LIMA MEMORIAL FOUNDATION: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
LIMA MEMORIAL FOUNDATION (EIN 34-1707570)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-13
IRS object ID
201733179349306313
Schema version
2016v3.0
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)
Return2017-11-13T14:48:39-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN381357951PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1250 S High St Suite 100AddressLine1Txt
CityColumbusCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43215ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN341707570EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Lima Memorial Hospital FoundationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlLIMABusinessNameControlTxt
Phone4192265073PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11001 BELLEFONTAINE AVENUEAddressLine1Txt
CityLIMACityNm
State AbbreviationOHStateAbbreviationCd
ZIP45804ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOHN T FISCHBACHPersonNm
Person TitleDIRECTORPersonTitleTxt
Phone4192265073PhoneNum
Signature2017-11-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBernie OstrowskiPreparerPersonNm
PTINP00366367PTIN
Phone6148493000PhoneNum
Preparation2017-11-09PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address74.113.40.52IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-10IPDt
IP Tm07:08:29IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdD2C65B82CF57FFF836B622BD9D1D9898FD497B3BAtSubmissionCreationDeviceId
At Submission Filing Device IdCDA108602048A852A3C7A9C68094104E2D92ED46AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerLYNN CARPENTERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11001 BELLEFONTAINE AVENUEAddressLine1Txt
CityLIMACityNm
State AbbreviationOHStateAbbreviationCd
ZIP45804ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,727,587GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1993FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionTHE MISSION OF THE LIMA MEMORIAL FOUNDATION IS TO PROVIDE QUALITY HEALTH CARE THROUGH PHILANTHROPY TO THE COMMUNITIES WHICH LIMA MEMORIAL HEALTH SYSTEM SERVES.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers75TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$248,102PYContributionsGrantsAmt
CY Contributions Grants$1,487,949CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$261,740PYInvestmentIncomeAmt
CY Investment Income$124,438CYInvestmentIncomeAmt
PY Other Revenue$326,849PYOtherRevenueAmt
CY Other Revenue-$5,736CYOtherRevenueAmt
PY Total Revenue$836,691PYTotalRevenueAmt
CY Total Revenue$1,606,651CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$307,180PYOtherExpensesAmt
CY Other Expenses$2,574,861CYOtherExpensesAmt
PY Total Expenses$307,180PYTotalExpensesAmt
CY Total Expenses$2,574,861CYTotalExpensesAmt
PY Revenues Less Expenses$529,511PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$968,210CYRevenuesLessExpensesAmt
Total Assets BOY$6,475,547TotalAssetsBOYAmt
Total Assets EOY$5,471,373TotalAssetsEOYAmt
Total Liabilities BOY$12TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,135TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,475,535NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$5,468,238NetAssetsOrFundBalancesEOYAmt
MissionTHE MISSION OF THE LIMA MEMORIAL FOUNDATION IS TO PROVIDE QUALITY HEALTH CARE THROUGH PHILANTHROPY TO THE COMMUNITIES WHICH LIMA MEMORIAL HEALTH SYSTEM SERVES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$2,563,801ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescTHE 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.Desc
Total Program Service Expenses$2,563,801TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMERI FOSTERPersonNm
Phone4192265197PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11001 BELLEFONTAINE AVENUEAddressLine1Txt
CityLIMACityNm
State AbbreviationOHStateAbbreviationCd
ZIP45804ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
DR WALTER ELROD
TRUSTEE1.000.00Yes (X)$0$0$0
ROBERT ARMSTRONG
TRUSTEE/LMH COO1.0039.00Yes (X)$0$343,323$115,851
DR RAFAEL NIVAR
TRUSTEE1.000.00Yes (X)$0$0$0
KAREN PHILLIPS
TRUSTEE1.000.00Yes (X)$0$0$0
SCOTT SHUTT
CHAIRMAN1.000.00Yes (X)$0$0$0Yes (X)
MICHAEL SWICK
TRUSTEE/LMH CEO1.0039.00Yes (X)$0$579,615$246,377Yes (X)
JANICE M VONDEREMBSE
TRUSTEE1.000.00Yes (X)$0$0$0
KERMIT STROH
TRUSTEE1.001.00Yes (X)$0$0$0
WILFRED ELLIS MD
TRUSTEE1.000.00Yes (X)$0$0$0
STEVE ROMEY
SECRETARY/TREASURER1.000.00Yes (X)$0$0$0Yes (X)
BILL TIMMERMEISTER
TRUSTEE1.000.00Yes (X)$0$0$0
JIM MEREDITH
TRUSTEE1.000.00Yes (X)$0$0$0
ERIC WEICHART
VICE-CHAIRMAN1.000.00Yes (X)$0$0$0Yes (X)
LYNN CARPENTER
EXECUTIVE DIRECTOR20.0020.00$0$151,825$27,492Yes (X)
JOHN T FISCHBACH
VP OF FINANCE/CFO (SEE SCH J)0.5040.00$0$249,220$54,109Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,323,983TotReportableCompRltdOrgAmt
Total Other Compensation$443,829TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$620,647FundraisingAmt
Related Organizations$120,169RelatedOrganizationsAmt
All Other Contributions$747,133AllOtherContributionsAmt
Noncash Contributions$136,739NoncashContributionsAmt
Total Contributions$1,487,949TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$124,438TotalRevenueColumnAmt
