GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION (EIN 36-3332852)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-13
- IRS object ID
- 201321339349300317
- Schema version
- 2011v1.5
- 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) |
|---|---|---|
| Timestamp | 2013-05-13T07:21:32-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363332852 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GOTT | NameControl |
| Phone | 7084504966 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 W NORTH AVE | AddressLine1 |
| City | MELROSE PARK | City |
| State | IL | State |
| ZIP Code | 60160 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ELLYN CHIN | Name |
| Title | TREASURER | Title |
| Phone | 7084504966 | Phone |
| Date Signed | 2013-05-13 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LARRY GOLDBERG | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 W NORTH AVE | AddressLine1 |
| City | MELROSE PARK | City |
| State | IL | State |
| ZIP Code | 60160 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 6544238 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1984 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | TO OWN AND EQUIP HEALTH CARE AND COMMUNITY-BASED SOCIAL SERVICE FACILITIES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 4 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 152 | TotalNbrEmployees |
| Total Nbr Volunteers | 3 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 6669436 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5734887 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 48268 | InvestmentIncomePriorYear |
| Investment Income Current Year | 43062 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 19596 | OtherRevenuePriorYear |
| Other Revenue Current Year | 766289 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6737300 | TotalRevenuePriorYear |
| Total Revenue Current Year | 6544238 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 77483 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 83680 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 3021297 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5044685 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5555675 | OtherExpensePriorYear |
| Other Expenses Current Year | 3184599 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 8654455 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8312964 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1917155 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1768726 | RevenuesLessExpensesCY |
| Total Assets BOY | 8271463 | TotalAssetsBOY |
| Total Assets EOY | 12001021 | TotalAssetsEOY |
| Total Liabilities BOY | 11968693 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 23053022 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -3697230 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -11052001 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO OWN AND EQUIP HEALTH CARE AND COMMUNITY-BASED SOCIAL SERVICE FACILITIES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7106874 | Expense |
| Grants | 83680 | Grants |
| Revenue | 6324854 | Revenue |
| Description | GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION (GCHS) IS A WHOLLY OWNED SUBSIDIARY OF GOTTLIEB MEMORIAL HOSPITAL (GMH). THE PURPOSES FOR WHICH GCHS IS ORGANIZED INCLUDE OWNING AND EQUIPPING HEALTH CARE FACILITIES AND COMMUNITY-BASED SOCIAL SERVICE FACILITIES. GCHS IS NOT SUBJECT TO THE ILLINOIS COMMUNITY BENEFITS ACT AND IS, THEREFORE, NOT REQUIRED TO SUBMIT A COMMUNITY BENEFIT REPORT. HOWEVER, BECAUSE IT IS A WHOLLY-OWNED SUBSIDIARY OF GMH, GCHS' COMMUNITY OUTREACH WORK IS A FURTHER DEMONSTRATION OF GMH'S MISSION OF CARE. THE AMOUNTS DESCRIBED IN THE FOLLOWING GCHS LIST OF COMMUNITY SERVICES ARE NOT QUANTIFIED IN THE GMH COMMUNITY BENEFIT CALCULATED TOTALS. FY2012 GCHS COMMUNITY ACTIVITIES, SERVICES AND PROGRAMS:- SUPPORTING OTHER NOT-FOR-PROFITS - GCHS PROVIDED A FINANCIAL CONTRIBUTION TO PCC COMMUNITY WELLNESS CENTER (A FEDERALLY-QUALIFIED HEALTH CLINIC) TO SUPPORT ACTIVITIES AND SERVICES FOR LOW-INCOME AND UNDERSERVED INDIVIDUALS. GOTTLIEB CENTER FOR FITNESS DONATED NEARLY 80 MEMBERSHIPS TO NOT-FOR-PROFIT ORGANIZATIONS. IN ADDITION, THE FITNESS CENTER'S STAFF COORDINATED THE COLLECTION OF FOOD FOR LOCAL SHELTERS AND EMPLOYEE PARTICIPATION IN NOT-FOR-PROFIT ORGANIZATIONS' FUND-RAISING WALKS. - PEDIATRIC OBESITY PILOT PROGRAM - A TEAM OF CLINICIANS OFFERED A COMPLIMENTARY PEDIATRIC OBESITY PILOT PROGRAM TO A GROUP OF AREA CHILDREN AND PARENTS TO ADDRESS NEEDS OF FAMILIES STRUGGLING WITH OBESITY. THE PROGRAM CONCEPTS BECAME PART OF A LARGER LOYOLA UNIVERSITY HEALTH SYSTEM PROGRAM. - SUPPORT ACTIVE KIDS - GCHS PROVIDED A GRANT TO PROJECT FIT AMERICA (A NOT FOR PROFIT HEALTH-RELATED ORGANIZATION) TO SUPPORT BUILDING A PARK IN A LOW-INCOME AREA TO PROMOTE HEALTHY LIFESTYLES FOR DISADVANTAGED CHILDREN AND FAMILIES. - CHARITABLE HEALTH CLUB MEMBERSHIP PROGRAM - NEARLY 2,000 COMMUNITY RESIDENTS WHO COULD NOT AFFORD A HEALTH CLUB MEMBERSHIP, OR WHO WERE DETERMINED IN NEED OF SERVICES TO MAINTAIN OR IMPROVE THEIR HEALTH, WERE PROVIDED WITH A COMPLIMENTARY GOTTLIEB CENTER FOR FITNESS MEMBERSHIP FOR A TOTAL AMOUNT OF MORE THAN $120,000 IN FREE MEMBERSHIPS. - SUPPORTING VETERANS - GOTTLIEB CENTER FOR FITNESS PROVIDED THE USE OF ITS FACILITIES FOR THE UNITED STATES MILITARY RECRUITING OFFICE TO CONDUCT PHYSICAL ASSESSMENTS OF POTENTIAL RECRUITS. IT ALSO HOSTED AN EVENT TO RAISE FUNDS TOWARD THE PURCHASE OF ADAPTIVE EXERCISE EQUIPMENT FOR WOUNDED VETERANS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | THE MISSION STATEMENT FOR GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION IS AS FOLLOWS:WE SERVE TOGETHER IN TRINITY HEALTH IN THE SPIRIT OF THE GOSPELTO HEAL BODY, MIND, AND SPIRITTO IMPROVE THE HEALTH OF OUR COMMUNITIES AND TO STEWARD THE RESOURCES ENTRUSTED TO US. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 7106874 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 152 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 4 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELLYN CHIN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7084504534 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 W NORTH AVE | AddressLine1 |
| City | MELROSE PARK | City |
| State | IL | State |
| ZIP Code | 60160 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (11 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| LARRY GOLDBERG | ||||||||
| PRESIDENT AS OF 4/12 | 2.00 | X | X | 0 | 196650 | 12915 | ||
| PATRICIA CASSIDY | ||||||||
| PRES 12/11-3/12, SECY UNTIL 1/12 | 10.00 | X | X | 0 | 1885874 | 173667 | ||
| JILL RAPPIS | ||||||||
