MONROE CANCER CENTER: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MONROE CANCER CENTER (EIN 27-1302183)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-12
- IRS object ID
- 201623179349300102
- Schema version
- 2015v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-12T00:24:23-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 4200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 462045108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271302183 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONROE CANCER CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MONR | BusinessNameControlTxt |
| Phone | 7342401800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 STEWART RD | AddressLine1Txt |
| City | MONROE | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48162 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL P BROWNING | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 7342401800 | PhoneNum |
| Signature | 2016-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHAWNA M JIMENEZ | PreparerPersonNm |
| PTIN | P01222873 | PTIN |
| Phone | 3174648600 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL P BROWNING | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1801 RICHARDS ROAD | AddressLine1Txt |
| City | TOLEDO | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43607 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,367,455 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PROMEDICA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2009 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | MONROE CANCER CENTER PROVIDES ADVANCED CANCER DIAGNOSTIC, TREATMENT PLANNING AND TREATMENT SERVICES TO PATIENTS, PRIMARILY THROUGH RADIATION ONCOLOGY, IN MONROE COUNTY, MICHIGAN AND THE TOLEDO AREA IN OHIO. | ActivityOrMissionDesc |
| Voting Members Governing Body | 1 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 1 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,549,508 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,367,007 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,382 | PYInvestmentIncomeAmt |
| CY Investment Income | $448 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $13,550,890 | PYTotalRevenueAmt |
| CY Total Revenue | $1,367,455 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,045,896 | PYOtherExpensesAmt |
| CY Other Expenses | $2,700,137 | CYOtherExpensesAmt |
| PY Total Expenses | $14,045,896 | PYTotalExpensesAmt |
| CY Total Expenses | $2,700,137 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$495,006 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,332,682 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,143,475 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,909,062 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $123,984 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,122,253 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,019,491 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $786,809 | NetAssetsOrFundBalancesEOYAmt |
| Mission | MONROE CANCER CENTER PROVIDES ADVANCED CANCER DIAGNOSTIC, TREATMENT PLANNING AND TREATMENT SERVICES, PRIMARILY THROUGH RADIATION ONCOLOGY SERVICES, TO PATIENTS IN MICHIGAN'S MONROE COUNTY AREA AND OHIO'S TOLEDO AREA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,604,799 | ExpenseAmt |
| Revenue | $1,367,007 | RevenueAmt |
| Desc | MONROE CANCER CENTER PROVIDES ADVANCED RADIATION/ONCOLOGY SERVICES TO MICHIGAN'S MONROE COUNTY AND OHIO'S TOLEDO AREA. | Desc |
| Total Program Service Expenses | $2,604,799 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 1 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIAN HANSEN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4198918505 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5901 MONCLOVA RD | AddressLine1Txt |
| City | MAUMEE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43537 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (5 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| ANN KUJAWA | |||||||||
| VICE-CHAIR | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $157,948 | $36,769 | ||
| JOHN E KIBBLE | |||||||||
| CHAIRPERSON | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $280,576 | $167,839 | ||
| MARGARET DIMOND | |||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GARY AKENBERGER | |||||||||
| SR. VP FINANCE, PHS | 0.50 | 45.00 | $0 | $415,589 | $89,075 | Yes (X) | |||
