2014-05-13T08:51:05-05:00 2013-06-30 381357951 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2012-07-01 383022945 PORTAGE HEALTH FOUNDATION PORT 9064878000 400 QUINCY STREET PO BOX 299 HANCOCK MI 49930 KEVIN STORE 9064878000 2014-04-22 1 P00181637 2319477800 2012 2016-03-07 17:11:31Z X JAMES BOGAN 400 QUINCY STREET PO BOX 299 HANCOCK MI 49930 1112181 0 X WWW.PORTAGEHEALTH.ORG X 1990 MI TO SUPPORT AND ASSIST THE MISSION OF PORTAGE HEALTH, A TAX-EXEMPT HEALTHCARE ORGANIZATION, THROUGH FINANCIAL ASSISTANCE. 13 11 0 12 0 0 57648 53243 0 0 74718 98887 -2062 -5008 130304 147122 31690 39440 0 0 0 0 0 0 0 10326 10819 42016 50259 88288 96863 1891937 2076610 0 0 1891937 2076610 TO SUPPORT AND ASSIST THE MISSION OF PORTAGE HEALTH, A TAX EXEMPT HEALTHCARE ORGANIZATION, THROUGH FINANCIAL ASSISTANCE. 0 0 37990 37990 PROMOTION OF CHARITABLE MISSION OF RELATED TAX-EXEMPT HEALTHCARE ENTITY 1200 1200 GAS CARDS FOR TRAVELING RADIATION PATIENTS 250 250 OUTSTANDING NURSING AWARD 39440 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 13 11 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 0 0 1 0 0 MI X SUSAN BINKLEY CFO (SEE SCHEDULE O FOR ADDL INFO) 9064831503 500 CAMPUS DRIVE HANCOCK MI 49930 PAUL OLLILA 0.50 0.00 X 0 0 0 NANCY FENTON 0.50 0.00 X 0 0 0 TERRY KINZEL MD 0.50 24.00 X 0 135550 11006 JEANNE KURTZ 0.50 0.00 X 0 0 0 LENNON MATTILA HUGHES 1.00 0.00 X X 0 0 0 JAMES BOGAN 0.50 40.00 X X 0 345968 30690 WILLIAM POLKINGHORNE 0.50 0.00 X 0 0 0 ROGER HELMAN JD CFP 1.00 0.00 X X 0 0 0 DANA JOHNSON PHD 0.50 0.00 X 0 0 0 MICHELE BLAU 0.50 0.00 X 0 0 0 BRENT PETERSON 0.50 0.00 X 0 0 0 BERNADETTE YEOLMAN-OUELLETTE 1.00 0.00 X X 0 0 0 JEFFRY DENNIS 0.50 0.00 X 0 0 0 BRIAN DONAHUE 0.50 40.00 X 0 178963 27706 KEVIN STORE 0.50 40.00 X 0 150760 20741 0 811241 90143 0 0 1 0 0 37066 16177 53243 54653 54653 996008 951774 44234 44234 44234 8277 37066 13285 -5008 -5008 147122 0 0 93879 37990 37990 1450 1450 10819 10819 50259 39440 10819 0 49728 57176 549306 791893 18615 18615 0 0 1276884 1209824 16019 17717 1891937 2076610 0 0 X 1891937 2076610 1891937 2076610 1891937 2076610 96863 87810 0 X X 0 1 X 1 0 X X X 0 0 0 PORTAGE HEALTH INC 381381288 3 1 1 1 37990 1 37990 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1842209 1570 186682 11028 2019433 1773348 31535 47838 10513 1842209 1557595 20390 205536 10173 1773348 1501685 27263 38238 9591 1557595 1672098 21989 -183299 9103 1501685 0.99100 0.00900 0.00000 1 0 18615 18615 0 0 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE TO BE USED FOR GRANTING WITHIN PORTAGE HEALTH, INC. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: NOTES TO CONSOLIDATED FINANCIAL STATEMENTS: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF JUNE 30, 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. SPRING BALL 29528 22315 7213 2400 4000 3531 AUCTION 14690 14306 384 1548 50 1 1125 445 680 500 1256 45343 37066 8277 1548 2400 4000 500 4837 13285 -5008 1 PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 7990 N/A N/A NAMASTE CARE EQUIPMENT PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 30000 N/A N/A WELLNESS INITIATIVE 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION REQUESTS A PROGRAM OVERVIEW AND BUDGET, A 6 MONTH PROGRESS REPORT, AND A FINAL STATUS REPORT COMPLETED WITHIN 60 DAYS FROM THE FINAL EXPENDITURES. 