Exclusion$124,438ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$115,200FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$620,647ContriRptFundraisingEventAmt
Fundraising Direct Expenses$120,936FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$5,736TotalRevenueColumnAmt
Exclusion-$5,736ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,606,651TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$118,702ExclusionAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$2,545,301TotalAmt
Program Services$2,545,301ProgramServicesAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
ASSOCIATE RELIEF FUND$18,500$18,500
ADMIN AND GENERAL$11,060$11,060

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,574,861TotalAmt
Program Services$2,563,801ProgramServicesAmt
Management And General$11,060ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$229,522BOYAmt
EOY$264,137EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$97,738BOYAmt
EOY$413EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$112,633BOYAmt
EOY$740,935EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,836BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$6,030,818BOYAmt
EOY$4,462,411EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,477EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$6,475,547BOYAmt
EOY$5,471,373EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$12BOYAmt
EOY$3,135EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12BOYAmt
EOY$3,135EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,884,740BOYAmt
EOY$4,517,300EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$381,271BOYAmt
EOY$741,414EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$209,524BOYAmt
EOY$209,524EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,475,535BOYAmt
EOY$5,468,238EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,475,547BOYAmt
EOY$5,471,373EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$968,210ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$12,210NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$26,877OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1LIMA MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN341883284EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$2,545,301SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$2,545,301SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$278,418BeginningYearBalanceAmt
Investment Earnings Or Losses$4,344InvestmentEarningsOrLossesAmt
End Year Balance$282,762EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$271,649BeginningYearBalanceAmt
Investment Earnings Or Losses$6,769InvestmentEarningsOrLossesAmt
End Year Balance$278,418EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$262,577BeginningYearBalanceAmt
Investment Earnings Or Losses$9,072InvestmentEarningsOrLossesAmt
End Year Balance$271,649EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$259,156BeginningYearBalanceAmt
Investment Earnings Or Losses$3,421InvestmentEarningsOrLossesAmt
End Year Balance$262,577EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$243,874BeginningYearBalanceAmt
Contributions$11,512ContributionsAmt
Investment Earnings Or Losses$3,770InvestmentEarningsOrLossesAmt
End Year Balance$259,156EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.25000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.75000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescMUTUAL FUNDS, BOND FUNDSDesc
Book Value$4,462,411BookValueAmt
Method ValuationCMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$4,462,411TotalBookValueSecuritiesAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 $763,936 AND $657,739 ON ITS FILED INCOME TAX RETURNS IN 2016 AND 2015, 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.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1JOURNEY TO REMEvent1Nm
Gross Receipts Event1$535,636GrossReceiptsEvent1Amt
Charitable Contri Event1$444,196CharitableContriEvent1Amt
Gross Revenue Event1$91,440GrossRevenueEvent1Amt
Other Direct Expenses Event1$102,401OtherDirectExpensesEvent1Amt
Event2GOLF EVENTEvent2Nm
Gross Receipts Event2$200,211GrossReceiptsEvent2Amt
Charitable Contri Event2$176,451CharitableContriEvent2Amt
Gross Revenue Event2$23,760GrossRevenueEvent2Amt
Other Direct Expenses Event2$18,535OtherDirectExpensesEvent2Amt
Gross Receipts Total$735,847GrossReceiptsTotalAmt
Charitable Contributions Tot$620,647CharitableContributionsTotAmt
Gross Revenue Total Events$115,200GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$120,936OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$120,936DirectExpenseSummaryEventsAmt
Net Income Summary-$5,736NetIncomeSummaryAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
ROBERT ARMSTRONG
TRUSTEE/LMH COO$0$233,499$0$102,708$0$7,116$0$93,155$0$22,696$0$459,174$0$0
MICHAEL SWICK
TRUSTEE/LMH CEO$0$352,679$0$213,202$0$13,734$0$223,681$0$22,696$0$825,992$0$0
LYNN CARPENTER
EXECUTIVE DIRECTOR$0$133,288$0$14,000$0$4,537$0$4,796$0$22,696$0$179,317$0$0
JOHN T FISCHBACH
VP OF FINANCE/CFO (SEE SCH J)$0$231,105$0$12,500$0$5,615$0$54,109$0$0$0$303,329$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 4bTHE 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.: $51,305 MICHAEL D. SWICK: $181,831
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.