| PAMELA M JENSEN | |||||||||
| FORMER OFFICER | 0.00 | 41.00 | $0 | $281,184 | $63,692 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,135,297 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $357,375 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| TOLEDO RADIATION ONCOLOGY | |||||
| 3000 REGENCY COURT SUITE 207 | TOLEDO | OH | 43623 | BILLING SERVICES | $191,667 |
| VARIAN MEDICAL SYSTEMS | |||||
| 70140 NETWORK PLACE | CHICAGO | IL | 60673 | EQUIPMENT REPAIRS | $105,093 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $1,367,007 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,367,007 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,367,007 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $448 | TotalRevenueColumnAmt |
| Exclusion | $448 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,367,455 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,367,007 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $448 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,664 | TotalAmt |
| Management And General | $11,664 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,472 | TotalAmt |
| Management And General | $62,472 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,537 | TotalAmt |
| Management And General | $16,537 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,506,909 | TotalAmt |
| Program Services | $1,502,244 | ProgramServicesAmt |
| Management And General | $4,665 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,683 | TotalAmt |
| Program Services | $8,683 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,416 | TotalAmt |
| Program Services | $268,416 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,452 | TotalAmt |
| Program Services | $127,452 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,512 | TotalAmt |
| Program Services | $10,512 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| EQUIPMENT RENTAL | $634,896 | $634,896 |
| PERSONAL PROPERTY TAX | $35,588 | $35,588 |
| MEDICAL SUPPLIES | $15,735 | $15,735 |
| FOOD | $1,223 | $1,223 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50 | TotalAmt |
| Program Services | $50 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,700,137 | TotalAmt |
| Program Services | $2,604,799 | ProgramServicesAmt |
| Management And General | $95,338 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $438,002 | BOYAmt |
| EOY | $106,073 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $222,946 | BOYAmt |
| EOY | $176,631 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,666 | BOYAmt |
| EOY | $33,537 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,257,046 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $764,225 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $442,861 | BOYAmt |
| EOY | $492,821 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,100,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,143,475 | BOYAmt |
| EOY | $1,909,062 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,984 | BOYAmt |
| EOY | $305,521 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $816,732 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,984 | BOYAmt |
| EOY | $1,122,253 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,019,491 | BOYAmt |
| EOY | $786,809 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,019,491 | BOYAmt |
| EOY | $786,809 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,143,475 | BOYAmt |
| EOY | $1,909,062 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,332,682 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,100,000 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $175 | CurrentTaxYearMinus3YearsAmt |
| Total | $175 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,911,955 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,271,356 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,235,811 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,549,508 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,367,007 | CurrentTaxYearAmt |
| Total | $48,335,637 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,911,955 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,271,531 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,235,811 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,549,508 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,367,007 | CurrentTaxYearAmt |
