2013-08-06T10:28:30-05:00 2012-09-30 381357951 PLANTE & MORAN PLLC 511 RENAISSANCE DRIVE ST JOSEPH MI 49085 990 2011-10-01 382156872 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC LAKE 2699838166 1234 NAPIER AVENUE ST JOSEPH MI 49085 TIMOTHY CALHOUN 2699838166 2013-08-02 1 KENLEY PENNER CPA P00740260 2699828000 2011 2016-02-24 21:20:13Z LAKELAND HEALTHCARE TIMOTHY CALHOUN 1234 NAPIER AVENUE ST JOSEPH MI 49085 647871765 0 X LAKELANDHEALTH.ORG X 1985 MI LAKELAND HOSPITAL IS A 339 BED ACUTE CARE HOSPITAL AND PROVIDES A FULL CONTINIUM OF HEALTHCARE SERVICES TO IT'S TRI-COUNTY AREA. LAKELAND REGIONAL HEALTH SYSTEM IS THE PARENT COMPANY FOR LAKELAND HOSPITALS, NURSING HOMES, AND OTHER HEALTH-RELATED SERVICE CORPORATIONS SERVING THE TRI-COUNTY AREA. 23 20 3480 700 3972505 0 2506830 2328759 330557561 340827922 15201730 11129802 1247457 339551 349513578 354626034 8951144 16620636 0 0 142609341 147763544 0 0 0 159951479 172246814 311511964 336630994 38001614 17995040 611140367 658444079 196141630 201012754 414998737 457431325 TO BE SOUTHWESTERN MICHIGAN'S LEADER IN SAFE, HIGH QUALITY, PATIENT CENTERED, COMPASSIONATE, HEALTH-RELATED SERVICES. 0 0 250228198 16620636 336855417 HOSPITAL SERVICES PROVIDED TO 17,971 INPATIENTS AND 308,968 OUTPATIENTS. 250228198 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 3480 1 1 1 0 0 0 0 0 0 0 0 0 X 23 20 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X TIMOTHY J CALHOUN 2699838166 1234 NAPIER AVENUE ST JOSEPH MI 49085 X DANIEL HOPP 5.00 X X 0 0 0 JEFF EDMUNDS 3.00 X X 0 0 0 TERRENCE ALLEN 3.00 X X 0 0 0 LOREN HAMEL MD 30.00 X X 1133955 0 19917 NIELS-ERIK ANDREASEN 2.00 X 0 0 0 JOSEPH BARRETT 2.00 X 0 0 0 LENNY BECKER 2.00 X 0 0 0 DAVID BINKLEY 2.00 X 0 0 0 LAURIANNE DAVIS 2.00 X 0 0 0 BETH DODGE 2.00 X 0 0 0 LYNN GRAY MD 2.00 X 0 0 0 PATRICIA HALL 2.00 X 0 0 0 GEORGE HEENAN MD 2.00 X 0 0 0 STEPHEN HEMPEL MD 40.00 X 285002 0 25780 J DOUGLAS HUGGETT DO 2.00 X 0 0 0 MICHAEL MORTIMORE 2.00 X 0 0 0 KENNETH O'NEILL MD 4.00 X 225450 0 31797 MARCUS ROBINSON 2.00 X 0 0 0 JEFFREY SCHMIDT DDS 2.00 X 0 0 0 LINDA STANLEY MD 2.00 X 0 0 0 WESLEY STEPHENS 2.00 X 0 0 0 THOMAS YEAGER 2.00 X 0 0 0 JUDITH ZACHA 2.00 X 0 0 0 LEN AMAT 2.00 X 0 0 0 GEORGE KOLETTIS MD 2.00 X 0 0 0 MICHAEL WELCH 2.00 X 0 0 0 LINDA BEUSHAUSEN 1.00 X 0 101954 7395 TIMOTHY CALHOUN 30.00 X 676386 0 41838 RAY CRUSE 5.00 X 164038 0 6984 LAURIE FLEMING 30.00 X 323423 0 12130 LOWELL HAMEL MD 20.00 X 375777 0 10205 DENNIS MACK 40.00 X 433637 0 35231 MARY ANN PATER 30.00 X 498804 0 27147 NORMA TIRADO-KELLENBERGER 30.00 X 347736 0 25936 WARREN WHITE 10.00 X 261883 0 25000 EILEEN WILLITS 30.00 X 568103 0 40836 DAVID BURGHART 1.00 X 163232 0 19374 JAMES SCHLAMAN 20.00 X 153488 0 14341 BART BERNDT 40.00 X 140474 0 14607 NEIL JOHNSON 30.00 X 136967 0 29213 MARK PAULSON 35.00 X 145489 0 9635 TIMOTHY ROBERTS 30.00 X 172916 0 6568 JANN TOTZKE 40.00 X 142672 0 9858 6349432 101954 413792 73 0 1 0 LAKELAND MEDICAL PRACTICE 122 GRANT STREET NILES MI 49210 PHYSICIAN SERVICES 6667413 SUNSET COAST ANESTHESIA ASSOCIATES 1234 NAPIER AVE ST JOSEPH MI 