COREWELL HEALTH: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COREWELL HEALTH (EIN 38-2539929)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-05-15
IRS object ID
201311359349303331
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

FieldValueIRS element (for citing)
Timestamp2013-05-15T10:21:52-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN381357951EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1511 RENAISSANCE DRIVEAddressLine1
CityST JOSEPHCity
StateMIState
ZIP Code49085ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN382539929EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LAKELAND HEALTH FOUNDATIONBusinessNameLine1
Business Name Line2BENTON HARBOR/ST JOSEPHBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlLAKENameControl
Phone2699838300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11234 NAPIER AVENUEAddressLine1
CitySAINT JOSEPHCity
StateMIState
ZIP Code49085ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTIMOTHY CALHOUNName
TitleVP - FINANCE/CFOTitle
Phone2699838300Phone
Date Signed2013-05-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKENLEY G PENNER CPAName
PTINP00185160PTIN
Phone2699828000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID BURGHARTNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11234 NAPIER AVENUEAddressLine1
CitySAINT JOSEPHCity
StateMIState
ZIP Code49085ZIPCode
FieldValueIRS element (for citing)
Gross Receipts7804996GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization OtherXTypeOfOrganizationOther
Year Formation1984YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionTO PROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM.ActivityOrMissionDescription
Nbr Voting Members Governing Body29NbrVotingMembersGoverningBody
Nbr Independent Voting Members26NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers26TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1345122ContributionsGrantsPriorYear
Contributions Grants Current Year2561310ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year367061InvestmentIncomePriorYear
Investment Income Current Year156539InvestmentIncomeCurrentYear
Other Revenue Prior Year47199OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year1759382TotalRevenuePriorYear
Total Revenue Current Year2717849TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2396991GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1788895GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year295294TotalFundrsngExpCurrentYear
Other Expense Prior Year49047OtherExpensePriorYear
Other Expenses Current Year387906OtherExpensesCurrentYear
Total Expenses Prior Year2446038TotalExpensesPriorYear
Total Expenses Current Year2176801TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-686656RevenuesLessExpensesPriorYear
Revenues Less Expenses CY541048RevenuesLessExpensesCY
Total Assets BOY7400698TotalAssetsBOY
Total Assets EOY7371735TotalAssetsEOY
Total Liabilities BOY977115TotalLiabilitiesBOY
Total Liabilities EOY5800TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6423583NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7365935NetAssetsOrFundBalancesEOY
Mission DescriptionPROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense1741200Expense
Grants1741200Grants
DescriptionTHE FOUNDATION DISTRIBUTED FUNDS TO A LOCAL AREA HOSPITAL FOR BETTER EQUIPMENT AND FACILITIES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense47695Expense
Grants47695Grants
DescriptionTHE FOUNDATION DISTRIBUTED FUNDS TO 58 LOCAL HEALTH CARE INDIVIDUALS FOR TUITION RELATED EXPENSES.Description
FieldValueIRS element (for citing)
Total Program Service Expense1788895TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members29NbrVotingGoverningBodyMembers
Number Independent Voting Members26NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1STACY WAHLSTROMBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2696871147TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11234 NAPIER AVEAddressLine1
CityST JOSEPHCity
StateMIState
ZIP Code49085ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (33 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
BILL HANLEY
CHAIRPERSON2.00XX000
RANDY BETTICH
VICE CHAIRPERSON2.00XX000
RICK DYER
SECRETARY/TREASURER2.00XX000
LOREN HAMEL MD
DIRECTOR AND CEO2.00XX0113395519917
SANDI BOWMAN
DIRECTOR2.00X000
LUCAS BROWN
DIRECTOR2.00X000
RICHARD BUCKALEW
DIRECTOR2.00X1500000
JAMES CLEVER
DIRECTOR2.00X000
EDWARD CONRAD