| Total | $48,335,812 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $48,335,812 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,539 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,845 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,513 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,382 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $448 | CurrentTaxYearAmt |
| Total | $12,727 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,539 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,845 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,513 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,382 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $448 | CurrentTaxYearAmt |
| Total | $12,727 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,916,494 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,275,376 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,238,324 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,550,890 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,367,455 | CurrentTaxYearAmt |
| Total | $48,348,539 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99970 | PublicSupportCY509Pct |
| Investment Income CY | 0.00030 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $122,265 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,415 | DepreciationAmt |
| Book Value | $99,850 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,062,098 | OtherCostOrOtherBasisAmt |
| Depreciation | $710,322 | DepreciationAmt |
| Book Value | $351,776 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $72,683 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,488 | DepreciationAmt |
| Book Value | $41,195 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $492,821 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $816,732 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $816,732 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | MONROE CANCER CENTER IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES (PHS). THE FOLLOWING REFLECTS PHS'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740. EXCEPT AS NOTED BELOW, PHS DID NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 AND 2014. FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014, A TAXABLE SUBSIDIARY OF PHS RECOGNIZED A LIABILITY FOR UNCERTAIN TAX POSITIONS OF $0 AND $9,027,000, RESPECTIVELY. MONROE CANCER CENTER DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 AND 2014. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANN KUJAWA | ||||||||||||||
| VICE-CHAIR | $0 | $147,904 | $0 | $2,750 | $0 | $7,294 | $0 | $15,548 | $0 | $21,221 | $0 | $194,717 | $0 | $0 |
| JOHN E KIBBLE | ||||||||||||||
| CHAIRPERSON | $0 | $53,127 | $0 | $20,399 | $0 | $207,050 | $0 | $167,007 | $0 | $832 | $0 | $448,415 | $0 | $0 |
| GARY AKENBERGER | ||||||||||||||
| SR. VP FINANCE, PHS | $0 | $291,582 | $0 | $84,049 | $0 | $39,958 | $0 | $67,444 | $0 | $21,631 | $0 | $504,664 | $0 | $0 |
| PAMELA M JENSEN | ||||||||||||||
| FORMER OFFICER | $0 | $221,829 | $0 | $56,031 | $0 | $3,324 | $0 | $48,779 | $0 | $14,913 | $0 | $344,876 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF MONROE CANCER CENTER, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINE 4A: | UNDER A VOLUNTARY TERMINATION AGREEMENT ENTERED INTO BY THE EMPLOYEE AND THE ORGANIZATION OR UPON A QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM PROMEDICA. SEVERANCE PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING LISTED PERSONS IN PART VII: JOHN E. KIBBLE $150,599 |
| PART I, LINE 4B: | ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | EFFECTIVE APRIL 1, 2015, MONROE CANCER CENTER AMENDED ITS ARTICLE OF INCORPORATION AND BYLAWS. THE SIGNIFICANT CHANGES ARE AS FOLLOWS: - MERCY MEMORIAL HOSPITAL CORPORATION AND EMMA L. BIXBY MEDICAL CENTER BECAME THE MEMBERS. - THE NUMBER OF THE BOARD OF DIRECTORS SHALL CONSIST OF 3 VOTING DIRECTORS WHO ARE APPOINTED BY THE MEMBERS. - A QUORUM FOR TRANSACTION OF BUSINESS IN ANY MEETING OF THE BOARD OF DIRECTORS EXISTS WHEN A MAJORITY OF THE DIRECTORS ARE PRESENT. |
