2016-11-02T15:44:40-05:00 2015-12-31 381357951 PLANTE & MORAN PLLC 250 S High St Suite 100 Columbus OH 43215 990 2015-01-01 341935236 LIMA MEMORIAL PROFESSIONAL CORPORATION LIMA 4192283335 1001 BELLEFONTAINE AVENUE LIMA OH 45804 JOHN T FISCHBACH VICE PRESIDENT/CFO 4192283335 2016-10-20 1 Bernie Ostrowski P00366367 6148493000 2015 2017-02-10 21:41:12Z MICHAEL D SWICK 1001 BELLEFONTAINE AVENUE LIMA OH 45804 19199609 0 X WWW.DOCLMPC.ORG X 2000 OH WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 12 2 275 2 22423 -2199 0 0 21557015 19175335 1006 477 36201 23797 21594222 19199609 1000 10000 0 0 24048222 22165814 0 0 0 7762214 6286613 31811436 28462427 -10217214 -9262818 4148619 4438576 80946908 90499683 -76798289 -86061107 WE ARE HERE TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITIES THROUGH COMPREHENSIVE HEALTH SERVICES. 0 0 26041791 10000 19176709 PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY REGARDLESS OF ABILITY TO PAY. 26041791 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 59 0 1 275 1 1 1 0 0 0 0 0 0 0 0 0 X 12 2 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X MERI FOSTER 4192265197 1001 BELLEFONTAINE AVENUE LIMA OH 45804 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 6.00 34.00 X X 0 569813 238418 ROBERT E ARMSTRONG JR VICE PRESIDENT/COO (SEE SC 10.00 30.00 X X 0 334953 109332 FRANK BALDAUF MD CHAIRMAN (SEE SCH J) 40.00 0.00 X X 182478 0 20095 KERMIT F STROH BOARD MEMBER 1.00 1.00 X 0 0 0 KHA H TRAN MD VP/CMO/TREASURER (SEE SCH 20.00 20.00 X X 0 290472 103404 CHERYL WAYMAN PA-C SECRETARY 40.00 0.00 X X 118730 0 16692 DAVID ROSI BOARD MEMBER (SEE SCH J) 40.00 0.00 X 397607 0 30214 G ALLEN BRYANT VICE CHAIRMAN (SEE SCH J) 40.00 0.00 X X 317034 0 21064 JEREMY HEFFNER MD BOARD MEMBER (SEE SCH J) 40.00 0.00 X 501742 0 44164 SUSAN KAUFMAN BOARD MEMBER (SEE SCH J) 40.00 0.00 X 255180 0 22219 JENNIFER MAAG BOARD MEMBER (SEE SCH J) 40.00 0.00 X 150908 0 30988 JOHN H JOHNSON BOARD MEMBER 1.00 1.00 X 0 0 0 PIERRE BAMDAD MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 731395 0 35771 MEHRAN ARABPOUR MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 728894 0 57414 PAUL N ANIKE MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 728844 0 57414 VENKAT R BATTULA MD PHYSICIAN (SEE SCH J) 40.00 0.00 X 688748 0 57414 PAMELA R GARDNER PHYSICIAN (SEE SCH J) 40.00 0.00 X 635982 0 46486 ANITA GOOD DIRECTOR-POP HEALTHCARE COORD 1.00 39.00 X 0 169394 19740 BRUCE SUCHLAND PHYSICIAN 40.00 0.00 X 101351 0 21267 5538893 1364632 932096 44 1 1 0 ECLINICALWORKS LLC 110 TURNPIKE ROAD SUITE 308 WESTBORO MA 01581 EMR SOFTWARE 206901 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 LOCUM TENENS 197343 PULMONARY & CRITICAL CARE 1661 HOLLAND ROAD SUITE 200 MAUMEE OH 43534 PHYSICIAN SERVICES 138000 THE SOS GROUP 29065 CLEMENS ROAD SUITE 200 WESTLAKE OH 44145 COLLECTIONS 122835 4 PATIENT SERVICE REV 621110 19175335 19175335 19175335 477 477 BILLING SERVICES 561000 22423 22423 PURCHASE DISCOUNTS 621110 1374 1374 23797 19199609 19176709 22423 477 X 10000 10000 2491721 2491721 15930671 14702360 1228311 382220 379092 3128 2364214 2021106 343108 996988 911293 85695 3059639 2601471 458168 74844 39671 35173 324025 221553 102472 241182 222510 18672 101925 82129 19796 57325 47528 9797 264112 264112 MEDICAL SUPPLIES 869520 869253 267 BAD DEBT EXPENSE 791544 791544 MANAGED CARE ORG 79623 79623 EDUCATION & REWARDS 30170 13794 16376 392704 293031 99673 28462427 26041791 2420636 0 825319 632194 311574 906272 2161723 2024548 283821 187263 357772 346001 1090025 747727 208410 342298 4148619 4438576 2356410 2049347 78590498 88450336 80946908 90499683 X -76798289 -86061107 -76798289 -86061107 4148619 4438576 -9262818 0 X X 0 1 X 1 0 X 30476 30476 1059549 747727 311822 342298 advances from lima memorial joint operating co. 87544064 PENSION FUND 457B & F 906272 88450336 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 $657,739 AND $443,903 ON ITS FILED INCOME TAX RETURNS IN 2015 AND 2014, 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. 