DIRECTOR2.00X000
WENDY EDWARDS
DIRECTOR2.00X000
MARC FLORIAN
DIRECTOR2.00X000
ROBERT GOTTLIEB
DIRECTOR2.00X000
BRITTANY GRASLEY
DIRECTOR2.00X000
GYL KASEWURM
DIRECTOR2.00X000
TINA KIRBY
DIRECTOR2.00X000
KURT MARZKE
DIRECTOR2.00X000
BARBARA MEEKS
DIRECTOR2.00X000
RANDALL MILLER
DIRECTOR2.00X000
PAT MOODY
DIRECTOR2.00X000
TIM PASSARO
DIRECTOR2.00X000
JOHN PROOS MD
DIRECTOR2.00X000
DON RADDE
DIRECTOR2.00X000
EBON SANDERS
DIRECTOR2.00X000
KATHLEEN SNYDER
DIRECTOR2.00X000
CAROL STARKS
DIRECTOR2.00X000
DENNIS SZYMANSKI MD
DIRECTOR2.00X042558116472
KAY VARGA-SMITH
DIRECTOR2.00X000
DANA WALES
DIRECTOR2.00X000
MARGE WIATROWSKI
DIRECTOR2.00X000
LEO SOORUS PART-YEAR
PAST CHAIRPERSON2.00XX000
JERRY ALBERTS PART-YEAR
DIRECTOR2.00X000
DAVID BURGHART
PRESIDENT2.00X016323219374
TIMOTHY CALHOUN
VP - FINANCE AND CFO2.00X067638641838
FieldValueIRS element (for citing)
Total Reportable Comp From Org15000TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2399154TotalReportableCompFrmRltdOrgs
Total Other Compensation97601TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations383334RelatedOrganizations
All Other Contributions2177976AllOtherContributions
Total Contributions2561310TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column96864TotalRevenueColumn
Exclusion$96,864ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities5146822Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5087147Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities59675Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column59675TotalRevenueColumn
Exclusion$59,675ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2717849TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$156,539ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1741200Total
Program Services1741200ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total47695Total
Program Services47695ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total295294Total
Fundraising295294Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3900Total
Management And General3900ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total28400Total
Management And General28400ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total11722Total
Management And General11722ManagementAndGeneral

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionBAD DEBTS - PLEDGESDescription
Total46665Total
Management And General46665ManagementAndGeneral

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1925Total
Management And General1925ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2176801Total
Program Services1788895ProgramServices
Management And General92612ManagementAndGeneral
Fundraising295294Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY880682BOY
EOY979742EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1799744BOY
EOY2405405EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4720272BOY
EOY3986588EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7400698BOY
EOY7371735EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY977115BOY
EOY5800EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY977115BOY
EOY5800EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2877690BOY
EOY3314731EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2847193BOY
EOY3352504EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY698700BOY
EOY698700EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6423583BOY
EOY7365935EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7400698BOY
EOY7371735EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses541048ReconcilationRevenueExpenses
Reconcilation Other Changes401304ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1882496CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years392059CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2923180CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1345122CurrentTaxYearMinus1Year
Current Tax Year2561310CurrentTaxYear
Total9104167Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1882496CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years392059CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2923180CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1345122CurrentTaxYearMinus1Year
Current Tax Year2561310CurrentTaxYear
Total9104167Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total2986537AmountsSubstContributorsTotal