| ASST SECY UNTIL 1/12;SECY AS OF 1/12 | 2.00 | X | X | 0 | 288502 | 58102 | ||
| ELLYN CHIN | ||||||||
| TREASURER | 10.00 | X | X | 0 | 282497 | 62935 | ||
| KENNETH FISHBAIN | ||||||||
| DIRECTOR | 10.00 | X | 0 | 519217 | 69060 | |||
| DULCES LEON-JAUREGUI MD | ||||||||
| PHYSICIAN | 40.00 | 308867 | 0 | 48204 | X | |||
| ROBERTO LEVI-D'ANCONA MD | ||||||||
| PHYSICIAN | 40.00 | 287956 | 0 | 26158 | X | |||
| ANAND LAL MD | ||||||||
| PHYSICIAN | 40.00 | 159833 | 0 | 53084 | X | |||
| MICHAEL HUGAR MD | ||||||||
| PHYSICIAN | 40.00 | 155199 | 0 | 18579 | X | |||
| CARLOS BOLMEY MD | ||||||||
| PHYSICIAN | 40.00 | 148064 | 0 | 44708 | X | |||
| PAUL WHELTON | ||||||||
| FORMER OFFICER | 0.00 | 0 | 3693100 | 1453069 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1059919 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 6865840 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 2020481 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET HEALTH PROGRAM SVC | 900099 | 3533592 | 3533592 |
| HFC MEMBERSHIP FEES | 900099 | 2201295 | 2201295 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5734887 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32951 | TotalRevenueColumn |
| Exclusion | $32,951 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 154229 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 154229 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 154229 | TotalRevenueColumn |
| Exclusion | $154,229 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 10111 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 10111 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10111 | TotalRevenueColumn |
| Exclusion | $10,111 | ExclusionAmount |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 612060 | TotalRevenueColumn |
| Related Or Exempt Function Income | 589967 | RelatedOrExemptFunctionIncome |
| Exclusion | $22,093 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 612060 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6544238 | TotalRevenueColumn |
| Related Or Exempt Function Income | 6324854 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $219,384 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83680 | Total |
| Program Services | 83680 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4150377 | Total |
| Program Services | 3787449 | ProgramServices |
| Management And General | 362928 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 619410 | Total |
| Program Services | 555102 | ProgramServices |
| Management And General | 64308 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 274898 | Total |
| Program Services | 247856 | ProgramServices |
| Management And General | 27042 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 278043 | Total |
| Program Services | 226435 | ProgramServices |
| Management And General | 51608 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15104 | Total |
| Program Services | 15104 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 235680 | Total |
| Program Services | 209657 | ProgramServices |
| Management And General | 26023 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72984 | Total |
| Program Services | 44884 | ProgramServices |
| Management And General | 28100 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1210621 | Total |
| Program Services | 851842 | ProgramServices |
| Management And General | 358779 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7311 | Total |
| Program Services | 7311 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7487 | Total |
| Program Services | 7487 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 537441 | Total |
| Program Services | 301219 | ProgramServices |
| Management And General | 236222 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67888 | Total |
| Program Services | 67888 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 325746 | 325746 | |
| BAD DEBT | 138072 | 138072 | |
| SUBSCRIPTIONS & DUES | 19776 | 19592 | 184 |
| UBI TAXES | 615 | 615 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 267831 | Total |
| Program Services | 217550 | ProgramServices |
| Management And General | 50281 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8312964 | Total |
| Program Services | 7106874 | ProgramServices |
| Management And General | 1206090 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1257983 | BOY |
| EOY | 564922 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 413406 | BOY |
| EOY | 366976 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 980135 | BOY |
| EOY | 722740 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24876 | BOY |
| EOY | 25877 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 9526367 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 537441 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4677696 | BOY |
| EOY | 8988926 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 913367 | BOY |
| EOY | 7500 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4000 | BOY |
| EOY | 1324080 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8271463 | BOY |
| EOY | 12001021 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1934139 | BOY |
| EOY | 1921205 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 26723 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10034554 | BOY |
| EOY | 21105094 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11968693 | BOY |
| EOY | 23053022 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -3697230 | BOY |
| EOY | -11052001 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -3697230 | BOY |
| EOY | -11052001 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8271463 | BOY |
| EOY | 12001021 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1768726 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -5586045 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2313235 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2176241 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2093195 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2118286 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2201295 | CurrentTaxYear |
| Total | 10902252 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 5075301 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4941217 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 4546564 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4551150 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4145652 | CurrentTaxYear |
| Total | 23259884 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 7388536 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 7117458 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6639759 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6669436 | CurrentTaxYearMinus1Year |
