2017-11-13T14:48:39-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 250 S High St Suite 100 Columbus OH 43215 990 2016-01-01 341707570 Lima Memorial Hospital Foundation LIMA 4192265073 1001 BELLEFONTAINE AVENUE LIMA OH 45804 JOHN T FISCHBACH DIRECTOR 4192265073 2017-11-10 1 Bernie Ostrowski P00366367 6148493000 2017-11-09 74.113.40.52 2017-11-10 07:08:29 ES P D2C65B82CF57FFF836B622BD9D1D9898FD497B3B CDA108602048A852A3C7A9C68094104E2D92ED46 2016 2017-02-10 21:41:12Z LYNN CARPENTER 1001 BELLEFONTAINE AVENUE LIMA OH 45804 1727587 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. 13 11 0 75 0 0 248102 1487949 0 0 261740 124438 326849 -5736 836691 1606651 0 0 0 0 0 0 0 0 0 307180 2574861 307180 2574861 529511 -968210 6475547 5471373 12 3135 6475535 5468238 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 2563801 0 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. 2563801 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 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 3 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 13 11 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 DR WALTER ELROD TRUSTEE 1.00 0.00 X 0 0 0 ROBERT ARMSTRONG TRUSTEE/LMH COO 1.00 39.00 X 0 343323 115851 DR RAFAEL NIVAR TRUSTEE 1.00 0.00 X 0 0 0 KAREN PHILLIPS TRUSTEE 1.00 0.00 X 0 0 0 SCOTT SHUTT CHAIRMAN 1.00 0.00 X X 0 0 0 MICHAEL SWICK TRUSTEE/LMH CEO 1.00 39.00 X X 0 579615 246377 JANICE M VONDEREMBSE TRUSTEE 1.00 0.00 X 0 0 0 KERMIT STROH TRUSTEE 1.00 1.00 X 0 0 0 WILFRED ELLIS MD TRUSTEE 1.00 0.00 X 0 0 0 STEVE ROMEY SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 BILL TIMMERMEISTER TRUSTEE 1.00 0.00 X 0 0 0 JIM MEREDITH TRUSTEE 1.00 0.00 X 0 0 0 ERIC WEICHART VICE-CHAIRMAN 1.00 0.00 X X 0 0 0 LYNN CARPENTER EXECUTIVE DIRECTOR 20.00 20.00 X 0 151825 27492 JOHN T FISCHBACH VP OF FINANCE/CFO (SEE SCH J) 0.50 40.00 X 0 249220 54109 0 1323983 443829 0 0 1 0 0 620647 120169 747133 136739 1487949 124438 124438 115200 620647 120936 -5736 -5736 1606651 0 0 118702 2545301 2545301 ASSOCIATE RELIEF FUND 18500 18500 ADMIN AND GENERAL 11060 11060 2574861 2563801 11060 0 229522 264137 97738 413 112633 740935 4836 0 6030818 4462411 0 3477 6475547 5471373 12 3135 12 3135 X 5884740 4517300 381271 741414 209524 209524 6475535 5468238 6475547 5471373 X -968210 -12210 -26877 X X 0 1 X 1 0 X X 1 LIMA MEMORIAL HOSPITAL 341883284 3 1 2545301 0 1 2545301 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 278418 4344 282762 271649 6769 278418 262577 9072 271649 259156 3421 262577 243874 11512 3770 259156 0.25000 0.75000 0.00000 0 0 0 MUTUAL FUNDS, BOND FUNDS 4462411 C 4462411 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 $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. JOURNEY TO REM 535636 444196 91440 102401 GOLF EVENT 200211 176451 23760 18535 735847 620647 115200 120936 120936 -5736 0 1 0 0 0 0 0 0 0 ROBERT ARMSTRONG TRUSTEE/LMH COO 0 233499 0 102708 0 7116 0 93155 0 22696 0 459174 0 0 MICHAEL SWICK TRUSTEE/LMH CEO 0 352679 0 213202 0 13734 0 223681 0 22696 0 825992 0 0 LYNN CARPENTER EXECUTIVE DIRECTOR 0 133288 0 14000 0 4537 0 4796 0 22696 0 179317 0 0 JOHN T FISCHBACH VP OF FINANCE/CFO (SEE SCH J) 0 231105 0 12500 0 5615 0 54109 0 0 0 303329 0 0 Part I, Line 4b 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.: $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. X AUCTION ITEMS 28 136739 DONORS DETERMINATION 28 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 -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. 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 12a, I 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 1 0 LIMA MEMORIAL JOINT OPERATING COMPANY R 2545301 CASH