0 1 0 0 0 0 0 0 0 MICHAEL D SWICK PRESIDENT/CEO (SEE SCH J) 0 342960 0 209931 0 16922 0 220204 0 18214 0 808231 0 0 ROBERT E ARMSTRONG JR VICE PRESIDENT/COO (SEE SC 0 226704 0 101133 0 7116 0 91118 0 18214 0 444285 0 0 FRANK BALDAUF MD CHAIRMAN (SEE SCH J) 143930 0 38548 0 0 0 5524 0 14571 0 202573 0 0 0 KHA H TRAN MD VP/CMO/TREASURER (SEE SCH 0 203516 0 80731 0 6225 0 77099 0 26305 0 393876 0 0 DAVID ROSI BOARD MEMBER (SEE SCH J) 397607 0 0 0 0 0 12000 0 18214 0 427821 0 0 0 G ALLEN BRYANT VICE CHAIRMAN (SEE SCH J) 297034 0 20000 0 0 0 7950 0 13114 0 338098 0 0 0 JEREMY HEFFNER MD BOARD MEMBER (SEE SCH J) 411979 0 89763 0 0 0 25950 0 18214 0 545906 0 0 0 SUSAN KAUFMAN BOARD MEMBER (SEE SCH J) 178174 0 77006 0 0 0 7648 0 14571 0 277399 0 0 0 JENNIFER MAAG BOARD MEMBER (SEE SCH J) 131901 0 19007 0 0 0 4683 0 26305 0 181896 0 0 0 PIERRE BAMDAD MD PHYSICIAN (SEE SCH J) 649648 0 81747 0 0 0 21200 0 14571 0 767166 0 0 0 MEHRAN ARABPOUR MD PHYSICIAN (SEE SCH J) 647147 0 81747 0 0 0 39200 0 18214 0 786308 0 0 0 PAUL N ANIKE MD PHYSICIAN (SEE SCH J) 649597 0 79247 0 0 0 39200 0 18214 0 786258 0 0 0 VENKAT R BATTULA MD PHYSICIAN (SEE SCH J) 599501 0 89247 0 0 0 39200 0 18214 0 746162 0 0 0 PAMELA R GARDNER PHYSICIAN (SEE SCH J) 549235 0 86747 0 0 0 39200 0 7286 0 682468 0 0 0 ANITA GOOD DIRECTOR-POP HEALTHCARE COORD 0 148829 0 19000 0 1565 0 5169 0 14571 0 189134 0 0 BRUCE SUCHLAND PHYSICIAN 89253 0 12098 0 0 0 3053 0 18214 0 122618 0 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: $49,268 MICHAEL D. SWICK: $178,354 KHA H. TRAN: $35,249 ANN-MARIE JEAN POHL: $20,363 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 11 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 171,751. Management and general expenses 30,249. Fundraising expenses 0. Total expenses 202,000. LOCUM TENENS FEE: Program service expenses 364,961. Management and general expenses 64,277. Fundraising expenses 0. Total expenses 429,238. COLLECTION FEES: Program service expenses 421,920. Management and general expenses 74,308. Fundraising expenses 0. Total expenses 496,228. EQUIPMENT RENTAL FEES: Program service expenses 1,436,989. Management and general expenses 253,080. Fundraising expenses 0. Total expenses 1,690,069. WASTE REMOVAL FEES: Program service expenses 15,616. Management and general expenses 2,750. Fundraising expenses 0. Total expenses 18,366. GROUNDS FEES: Program service expenses 1,934. Management and general expenses 341. Fundraising expenses 0. Total expenses 2,275. LAUNDRY FEES: Program service expenses 10,221. Management and general expenses 1,800. Fundraising expenses 0. Total expenses 12,021. CLEANING FEES: Program service expenses 58,519. Management and general expenses 10,306. Fundraising expenses 0. Total expenses 68,825. SERVICE CONTRACTS: Program service expenses 119,560. Management and general expenses 21,057. Fundraising expenses 0. Total expenses 140,617. 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 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 11a, I 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 11a, I 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 9273140 EQUITY TRANSFER LIMA MEMORIAL JOINT OPERATING COMPANY K 1070569 LEASE CONTRACT ELM TREE FOUNDATION K 273574 LEASE CONTRACT