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
DescAUCTION ITEMSDesc
Contribution28ContributionCnt
Noncash Contributions Rpt F990$136,739NoncashContributionsRptF990Amt
Method Of Determining RevenuesDONORS DETERMINATIONMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Form8283 Received28Form8283ReceivedCnt
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6THE SOLE MEMBER IS LIMA MEMORIAL JOINT OPERATING COMPANY.
Form 990, Part VI, Section A, line 7aLIMA MEMORIAL JOINT OPERATING COMPANY HAS THE POWER TO APPOINT BOARD MEMBERS FOR THE LIMA MEMORIAL HOSPITAL FOUNDATION.
Form 990, Part VI, Section A, line 7bAMENDMENTS OF THE ARTICLES MUST BE APPROVED BY LIMA MEMORIAL JOINT OPERATING COMPANY.
Form 990, Part VI, Section B, line 11bTHE 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 12cEACH 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 19DOCUMENTS 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 -14,961. TRUE UP ADJUSTMENT FOR PLEDGES RECEIVABLE -85,945. ADJUSTMENT FROM MANUAL TO MEDITECH 73,981. PRIOR PERIOD ADJUSTMENT FOR FUNDRAISING EXPENSE 48.
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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
LIMA MEMORIAL JOINT OPERATING COMPANY
1001 BELLEFONTAINE AVELIMAOH45804341883028HEALTHCAREOH501(C)(3)Line 3N/A0
LIMA MEMORIAL HOSPITAL
1001 BELLEFONTAINE AVELIMAOH45804344434676HEALTHCAREOH501(C)(3)Line 3Yes (1)LIMA MEMORIAL JOINT OPERATING COMPANY
LIMA MEMORIAL HOSPITAL AUXILIARY
1001 BELLEFONTAINE AVELIMAOH45804341694632SUPPORTING ORGANIZATION FOR LIMA MEMORIAL HOSPITALOH501(C)(3)Line 12a, IYes (1)LIMA MEMORIAL JOINT OPERATING COMPANY
LIMA MEMORIAL PROFESSIONAL CORPORATION
1001 BELLEFONTAINE AVELIMAOH45804341935236HEALTHCAREOH501(C)(3)Line 3Yes (1)LIMA MEMORIAL JOINT OPERATING COMPANY

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1LMHS WOMEN'S HEALTH CO-MANAGEMENT COMPANY LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11001 BELLEFONTAINE AVEAddressLine1Txt
CityLIMACityNm
State AbbreviationOHStateAbbreviationCd
ZIP45804ZIPCd
FieldValueIRS element (for citing)
EIN271023520EIN
Primary ActivitiesWOMEN'S HEALTH CO-MANAGEMENTPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1ELM TREE FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11220 EAST ELM STREETAddressLine1Txt
CityLIMACityNm
State AbbreviationOHStateAbbreviationCd
ZIP45804ZIPCd
FieldValueIRS element (for citing)
EIN341417720EIN
Primary ActivitiesRENTAL REAL ESTATEPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Entity TypeCEntityTypeTxt
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1LIMA MEMORIAL JOINT OPERATING COMPANYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeRTransactionTypeTxt
Involved$2,545,301InvolvedAmt
Method Of Amount DeterminationCASHMethodOfAmountDeterminationTxt

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