| FORM 990, PART VI, SECTION A, LINE 6 | AS A MICHIGAN NON-PROFIT ORGANIZATION, THIS CORPORATION HAS 2 CORPORATE MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE PARENT CORPORATION AND SOLE MEMBER OF MERCY MEMORIAL HOSPITAL CORPORATION AND EMMA L. BIXBY MEDICAL CENTER, WHICH ARE THE MEMBERS OF MONROE CANCER CENTER. AS THE SOLE MEMBER OF MERCY MEMORIAL HOSPITAL CORPORATION AND EMMA L. BIXBY MEDICAL CENTER, PHS HAS THE RIGHT TO (A) NOMINATE AND ELECT A MINORITY OF THE MEMBERS AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF MONROE CANCER CENTER, AND (B) FILL ANY VACANCY OF THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER AND (VI) ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR LIQUIDATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | UNDER THE GUIDANCE OF PROMEDICA HEALTH SYSTEM, INC.'S (PHS) TAX CONSULTANTS, FORM 990S ARE PREPARED BY THE RESPECTIVE ACCOUNTING DEPARTMENT OF EACH AFFILIATE AND REVIEWED BY THE AFFILIATE'S FINANCE LEADERSHIP. AFTER AFFILIATE'S FINANCE LEADERSHIP APPROVAL, COPIES OF THE FORM 990 FOR PHS AND THEIR SUBSIDIARIES ARE PROVIDED TO THE RESPECTIVE COMPANY'S BOARD OF TRUSTEES AND ARE REVIEWED AND SIGNED BY A PRINCIPAL OFFICER PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER CERTIFICATION STATEMENT WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER CERTIFICATION STATEMENTS ARE COMPILED AND REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER CERTIFICATION STATEMENTS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO FILE THE CERTIFICATION STATEMENT, OR THE FILING OF A FALSE OR INCOMPLETE CERTIFICATION STATEMENT, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S CERTIFICATION STATEMENT OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL SALARIED EMPLOYEES AND SPECIFICALLY IDENTIFIED HOURLY EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE BY AN ESTABLISHED DEADLINE THAT IS COMMUNICATED TO THE EMPLOYEE. THE HUMAN RESOURCES DEPARTMENT ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND PROVIDES NOTIFICATION TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL EMPLOYEE CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT. ALL NEW EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYEE STANDARD OF CONDUCT AND THE EMPLOYEE CERTIFICATION STATEMENT WHICH THE NEW EMPLOYEE IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. THE AUDIT & COMPLIANCE DEPARTMENT HAS ACCESS TO A REPORT THAT IDENTIFIES ALL NEW HIRES. A SAMPLE OF EMPLOYEES IS IDENTIFIED AND AN AUDIT IS CONDUCTED TO ENSURE THAT REQUIRED DOCUMENTATION IS ON FILE. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE V.P., AUDIT & COMPLIANCE AND IF NECESSARY DISCUSSED WITH THE BUSINESS UNIT PRESIDENT IN WHICH THE EMPLOYEE WORKS, AND GENERAL COUNSEL. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL OF THE PHS PRESIDENT/CEO. RESULTS OF THE EMPLOYEE PROCESS AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FAILURE TO COMPLETE THE CERTIFICATION QUESTIONNAIRE, OR THE COMPLETION OF A FALSE OR INCOMPLETE CERTIFICATION QUESTIONNAIRE, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE EMPLOYEE'S CERTIFICATION QUESTIONNAIRE OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. EMPLOYED PHYSICIANS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL EMPLOYED PHYSICIANS ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC PHYSICIAN CERTIFICATION QUESTIONNAIRE BY THE ESTABLISHED AND COMMUNICATED DEADLINE. THE OFFICE OF THE PRESIDENT/CHIEF MEDICAL OFFICER AND THE CHIEF OPERATING OFFICER FOR PROMEDICA PHYSICIAN GROUP (PPG) ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND REVIEWED AND ENSURES NOTIFICATION IS PROVIDED TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL PHYSICIAN CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND ALSO ENSURES COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT ARE FORWARDED ACCORDINGLY. ALL NEW EMPLOYED PHYSICIANS ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYED PHYSICIAN STANDARD OF CONDUCT AND THE PHYSICIAN CERTIFICATION STATEMENT WHICH THE NEW PHYSICIAN IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, CHIEF OPERATING OFFICER OR THEIR DESIGNEE, AND IF APPROPRIATE, ARE SUBSEQUENTLY REPORTED TO THE OFFICE OF THE V.P., AUDIT & COMPLIANCE. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL BY THE PHS PRESIDENT/CHIEF EXECUTIVE OFFICER. RESULTS OF THE EMPLOYED PHYSICIAN AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. ANY ITEMS THAT MEET CRITERIA FOR PUBLIC DISCLOSURE WILL BE COMMUNICATED TO THE APPROPRIATE PHYSICIAN BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE IN ADVANCE OF THE POSTING. THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE WILL PROVIDE THE PHYSICIAN-INDUSTRY RELATIONSHIP DISCLOSURES TO THE APPLICABLE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. THE PUBLIC DISCLOSURE WILL BE POSTED ON THE PPG PHYSICIAN WEBSITE (I.E., WWW.PPGDOCS.ORG) DATABASE BY THE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. |
