2018-08-14T12:04:03-05:00 2017-09-30 381357951 PLANTE & MORAN PLLC 511 Renaissance Dr Ste 120 St Joseph MI 49085 990 2016-10-01 382539929 LAKELAND HEALTH FOUNDATION BENTON HARBOR/ST JOSEPH LAKE 2699838300 1234 NAPIER AVE ST JOSEPH MI 49085 timothy calhoun VP - FINANCE & CFO 2699838300 2018-08-13 1 Carol LaLonde CPA P00181637 2699828000 2018-08-06 2016 2022-09-23 18:48:47Z DAVID BURGHART 1234 NAPIER AVE ST JOSEPH MI 49085 13772690 0 X LAKELANDHEALTH.ORG/LAKELAND-HEALTH-FOUNDATIONS X 1984 MI TO PROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM. 31 29 0 31 0 0 1380756 4183555 0 0 371083 909066 -13490 -22591 1738349 5070030 1541751 3217143 0 0 0 0 0 0 0 151635 204417 1693386 3421560 44963 1648470 18637915 20508537 673176 358138 17964739 20150399 TO ENHANCE HEALTH AND SERVE OUR COMMUNITY. 0 0 3037641 3037641 THE FOUNDATION DISTRIBUTED FUNDS TO A LOCAL AREA HOSPITAL FOR BETTER EQUIPMENT AND FACILITIES. THE FOUNDATION ALSO DISTRIBUTED FUNDS TO LOCAL NOT FOR PROFIT ENTITIES. 179502 179502 THE FOUNDATION DISTRIBUTED FUNDS TO 54 LOCAL HEALTH CARE STUDENTS FOR TUITION RELATED EXPENSES. THE FOUNDATION ALSO DISTRIBUTED FUNDS TO 15 ASSOCIATES IN NEED OF ASSISTANCE. 3217143 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 6 0 1 0 0 0 0 0 0 0 0 0 0 0 X 31 29 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X STACY WAHLSTROM 2696871147 3776 HOLLYWOOD RD ST JOSEPH MI 49085 RICHARD DYER CHAIR 2.00 0.00 X X 0 0 0 DANA WALES VICE CHAIR 1.00 0.00 X X 0 0 0 LUCAS BROWN SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 BRANDI SMITH-GORDON VP AND FOUNDATION PRESIDENT 20.00 10.00 X X 0 86197 274 RANDY BETTICH PAST CHAIR 1.00 0.00 X X 0 0 0 LOREN HAMEL MD DIRECTOR AND LAKELAND CFO 1.00 42.00 X X 0 823810 60765 DAVID BURGHART VP AND FOUNDATION PRESIDENT - PY 20.00 10.00 X X 0 200198 28062 MIKE BIRKHOLM DIRECTOR 1.00 0.00 X 0 0 0 SANDI BOWMAN DIRECTOR 1.00 0.00 X 0 0 0 RICHARD BUCKALEW DIRECTOR 1.00 0.00 X 0 0 0 JAMES CLEVER DIRECTOR 1.00 0.00 X 0 0 0 WENDY EDWARDS DIRECTOR 1.00 0.00 X 0 0 0 DAVE EIFLER DIRECTOR 1.00 0.00 X 0 0 0 MARC FLORIAN DIRECTOR 1.00 0.00 X 0 0 0 SANDY GARLAND DIRECTOR 1.00 1.00 X 0 0 0 KC GAST DIRECTOR 1.00 0.00 X 0 0 0 ROBERT GOTTLIEB DIRECTOR 1.00 0.00 X 0 0 0 BRITTANY GRASLEY DIRECTOR 1.00 0.00 X 0 0 0 CAROLYN HANSON DIRECTOR 1.00 0.00 X 0 0 0 GYL KASEWURM DIRECTOR 1.00 0.00 X 0 0 0 SHANE LIES DIRECTOR 1.00 0.00 X 0 0 0 KURT MARZKE DIRECTOR 1.00 0.00 X 0 0 0 BARBARA MEEKS DIRECTOR 1.00 0.00 X 0 0 0 RANDALL MILLER DIRECTOR 1.00 0.00 X 0 0 0 TIM PASSARO DIRECTOR 1.00 0.00 X 0 0 0 DON RADDE DIRECTOR 1.00 0.00 X 0 0 0 EBON SANDERS DIRECTOR 1.00 0.00 X 0 0 0 STEPHEN SMITH DIRECTOR 1.00 0.00 X 0 0 0 CAROL STARKS DIRECTOR 1.00 0.00 X 0 0 0 DENNIS SZYMANSKI MD DIRECTOR 1.00 0.00 X 0 0 0 KAY VARGA-SMITH DIRECTOR 1.00 0.00 X 0 0 0 MARGE WIATROWSKI DIRECTOR 1.00 0.00 X 0 0 0 TIMOTHY CALHOUN VP - FINANCE & CFO 5.00 49.00 X 0 434519 45031 0 1544724 134132 0 0 1 0 0 143086 4040469 4183555 385683 385683 9180872 8657489 523383 523383 523383 18410 143086 40723 -22313 -22313 4170 4448 -278 -278 5070030 0 0 886475 3037641 3037641 179502 