2013-05-15T10:21:52-05:00 2012-09-30 381357951 PLANTE & MORAN PLLC 511 RENAISSANCE DRIVE ST JOSEPH MI 49085 990 2011-10-01 382539929 LAKELAND HEALTH FOUNDATION BENTON HARBOR/ST JOSEPH LAKE 2699838300 1234 NAPIER AVENUE SAINT JOSEPH MI 49085 TIMOTHY CALHOUN 2699838300 2013-05-14 1 KENLEY G PENNER CPA P00185160 2699828000 2011 2016-02-24 21:20:13Z DAVID BURGHART 1234 NAPIER AVENUE SAINT JOSEPH MI 49085 7804996 0 X N/A X 1984 MI TO PROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM. 29 26 0 26 0 0 1345122 2561310 0 0 367061 156539 47199 0 1759382 2717849 2396991 1788895 0 0 0 0 0 0 295294 49047 387906 2446038 2176801 -686656 541048 7400698 7371735 977115 5800 6423583 7365935 PROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM. 0 0 1741200 1741200 THE FOUNDATION DISTRIBUTED FUNDS TO A LOCAL AREA HOSPITAL FOR BETTER EQUIPMENT AND FACILITIES. 47695 47695 THE FOUNDATION DISTRIBUTED FUNDS TO 58 LOCAL HEALTH CARE INDIVIDUALS FOR TUITION RELATED EXPENSES. 1788895 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 X 29 26 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 1234 NAPIER AVE ST JOSEPH MI 49085 X BILL HANLEY 2.00 X X 0 0 0 RANDY BETTICH 2.00 X X 0 0 0 RICK DYER 2.00 X X 0 0 0 LOREN HAMEL MD 2.00 X X 0 1133955 19917 SANDI BOWMAN 2.00 X 0 0 0 LUCAS BROWN 2.00 X 0 0 0 RICHARD BUCKALEW 2.00 X 15000 0 0 JAMES CLEVER 2.00 X 0 0 0 EDWARD CONRAD 2.00 X 0 0 0 WENDY EDWARDS 2.00 X 0 0 0 MARC FLORIAN 2.00 X 0 0 0 ROBERT GOTTLIEB 2.00 X 0 0 0 BRITTANY GRASLEY 2.00 X 0 0 0 GYL KASEWURM 2.00 X 0 0 0 TINA KIRBY 2.00 X 0 0 0 KURT MARZKE 2.00 X 0 0 0 BARBARA MEEKS 2.00 X 0 0 0 RANDALL MILLER 2.00 X 0 0 0 PAT MOODY 2.00 X 0 0 0 TIM PASSARO 2.00 X 0 0 0 JOHN PROOS MD 2.00 X 0 0 0 DON RADDE 2.00 X 0 0 0 EBON SANDERS 2.00 X 0 0 0 KATHLEEN SNYDER 2.00 X 0 0 0 CAROL STARKS 2.00 X 0 0 0 DENNIS SZYMANSKI MD 2.00 X 0 425581 16472 KAY VARGA-SMITH 2.00 X 0 0 0 DANA WALES 2.00 X 0 0 0 MARGE WIATROWSKI 2.00 X 0 0 0 LEO SOORUS PART-YEAR 2.00 X X 0 0 0 JERRY ALBERTS PART-YEAR 2.00 X 0 0 0 DAVID BURGHART 2.00 X 0 163232 19374 TIMOTHY CALHOUN 2.00 X 0 676386 41838 15000 2399154 97601 0 0 1 0 0 383334 2177976 2561310 96864 96864 5146822 5087147 59675 59675 59675 2717849 0 0 156539 1741200 1741200 47695 47695 295294 295294 3900 3900 28400 28400 11722 11722 BAD DEBTS - PLEDGES 46665 46665 1925 1925 2176801 1788895 92612 295294 880682 979742 1799744 2405405 4720272 3986588 7400698 7371735 977115 5800 977115 5800 X 2877690 3314731 2847193 3352504 698700 698700 6423583 7365935 7400698 7371735 X 541048 401304 X X 0 1 1 X 0 X 1882496 392059 2923180 1345122 2561310 9104167 1882496 392059 2923180 1345122 2561310 9104167 2986537 6117630 241404 154774 145044 119160 96864 757246 42105 47199 89304 9950717 0.61480 0.66840 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 854341 35899 42587 56528 876299 821475 92383 59517 854341 2903675 30080 48478 2160758 821475 3815278 389004 3568 1304175 2903675 0.01430 0.79730 0.18840 0 0 0 2717849 2176801 541048 401304 401304 942352 3119153 401304 401304 2717849 0 2717849 2176801 0 2176801 0 2176801 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. 