| Current Tax Year | 6346947 | CurrentTaxYear |
| Total | 34162136 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 34162136 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 238362 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 138720 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 4177 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 48268 | CurrentTaxYearMinus1Year |
| Current Tax Year | 187180 | CurrentTaxYear |
| Total | 616707 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 238362 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 138720 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 4177 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 48268 | CurrentTaxYearMinus1Year |
| Current Tax Year | 187180 | CurrentTaxYear |
| Total | 616707 | Total |
Net Income From Other UBI NetIncomeFromOtherUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 26616 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 20901 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 18132 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 19596 | CurrentTaxYearMinus1Year |
| Total | 85245 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 7653514 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 7277079 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6662068 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6737300 | CurrentTaxYearMinus1Year |
| Current Tax Year | 6534127 | CurrentTaxYear |
| Total | 34864088 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.97990 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.97700 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.01770 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.02100 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8628703 | OtherCostOrOtherBasis |
| Depreciation | 435157 | Depreciation |
| Book Value | 8193546 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 606523 | OtherCostOrOtherBasis |
| Depreciation | 102284 | Depreciation |
| Book Value | 504239 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 291141 | OtherCostOrOtherBasis |
| Book Value | 291141 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8988926 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| MISCELLANEOUS RECEIVABLES | 102639 |
| INTERCOMPANY RECEIVABLES | 1221441 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1324080 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| INTERCOMPANY PAYABLES | $20,909,223 |
| OTHER CURRENT LIABILITIES | $195,871 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 21105094 | TotalOfAmounts |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| PCC COMMUNITY WELLNESS CENTER | |||||||
| 14 WEST LAKE STREET | CHICAGO | IL | 60302 | 363828320 | 501(C)(3) | 68750 | GENERAL SUPPORT OF FEDERALLY QUALIFIED HEALTH CENTER |
| PROJECT FIT AMERICA | |||||||
| PO BOX 308 | BOYES HOT SPRINGS | CA | 95416 | 363730823 | 501(C)(3) | 14930 | PROVIDE CARDIOVASCULAR HEALTH AND FITNESS TO SCHOOLS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: A FORMAL GRANT AGREEMENT IS SIGNED BY AN OFFICER OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION AND AN OFFICER OF THE RECEIVING ORGANIZATION. ALL GRANT AGREEMENTS CLEARLY DEFINE THE USE AND LEVEL OF SUPPORT PROVIDED BY THE ORGANIZATION. GRANTS ARE INCLUDED IN THE ANNUAL BUDGET PROCESS. GRANTS ARE IDENTIFIED SEPARATELY IN THE FINANCIAL RECORDS OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION. A RESPONSIBLE PERSON AT MANAGER LEVEL OR ABOVE APPROVES REQUESTS FOR REIMBURSEMENT. THE FINANCE DEPARTMENT ALSO REVIEWS THE REIMBURSEMENTS TO ENSURE THEY ARE IN ACCORDANCE WITH THE GRANT AGREEMENT. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LARRY GOLDBERG | |||||||||||||
| 0 | 126243 | 0 | 50000 | 0 | 20407 | 0 | 12003 | 0 | 912 | 0 | 209565 | 0 | 0 |
| PATRICIA CASSIDY | |||||||||||||
| 0 | 490629 | 0 | 217040 | 0 | 1178205 | 0 | 158843 | 0 | 14824 | 0 | 2059541 | 0 | 0 |
| JILL RAPPIS | |||||||||||||
| 0 | 237141 | 0 | 50152 | 0 | 1209 | 0 | 49455 | 0 | 8647 | 0 | 346604 | 0 | 0 |
| ELLYN CHIN | |||||||||||||
| 0 | 246641 | 0 | 10856 | 0 | 25000 | 0 | 36904 | 0 | 26031 | 0 | 345432 | 0 | 0 |
| KENNETH FISHBAIN | |||||||||||||
| 0 | 317784 | 0 | 6433 | 0 | 195000 | 0 | 57770 | 0 | 11290 | 0 | 588277 | 0 | 0 |
| DULCES LEON-JAUREGUI MD | |||||||||||||
| 214644 | 0 | 94223 | 0 | 0 | 0 | 22657 | 0 | 25547 | 0 | 357071 | 0 | 0 | 0 |
| ROBERTO LEVI-D'ANCONA MD | |||||||||||||
| 286167 | 0 | 1789 | 0 | 0 | 0 | 0 | 0 | 26158 | 0 | 314114 | 0 | 0 | 0 |
| ANAND LAL MD | |||||||||||||
| 159833 | 0 | 0 | 0 | 0 | 0 | 30037 | 0 | 23047 | 0 | 212917 | 0 | 0 | 0 |
| MICHAEL HUGAR MD | |||||||||||||
| 155199 | 0 | 0 | 0 | 0 | 0 | 9176 | 0 | 9403 | 0 | 173778 | 0 | 0 | 0 |
| CARLOS BOLMEY MD | |||||||||||||
| 127206 | 0 | 20858 | 0 | 0 | 0 | 21661 | 0 | 23047 | 0 | 192772 | 0 | 0 | 0 |
| PAUL WHELTON | |||||||||||||
| 0 | 485635 | 0 | 251100 | 0 | 2956365 | 0 | 1438402 | 0 | 14667 | 0 | 5146169 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 3 | AS OF JULY 1, 2011, GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION'S PRESIDENT IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION'S PRESIDENT: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINES 4A-B | PART I, LINES 4A-B: THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT IN CALENDAR 2011. THESE AMOUNTS WERE INCLUDED IN COLUMN B(III): PATRICIA CASSIDY - $1,031,555 PAUL WHELTON - $432,802 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES THE FOLLOWING SEVERANCE AMOUNTS WHICH WERE UNPAID AS OF 12/31/11: PATRICIA CASSIDY - $121,005 ($60,503 WAS PAID IN 2012 AND $60,502 TO BE PAID IN 2013) PAUL WHELTON - $1,427,198 ($930,012 WAS PAID IN 2012 AND $497,186 TO BE PAID IN 2013) PART I, LINE 4A: THE FOLLOWING INDIVIDUAL RECEIVED A CHANGE-OF-CONTROL PAYMENT IN CALENDAR 2011. THIS AMOUNT WAS INCLUDED IN COLUMN B(III): KENNETH FISHBAIN - $162,500 PART I, LINE 4B: THE FOLLOWING IS A PARTICIPANT IN THE TRINITY HEALTH PENSION RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2011). THE FOLLOWING ACCRUAL FOR 2011 FOR THIS PLAN IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: LARRY GOLDBERG - $5,686 THE FOLLOWING IS A PARTICIPANT IN THE LOYOLA UNIVERSITY MEDICAL CENTER RETIREMENT RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2011). THE FOLLOWING TAXABLE AMOUNT FOR 2011 FOR THIS PLAN IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: PATRICIA CASSIDY - $145,408 PART II: THE FOLLOWING INDIVIDUAL BECAME VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) DURING CALENDAR 2011. AS A RESULT, THE VESTED AMOUNT WAS INCLUDED IN HIS 2011 TAXABLE INCOME. THE FOLLOWING VESTED SERP AMOUNT IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: PAUL WHELTON - $2,362,626 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION IS GOTTLIEB MEMORIAL HOSPITAL. SEE LINE 7 FOR ADDITIONAL INFORMATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | GOTTLIEB MEMORIAL HOSPITAL IS THE SOLE MEMBER OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION. GOTTLIEB MEMORIAL HOSPITAL HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 7B | AS SOLE MEMBER, GOTTLIEB MEMORIAL HOSPITAL MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. GOTTLIEB MEMORIAL HOSPITAL MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY THE TRINITY HOME OFFICE TAX DEPARTMENT BASED ON INFORMATION PROVIDED BY A MULTI-DISCIPLINARY TEAM OF LOYOLA AND GOTTLIEB STAFF. A DETAILED SUMMARY OF THE DRAFT FROM 990 IS PRESENTED TO THE ORGANIZATION'S BOARD FINANCE & PLANNING COMMITTEE AND THE ORGANIZATION'S OFFICERS ARE PROVIDED A COPY OF THE ORGANIZATION'S DRAFT FORM 990 (INCLUDING ALL KEY REQUIRED SCHEDULES). THE COMPLETE FORM 990 IS PROVIDED TO THE GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION BOARD IN ELECTRONIC FORM, PRIOR TO FINALIZING AND FILING THE FORM. | |
| FORM 990, PART VI, SECTION B, LINE 12C | GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE REVIEWED WITH THE BOARD OF DIRECTORS OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION ON AN ANNUAL BASIS. | |
| FORM 990, PART VI, SECTION B, LINE 15 | TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | EFFECTIVE JULY 1, 2011, GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. | |
| FORM 990, PART VII, SECTION A, LINE 1, COLUMN B: | THE HOURS LISTED IN COLUMN B OF PART VII, SECTION A, LINE 1 REFLECT ONLY THE INDIVIDUALS' AVERAGE WEEKLY HOURS SPENT DIRECTLY ON THE ACTIVITIES OF THE REPORTING ORGANIZATION. IN ADDITION, THESE ARE THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: PATRICIA CASSIDY - 30 HOURS ELLYN CHIN - 30 HOURS KENNETH FISHBAIN - 30 HOURS LARRY GOLDBERG - 43 HOURS JILL RAPPIS - 45 HOURS | ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: |
| FORM 990, PART XI, LINE 5: | EQUITY TRANSFERS TO AFFILIATES -9,281,794. OTHER TRANSACTIONS -1,481. PURCHASE ACCOUNTING ADJUSTMENTS DUE TO ACQUISITION BY TRINITY HEALTH CORP. 3,697,230. TOTAL TO FORM 990, PART XI, LINE 5: -5,586,045. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2: | GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY12 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (96 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP | |||||||||||
| 245 STATE ST SE | GRAND RAPIDS | MI | 49503 | 272491974 | HEALTHCARE SERVICES | MI | 501(C)(3) | 9 | TRINITY HEALTH-MICHIGAN | 0 | |
| AMICARE HOSPICE SERVICES INC | |||||||||||
| 20555 VICTOR PARKWAY | LIVONIA | MI | 48152 | 382949053 | PROVIDE HOSPICE SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HOME HEALTH SERVICES INC | 0 | |
| AUXILIARY OF HOLY ROSARY HOSPITAL | |||||||||||
| 351 SW 9TH STREET | ONTARIO | OR | 97914 | 943059469 | SUPPORTS SERVICES OF RELATED HOSPITAL | OR | 501(C)(3) | 9 | SAINT ALPHONSUS MEDICAL CENTER-ONTARIO | 0 | |
| BAUM HARMON MERCY HOSPITAL | |||||||||||
| 255 NORTH WELCH AVENUE | PRIMGHAR | IA | 51245 | 421500277 | ACUTE/AMBULATORY HEALTHCARE SERVICES | IA | 501(C)(3) | 3 | MERCY HEALTH SERVICES-IOWA CORP | 0 | |
| BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION | |||||||||||
| 255 NORTH WELCH AVENUE | PRIMGHAR | IA | 51245 | 262973307 | SUPPORT THE SERVICES OF RELATED HOSPITAL | IA | 501(C)(3) | 11, TYPE I | BAUM HARMON MERCY HOSPITAL | 0 | |
| CATHERINE MCAULEY HEALTH SERVICES CORP | |||||||||||
| PO BOX 995 | ANN ARBOR | MI | 48106 | 382507173 | FURTHER TRINITY HEALTH ACTIVITIES, ORGANIZE AND DEVELOP MEDICAL SERVICES | MI | 501(C)(3) | 11, TYPE II | TRINITY HEALTH-MICHIGAN | 0 | |
| COMMUNITY HEALTH PARTNERS OF SOUTH BEND | |||||||||||
| PO BOX 3998 | SOUTH BEND | IN | 46619 | 263051440 | HEALTHCARE SERVICES | IN | 501(C)(3) | 3 | SAINT JOSEPH REGIONAL MEDICAL CENTER INC | 0 | |
| CRANBROOK HOSPICE CARE | |||||||||||
| 281 ENTERPRISE COURT | BLOOMFIELD HILLS | MI | 48302 | 383320699 | PROVIDE HOSPICE HEALTH SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HOME HEALTH SERVICES INC | 0 | |
| DILEY RIDGE MEDICAL CENTER | |||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 342032340 | HOSPITAL CAMPUS IN FAIRFIELD COUNTY OHIO | OH | 501(C)(3) | 3 | MOUNT CARMEL HEALTH SYSTEM | 0 | |
| DUBUQUE MERCY HEALTH FOUNDATION INC | |||||||||||
| 250 MERCY DRIVE | DUBUQUE | IA | 52001 | 262227941 | SUPPORT THE SERVICES OF RELATED HOSPITAL | IA | 501(C)(3) | 11, TYPE I | MERCY HEALTH SERVICES-IOWA CORP | 0 | |
| DYERSVILLE HEALTH FOUNDATION INC | |||||||||||
| 1111 3RD STREET SW | DYERSVILLE | IA | 52040 | 205383271 | SUPPORT THE SERVICES OF RELATED HOSPITAL | IA | 501(C)(3) | 11, TYPE I | MERCY HEALTH SERVICES-IOWA CORP | 0 | |
| GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION | |||||||||||
| 701 W NORTH AVE | MELROSE PARK | IL | 60160 | 363332852 | SUPPORT THE SERVICES OF RELATED HOSPITAL | IL | 501(C)(3) | 9 | GOTTLIEB MEMORIAL HOSPITAL | 0 | |
| GOTTLIEB MEMORIAL FOUNDATION | |||||||||||
| 701 W NORTH AVE | MELROSE PARK | IL | 60160 | 743260011 | SUPPORT THE SERVICES OF RELATED HOSPITAL | IL | 501(C)(3) | 11, TYPE III-FI | 0 | N/A | |
| GOTTLIEB MEMORIAL HOSPITAL | |||||||||||
| 701 W NORTH AVE | MELROSE PARK | IL | 60160 | 362379649 | HEALTHCARE SERVICES | IL | 501(C)(3) | 3 | LOYOLA UNIVERSITY HEALTH SYSTEM | 0 | |
| HACKLEY HOSPITAL | |||||||||||
| 1700 CLINTON ST PO BOX 3302 | MUSKEGON | MI | 494433302 | 381358196 | HEALTHCARE SERVICES | MI | 501(C)(3) | 3 | MERCY HEALTH PARTNERS | 0 | |
| HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST | |||||||||||
| PO BOX 3302 | MUSKEGON | MI | 494433302 | 382299878 | SELF INSURANCE FOR GENERAL AND MALPRACTICE LIABILITY | MI | 501(C)(3) | 11, TYPE III-FI | MERCY HEALTH PARTNERS | 0 | |
| HACKLEY LIFE COUNSELING | |||||||||||
| 1352 TERRACE ST | MUSKEGON | MI | 494423545 | 381386362 | COUNSELING, EDUCATION, AND SUPPORT | MI | 501(C)(3) | 9 | MERCY HEALTH PARTNERS | 0 | |
| HACKLEY VISITING NURSE SERVICES AND HOSPICE INC | |||||||||||
| 888 TERRACE ST | MUSKEGON | MI | 49440 | 381359598 | PROVIDE HOME HEALTH CARE SERVICES | MI | 501(C)(3) | 7 | MERCY HEALTH PARTNERS | 0 | |
| HOLY CROSS CARENET INC | |||||||||||
| PO BOX 9184 | FARMINGTON HILLS | MI | 48333 | 521945054 | LONG-TERM CARE AND REHABILITATION FOR THE ELDERLY | MD | 501(C)(3) | 9 | TRINITY CONTINUING CARE SERVICES | 0 | |
| HOLY CROSS HOSPITAL FOUNDATION INC | |||||||||||
| 11801 TECH ROAD | SILVER SPRING | MD | 20904 | 208428450 | CHARITABLE FUNDRAISING | MD | 501(C)(3) | 11, TYPE I | HOLY CROSS HOSPITAL OF SILVER SPRING | 0 | |