179502 117984 117984 BAD DEBT EXPENSE 86433 86433 3421560 3217143 204417 0 503445 1241435 1136379 2506645 16998091 15127041 0 1633416 18637915 20508537 56268 106827 616908 251311 673176 358138 X 6051594 6532647 2151945 3839052 9761200 9778700 17964739 20150399 18637915 20508537 X 1648470 544142 -6952 X X 0 1 X 1 0 X 2737959 12570378 820634 1380756 4183555 21693282 2737959 12570378 820634 1380756 4183555 21693282 1841791 19851491 96554 248976 427075 419163 385683 1577451 26945 22580 49525 23320258 0.85130 0.85660 X Schedule A, Part II, Line 10, Explanation of Other Income: FUNDRAISING EVENT INCOME - 2015 Amount: $ 19,945. 2016 Amount: $ 18,410. GAMING INCOME - 2015 Amount: $ 7,000. 2016 Amount: $ 4,170. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13256964 101293 1082532 772500 13668289 12965805 74204 940068 723113 13256964 13345103 97628 288404 765330 12965805 1029717 12033910 312388 30912 13345103 876299 264459 111041 1029717 0.22510 0.71540 0.05950 0 0 0 COHEN & STEERS INSTITUTIONAL REALTY SHARES 1633416 F 1633416 DUE TO RELATED PARTIES 4189 FUNDS HELD ON BEHALF OF OTHERS 247122 251311 6035535 544142 376192 920334 5115201 -45171 -45171 5070030 3849875 376192 52123 428315 3421560 0 3421560 Part V, Line 4: TO PROVIDE SCHOLARSHIPS FOR HEALTHCARE RELATED TO STUDY/WORK. Part XI, Line 4b - Other Adjustments: FUNDRAISING EVENT EXPENSES -40,723. GAMING EXPENSES -4,448. Part XII, Line 2d - Other Adjustments: UNCOLLECTIBLE PLEDGE RECOVERY 6,952. FUNDRAISING EVENT EXPENSES 40,723. GAMING EXPENSES 4,448. GALA EVENT 161496 143086 18410 13014 19884 2265 5560 161496 143086 18410 13014 19884 2265 5560 40723 -22313 1 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 382156872 501(C)(3) 2322770 DISTRIBUTED FUNDS TO LOCAL HOSPITAL TO PROVIDE BETTER EQUIPMENT AND FACILITIES BERRIEN RESA 711 SAINT JOSEPH AVENUE BERRIEN SPRINGS MI 49103 381714920 115 30000 GENERAL SUPPORT RADIOLOGY ASSOCIATES OF BERRIEN COUNTY 31 N SAINT JOSEPH AVE NILES MI 49120 381897758 5348 GENERAL SUPPORT ANDREWS UNIVERSITY 4150 ADMINISTRATION DRIVE BERRIEN SPRINGS MI 49104 381627600 501(C)(3) 50000 GENERAL SUPPORT GREATER NILES ECONOMIC DEVELOPMENT FULL EMPLOYMENT CORPORATION 333 NORTH 2ND STREET NILES MI 49120 382477818 501(C)(3) 35000 GENERAL SUPPORT LAKESHORE PUBLIC SCHOOLS 5771 CLEVELAND AVENUE STEVENSVILLE MI 49127 386029219 115 15000 GENERAL SUPPORT LOGAN COMMUNITY RESOURCES INC 2505 E JEFFERSON BLVD SOUTH BEND IN 46615 350965639 501(C)(3) 10000 GENERAL SUPPORT LAKE MICHIGAN COLLEGE FOUNDATION 2755 E NAPIER AVENUE BENTON HARBOR MI 49022 382714753 501(C)(3) 23500 GENERAL SUPPORT HOSPICE AT HOME 4025 HEALTH PARK LANE ST JOSEPH MI 49085 382416086 501(C)(3) 340889 GENERAL SUPPORT NEIGHBOR TO NEIGHBOR 9147 US 31 N BERRIEN SPRINGS MI 49103 386068297 501(C)(3) 40000 GENERAL SUPPORT NILES-BUCHANAN YMCA 905 NORTH FRONT STREET NILES MI 49120 381358236 501(C)(3) 25000 GENERAL SUPPORT SAMARITAN COUNSELING CENTER 1850 COLFAX AVENUE BENTON HARBOR MI 49022 382032501 501(C)(3) 20000 GENERAL SUPPORT SOUTHWESTERN MICHIGAN COLLEGE FOUNDATION 58900 CHERRY GROVE ROAD DOWAGIAC MI 49047 381943374 501(C)(3) 25000 GENERAL SUPPORT UNITED WAY OF SOUTHWEST MICHIGAN 2015 LAKEVIEW AVENUE ST JOSEPH MI 49085 381358411 501(C)(3) 15000 GENERAL SUPPORT 14 0 HEALTH CARE SCHOLARSHIPS 54 171526 n/a N/A GRANTS TO ASSOCIATES IN NEED 15 7976 N/A N/A Part I, Line 2: THE SCHOLARSHIP GRANTS ARE MONITORED TO ENSURE THE STUDENT IS FURTHERING THEIR EDUCATION WITHIN THE HEALTHCARE INDUSTRY. 