| FORM 990, PART VI, SECTION B, LINE 15 | MONROE CANCER CENTER'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF MONROE CANCER CENTER'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE MADE BY A COMPENSATION COMMITTEE OF PHS. EACH YEAR INDEPENDENT CONSULTANTS CONDUCT AN ANNUAL SURVEY AND RECOMMEND EXECUTIVE PAYROLL BASE SALARY RANGES BASED UPON THE MARKET. THE DATA IS REVIEWED AND APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE EVERY OCTOBER. SALARY ADJUSTMENTS ARE DETERMINED AT THE DECEMBER MEETING OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES OTHER FORMS OF COMPENSATION BASED UPON THE PRIOR YEAR PERFORMANCE AT THE JANUARY MEETING EACH YEAR. |
| FORM 990, PART VI, SECTION C, LINE 19 | PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASE SERVICES - PHYSICIAN: PROGRAM SERVICE EXPENSES 687,517. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 687,517. PURCHASE SERVICES - NON PHYSICIAN: PROGRAM SERVICE EXPENSES 528,897. MANAGEMENT AND GENERAL EXPENSES 4,665. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 533,562. PURCHASE SERVICES - OTHER: PROGRAM SERVICE EXPENSES 285,830. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 285,830. |
| FORM 990, PART XI, LINE 9: | WRITE-UP OF INTANGIBLE ASSET 1,100,000. |
| FORM 990, PART XII, LINE 2C: | MONROE CANCER CENTER IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES (PHS) WHICH ARE PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE PHS AUDIT/COMPLIANCE COMMITTEE WHICH PROVIDES ASSISTANCE TO THE PHS BOARDS OF TRUSTEES IN FULFILLING ITS FIDUCIARY RESPONSIBILITIES AND MAINTAINS FREE AND OPEN COMMUNICATION BETWEEN THE COMMITTEE, THE V.P. OF AUDIT/COMPLIANCE, THE INDEPENDENT AUDITORS AND MANAGEMENT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. MAJOR RESPONSIBILITIES OF THE AUDIT/COMPLIANCE COMMITTEE INCLUDE: - ANNUALLY, APPROVE THE ENGAGEMENT OF THE EXTERNAL AUDITOR, INCLUDING RELATED SCOPE, FEES AND REPORTS. - REVIEW WITH MANAGEMENT AND THE INDEPENDENT AUDITORS THE ANNUAL FINANCIAL STATEMENTS AND RESULTS OF THE AUDIT, INCLUDING REQUIRED MATTERS TO BE COMMUNICATED TO THE COMMITTEE BY THE INDEPENDENT AUDITORS UNDER GENERALLY ACCEPTED AUDITING STANDARDS. - DISCUSS WITH THE EXTERNAL AUDITORS THEIR INDEPENDENCE FROM MANAGEMENT AND THE ORGANIZATION AND THE MATTERS INCLUDED IN WRITTEN DISCLOSURE REQUIRED BY THE INDEPENDENCE STANDARDS BOARD. - OVERSEE MANAGEMENT ACTION PLANS RESULTING FROM EXTERNAL MANAGEMENT LETTER. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (25 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| COBRA VENTURES LLC | |||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 204671613 | LAND LEASING | OH | $5,510 | $94,354 | ST LUKE'S HOSPITAL FOUNDATION |
| MIDWEST CARDIOVASCULAR CONSULTANTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 611448753 | EMPLOYS PHYSICIANS | OH | $0 | $535,504 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA CENTRAL PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341881137 | EMPLOYS PHYSICIANS | OH | $231,170,716 | $291,204,025 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA EAST PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341881145 | EMPLOYS PHYSICIANS | OH | $7,735,386 | -$1,576,704 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA WEST PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341893773 | EMPLOYS PHYSICIANS | OH | $15,982,568 | -$8,068,901 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 263888045 | EMPLOYS PHYSICIANS | OH | $30,141,070 | -$56,519,329 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA CARDIOTHORACIC PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 270978204 | EMPLOYS PHYSICIANS | OH | $5,936,506 | -$9,670,745 | PROMEDICA PHYSICIAN GROUP |
| WELLCARE PHYSICIANS LLC | |||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 611528443 | EMPLOYS PHYSICIANS | OH | $16,368,856 | $8,878,730 | PROMEDICA PHYSICIAN GROUP |
| THE PHARMACY COUNTER LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 271325141 | MEDICAL EQUIPMENT & PHARMACY | OH | $60,641,144 | $17,065,865 | PROMEDICA PHYSICIAN GROUP |
| WOLF CREEK ASSOCIATES LLC | |||||||||
| 901 KIMOLE LN | ADRIAN | MI | 49221 | 383164818 | FACILITY LEASING | MI | $131,432 | $1,308,580 | EMMA L BIXBY MEDICAL CENTER |