| HOLY CROSS HOSPITAL OF SILVER SPRING INC | |||||||||||
| 1500 FOREST GLEN RD | SILVER SPRING | MD | 209101484 | 520738041 | HEALTHCARE SERVICES | MD | 501(C)(3) | 3 | TRINITY HEALTH CORPORATION | 0 | |
| HOLY CROSS MEDICAL CENTER | |||||||||||
| 20555 VICTOR PARKWAY | LIVONIA | MI | 48152 | 951985442 | HEALTHCARE SERVICES (FORMERLY) | CA | 501(C)(3) | 3 | TRINITY HEALTH CORPORATION | 0 | |
| HOSPICE OF NORTH IOWA | |||||||||||
| 232 SECOND STREET SE | MASON CITY | IA | 504016208 | 421173708 | HOSPICE HEALTH CARE SERVICES | IA | 501(C)(3) | 7 | MERCY HEALTH SERVICES-IOWA CORP | 0 | |
| HOSPICE OF WASHTENAW II | |||||||||||
| 806 AIRPORT BLVD | ANN ARBOR | MI | 48108 | 383320707 | HOSPICE HEALTH CARE SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HEALTH-MICHIGAN | 0 | |
| HPCN | |||||||||||
| 1675 LEAHY STREET | MUSKEGON | MI | 49442 | 300207909 | HEALTHCARE SERVICES | MI | 501(C)(3) | 11, TYPE II | MERCY HEALTH PARTNERS | 0 | |
| IHA HEALTH SERVICES CORPORATION | |||||||||||
| 24 FRANK LLOYD WRIGHT DR LOBBY J | ANN ARBOR | MI | 48106 | 383316559 | PROVIDES OFFICE-BASED MEDICAL CARE | MI | 501(C)(3) | 9 | TRINITY HEALTH-MICHIGAN | 0 | |
| LAKESHORE COMMUNITY HOSPITAL INC | |||||||||||
| 72 S STATE STREET | SHELBY | MI | 494551228 | 382549295 | ACUTE HEALTHCARE SERVICES | MI | 501(C)(3) | 3 | MERCY HEALTH PARTNERS | 0 | |
| LOYOLA UNIVERSITY HEALTH SYSTEM | |||||||||||
| 2160 SOUTH FIRST AVENUE | MAYWOOD | IL | 60153 | 363342448 | HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT | IL | 501(C)(3) | 11, TYPE II | TRINITY HEALTH CORPORATION | 0 | |
| LOYOLA UNIVERSITY MEDICAL CENTER | |||||||||||
| 2160 SOUTH FIRST AVENUE | MAYWOOD | IL | 60153 | 364015560 | HEALTHCARE SERVICES | IL | 501(C)(3) | 3 | LOYOLA UNIVERSITY HEALTH SYSTEM | 0 | |
| MARIAN HOME HEALTHCARE | |||||||||||
| 801 5TH STREET | SIOUX CITY | IA | 51101 | 383320705 | PROVIDE HOME HEALTH CARE SERVICES | IA | 501(C)(3) | 11, TYPE I | MERCY HEALTH SERVICES-IOWA CORP | 0 | |
| MCAULEY CLINIC CORPORATION | |||||||||||
| PO BOX 992 | ANN ARBOR | MI | 48106 | 382561013 | HEALTHCARE SERVICES (FORMERLY) | MI | 501(C)(3) | 3 | CATHERINE MCAULEY HEALTH SERVICES CORP | 0 | |
| MERCY AMICARE HOME HEALTHCARE OAKLAND | |||||||||||
| 281 ENTERPRISE COURT | BLOOMFIELD HILLS | MI | 483020312 | 383320698 | PROVIDE HOME HEALTH CARE SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HOME HEALTH SERVICES INC | 0 | |
| MERCY AMICARE HOME HEALTHCARE PORT HURON | |||||||||||
| 505 HURON AVENUE | PORT HURON | MI | 48060 | 383320701 | PROVIDE HOME HEALTH CARE SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HOME HEALTH SERVICES INC | 0 | |
| MERCY FOUNDATION INC | |||||||||||
| 2525 SOUTH MICHIGAN AVENUE | CHICAGO | IL | 60616 | 363227350 | SUPPORTS THE SERVICES OF RELATED HEALTH CARE SYSTEM | IL | 501(C)(3) | 11, TYPE I | MERCY HEALTH SYSTEM OF CHICAGO | 0 | |
| MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE | |||||||||||
| 684 HARVEY STREET | MUSKEGON | MI | 49442 | 383321856 | PROVIDE HOME HEALTH CARE SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HOME HEALTH SERVICES INC | 0 | |
| MERCY HEALTH PARTNERS | |||||||||||
| 1415 LEAHY STREET | MUSKEGON | MI | 49442 | 382589966 | HEALTHCARE SYSTEM SUPPORT | MI | 501(C)(3) | 11, TYPE I | TRINITY HEALTH-MICHIGAN | 0 | |
| MERCY HEALTH SERVICES - IOWA CORP | |||||||||||
| 1000 4TH STREET SW | MASON CITY | IA | 50401 | 311373080 | HEALTHCARE SERVICES | DE | 501(C)(3) | 3 | TRINITY HEALTH-MICHIGAN | 0 | |
| MERCY HEALTH SYSTEM OF CHICAGO | |||||||||||
| 2525 SOUTH MICHIGAN AVENUE | CHICAGO | IL | 60616 | 363163327 | HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT | IL | 501(C)(3) | 11, TYPE I | TRINITY HEALTH CORPORATION | 0 | |
| MERCY HEALTH SYSTEM OF CHICAGO LIABILITY SELF INSURANCE TRUST | |||||||||||
| BK OF AMERICA 231 S LASALLE | CHICAGO | IL | 60697 | 912092113 | SELF INSURANCE FOR PROFESSIONAL AND COMPREHENSIVE LIABILITY | IL | 501(C)(3) | 11, TYPE III-FI | MERCY HEALTH SYSTEM OF CHICAGO | 0 | |
| MERCY HEALTHCARE FOUNDATION | |||||||||||
| 1410 N 4TH ST | CLINTON | IA | 52732 | 421316126 | FUNDRAISING AND FINANCIAL ASSISTANCE FOR HOSPITAL CHARITABLE SERVICES | IA | 501(C)(3) | 11, TYPE I | MERCY MEDICAL CENTER-CLINTON | 0 | |
| MERCY HOSPITAL AND MEDICAL CENTER | |||||||||||
| 2525 SOUTH MICHIGAN AVENUE | CHICAGO | IL | 60616 | 362170152 | HEALTHCARE SERVICES | IL | 501(C)(3) | 3 | MERCY HEALTH SYSTEM OF CHICAGO | 0 | |
| MERCY HOSPITAL CADILLAC FOUNDATION | |||||||||||
| 400 HOBART | CADILLAC | MI | 496012331 | 203357131 | SUPPORT THE SERVICES OF RELATED HOSPITAL | MI | 501(C)(3) | 11, TYPE I | TRINITY HEALTH-MICHIGAN | 0 | |
| MERCY HOSPITAL GIFT SHOP | |||||||||||
| 2601 ELECTRIC AVE | PORT HURON | MI | 48060 | 381630480 | VOLUNTEER SERVICE AUXILIARY | MI | 501(C)(3) | 11, TYPE I | TRINITY HEALTH-MICHIGAN | 0 | |
| MERCY MEDICAL CENTER - CLINTON INC | |||||||||||
| 1410 NORTH 4TH ST | CLINTON | IA | 527322940 | 421336618 | TO PROVIDE QUALITY HEALTH CARE | DE | 501(C)(3) | 3 | MERCY HEALTH SERVICES-IOWA CORP | 0 | |
| MERCY MEDICAL CENTER - SIOUX CITY FOUNDATION | |||||||||||
| 801 5TH STREET | SIOUX CITY | IA | 51102 | 141880022 | SUPPORT THE SERVICES OF RELATED HOSPITAL | IA | 501(C)(3) | 7 | MERCY HEALTH SERVICES-IOWA CORP | 0 | |
| MERCY MEDICAL CENTER FOUNDATION - NORTH IOWA | |||||||||||
| 1000 4TH STREET SW | MASON CITY | IA | 504012800 | 421229151 | SUPPORT THE SERVICES OF RELATED HOSPITAL | IA | 501(C)(3) | 11, TYPE III-FI | MERCY HEALTH SERVICES-IOWA CORP | 0 | |
| MERCY NORTH HOMECARE AND HOSPICE | |||||||||||
| 7985 MACKINAW TRAIL | CADILLAC | MI | 49601 | 383313897 | HOME HEALTH AND HOSPICE SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HOME HEALTH SERVICES INC | 0 | |
| MERCY PHYSICIAN GROUP INC | |||||||||||
| 1512 12TH AVENUE ROAD | NAMPA | ID | 83686 | 208192593 | TO PROVIDE QUALITY HEALTH CARE | ID | 501(C)(3) | 9 | SAINT ALPHONSUS MEDICAL CENTER-NAMPA | 0 | |
| MERCY SERVICES FOR AGING NON-PROFIT HOUSING CORPORATION | |||||||||||
| PO BOX 9184 | FARMINGTON HILLS | MI | 483339184 | 382719605 | PROVIDES LONG-TERM CARE FOR THE ELDERLY | MI | 501(C)(3) | 11, TYPE II | TRINITY CONTINUING CARE SERVICES INC | 0 | |
| MIDWEST MEDFLIGHT | |||||||||||
| 1300 VICTORS WAY | ANN ARBOR | MI | 48108 | 382684671 | AEROMEDICAL TRANSPORT | MI | 501(C)(3) | 9 | TRINITY HEALTH-MICHIGAN | 0 | |
| MOUNT CARMEL CARE CONTINUUM SERVICES CORP | |||||||||||
| 793 WEST STATE STREET | COLUMBUS | OH | 43222 | 311126211 | COOPERATIVE HOSPITAL SERVICE ORGANIZATION | OH | 501(C)(3) | 3 | MOUNT CARMEL HEALTH SYSTEM | 0 | |
| MOUNT CARMEL COLLEGE OF NURSING | |||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 311308555 | COLLEGE OF NURSING | OH | 501(C)(3) | 2 | MOUNT CARMEL HEALTH | 0 | |