0 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 382156872 501(C)3 1482087 N/A N/A DISTRIBUTED FUNDS TO LOCAL HOSPITAL TO PROVIDE BETTER EQUIPMENT AND FACILITIES LAKELAND HEALTH FOUNDATION NILES 1234 NAPIER AVENUE ST JOSEPH MI 49085 383130558 501(C)3 19804 N/A N/A GENERAL SUPPORT HOSPICE AT HOME INC 4025 HEALTH PARK LANE ST JOSEPH MI 49085 382416086 501(C)3 83607 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 BERRIEN SPRINGS ORONOKO FIRE DEPARTMENT 4411 E SNOW ROAD BERRIEN SPRINGS MI 49103 381885166 GOVERNMENTAL 10000 N/A N/A GENERAL SUPPORT 5 0 SCHOLARSHIPS 58 47695 N/A N/A PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FUNDS ARE GIVEN TO RELATED ORGANIZATIONS, THEREFORE THE USE OF THE FUNDS ARE NOT MONITORED. 0 1 0 0 0 0 0 0 0 LOREN HAMEL MD 0 527883 0 167760 0 438312 0 17682 0 2235 0 1153872 0 0 DENNIS SZYMANSKI MD 0 425581 0 0 0 0 0 8735 0 7737 0 442053 0 0 DAVID BURGHART 0 162032 0 1200 0 0 0 18001 0 1373 0 182606 0 0 TIMOTHY CALHOUN 0 288184 0 67718 0 320484 0 38500 0 3338 0 718224 0 0 PART I, LINE 4B THE 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. 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. 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 19 THE 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 401,304. 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 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 SPECIALITY 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 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 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 AVENUE 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 PHARMACY SHOPPE INC DBA LAKELAND PHARMACY SHOPPE INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 382929090 PHARMACEUTICALS MI N/A C LAKELAND MEDICAL PRACTICES 1234 NAPIER AVENUE ST JOSEPH MI 49085 270381199 MEDICAL ADMINISTRATIVE SERVICES MI N/A C SOUTHWESTERN MEDICAL CLINIC PHYSICIANS INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 272589359 PHYSICIAN OFFICE MI N/A C FOUR FLAGS PROPERTIES INC 122 GRANT STREET NILES MI 49120 364501639 PROPERTY MANAGEMENT/RENTAL MI N/A C LAKELAND HEALTH VENTURES INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 272313790 HOLDING COMPANY MI N/A C LAKELAND PHYSICIAN CARE NETWORK 1234 NAPIER AVENUE ST JOSEPH MI 49085 208513031 MEDICAL SERVICES MI N/A C LAKELAND PERSONAL CARE SERVICES INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 272990797 HEALTH CARE SERVICES MI N/A C LAKELAND CARE INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 383225306 CONTRACT NEGOTIATION MI N/A C 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 LAKELAND HEALTH ENTERPRISES DBA LAKELAND PRACTICE SOLUTIONS O 17400 REIMB FOR ACCOUNTING SERVICES LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC B 1482087 ACTUAL AMOUNTS GRANTED LAKELAND HEALTH FOUNDATION NILES B 19804 ACTUAL AMOUNTS GRANTED HOSPICE AT HOME B 83607 ACTUAL AMOUNTS GRANTED