1001 BELLEFONTAINE AVENUE LIMA OH 45804 341883284 HEALTHCARE OH 501(C)(3) LINE 3 N/A 0 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 1 0 0 1 1 0 1 0 1 LIMA MEMORIAL JOINT OPERATING COMPANY S 18205248 EQUITY TRANSFER LIMA MEMORIAL JOINT OPERATING COMPANY K 909196 LEASE CONTRACT ELM TREE FOUNDATION K 503541 LEASE CONTRACT