| MOUNT CARMEL HEALTH | |||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 314379602 | HEALTHCARE SERVICES | OH | 501(C)(3) | 3 | MOUNT CARMEL HEALTH SYSTEM | 0 | |
| MOUNT CARMEL HEALTH INSURANCE COMPANY | |||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 251912781 | HEALTH INSURANCE | OH | 501(C)(4) | N/A | MOUNT CARMEL HEALTH SYSTEM | 0 | |
| MOUNT CARMEL HEALTH PLAN INC | |||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 311471229 | MEDICARE HMO FOR SENIORS | OH | 501(C)(4) | N/A | MOUNT CARMEL HEALTH SYSTEM | 0 | |
| MOUNT CARMEL HEALTH SYSTEM | |||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 311439334 | HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT | OH | 501(C)(3) | 11, TYPE I | TRINITY HEALTH CORPORATION | 0 | |
| MOUNT CARMEL HEALTH SYSTEM FOUNDATION | |||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 311113966 | SUPPORT THE SERVICES OF RELATED HOSPITAL | OH | 501(C)(3) | 11, TYPE I | MOUNT CARMEL HEALTH SYSTEM | 0 | |
| MOUNT CARMEL HOME CARE LLC | |||||||||||
| 1144 DUBLIN ROAD SUITE B | COLUMBUS | OH | 43215 | 262729300 | PROVIDE HOME HEALTH CARE SERVICES | OH | 501(C)(3) | 9 | TRINITY HOME HEALTH SERVICES INC | 0 | |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL | |||||||||||
| 7333 SMITHS MILL RD | NEW ALBANY | OH | 43054 | 870790288 | HEALTHCARE SERVICES | OH | 501(C)(3) | 3 | MOUNT CARMEL HEALTH SYSTEM | 0 | |
| MRI MOBILE SERVICES OF WEST MICHIGAN | |||||||||||
| 1820 - 44TH STREET | KENTWOOD | MI | 49508 | 383073745 | OPERATE MAGNETIC IMAGING RESONANCE (FORMERLY) | MI | 501(C)(3) | 9 | TRINITY HEALTH-MICHIGAN | 0 | |
| MUSKEGON COMMUNITY HEALTH PROJECT | |||||||||||
| 565 W WESTERN AVENUE | MUSKEGON | MI | 49440 | 911932918 | FACILITATE AND COORDINATE HEALTHCARE AND RELATED SERVICES | MI | 501(C)(3) | 7 | MERCY HEALTH PARTNERS | 0 | |
| OAKLAND MERCY HOSPITAL | |||||||||||
| 601 EAST 2ND STREET | OAKLAND | NE | 68045 | 208072234 | HEALTHCARE SERVICES | NE | 501(C)(3) | 3 | MERCY HEALTH SERVICES-IOWA CORP | 0 | |
| OAKLAND MERCY HOSPITAL FOUNDATION | |||||||||||
| 601 E 2ND STREET | OAKLAND | NE | 68045 | 311678345 | SUPPORTS SERVICES OF RELATED HOSPITAL | NE | 501(C)(3) | 11, TYPE III-FI | OAKLAND MERCY HOSPITAL | 0 | |
| PORT HURON MERCY FAMILY CARE INC | |||||||||||
| 2601 ELECTRIC AVE | PORT HURON | MI | 48060 | 201855647 | HEALTHCARE SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HEALTH-MICHIGAN | 0 | |
| PROFESSIONAL MED TEAM | |||||||||||
| 965 FORK STREET | MUSKEGON | MI | 494423257 | 382638284 | MEDICAL CARE, TRANSPORTATION AND EDUCATION | MI | 501(C)(3) | 9 | TRINITY HEALTH-MICHIGAN | 0 | |
| PROFESSIONAL OFFICE CORPORATION | |||||||||||
| 1303 EAST HERNDON AVE | FRESNO | CA | 93720 | 942839324 | HEALTHCARE SERVICES | CA | 501(C)(3) | 11, TYPE I | SAINT AGNES MEDICAL CENTER | 0 | |
| SAINT AGNES MEDICAL CENTER | |||||||||||
| 1303 EAST HERNDON AVE | FRESNO | CA | 93720 | 941437713 | HEALTHCARE SERVICES | CA | 501(C)(3) | 3 | TRINITY HEALTH CORPORATION | 0 | |
| SAINT ALPHONSUS BUILDING COMPANY INC | |||||||||||
| 1055 NORTH CURTIS RD | BOISE | ID | 83706 | 820401011 | SUPPORTS SERVICES OF RELATED HOSPITAL | ID | 501(C)(3) | 11, TYPE I | SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC | 0 | |
| SAINT ALPHONSUS DIVERSIFIED CARE INC | |||||||||||
| 1055 NORTH CURTIS RD | BOISE | ID | 83706 | 943028978 | SUPPORTS SERVICES OF RELATED HOSPITAL | ID | 501(C)(3) | 11, TYPE I | SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC | 0 | |
| SAINT ALPHONSUS FOUNDATION-BAKER CITY INC | |||||||||||
| 3325 POCAHONTAS ROAD | BAKER CITY | OR | 97814 | 943164869 | SUPPORT THE SERVICES OF RELATED HOSPITAL | OR | 501(C)(3) | 7 | SAINT ALPHONSUS MEDICAL CENTER - BAKER CITY | 0 | |
| SAINT ALPHONSUS FOUNDATION-ONTARIO INC | |||||||||||
| 351 SW 9TH STREET | ONTARIO | OR | 97914 | 202683560 | SUPPORT THE SERVICES OF RELATED HOSPITAL | OR | 501(C)(3) | 11, TYPE I | SAINT ALPHONSUS MEDICAL CENTER-ONTARIO | 0 | |
| SAINT ALPHONSUS HEALTH SYSTEM INC | |||||||||||
| 1055 N CURTIS ROAD | BOISE | ID | 83706 | 271929502 | HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT | ID | 501(C)(3) | 11, TYPE I | TRINITY HEALTH CORPORATION | 0 | |
| SAINT ALPHONSUS MEDICAL CENTER-BAKER CITY | |||||||||||
| 3325 POCAHONTAS ROAD | BAKER CITY | OR | 97814 | 271790052 | TO PROVIDE QUALITY HEALTH CARE | OR | 501(C)(3) | 3 | SAINT ALPHONSUS HEALTH SYSTEM INC | 0 | |
| SAINT ALPHONSUS MEDICAL CENTER-NAMPA | |||||||||||
| 1512 12TH AVENUE ROAD | NAMPA | ID | 83686 | 820200896 | TO PROVIDE QUALITY HEALTH CARE | ID | 501(C)(3) | 3 | SAINT ALPHONSUS HEALTH SYSTEM INC | 0 | |
| SAINT ALPHONSUS MEDICAL CENTER-NAMPA HEALTH FOUNDATION INC | |||||||||||
| 1512 12TH AVENUE ROAD | NAMPA | ID | 83686 | 261737256 | SUPPORT THE SERVICES OF RELATED HOSPITAL | ID | 501(C)(3) | 7 | SAINT ALPHONSUS MEDICAL CENTER-NAMPA | 0 | |
| SAINT ALPHONSUS MEDICAL CENTER-ONTARIO | |||||||||||
| 351 SW 9TH STREET | ONTARIO | OR | 97914 | 271789847 | TO PROVIDE QUALITY HEALTH CARE | OR | 501(C)(3) | 3 | SAINT ALPHONSUS HEALTH SYSTEM INC | 0 | |
| SAINT ALPHONSUS REGIONAL MEDICAL CENTER | |||||||||||
| 1055 NORTH CURTIS RD | BOISE | ID | 83706 | 820200895 | HEALTHCARE SERVICES | ID | 501(C)(3) | 3 | SAINT ALPHONSUS HEALTH SYSTEM INC | 0 | |
| SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC | |||||||||||
| 1915 LAKE AVENUE PO BOX 670 | PLYMOUTH | IN | 46563 | 351142669 | HEALTHCARE SERVICES | IN | 501(C)(3) | 3 | SAINT JOSEPH REGIONAL MEDICAL CENTER INC | 0 | |
| SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC | |||||||||||
| PO BOX 1935 | SOUTH BEND | IN | 466341935 | 350868157 | HEALTHCARE SERVICES | IN | 501(C)(3) | 3 | SAINT JOSEPH REGIONAL MEDICAL CENTER INC | 0 | |
| SAINT JOSEPH REGIONAL MEDICAL CENTER MISHAWAKA AUXILIARY INC | |||||||||||
| 5215 HOLY CROSS PARKWAY | MISHAWAKA | IN | 46545 | 356033285 | HOSPITAL SERVICE AUXILIARY | IN | 501(C)(4) | N/A | SAINT JOSEPH REGIONAL MEDICAL CENTER-S BEND | 0 | |
| SAINT JOSEPH REGIONAL MEDICAL CENTER PLYMOUTH AUXILIARY INC | |||||||||||
| 1915 LAKE AVENUE | PLYMOUTH | IN | 46563 | 356043563 | HOSPITAL SERVICE AUXILIARY | IN | 501(C)(3) | 11, TYPE II | SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH | 0 | |
| SAINT JOSEPH REGIONAL MEDICAL CENTER INC | |||||||||||
| 801 EAST LASALLE AVE | SOUTH BEND | IN | 46617 | 351568821 | HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT | IN | 501(C)(3) | 11, TYPE I | TRINITY HEALTH CORPORATION | 0 | |
| SAINT JOSEPH'S TOWER INC | |||||||||||
| PO BOX 9184 | FARMINGTON HILLS | MI | 483339184 | 311040468 | PROVIDES HOUSING FOR LOW INCOME ELDERLY INDIVIDUALS | IN | 501(C)(3) | 9 | TRINITY CONTINUING CARE SERVICES-INDIANA | 0 | |