0 1 0 0 0 0 0 0 0 LOREN HAMEL MD DIRECTOR AND LAKELAND CFO 0 598084 0 179670 0 46056 0 51917 0 8848 0 884575 0 0 DAVID BURGHART VP AND FOUNDATION PRESIDENT - PY 0 174440 0 18564 0 7194 0 19214 0 8848 0 228260 0 0 TIMOTHY CALHOUN VP - FINANCE & CFO 0 348199 0 68401 0 17919 0 36183 0 8848 0 479550 0 0 Part I, Line 4b LAKELAND MAINTAINS A 457F NONQUALIFIED DEFERRED COMPENSATION PLAN FOR A SELECT GROUP OF MANAGEMENT AND HIGHLY COMPENSATED EMPLOYEES. THE INDIVIDUALS LISTED IN PART VII WHO PARTICIPATED IN THE PLAN ARE: DAVID BURGHART; LOREN HAMEL, MD; TIMOTHY CALHOUN Form 990, Part VI, Section A, line 6 THE CORPORATION IS ORGANIZED ON A STOCK BASIS. THE SOLE STOCKHOLDER OF THE ORGANIZATION IS LAKELAND REGIONAL HEALTH SYSTEM. Form 990, Part VI, Section A, line 7b THE SOLE STOCKHOLDER OF THE ORGANIZATION, LAKELAND REGIONAL HEALTH SYSTEM, APPROVES THE GOVERNING BODY'S ELECTION OF MEMBERS TO THE GOVERNING BODY. Form 990, Part VI, Section B, line 11b A copy of the 990 has been posted on the Board portal for review prior to filing. The Board portal is available to all Board members. Form 990, Part VI, Section B, line 12c THE CORPORATE COMPLIANCE DEPARTMENT, IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY, ANNUALLY DISTRIBUTES THE CONFLICT OF INTEREST DISCLOSURE SURVEY TO ALL CORPORATE AND SUBSIDIARY ORGANIZATION BOARD MEMBERS, EXECUTIVES AND OTHER LEADERSHIP EMPLOYEES. THE CORPORATE COMPLIANCE DEPARTMENT, THROUGH THE GOVERNANCE COMMITTEE, COMPILES AND ANALYZES SURVEY DATA BY ORGANIZATION, INVESTIGATES, AND REVIEWS POTENTIAL CONFLICTS WITH THE ORGANIZATION'S CEO AND BOARD CHAIR, AND WHEN NECESSARY, RECOMMENDS ACTIONS TO BE TAKEN TO RESOLVE IDENTIFIED CONFLICTS. A COMPLETE REPORT OF ALL CORPORATE AND SUBSIDIARY BOARD MEMBER AND EXECUTIVE DISCLOSURES, CONFLICTS IDENTIFIED AND ACTIONS TAKEN IS REVIEWED BY THE GOVERNANCE COMMITTEE AND EACH SUBSIDIARY CEO AND BOARD CHAIR RECEIVES A REPORT SPECIFIC TO THEIR ORGANIZATION'S BOARD MEMBERS AND EXECUTIVES. BOARD MEMBERS FAILING TO COMPLETE A DISCLOSURE SURVEY OR INTENTIONALLY FAILING TO REPORT A KNOWN CONFLICT OF INTEREST ARE ASKED TO RESIGN. Form 990, Part VI, Section B, line 15 THE CEO AND SENIOR MANAGEMENT ARE PAID BY A RELATED ORGANIZATION. THE RELATED ORGANIZATION USES THE FOLLOWING PROCESS TO DETERMINE COMPENSATION. AN INDEPENDENT FIRM IS HIRED BY THE BOARD TO DETERMINE COMPENSATION PACKAGES FOR THE CEO AND SENIOR MANAGEMENT ON AN ANNUAL BASIS. THE FIRM PRESENTS COMPARATIVE PAY RANGES AND COMPENSATION RECOMMENDATIONS TO THE GOVERNANCE (COMPENSATION) COMMITTEE FOR THEIR APPROVAL. FOR SENIOR MANAGEMENT, THE CEO CAN PROVIDE INPUT AND RECOMMENDATIONS TO THE GOVERNANCE COMMITTEE. FOR THE CEO'S COMPENSATION, THE GOVERNANCE COMMITTEE PRESENTS THE COMPENSATION PACKAGE TO THE FULL BOARD FOR APPROVAL. WRITTEN CONTRACTS FOR THE CEO ARE APPROVED BY THE FULL BOARD OF DIRECTORS. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS FISCAL YEAR 2017. Form 990, Part VI, Section C, line 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. Form 990, Part XI, line 9: UNCOLLECTIBLE PLEDGE RECOVERY -6,952. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN AUDIT OVERSIGHT PROCESS FROM THE PRIOR YEAR. LAKELAND REGIONAL HEALTH SYSTEM INC 1234 NAPIER AVE ST JOSEPH MI 49085 382609624 PROVIDE A COMPREHENSIVE SYSTEM OF HEALTH CARE TO CITIZENS OF THE COMMUNITY MI 501(c)(3) Line 12b, II N/A 0 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC 1234 NAPIER AVE ST JOSEPH MI 49085 382156872 PROVIDE A COMPREHENSIVE SYSTEM OF HEALTH CARE TO CITIZENS OF THE COMMUNITY MI 501(c)(3) Line 3 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELAND SPECIALTY HOSPITAL AT BERRIEN CENTER 1234 NAPIER AVE ST JOSEPH MI 49085 383452303 LONGTERM HEALTHCARE/HEALING SERVICES MI 501(c)(3) Line 3 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELAND HEALTH FOUNDATION NILES 1234 NAPIER AVE ST JOSEPH MI 49085 383130558 PROMOTE/ASSIST IN PROVIDING HEALTH CARE SERVICES IN SOUTHWESTERN MICHIGAN MI 501(c)(3) Line 7 LAKELAND REGIONAL HEALTH SYSTEM INC 1 MERCY MEMORIAL HEALTH SERVICES INC 3425 LAKESHORE DRIVE ST JOSEPH MI 49085 382748035 PROVIDE HOMECARE AND LONG-TERM HEALTHCARE TO PATIENTS IN SOUTHWEST MICHIGAN MI 501(c)(3) Line 10 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELAND COMMUNITY HOSPITAL - WATERVLIET 400 MEDICAL PARK DRIVE WATERVLIET MI 49098 381368745 TO PROVIDE GENERAL HEALTH OF THE COMMUNITY THROUGH EDUCATION AND HEALTHCARE MI 501(c)(3) Line 3 LAKELAND REGIONAL HEALTH SYSTEM INC 1 HOSPICE AT HOME INC 4025 HEALTH PARK LANE ST JOSEPH MI 49085 382416086 TO PROVIDE HOSPICE AND PALLIATIVE CARE TO THE TERMINALLY ILL MI 501(c)(3) Line 7 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELAND HEALTH ENTERPRISES INC 31 NORTH ST JOSEPH AVENUE NILES MI 49120 382669798 ACCOUNTING AND BILLING MI N/A C 1 PHARMACY SHOPPE INC DBA LAKELAND PHARMACY SHOPPE INC 1234 NAPIER AVE ST JOSEPH MI 49085 382929090 PHARMACEUTICALS MI N/A C 1 LAKELAND MEDICAL PRACTICES 1234 NAPIER AVE ST JOSEPH MI 49085 270381199 MEDICAL ADMINISTRATIVE SERVICES MI N/A C 1 SOUTHWESTERN MEDICAL CLINIC PHYSICIANS INC 1234 NAPIER AVE ST JOSEPH MI 49085 272589359 PHYSICIAN OFFICE MI N/A C 1 FOUR FLAGS PROPERTIES INC 122 GRANT STREET NILES MI 49120 364501639 PROPERTY MANAGEMENT/RENTAL MI N/A C 1 LAKELAND HEALTH VENTURES INC 1234 NAPIER AVE ST JOSEPH MI 49085 272313790 HOLDING COMPANY MI N/A C 1 LAKELAND PHYSICIAN CARE NETWORK 1234 NAPIER AVE ST JOSEPH MI 49085 208513031 MEDICAL SERVICES MI N/A C 1 LAKELAND PERSONAL CARE SERVICES INC 1234 NAPIER AVE ST JOSEPH MI 49085 272990797 HEALTH CARE SERVICES MI N/A C 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC B 2322770 ACTUAL AMOUNTS GRANTED LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC O 376193 ALLOCATION OF EXPENSE HOSPICE AT HOME INC B 340889 ACTUAL AMOUNTS GRANTED