Public Support Total1706117630PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years241404CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years154774CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years145044CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year119160CurrentTaxYearMinus1Year
Current Tax Year96864CurrentTaxYear
Total757246Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years42105CurrentTaxYearMinus4Years
Current Tax Year Minus1 Year47199CurrentTaxYearMinus1Year
Total89304Total
FieldValueIRS element (for citing)
Total Support9950717TotalSupport
Public Support Pertcentage1700.61480PublicSupportPertcentage170
Public Support Pertcent Prior Year0.66840PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance854341BeginningOfYearBalance
Contributions35899Contributions
Investment Earnings Or Losses42587InvestmentEarningsOrLosses
Other Expenditures56528OtherExpenditures
End Of Year Balance876299EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance821475BeginningOfYearBalance
Investment Earnings Or Losses92383InvestmentEarningsOrLosses
Other Expenditures59517OtherExpenditures
End Of Year Balance854341EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2903675BeginningOfYearBalance
Contributions30080Contributions
Investment Earnings Or Losses48478InvestmentEarningsOrLosses
Other Expenditures2160758OtherExpenditures
End Of Year Balance821475EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3815278BeginningOfYearBalance
Contributions389004Contributions
Investment Earnings Or Losses3568InvestmentEarningsOrLosses
Other Expenditures1304175OtherExpenditures
End Of Year Balance2903675EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.01430BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.79730PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.18840TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Total Revenue2717849TotalRevenue
Total Expenses2176801TotalExpenses
Excess Or Deficit For Year541048ExcessOrDeficitForYear
Net Unrealized GL On Investments401304NetUnrealizedGLOnInvestments
Total Adjustments401304TotalAdjustments
Excess Or Deficit Per FS942352ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt3119153TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments401304NetUnrealizedGainsInvestments
Revenue Not Rptd F990401304RevenueNotRptdF990
Revenue Subtotal2717849RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9902717849TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2176801TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal2176801ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9902176801TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:TO PROVIDE SCHOLARSHIPS FOR HEALTHCARE RELATED TO STUDY/WORK.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X: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, 2012 AND 2011, 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, 2009.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistancePurpose Of GrantPurposeOfGrant
LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC
1234 NAPIER AVENUEST JOSEPHMI49085382156872501(C)31482087N/AN/ADISTRIBUTED FUNDS TO LOCAL HOSPITAL TO PROVIDE BETTER EQUIPMENT AND FACILITIES
LAKELAND HEALTH FOUNDATION NILES
1234 NAPIER AVENUEST JOSEPHMI49085383130558501(C)319804N/AN/AGENERAL SUPPORT
HOSPICE AT HOME INC
4025 HEALTH PARK LANEST JOSEPHMI49085382416086501(C)383607N/AN/AGENERAL SUPPORT
BERRIEN REGIONAL EDUCATION SERVICE AGENCY
711 ST JOSEPH AVENUEBERRIEN SPRINGSMI49103381714920GOVERNMENTAL30000N/AN/AGENERAL SUPPORT
BERRIEN SPRINGS ORONOKO FIRE DEPARTMENT
4411 E SNOW ROADBERRIEN SPRINGSMI49103381885166GOVERNMENTAL10000N/AN/AGENERAL SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants5TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients58NumberOfRecipients
Amount Of Cash Grant47695AmountOfCashGrant
Method Of ValuationN/AMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE FUNDS ARE GIVEN TO RELATED ORGANIZATIONS, THEREFORE THE USE OF THE FUNDS ARE NOT MONITORED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
LOREN HAMEL MD
052788301677600438312017682022350115387200
DENNIS SZYMANSKI MD
042558100000873507737044205300
DAVID BURGHART
0162032012000001800101373018260600
TIMOTHY CALHOUN
0288184067718032048403850003338071822400

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4BReturnReference