| SAINT MARY'S AMICARE HOME HEALTHCARE | |||||||||||
| 1430 MONROE NW | GRAND RAPIDS | MI | 49505 | 383320700 | PROVIDE HOME HEALTH CARE SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HOME HEALTH SERVICES INC | 0 | |
| SAINT MARY'S FOUNDATION (FKA SAINT MARY'S DORAN FOUNDATION) | |||||||||||
| 200 JEFFERSON ST SE | GRAND RAPIDS | MI | 49503 | 381779602 | SUPPORTS SERVICES OF RELATED HOSPITAL | MI | 501(C)(3) | 7 | TRINITY HEALTH-MICHIGAN | 0 | |
| ST JOSEPH MERCY OAKLAND FOUNDATION | |||||||||||
| 44405 WOODWARD AVE | PONTIAC | MI | 48341 | 352356789 | SUPPORTS SERVICES OF RELATED HOSPITAL | MI | 501(C)(3) | 11, TYPE I | TRINITY HEALTH-MICHIGAN | 0 | |
| ST ANN'S HOSPITAL | |||||||||||
| 500 SOUTH CLEVELAND AVE | WESTERVILLE | OH | 43081 | 314412701 | HEALTHCARE SERVICES | OH | 501(C)(3) | 3 | MOUNT CARMEL HEALTH SYSTEM | 0 | |
| THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER | |||||||||||
| 4215 EDISON LAKES PARKWAY | MISHAWAKA | IN | 46545 | 351654543 | SUPPORTS SERVICES OF RELATED HOSPITAL | IN | 501(C)(3) | 11, TYPE I | SAINT JOSEPH REGIONAL MEDICAL CENTER INC | 0 | |
| TRI-HOSPITAL MRI CENTER | |||||||||||
| 4190 24TH AVENUE | FORT GRATIOT | MI | 48054 | 382884297 | MRI SERVICES | MI | 501(C)(3) | 3 | TRINITY HEALTH-MICHIGAN | 0 | |
| TRINITY CONTINUING CARE SERVICES | |||||||||||
| PO BOX 9184 | FARMINGTON HILLS | MI | 483339184 | 382559656 | MANAGEMENT SERVICES FOR LONG TERM CARE AND SENIOR LIVING FACILITIES | MI | 501(C)(3) | 11, TYPE I | TRINITY HEALTH CORPORATION | 0 | |
| TRINITY CONTINUING CARE SERVICES - INDIANA INC | |||||||||||
| PO BOX 9184 | FARMINGTON HILLS | MI | 483339184 | 930907047 | PROVIDES LONG-TERM CARE AND RESIDENTIAL HOUSING | IN | 501(C)(3) | 9 | TRINITY CONTINUING CARE SERVICES | 0 | |
| TRINITY HEALTH - MICHIGAN | |||||||||||
| 20555 VICTOR PARKWAY | LIVONIA | MI | 48152 | 382113393 | HEALTHCARE SERVICES | MI | 501(C)(3) | 3 | TRINITY HEALTH CORPORATION | 0 | |
| TRINITY HEALTH CORPORATION | |||||||||||
| 20555 VICTOR PARKWAY | LIVONIA | MI | 48152 | 351443425 | HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT | IN | 501(C)(3) | 11, TYPE I | 0 | N/A | |
| TRINITY HEALTH INTERNATIONAL | |||||||||||
| 20555 VICTOR PARKWAY | LIVONIA | MI | 48152 | 421253527 | HEALTHCARE TRAINING AND SUPPORT SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HEALTH CORPORATION | 0 | |
| TRINITY HEALTH WELFARE BENEFIT TRUST | |||||||||||
| 20555 VICTOR PARKWAY | LIVONIA | MI | 48152 | 208151733 | RETIREE MEDICAL AND RETIREE LIFE INSURANCE COVERAGE | MI | 501(C)(9) | N/A | TRINITY HEALTH CORPORATION | 0 | |
| TRINITY HOME HEALTH SERVICES INC | |||||||||||
| 17410 COLLEGE PARKWAY | LIVONIA | MI | 48152 | 382621935 | HOME HEALTH CARE SYSTEM MANAGEMENT SERVICES | MI | 501(C)(3) | 11, TYPE I | TRINITY HEALTH CORPORATION | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (32 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|
| ADVENT REHABILITATION LLC | ||||||||||
| 607 DEWEY AVENUE SUITE 300 | GRAND RAPIDS | MI | 49504 | 383306673 | REHABILITATION THERAPY SERVICES | MI | N/A | N/A | 0 | 0 |
| BIG RUN MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP | ||||||||||
| 793 W STATE STREET | COLUMBUS | OH | 43222 | 311608125 | MEDICAL OFFICE BUILDING RENTAL | OH | N/A | N/A | 0 | 0 |
| CENTER FOR DIGESTIVE CARE LLC | ||||||||||
| 5300 ELLIOTT DRIVE | YPSILANTI | MI | 48197 | 030447062 | PROVIDE GASTROINTESTINAL SERVICES | MI | N/A | N/A | 0 | 0 |
| CENTRAL OHIO SLEEP MEDICINE LTD | ||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 311701029 | SLEEP MEDICINE SERVICES | OH | N/A | N/A | 0 | 0 |
| CLINTON IMAGING SERVICES LLC | ||||||||||
| 615 VALLEY VIEW DR STE 202 | MOLINE | IL | 61265 | 412044739 | MRI DIAGNOSTIC SERVICES | IA | N/A | N/A | 0 | 0 |
| FOREST PARK IMAGING LLC | ||||||||||
| 1000 4TH STREET SW | MASON CITY | IA | 50401 | 134365966 | X-RAY AND MAMMOGRAPHY SERVICES | IA | N/A | N/A | 0 | 0 |
| FRANCES WARDE MEDICAL LABORATORY | ||||||||||
| 300 WEST TEXTILE ROAD | ANN ARBOR | MI | 48104 | 382648446 | LABORATORY | MI | N/A | N/A | 0 | 0 |
| FRESNO IMAGING CENTER | ||||||||||
| 1303 E HERNDON AVE | FRESNO | CA | 93720 | 770363563 | DIAGNOSTIC IMAGING | CA | N/A | N/A | 0 | 0 |
| HAWARDEN REGIONAL HEALTH CLINICS LLC | ||||||||||
| 1122 AVENUE L | HAWARDEN | IA | 51023 | 201444339 | MEDICAL CLINIC | IA | N/A | N/A | 0 | 0 |
| IDAHO GYNONCOLOGY SERVICES LLC | ||||||||||
| 1055 N CURTIS RD | BOISE | ID | 83706 | 202975807 | PROVIDE GYN ONCOLOGY SERVICES | ID | N/A | N/A | 0 | 0 |
| INTERMOUNTAIN MEDICAL IMAGING LLC | ||||||||||
| 877 WEST MAIN ST STE 603 | BOISE | ID | 83702 | 820514422 | PROVIDE IMAGING SERVICES | ID | N/A | N/A | 0 | 0 |
| LOYOLA AMBULATORY SURGERY CENTER | ||||||||||
| 1S224 SUMMIT AVE STE 201 | OAKBROOK TERRACE | IL | 60181 | 364119522 | SURGICAL SERVICES | IL | N/A | N/A | 0 | 0 |
| MAGNETIC RESONANCE SERVICES PARTNERSHIP | ||||||||||
| 1416 SIXTH STREET SW | MASON CITY | IA | 50401 | 421328388 | MRI SERVICES | IA | N/A | N/A | 0 | 0 |
| MASON CITY AMBULATORY SURGERY CENTER LLC | ||||||||||
| 990 4TH STREET SW | MASON CITY | IA | 50401 | 201960348 | SURGERY-SAME DAY | IA | N/A | N/A | 0 | 0 |
| MCE MOB IV LIMITED PARTNERSHIP | ||||||||||
| 793 W STATE STREET | COLUMBUS | OH | 43222 | 421544707 | MEDICAL OFFICE BUILDING RENTAL | OH | N/A | N/A | 0 | 0 |
| MCMC POB III LIMITED PARTNERSHIP | ||||||||||
| 793 W STATE STREET | COLUMBUS | OH | 43222 | 311392994 | MEDICAL OFFICE BUILDING RENTAL | OH | N/A | N/A | 0 | 0 |
| MEDILUCENT MOB I | ||||||||||
| 793 W STATE STREET | COLUMBUS | OH | 43222 | 204911370 | MEDICAL OFFICE BUILDING RENTAL | OH | N/A | N/A | 0 | 0 |
| MERCY ADVANCED MRI LLC | ||||||||||
| 2525 SOUTH MICHIGAN AVE | CHICAGO | IL | 60616 | 262116721 | SUBLEASE MRI EQUIPMENT | IL | N/A | N/A | 0 | 0 |
| MERCY HEART & VASCULAR LLC | ||||||||||
| 2525 SOUTH MICHIGAN AVE | CHICAGO | IL | 60616 | 205272726 | SUBLEASE CT EQUIPMENT | IL | N/A | N/A | 0 | 0 |
| MERCY HEART CTR OP SERVICES LLC | ||||||||||
| 1000 4TH STREET SW | MASON CITY | IA | 50401 | 134237594 | CARDIOVASCULAR SERVICES | IA | N/A | N/A | 0 | 0 |
| MERCY OUTPATIENT SURGERY CENTER LLC | ||||||||||
| 1512 12TH AVENUE ROAD | NAMPA | ID | 83686 | 841380439 | OUTPATIENT SURGERY | ID | N/A | N/A | 0 | 0 |
| MICHIANA HEALTH INFORMATION NETWORK LLC | ||||||||||
| 215 WEST MADISON STREET | SOUTH BEND | IN | 46601 | 352050128 | COMMUNITY BASED CLINICAL INFO SYS & DATA DEPOSITORY | IN | N/A | N/A | 0 | 0 |
| MOUNT CARMEL EAST POB III LIMITED PARTNERSHIP | ||||||||||
| 793 W STATE STREET | COLUMBUS | OH | 43222 | 311369473 | MEDICAL OFFICE BUILDING RENTAL | OH | N/A | N/A | 0 | 0 |
| NEWCO AMBULATORY SURGERY CTR LLP | ||||||||||