| PROMEDICA MONROE CARDIOLOGY PLLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 272920342 | EMPLOYS PHYSICIANS | MI | $2,425,382 | -$3,059,070 | PROMEDICA PHYSICIAN GROUP |
| ERIE WEST HOSPICE & PALLIATIVE CARE LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 205752995 | PROVIDES HOSPICE CARE | OH | $4,709,330 | $7,039,875 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES |
| PROMEDICA ANESTHESIA CONSULTANTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 453251737 | EMPLOYS PHYSICIANS | OH | $30,303,052 | -$44,305,935 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA PHYSICIANS MANAGEMENT SERVICES LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 453230331 | PRACTICE MANAGEMENT | OH | $0 | -$2,356,472 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA SURGICAL SERVICES LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | EMPLOYS PHYSICIANS | OH | $0 | $0 | PROMEDICA PHYSICIAN GROUP | |
| MISSION POINTE GOLF COURSE LLC | |||||||||
| 2142 NORTH COVE | TOLEDO | OH | 43606 | GOLF COURSE | OH | $0 | $391,382 | PROMEDICA FOUNDATION | |
| PROMEDICA INNOVATIONS LLC | |||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | INVESTMENT COMPANY | OH | $0 | $0 | PROMEDICA HEALTH SYSTEM INC | |
| PROMEDICA GENITO-URINARY SURGEONS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 461120436 | EMPLOYS PHYSICIANS | OH | $11,558,436 | -$14,936,580 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA MONROE PHYSICIANS PLLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 461111822 | EMPLOYS PHYSICIANS | MI | $27,275 | -$757,452 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA MULTI-SPECIALTY PHYSICIANS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 454976786 | EMPLOYS PHYSICIANS | OH | $0 | $159,481 | PROMEDICA PHYSICIAN GROUP |
| PROMEDICA HOSPITALISTS LLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | EMPLOYS PHYSICIANS | OH | $0 | $0 | PROMEDICA PHYSICIAN GROUP | |
| PROMEDICA HOSPITALISTS PLLC | |||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | EMPLOYS PHYSICIANS | MI | $0 | $0 | PROMEDICA PHYSICIAN GROUP | |
| MEMORIAL ANESTHESIA LTD | |||||||||
| 715 SOUTH TAFT AVE | FREMONT | OH | 43420 | 205763680 | EMPLOYS PHYSICIANS | OH | $0 | $0 | PROMEDICA PHYSICIAN GROUP |
| MEMORIAL PROFESSIONAL SERVICES LTD | |||||||||
| 715 SOUTH TAFT AVE | FREMONT | OH | 43420 | 273763993 | EMPLOYS PHYSICIANS | OH | $10,132,691 | -$381,185 | PROMEDICA PHYSICIAN GROUP |
| PHS VENTURES LLC | |||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | 341880473 | HEALTH CARE MANAGEMENT SERVICES | DE | $0 | $0 | PROMEDICA HEALTH SYSTEM INC |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (29 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BAY PARK COMMUNITY HOSPITAL | |||||||||||
| 2801 BAY PARK DR | OREGON | OH | 43616 | 341883132 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| CARE ENTERPRISES INC | |||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 341366709 | FACILITY LEASING | OH | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| DEFIANCE HOSPITAL AUXILIARY | |||||||||||
| 1200 RALSTON | DEFIANCE | OH | 43512 | 510173779 | HOSPITAL / FOUNDATION SUPPORT | OH | 501(C)(3) | 11D, III-O | DEFIANCE HOSPITAL INC | Yes (1) | |
| DEFIANCE HOSPITAL INC | |||||||||||
| 1200 RALSTON | DEFIANCE | OH | 43512 | 344446484 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| EMMA L BIXBY MEDICAL CENTER | |||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 382796005 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| EMMA L BIXBY MEDICAL CENTER AUXILIARY | |||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 382149602 | HOSPITAL / FOUNDATION SUPPORT | MI | 501(C)(3) | 11B, II | EMMA L BIXBY MEDICAL CENTER | Yes (1) | |
| FLOWER HOSPITAL | |||||||||||
| 5200 HARROUN RD | SYLVANIA | OH | 43560 | 344428794 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| FOSTORIA HOSPITAL ASSOCIATION | |||||||||||
| 501 VAN BUREN STREET | FOSTORIA | OH | 44830 | 340898745 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| FOSTORIA HOSPITAL AUXILIARY | |||||||||||
| PO BOX 907 | FOSTORIA | OH | 44830 | 346517634 | HOSPITAL / FOUNDATION SUPPORT | OH | 501(C)(3) | 11A, I | FOSTORIA HOSPITAL ASSOCIATION | Yes (1) | |
| HERRICK MEDICAL CENTER AUXILIARY | |||||||||||
| 500 E POTTAWATAMIE ST | TECUMSEH | MI | 49286 | 383076105 | HOSPITAL / FOUNDATION SUPPORT | MI | 501(C)(3) | 11B, II | HERRICK MEMORIAL HOSPITAL INC | Yes (1) | |
