2017-08-09T12:13:54-05:00 2016-09-30 381357951 PLANTE & MORAN PLLC 511 Renaissance Dr Ste 120 St Joseph MI 49085 990 2015-10-01 382748035 MERCY MEMORIAL HEALTH SERVICES INC MERC 2699836501 4368 CLEVELAND AVENUE STEVENSVILLE MI 49127 TIMothy CALHOUN VP - FINANCE & CFO 2699836501 2017-08-03 1 Kenley Penner CPA P00740260 2699828000 2017-08-03 2015 2021-01-29 14:40:06Z PINE RIDGE A REHABILITATION & NURSING CENTER LOREN HAMEL MD 1234 NAPIER AVENUE ST JOSEPH MI 49085 10871177 0 X LAKELANDHEALTH.ORG X 1987 MI TO PROVIDE HOMECARE AND LONG-TERM HEALTHCARE TO PATIENTS IN THE SOUTHWEST MICHIGAN AREA. 3 0 175 50 0 0 0 0 10262005 10871177 -98908 0 0 0 10163097 10871177 0 0 0 0 5769423 6446683 0 0 0 4261846 4118043 10031269 10564726 131828 306451 12182814 12034036 9199673 8744444 2983141 3289592 TO ENHANCE HEALTH AND SERVE OUR COMMUNITY. 0 0 9085030 10871177 REHABILITATION & NURSING HOME OPERATIONS WERE PROVIDED TO 102 PATIENTS DURING FISCAL YEAR 2016. 9085030 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 11 0 1 175 1 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X PAUL KONOPACKI 2695567123 3776 HOLLYWOOD RD ST JOSEPH MI 49085 TIMOTHY CALHOUN VP - FINANCE & CFO 2.00 47.00 X X 0 424520 40988 MARY ANN PATER SECRETARY 2.00 47.00 X X 0 203440 25281 KENDALL TROYER CHAIRMAN 4.00 46.00 X X 0 180372 35872 LOREN HAMEL MD PRESIDENT & CEO 2.00 52.00 X 0 818576 56186 0 1626908 158327 0 0 1 0 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 631503534 REHAB SERVICES 895354 1 PATIENT SERVICE REVENUE (90% MEDI 621400 10849656 10849656 OTHER OPERATING REVENUE 621400 21521 21521 10871177 10871177 10871177 0 0 X 5009952 4258459 751493 175668 149318 26350 912018 775215 136803 349045 296688 52357 1075632 914287 161345 20692 17588 3104 132247 112410 19837 2521 2143 378 199683 169731 29952 436871 371340 65531 21776 18510 3266 SUPPLIES AND DRUGS 1148890 976557 172333 QAAP ASSESSMENTS 703929 703929 REPAIRS & MAINTENANCE 109045 92688 16357 PROVISION FOR BAD DEBTS -3844 -3844 270601 230011 40590 10564726 9085030 1479696 0 615084 349845 1327467 1922149 8889 17881 10928211 1207354 10089386 9720857 141988 23304 12182814 12034036 888076 686735 8125694 7768036 185903 289673 9199673 8744444 X 2983141 3289592 2983141 3289592 12182814 12034036 306451 0 X X 0 1 X 1 0 X 400000 400000 7410997 7271889 8016292 10262005 10871177 43832360 7410997 7271889 8416292 10262005 10871177 44232360 0 0 0 44232360 4769 357 21 5147 4769 357 21 5147 7415766 7272246 8416313 10262005 10871177 44237507 0.99990 0.99990 0.00010 0.00010 X 610891 610891 8358317 560415 7797902 1959003 646939 1312064 9720857 DUE TO RELATED PARTIES 289673 289673 10875021 3844 3844 10871177 0 10871177 10568570 0 10568570 -3844 -3844 10564726 Part XI, Line 2d - Other Adjustments: PROVISION FOR BAD DEBTS 3,844. Part XII, Line 4b - Other Adjustments: PROVISION FOR BAD DEBTS -3,844. 0 1 0 0 0 0 0 0 0 TIMOTHY CALHOUN VP - FINANCE & CFO 0 340225 0 65582 0 18713 0 35421 0 5567 0 465508 0 0 MARY ANN PATER SECRETARY 0 176606 0 17181 0 9653 0 19669 0 5612 0 228721 0 0 KENDALL TROYER CHAIRMAN 0 166360 0 6533 0 7479 0 19775 0 16097 0 216244 0 0 LOREN HAMEL MD PRESIDENT & CEO 0 594392 0 174346 0 49838 0 50619 0 5567 0 874762 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: LOREN HAMEL, MD AND TIMOTHY CALHOUN A HOSPITAL AUTHORITY OF THE CITY OF ST JOSEPH 383151499 NONEAVAIL 2012-09-06 8500000 NEW FACILITY CONSTRUCTION 0 0 0 A 8500000 105875 8394125 0 0 1 1 A 0 0 0 0 0 0 0 A 1 0 0 0 0 0 A 0 BOND ISSUE A: THE $8.5 MILLION BOND ISSUE WAS A DIRECT PURCHASE BOND BY JPMORGAN CHASE. BOND PROCEEDS WERE DRAWN DURING CONSTRUCTION PERIOD TO BUILD A NEW FACILITY. Form 990, Part VI, Section B, line 11 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 2016. Form 990, Part VI, Section C, line 19 THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. Form 990, Part IX, line 11g THERAPY SERVICES: Program service expenses 735,855. Management and general expenses 129,857. Fundraising expenses 0. Total expenses 865,712. MAINTENANCE AND OTHER ADMINISTRATIVE SERVICES: Program service expenses 178,432. Management and general expenses 31,488. Fundraising expenses 0. Total expenses 209,920. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN THE AUDIT OVERSIGHT PROCESS FROM THE PRIOR YEAR. LAKELAND REGIONAL HEALTH SYSTEM INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 382609624 PROVIDE A COMPREHENSIVE SYSTEM OF HEALTH CARE TO CITIZENS OF THE COMMUNITY MI 501(c)(3) Line 11b, II N/A 0 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC 1234 NAPIER AVENUE 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 AVENUE ST JOSEPH MI 49085 383452303 LONGTERM HEALTHCARE/HEALING SERVICES MI 501(c)(3) Line 3 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELAND HEALTH FOUNDATION BENTON HARBORST JOSEPH 1234 NAPIER AVENUE ST JOSEPH MI 49085 382539929 PROMOTE AND ASSIST IN PROVIDING HEALTH CARE MI 501(c)(3) Line 7 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELAND HEALTH FOUNDATION NILES 1234 NAPIER AVENUE 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 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 9 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 AVENUE ST JOSEPH MI 49085 382929090 PHARMACEUTICALS MI N/A C 1 LAKELAND MEDICAL PRACTICES 1234 NAPIER AVENUE ST JOSEPH MI 49085 270381199 MEDICAL ADMINISTRATIVE SERVICES MI N/A C 1 SOUTHWESTERN MEDICAL CLINIC PHYSICIANS INC 1234 NAPIER AVENUE 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 AVENUE ST JOSEPH MI 49085 272313790 HOLDING COMPANY MI N/A C 1 LAKELAND PHYSICIAN CARE NETWORK 1234 NAPIER AVENUE ST JOSEPH MI 49085 208513031 MEDICAL SERVICES MI N/A C 1 LAKELAND PERSONAL CARE SERVICES INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 272990797 HEALTH CARE SERVICES MI N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC P 353373 ALLOCATION OF EXPENSES