| 4190 24TH AVENUE | FORT GRATIOT | MI | 48059 | 300136708 | OUTPATIENT SURGERY CENTER | MI | N/A | N/A | 0 | 0 |
| RIVERVIEW MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP | ||||||||||
| 793 W STATE STREET | COLUMBUS | OH | 43222 | 311531135 | MEDICAL OFFICE BUILDING RENTAL | OH | N/A | N/A | 0 | 0 |
| SARMED OUTPATIENT PHARMACY LLC | ||||||||||
| 999 N CURTIS RD STE 102 | BOISE | ID | 83706 | 510483218 | PHARMACY | ID | N/A | N/A | 0 | 0 |
| SIXTY FOURTH STREET LLC | ||||||||||
| 2373 64TH ST STE 2200 | BYRON CENTER | MI | 49315 | 202443646 | PROVIDE OUTPATIENT SURGICAL CARE | MI | N/A | N/A | 0 | 0 |
| ST ALPHONSUS CALDWELL CANCER CTR LLC | ||||||||||
| 3123 MEDICAL DR | CALDWELL | ID | 83605 | 820526861 | RADIATION ONCOLOGY | ID | N/A | N/A | 0 | 0 |
| ST ANN'S MEDICAL OFFICE BLDG II LIMITED PARTNERSHIP | ||||||||||
| 793 W STATE STREET | COLUMBUS | OH | 43222 | 311603660 | MEDICAL OFFICE BUILDING RENTAL | OH | N/A | N/A | 0 | 0 |
| TAMARACK MEDICAL CLINIC LLC | ||||||||||
| 610 VILLAGE DRIVE | DONNELLY | ID | 83615 | 201637921 | OUTPATIENT MEDICAL SERVICES | ID | N/A | N/A | 0 | 0 |
| WESTAR MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP | ||||||||||
| 793 W STATE STREET | COLUMBUS | OH | 43222 | 311784409 | MEDICAL OFFICE BUILDING RENTAL | OH | N/A | N/A | 0 | 0 |
| WOODLAND IMAGING CENTER LLC | ||||||||||
| 5301 E HURON RIVER DR | ANN ARBOR | MI | 48106 | 760820959 | RADIOLOGY/IMAGING | MI | N/A | N/A | 0 | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (30 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | CountryAddressForeign/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HEALTH VENTURES INC | ||||||||||||||||
| 565 W WESTERN AVE | MUSKEGON | MI | 49440 | 383522260 | SOFTWARE MARKETING | MI | N/A | C | ||||||||
| GOTTLIEB MANAGEMENT SERVICES INC | ||||||||||||||||
| 701 W NORTH AVE | MELROSE PARK | IL | 60160 | 363330529 | MANAGEMENT SERVICES | IL | C | GOTTLIEB COMMUNITY HLTH SVCS | 288238 | 1589620 | 1.00000 | |||||
| HACKLEY HEALTH MANAGEMENT CENTER | ||||||||||||||||
| 1415 LEAHY ST | MUSKEGON | MI | 49442 | 382961814 | WEIGHT MANAGEMENT | MI | N/A | C | ||||||||
| HACKLEY HEALTH VENTURES INC | ||||||||||||||||
| 1415 LEAHY ST | MUSKEGON | MI | 49442 | 382589959 | OTHER MEDICAL SERVICES | MI | N/A | C | ||||||||
| HACKLEY HEALTHCARE EQUIPMENT | ||||||||||||||||
| 1415 LEAHY ST | MUSKEGON | MI | 49442 | 382578569 | HOME MEDICAL EQUIPMENT | MI | N/A | C | ||||||||
| HACKLEY PROFESSIONAL CENTER | ||||||||||||||||
| 1415 LEAHY ST | MUSKEGON | MI | 49442 | 383024797 | REAL ESTATE RENTAL | MI | N/A | C | ||||||||
| HACKLEY PROFESSIONAL PHARMACY | ||||||||||||||||
| 1415 LEAHY ST | MUSKEGON | MI | 49442 | 382447870 | PHARMACY | MI | N/A | C | ||||||||
| HEF INC | ||||||||||||||||
| 1415 LEAHY ST | MUSKEGON | MI | 49442 | 383086401 | OFFICE STAFFING | MI | N/A | C | ||||||||
| HOLY CROSS PRIVATE HOME SERVICES CORP | ||||||||||||||||
| 11801 TECH ROAD | SILVER SPRING | MD | 20904 | 521986562 | HOME CARE SERVICES | MD | N/A | C | ||||||||
| HPC CO-OWNERS ASSOCIATION | ||||||||||||||||
| 1700 CLINTON | MUSKEGON | MI | 49442 | 270734448 | CONDOMINIUM ASSOCIATION | MI | N/A | C | ||||||||
| HURON ARBOR CORPORATION | ||||||||||||||||
| 5301 EAST HURON RIVER DR PO BOX 992 | ANN ARBOR | MI | 48106 | 382475644 | PROVIDES OFFICE RENTAL SPACE | MI | N/A | C | ||||||||
| IHA AFFILIATION CORPORATION | ||||||||||||||||
| 24 FRANK LLOYD WRIGHT DR LOBBY J | ANN ARBOR | MI | 48106 | 383188895 | MEDICAL MANAGEMENT | MI | N/A | C | ||||||||
| LOYOLA UNIVERSITY OF CHICAGO INSURANCE CO LTD | ||||||||||||||||
| PROVISION OF INSURANCE COVERAGE | N/A | C | 23 LIME TREE BAY AVENUE | GRAND CAYMAN | CJ | CJ | ||||||||||
| MARYLAND CARE GROUP INC | ||||||||||||||||
| 11801 TECH ROAD | SILVER SPRING | MD | 20904 | 521815313 | HEALTHCARE HOLDING | MD | N/A | C | ||||||||
| MEDNOW INC | ||||||||||||||||
| 1512 12TH AVENUE ROAD | NAMPA | ID | 83686 | 820389927 | OUTPATIENT PHARMACY | ID | N/A | C | ||||||||
| MERCY MEDICAL SERVICES | ||||||||||||||||
| 801 5TH STREET | SIOUX CITY | IA | 51101 | 421283849 | PRIMARY CARE PHYSICIANS | IA | N/A | C | ||||||||
| MERCY SERVICES CORPORATION | ||||||||||||||||
| 2525 SOUTH MICHIGAN AVENUE | CHICAGO | IL | 60616 | 363227348 | DORMANT | IL | N/A | C | ||||||||
| MICHIGAN ATHLETIC CLUB | ||||||||||||||||
| 2500 BURTON | GRAND RAPIDS | MI | 49546 | 382647304 | ATHLETIC CLUB | MI | N/A | C | ||||||||
| MOUNT CARMEL BEHAVIORAL HEALTHCARE SERVICES INC | ||||||||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 310971510 | BEHAVIORAL HEALTHCARE SERVICES | OH | N/A | C | ||||||||
| MOUNT CARMEL HEALTH PROVIDERS INC | ||||||||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 311382442 | MEDICAL SERVICES | OH | N/A | C | ||||||||
| NORTH IOWA MERCY MEDICAL SERVICES INC | ||||||||||||||||
| 1000 4TH ST SW | MASON CITY | IA | 50401 | 421382308 | MEDICAL SERVICES | IA | N/A | C | ||||||||
| PRIORITY PLUS OF CALIFORNIA | ||||||||||||||||
| PO BOX 27230 | FRESNO | CA | 93729 | 770395267 | FORMERLY HLTH MGMT NOW DISCONTINUED OPERATIONS | CA | N/A | C | ||||||||
| SAINT ALPHONSUS PHYSICIANS PA | ||||||||||||||||
| 1055 NORTH CURTIS ROAD | BOISE | ID | 837061370 | 331078261 | PHYSICIANS | ID | N/A | C | ||||||||
| SAINT MARY'S HEALTH MANAGEMENT COMPANY | ||||||||||||||||
| 1640 EAST PARIS SE | GRAND RAPIDS | MI | 49546 | 383450733 | ATHLETIC CLUB | MI | N/A | C | ||||||||
| SURGERY CENTER FINANCING CORPORATION | ||||||||||||||||
| 6150 EAST BROAD STREET | COLUMBUS | OH | 43213 | 311531102 | FINANCE, INSURANCE AND REAL ESTATE | OH | N/A | C | ||||||||
| THRE SERVICES LLC | ||||||||||||||||
| 20555 VICTOR PARKWAY | LIVONIA | MI | 48152 | 452603654 | REAL ESTATE BROKERAGE SERVICES | MI | N/A | C | ||||||||
| TRINITY HEALTH EMPLOYEE BENEFIT TRUST | ||||||||||||||||
| 20555 VICTOR PARKWAY | LIVONIA | MI | 48152 | 383410377 | GRANTOR TRUST | MI | N/A | T | ||||||||
| VENZKE INSURANCE COMPANY LTD | ||||||||||||||||
| 980453602 | PROVISION OF INSURANCE COVERAGE | N/A | C | PO BOX 1051 GRAND CAYMAN | GRAND CAYMAN | CJ | CJ | |||||||||
| WESTSHORE HEALTH NETWORK | ||||||||||||||||
| 1820 44TH STREET | KENTWOOD | MI | 49508 | 383280200 | PHYSICIAN HOSPITAL ORGANIZATION | MI | N/A | C | ||||||||
| WORKPLACE HEALTH OF GRAND HAVEN | ||||||||||||||||
| 1415 LEAHY ST | MUSKEGON | MI | 49442 | 383112035 | OCCUPATIONAL HEALTH | MI | N/A | C | ||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| LOYOLA UNIVERSITY MEDICAL CENTER | ||
| K | 461000 | PER BOOKS |
| GOTTLIEB MEMORIAL HOSPITAL | ||
| B | 8374927 | PER BOOKS |
| GOTTLIEB MEMORIAL HOSPITAL | ||
| J | 82394 | PER BOOKS |
| GOTTLIEB MANAGEMENT SERVICES INC | ||
| B | 906867 | PER BOOKS |
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