| HERRICK MEMORIAL HOSPITAL INC | |||||||||||
| 500 E POTTAWATAMIE ST | TECUMSEH | MI | 49286 | 383049015 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| LENAWEE LONG TERM CARE | |||||||||||
| 700 LAKESHIRE TR | ADRIAN | MI | 49221 | 382879330 | LONG TERM CARE | MI | 501(C)(3) | 9 | EMMA L BIXBY MEDICAL CENTER | Yes (1) | |
| PROMEDICA CONTINUING CARE SERVICES CORP | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 344492440 | LONG TERM AND HOME HEALTH CARE | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| PROMEDICA COURIER SERVICES INC | |||||||||||
| 3170 W CENTRAL AVE | TOLEDO | OH | 43606 | 260324790 | COURIER SERVICE | OH | 501(C)(3) | 11B, II | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| PROMEDICA HEALTH SYSTEM INC | |||||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | 341517671 | PARENT COMPANY OF HEALTH SYSTEM | OH | 501(C)(3) | 11B, II | 0 | N/A | |
| PROMEDICA INDEMNITY CORP | |||||||||||
| ONE CHURCH ST 5TH FLOOR | BURLINGTON | VT | 05401 | 341931936 | PROFESSIONAL & GENERAL LIABILITY | VT | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341880767 | PHYSICIAN MANAGEMENT SERVICES | OH | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA PHYSICIAN GROUP | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341899439 | PHYSICIAN HEALTH CARE SERVICES | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| ST LUKE'S HOSPITAL | |||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 344428232 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| ST LUKE'S HOSPITAL FOUNDATION | |||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 341292849 | FOUNDATION | OH | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PROMEDICA FOUNDATION | |||||||||||
| 2142 N COVE BLVD | TOLEDO | OH | 43606 | 341517672 | FOUNDATION | OH | 501(C)(3) | 11B, II | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| THE TOLEDO HOSPITAL | |||||||||||
| 2142 N COVE BLVD | TOLEDO | OH | 43606 | 344428256 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| TOLEDO DISTRICT NURSE ASSOCIATION | |||||||||||
| 1946 N 13TH STREET | TOLEDO | OH | 43624 | 344427949 | SKILLED HOME CARE | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| VISITING NURSE HOSPICE AND HEALTH CARE | |||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 341831624 | HOSPICE HOME CARE | OH | 501(C)(3) | 9 | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | Yes (1) | |
| KAITLYN'S COTTAGE INC | |||||||||||
| 1260 RALSTON AVE | DEFIANCE | OH | 43512 | 454781053 | RESPITE CARE | OH | 501(C)(3) | 9 | DEFIANCE HOSPITAL INC | Yes (1) | |
| MEMORIAL HOSPITAL | |||||||||||
| 715 SOUTH TAFT AVE | FREMONT | OH | 43420 | 344430849 | HOSPITAL | OH | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| MONROE COMMUNITY HEALTH SERVICES | |||||||||||
| 718 N MACOMB | MONROE | MI | 48162 | 382934134 | LONG TERM CARE | MI | 501(C)(3) | 9 | MERCY MEMORIAL HOSPITAL CORPORATION | Yes (1) | |
| MERCY MEMORIAL HOSPITAL CORPORATION | |||||||||||
| 718 N MACOMB | MONROE | MI | 48162 | 381984289 | HOSPITAL | MI | 501(C)(3) | 3 | PROMEDICA HEALTH SYSTEM INC | Yes (1) | |
| PARAMOUNT ADVANTAGE | |||||||||||
| 1901 INDIAN WOOD CIR | MAUMEE | OH | 43537 | 203376102 | HEALTH INSURANCE | OH | 501(C)(3) | 9 | PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (12 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BIXBY MEDICAL OFFICE LIMITED PARTNERSHIP | |||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 382972398 | FACILITY LEASING | MI | EMMA L BIXBY MEDICAL CENTER | RELATED | $36,791 | $1,173,776 | 0 | Yes (1) | 0.64600 |
| REYNOLDS RD SURGICAL CENTER LLC | |||||||||||||
| 2865 N REYNOLDS RD | TOLEDO | OH | 43615 | 311569454 | FREESTANDING AMBULATORY SURGICAL CENTER | OH | THE TOLEDO HOSPITAL | RELATED | $726,688 | $2,333,126 | 0 | 0 | 0.65040 |
| WATERVILLE MEDICAL CENTER LLC | |||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 320160784 | FACILITY LEASING | OH | CARE ENTERPRISES INC | RELATED | $32,184 | $753,658 | 0 | 0 | 0.70000 |
| NORTHWEST OHIO DEDICATED BREAST MRI LLC | |||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 260679898 | MEDICAL DIAGNOSTICS | OH | THE TOLEDO HOSPITAL | RELATED | $211,264 | $449,126 | 0 | 0 | 0.50000 |
| WEST CENTRAL SURGICAL CENTER LLC | |||||||||||||
| 7055 W CENTRAL | TOLEDO | OH | 43617 | 200088459 | AMBULATORY SURGICAL CENTER | OH | THE TOLEDO HOSPITAL | RELATED | $298,291 | $2,912,457 | 0 | Yes (1) | 0.50000 |