ExplanationTHE CURRENT YEAR COMPENSATION INCLUDES A ROLL-OVER AMOUNT FOR THE SUPPLEMENTAL RETIREMENT PLAN INTO A 457F PLAN FOR ALL PARTICIPANTS. THIS AMOUNT INCLUDES ALL PRIOR YEARS OF SERVICE THAT WERE REQUIRED TO BE REPORTED IN THE CURRENT YEAR EVEN THOUGH THERE WAS NO ACTUAL DISTRIBUTION OF ANY MONIES. LOREN HAMEL, MD AND TIM CALHOUN WERE PARTICIPANTS IN THE PLAN.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6THE 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 11A 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 12CTHE 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.
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 CEOS 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 2012.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, FORM 990, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART VII:TIM CALHOUN, DAVID BURGHART, DENNIS SZYMANSKI AND LOREN HAMEL EACH WORKED AN AVERAGE OF AT LEAST 40 HOURS PER WEEK AT THE RELATED ORGANIZATION FROM WHICH THEY WERE COMPENSATED.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 401,304.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C:THERE HAS BEEN NO CHANGE IN AUDIT OVERSIGHT PROCESS FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
LAKELAND REGIONAL HEALTH SYSTEM INC
1234 NAPIER AVENUEST JOSEPHMI49085382609624PROVIDE A COMPREHENSIVE SYSTEM OF HEALTH CARE TO CITIZENS OF THE COMMUNITYMI501(C)(3)LINE 11B, IIN/A0
LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC
1234 NAPIER AVENUEST JOSEPHMI49085382156872PROVIDE A COMPREHENSIVE SYSTEM OF HEALTH CARE TO CITIZENS OF THE COMMUNITYMI501(C)(3)LINE 31LAKELAND REGIONAL HEALTH SYSTEM INC
LAKELAND SPECIALITY HOSPITAL AT BERRIEN CENTER
1234 NAPIER AVENUEST JOSEPHMI49085383452303LONGTERM HEALTHCARE/HEALING SERVICESMI501(C)(3)LINE 31LAKELAND REGIONAL HEALTH SYSTEM INC
LAKELAND HEALTH FOUNDATION NILES
1234 NAPIER AVENUEST JOSEPHMI49085383130558PROMOTE/ASSIST IN PROVIDING HEALTH CARE SERVICES IN SOUTHWESTERN MICHIGANMI501(C)(3)LINE 71LAKELAND REGIONAL HEALTH SYSTEM INC
MERCY MEMORIAL HEALTH SERVICES INC
3425 LAKESHORE DRIVEST JOSEPHMI49085382748035PROVIDE HOMECARE AND LONG-TERM HEALTHCARE TO PATIENTS IN SOUTHWEST MICHIGANMI501(C)(3)LINE 91LAKELAND REGIONAL HEALTH SYSTEM INC
LAKELAND COMMUNITY HOSPITAL - WATERVLIET
400 MEDICAL PARK DRIVEWATERVLIETMI49098381368745TO PROVIDE GENERAL HEALTH OF THE COMMUNITY THROUGH EDUCATION AND HEALTHCAREMI501(C)(3)LINE 91LAKELAND REGIONAL HEALTH SYSTEM INC
HOSPICE AT HOME INC
4025 HEALTH PARK LANEST JOSEPHMI49085382416086TO PROVIDE HOSPICE AND PALLIATIVE CARE TO THE TERMINALLY ILLMI501(C)(3)LINE 71LAKELAND REGIONAL HEALTH SYSTEM INC

Form990 Schedule R Part III Form990ScheduleRPartIII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
VAN'S MEDICAL EQUIPMENT OF LAKELAND LLC
1234 NAPIER AVENUEST JOSEPHMI49085261497708MEDICAL EQUIPMENTMIN/A
CLIFFSIDE COMPANY LLC
910 S WASHINGTON AVENUEROYAL OAKMI48067383306320ASSISTED LIVINGMIN/A
LAKELINE ASSOCIATES LLC
910 S WASHINGTON AVENUEROYAL OAKMI48067383306318PROPERTY MANAGEMENT/RENTALMIN/A
LIBERTY DIALYSIS LAKELAND LLC
7650 SE 27TH STREET SUITE 200MERCER ISLANDWA98040272099855MEDICAL SERVICESWAN/A
LDBH LLC
7650 SE 27TH STREET SUITE 200MERCER ISLANDWA98040451745643MEDICAL SERVICESWAN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
LAKELAND HEALTH ENTERPRISES INC
31 NORTH ST JOSEPH AVENUENILESMI49120382669798ACCOUNTING AND BILLINGMIN/AC
PHARMACY SHOPPE INC DBA LAKELAND PHARMACY SHOPPE INC
1234 NAPIER AVENUEST JOSEPHMI49085382929090PHARMACEUTICALSMIN/AC
LAKELAND MEDICAL PRACTICES
1234 NAPIER AVENUEST JOSEPHMI49085270381199MEDICAL ADMINISTRATIVE SERVICESMIN/AC
SOUTHWESTERN MEDICAL CLINIC PHYSICIANS INC
1234 NAPIER AVENUEST JOSEPHMI49085272589359PHYSICIAN OFFICEMIN/AC
FOUR FLAGS PROPERTIES INC
122 GRANT STREETNILESMI49120364501639PROPERTY MANAGEMENT/RENTALMIN/AC
LAKELAND HEALTH VENTURES INC
1234 NAPIER AVENUEST JOSEPHMI49085272313790HOLDING COMPANYMIN/AC
LAKELAND PHYSICIAN CARE NETWORK
1234 NAPIER AVENUEST JOSEPHMI49085208513031MEDICAL SERVICESMIN/AC
LAKELAND PERSONAL CARE SERVICES INC
1234 NAPIER AVENUEST JOSEPHMI49085272990797HEALTH CARE SERVICESMIN/AC
LAKELAND CARE INC
1234 NAPIER AVENUEST JOSEPHMI49085383225306CONTRACT NEGOTIATIONMIN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
LAKELAND HEALTH ENTERPRISES DBA LAKELAND PRACTICE SOLUTIONS
O17400REIMB FOR ACCOUNTING SERVICES
LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC
B1482087ACTUAL AMOUNTS GRANTED
LAKELAND HEALTH FOUNDATION NILES
B19804ACTUAL AMOUNTS GRANTED
HOSPICE AT HOME
B83607ACTUAL AMOUNTS GRANTED

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