2015-07-31T14:41:30-05:00 2014-09-30 381357951 PLANTE & MORAN PLLC 511 RENAISSANCE DRIVE ST JOSEPH MI 49085 990 2013-10-01 382539929 LAKELAND HEALTH FOUNDATION BENTON HARBOR/ST JOSEPH LAKE 2699838300 1234 NAPIER AVE ST JOSEPH MI 49085 TIMOTHY CALHOUN VP - FINANCE & CFO 2699838300 2015-07-30 1 KENLEY PENNER CPA P00740260 2699828000 2013 2016-02-25 16:41:14Z DAVID BURGHART 1234 NAPIER AVE ST JOSEPH MI 49085 16604064 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 28 0 30 0 0 2737959 12570378 0 0 196809 522247 0 0 2934768 13092625 4733162 960255 0 0 0 0 0 0 0 73707 215212 4806869 1175467 -1872101 11917158 7284238 18449136 1507817 670540 5776421 17778596 TO ENHANCE HEALTH AND SERVE OUR COMMUNITY. 0 0 858693 858693 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. 101562 101562 THE FOUNDATION DISTRIBUTED FUNDS TO 91 LOCAL HEALTH CARE INDIVIDUALS FOR TUITION RELATED EXPENSES. 960255 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 3 0 1 0 0 0 0 0 0 0 0 0 0 0 X 31 28 0 0 0 0 1 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 MI X STACY WAHLSTROM 2696871147 3776 HOLLYWOOD RD ST JOSEPH MI 49085 BILL HANLEY CHAIR 1.00 0.00 X X 0 0 0 RANDY BETTICH VICE CHAIR 1.00 0.00 X X 0 0 0 RICHARD DYER SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 DAVID BURGHART DIRECTOR AND FOUNDATION PRESIDENT 20.00 20.00 X X 0 166751 15533 LOREN HAMEL MD DIRECTOR AND LAKELAND CEO 1.00 54.00 X X 0 751087 52460 SANDI BOWMAN DIRECTOR 1.00 0.00 X 0 0 0 LUCAS BROWN 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 EDWARD CONRAD DIRECTOR 1.00 0.00 X 0 0 0 WENDY EDWARDS DIRECTOR 1.00 0.00 X 0 0 0 MARC FLORIAN DIRECTOR 1.00 0.00 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 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 JOHN PROOS MD 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 DIANA SEAMAN DIRECTOR/AUXILLARY PRESIDENT 1.00 1.00 X 0 0 0 KATHLEEN SNYDER 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 40.00 X 0 206100 10189 DANA WALES DIRECTOR 1.00 0.00 X 0 0 0 MARGE WIATROWSKI DIRECTOR 1.00 0.00 X 0 0 0 KAY VARGA-SMITH DIRECTOR 1.00 2.00 X 0 0 0 TIMOTHY CALHOUN VP - FINANCE & CFO 1.00 49.00 X 0 382993 37904 0 1506931 116086 0 0 1 0 0 12000000 570378 12570378 248976 248976 3784710 3511439 273271 273271 273271 13092625 0 0 522247 858693 858693 101562 101562 78018 78018 UNCOLLECTABLE PLEDGES 137194 137194 1175467 960255 215212 0 420582 1084334 2618019 1414055 4245637 15950747 7284238 18449136 1507817 670540 1507817 670540 X 1878961 4909987 3198760 3169909 698700 9698700 5776421 17778596 7284238 18449136 11917158 85017 0 X X 0 1 X 1 0 X 2923180 1345122 2561310 2737959 12570378 22137949 2923180 1345122 2561310 2737959 12570378 22137949 1849410 20288539 145044 119160 96864 96554 248976 706598 47199 47199 22891746 0.88630 0.64420 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: SALE OF ASSETS - 2010 AMOUNT: $ 47,199. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1029717 12033910 312388 30912 13345103 876299 264459 111041 1029717 854341 35899 42587 56528 876299 821475 92383 59517 854341 2903675 30080 48478 2160758 821475 0.22940 0.04380 0.72680 0 0 0 DUE TO RELATED PARTIES 670540 670540 X 13427893 85017 250251 335268 13092625 0 13092625 1425718 250251 250251 1175467 0 1175467 PART V, LINE 4: TO PROVIDE SCHOLARSHIPS FOR HEALTHCARE RELATED TO STUDY/WORK. PART X, LINE 2: THE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS, THEREFORE, NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES. ACCORDINGLY, CONTRIBUTIONS TO THE FOUNDATION ARE DEDUCTIBLE BY THE DONOR FOR FEDERAL INCOME TAXES. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE FOUNDATION TO EVALUATE TAX POSITIONS TAKEN BY THE FOUNDATION AND RECOGNIZE A TAX LIABILITY IF THE FOUNDATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. THE FOUNDATION HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2014 AND 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE FOUNDATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE FOUNDATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2011. 1 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 382156872 501(C)(3) 713693 N/A N/A DISTRIBUTED FUNDS TO LOCAL HOSPITAL TO PROVIDE BETTER EQUIPMENT AND FACILITIES CASSOPOLIS FAMILY CLINIC 261 M-62 CASSOPOLIS MI 49031 383082107 501(C)(3) 100000 N/A N/A CAPITAL CAMPAIGN CONTRIBUTION UNITED WAY OF SOUTHWEST MICHIGAN 2015 LAKEVIEW AVENUE ST JOSEPH MI 49085 381358411 501(C)(3) 15000 N/A N/A GENERAL SUPPORT BERRIEN REGIONAL EDUCATION SERVICE AGENCY 711 ST JOSEPH AVENUE BERRIEN SPRINGS MI 49103 381714920 GOVERNMENTAL 30000 N/A N/A GENERAL SUPPORT 4 HEALTH CARE SCHOLARSHIPS 91 97284 N/A N/A GRANTS TO ASSOCIATES IN NEED 11 4278 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 DAVID BURGHART DIRECTOR AND FOUNDATION PRESIDENT 0 162064 0 1440 0 3247 0 13977 0 1556 0 182284 0 0 LOREN HAMEL MD DIRECTOR AND LAKELAND CEO 0 548588 0 160650 0 41849 0 48749 0 3711 0 803547 0 0 DENNIS SZYMANSKI MD DIRECTOR 0 206100 0 0 0 0 0 8163 0 2026 0 216289 0 0 TIMOTHY CALHOUN VP - FINANCE & CFO 0 296996 0 58791 0 27206 0 34036 0 3868 0 420897 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 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 2014. 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 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 11B, 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 SPECIALITY 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 9 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 VAN'S MEDICAL EQUIPMENT OF LAKELAND LLC 1234 NAPIER AVE ST JOSEPH MI 49085 261497708 MEDICAL EQUIPMENT MI N/A CLIFFSIDE COMPANY LLC 910 S WASHINGTON AVENUE ROYAL OAK MI 48067 383306320 ASSISTED LIVING MI N/A LAKELINE ASSOCIATES LLC 910 S WASHINGTON AVENUE ROYAL OAK MI 48067 383306318 PROPERTY MANAGEMENT/RENTAL MI N/A LIBERTY DIALYSIS LAKELAND LLC 7650 SE 27TH STREET SUITE 200 MERCER ISLAND WA 98040 272099855 MEDICAL SERVICES WA N/A LDBH LLC 7650 SE 27TH STREET SUITE 200 MERCER ISLAND WA 98040 451745643 MEDICAL SERVICES WA N/A 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 LAKELAND CARE INC 1234 NAPIER AVE ST JOSEPH MI 49085 383225306 CONTRACT NEGOTIATION MI N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC B 713693 ACTUAL AMOUNTS GRANTED LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC C 12000000 ACTUAL AMOUNTS CONTRIBUTED LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC O 250250 ALLOCATION OF EXPENSE