| OHIO CARE AMBULATORY SURGICAL CENTER LLC | |||||||||||||
| 5959 MONCLOVA RD | MAUMEE | OH | 43537 | 341863472 | AMBULATORY SURGICAL CENTER | OH | ST LUKE'S HOSPITAL | RELATED | $73,215 | $1,293,530 | 0 | 0 | 0.54680 |
| LENAWEE PHYSICIAN HOSPITAL ORGANIZATION LLC | |||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 383605511 | PHYSICIAN MANAGEMENT SERVICES | MI | EMMA L BIXBY MEDICAL CENTER | RELATED | -$23,464 | $253,470 | 0 | Yes (1) | 0.50000 |
| PROMEDICA SURGICAL SERVICES CO-MANAGEMENT CO LLC | |||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 461989695 | PHYSICIAN MANAGEMENT SERVICES | OH | PROMEDICA HEALTH SYSTEM INC | RELATED | $743,257 | $816,423 | 0 | 0 | 0.51920 |
| EAST-WEST HOLDINGS LTD | |||||||||||||
| 715 SOUTH TAFT AVE | FREMONT | OH | 43420 | 204066818 | REAL ESTATE | OH | MEMORIAL HOSPITAL | RELATED | $6,016 | $306,259 | 0 | 0 | 0.50000 |
| SURGICAL INSTITUTE OF MONROE LLC | |||||||||||||
| 1051 S TELEGRAPH RD | MONROE | MI | 48161 | 270843485 | AMBULATORY SURGICAL CENTER | MI | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | RELATED | $4,044 | $3,684,750 | 0 | 0 | 0.54000 |
| PROMEDICA MASTER TENANT LLC | |||||||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | 475288490 | REAL ESTATE | OH | PROMEDICA MANAGER MEMBER LLC | RELATED | $103,328 | 0 | Yes (1) | 0.01000 | |
| PROMEDICA DOWNTOWN CAMPUS LANDLORD LLC | |||||||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | 473163945 | REAL ESTATE | OH | PROMEDICA MANAGER MEMBER LLC | RELATED | $22,771,216 | 0 | Yes (1) | 0.90000 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (12 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARE HOLDINGS | ||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 341796790 | HOLDING COMPANY | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | Yes (1) | ||
| HERRICK MEMORIAL DEVELOPMENT CORP | ||||||||||||
| 500 E POTTAWATAMIE TR | ADRIAN | MI | 49221 | 383146907 | FACILITY LEASING | MI | EMMA L BIXBY MEDICAL CENTER | C | 1.00000 | Yes (1) | $906 | $964,439 |
| LHA PHYSICIAN SERVICES CORPORATION | ||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 611451576 | PHYSICIAN BILLING | MI | EMMA L BIXBY MEDICAL CENTER | C | 1.00000 | Yes (1) | -$44,391 | |
| PHYSICIANS ADVANTAGE MSO | ||||||||||||
| 5901 MONCLOVA RD | MAUMEE | OH | 43537 | 061811760 | PHYSICIAN MANAGEMENT SERVICES | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | Yes (1) | ||
| PROMEDICA CENTRAL CORPORATION OF MICHIGAN | ||||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 383322278 | PHYSICIAN HEALTH CARE SERVICES | OH | PROMEDICA PHYSICIAN GROUP | C | 1.00000 | Yes (1) | -$1,047,084 | $3,582,068 |
| PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES | ||||||||||||
| 1901 INDIAN WOOD CIR | MAUMEE | OH | 43537 | 341570675 | HEALTH CARE INSURANCE | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | Yes (1) | $76,588,676 | $344,035,035 |
| PROMEDICA NORTH PHYSICIAN CORPORATION | ||||||||||||
| 5855 MONROE ST | SYLVANIA | OH | 43560 | 383482148 | PHYSICIAN HEALTH CARE SERVICES | OH | PROMEDICA PHYSICIAN GROUP | C | 1.00000 | Yes (1) | $203,340 | |
| PROMEDICA RETAIL GROUP INC | ||||||||||||
| 3890 MONROE ST | TOLEDO | OH | 43606 | 341159928 | FLORIST | OH | PROMEDICA PHYSICIANS AND CONTINUUM SERVICES | C | 1.00000 | Yes (1) | $485 | $1,016,984 |
| HERRICK MEMORIAL OFFICE PLAZA CONDOMINIUM ASSOCIATION | ||||||||||||
| 818 RIVERSIDE AVE | ADRIAN | MI | 49221 | 383639616 | FACILITY MANAGEMENT | MI | HERRICK MEMORIAL DEVELOPMENT CORP | C | 0.71800 | Yes (1) | $45 | $55,879 |
| PROMEDICA HEALTH NETWORK INC | ||||||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | 474006496 | PHYSICIAN MANAGEMENT SERVICES | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | Yes (1) | ||
| MONROE HEALTH VENTURES | ||||||||||||
| 718 N MACOMB | MONROE | MI | 48164 | 382704426 | PHARMACY | MI | MERCY MEMORIAL HOSPITAL CORPORATION | C | 1.00000 | Yes (1) | ||
| PROMEDICA MANAGER MEMBER LLC | ||||||||||||
| 1801 RICHARDS RD | TOLEDO | OH | 43607 | 475168737 | REAL ESTATE | OH | PROMEDICA HEALTH SYSTEM INC | C | 1.00000 | Yes (1) | $9,536,974 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| MERCY MEMORIAL HOSPITAL CORPORATION | ||
| N | $351,998 | FMV |
| MERCY MEMORIAL HOSPITAL CORPORATION | ||
| O | $402,987 | FMV |
| MERCY MEMORIAL HOSPITAL CORPORATION | ||
| P | $52,012 | FMV |
Comments