0 0 0 0 0 0 0 0 0 JAMES BOGAN 0 286165 0 51990 0 7813 0 14813 0 15877 0 376658 0 0 BRIAN DONAHUE 0 158076 0 19733 0 1154 0 12873 0 14833 0 206669 0 0 KEVIN STORE 0 77378 0 70652 0 2730 0 9149 0 11592 0 171501 0 0 SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I, LINE 3: THE FOLLOWING INDIVIDUALS, LISTED AS TOP MANAGEMENT OFFICIALS OF THE FOUNDATION, ARE COMPENSATED BY RELATED ORGANIZATION PORTAGE HEALTH, INC.: JAMES BOGAN, FOUNDATION DIRECTOR AND HOSPITAL PRESIDENT AND CEO KEVIN STORE, EXECUTIVE DIRECTOR PORTAGE HEALTH, INC. UTILIZES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANTS, WRITTEN EMPLOYEMENT CONTRACTS, COMPENSATION SURVEY OR STUDIES, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THEIR COMPENSATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTION AND RE-ELECTION OF ALL MEMBERS OF THE FOUNDATION BOARD OF DIRECTORS SHALL BE, INDIVIDUALLY OR COLLECTIVELY, BY AFFIRMATIVE ACTION OF THE BOARD OF DIRECTORS OF PORTAGE HEALTH. THE FOUNDATION BOARD SHALL NOMINATE CANDIDATES FOR ELECTION OR RE-ELECTION AS DIRECTORS BY RESOLUTION AND SUBMIT SUCH NOMINATIONS TO THE PORTAGE HEALTH BOARD OF DIRECTORS FOR RATIFICATION. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF THE FOUNDATION MAY PROPOSE AMENDMENTS TO THE BOARD BYLAWS, WHICH MUST BE THEN SUBMITTED FOR APPROVAL BY THE BOARD OF DIRECTORS OF PORTAGE HEALTH. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE DIRECTOR OF THE FOUNDATION REVIEWS THE FORM 990 IN DETAIL PRIOR TO FILING. THE 990 IS THEN REVIEWED WITH FOUNDATION BOARD MEMBERS AT A REGULARLY SCHEDULED BOARD MEETING. EACH BOARD MEMBER IS PROVIDED A COPY OF THE FORM 990 FOR REVIEW BEFORE THE RETURN HAS BEEN FILED. FORM 990, PART VI, SECTION B, LINE 12C AN ANNUAL CONFLICT OF INTEREST STATEMENT IS COMPLETED AND SIGNED BY EACH BOARD MEMBER. THE PRESIDENT AND CEO REVIEWS THE COMPLETED CONFLICT OF INTEREST FORMS. IF A CONFLICT IS IDENTIFIED, THAT BOARD MEMBER IS EXCUSED FROM ANY DICUSSION OR VOTE RELATING TO THE IDENTIFIED CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS UTILIZED AN OUTSIDE CONSULTANT TO RESEARCH AND PRESENT MARKET DATA FOR THE PURPOSES OF DETERMINING AND ADJUSTING, AS NECESSARY, THE COMPENSATION OF THE EXECUTIVE DIRECTOR. THE MOST RECENT MARKET SURVEY WAS CONDUCTED IN NOVEMBER 2011 AND IS ANTICIPATED TO BE CONDUCTED AND REVIEWED AGAIN IN NOVEMBER 2013. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2B: THE FINANCIAL STATEMENTS WERE AUDITED BY AN INDEPENDENT ACCOUNTANT ON A CONSOLIDATED BASIS. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, SECTION B, LINES 13 AND 14: THE FOUNDATION DOES NOT HAVE WRITTEN WHISTLEBLOWER OR DOCUMENT RETENTION AND DESTRUCTION POLICIES. THE FOUNDATION WOULD DEFER TO THE POLICIES OF PORTAGE HEALTH, INC. IN THESE CIRCUMSTANCES. FORM 990, PART VI, SECTION C, LINE 20: INDIVIDUALS WHO POSSESS THE BOOKS AND RECORDS OF THE ORGANIZATION: SUSAN BINKLEY, CFO PORTAGE HEALTH, INC. 500 CAMPUS DRIVE HANCOCK, MI 49930 (906) 483-1503 KEVIN STORE, EXECUTIVE DIRECTOR PORTAGE HEALTH FOUNDATION 400 QUINCY STREET, PO BOX 299 HANCOCK, MI 49930 (906) 523-5920 PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 IMPROVING HEALTH OF COMMUNITY BY PROVIDING HIGH QUALITY HEALTHCARE SERVICES MI 501(C)3 LINE 3 N/A 0 PORTAGE HEALTH RESOURCES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383041729 SENIOR MEALS MI 501(C)3 LINE 11A, I PORTAGE HEALTH INC 1 PORTAGE HEALTH HOME SERVICES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383565553 PRIVATE DUTY CARE MI 501(C)3 LINE 9 PORTAGE HEALTH INC 1 COPPER COUNTRY APOTHECARIES INC 500 CAMPUS DRIVE HANCOCK MI 49930 302083778 RETAIL PHARMACY MI N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0