49085 ANESTHESIA SERVICES 2104595 ALLIANCE - HNI PETCT SERVICES PO BOX 402209 ATLANTA GA 303842209 PET SCAN RADIOLOGY SERVICES 1792895 EMPG OF MICHIGAN PC 2000 GREEN RD SUITE 2300 ANN ARBOR MI 481051571 EMERGENCY ROOM PHYSICIANS 1423457 SOUTH BEND MEDICAL FOUNDATION INC PO BOX 2030 MISHAWAKA IN 465462030 LAB SERVICES 1417888 34 2199207 129552 2328759 PATIENT SERVICE REVENU 541380 334119392 330305285 3814107 OTHER OPERATING REVENU 541380 6708530 6550132 158398 340827922 7038674 7038674 339551 0 339551 339551 339551 296728106 608753 292665448 580283 4062658 28470 4091128 4091128 354626034 336855417 3972505 11469353 16620636 16620636 3985552 2909453 1076099 109764033 80127744 29636289 3403908 2484853 919055 22215512 16217324 5998188 8394539 6128013 2266526 217798 158993 58805 377294 275425 101869 9680093 7066468 2613625 441296 322146 119150 202832 148067 54765 4950276 3613701 1336575 5840676 4263693 1576983 809814 591164 218650 5080064 3708447 1371617 21114798 15413803 5700995 1928849 1408060 520789 MEDICAL AND OFFICE SUPP 57867400 42243202 15624198 BAD DEBTS 18521375 13520604 5000771 PHYSICIAN RELATIONS 17329463 12650508 4678955 QAAP ASSESSMENTS 8850411 6460800 2389611 19034375 13895094 5139281 336630994 250228198 86402796 0 64789752 56924015 25227681 26428165 6307708 6421808 4263553 4408111 455935369 218967996 224391760 236967373 274450703 309072223 11709210 18222384 611140367 658444079 33344820 33041600 113645230 110641991 49151580 57329163 196141630 201012754 X 410912010 453473155 4086727 3958170 414998737 457431325 611140367 658444079 X 17995040 24437548 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 24515 24515 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF DUES PAID TO MHA HAVE BEEN ALLOCATED TO LOBBYING ACTIVITIES. 5215020 5215020 184189171 62545920 121643251 5823309 3882475 1940834 255772281 152539601 103232680 4935588 4935588 236967373 PROVISION FOR MEDICAL MALPRACTICE 12200000 PROVISION FOR DEFERRED COMPENSATION 4311859 PROVISION FOR POSTRETIREMENT BENEFIT 16141180 INTEREST RATE SWAP AGREEMENTS 24676124 57329163 354626034 336630994 17995040 27743080 -3305532 24437548 42432588 378185595 27743080 -1984312 25758768 352426827 2199207 2199207 354626034 320010358 0 320010358 16620636 16620636 336630994 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL 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 HOSPITAL AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2012, 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 HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN FOUNDATIONS -96,655. CHANGE IN FAIR VALUE OF SWAP AGREEMENTS -1,887,657. CHANGE IN INTEREST FROM PARTNERSHIP K-1 -21,778. CAPITAL CONTRIBUTION TO LAKELAND HEALTH ENTERPRISES -635,793. REIMBURSED EXPENSES NETTED WITH TRANSFERS -663,649. TOTAL TO SCHEDULE D, PART XI, LINE 8: -3,305,532. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF SWAP AGREEMENTS -1,887,657. CHANGE IN INTEREST IN FOUNDATIONS -96,655. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION FROM LAKELAND HEALTH FOUNDATION, BENTON HARBOR/ST. JOSEPH 1,482,087. CONTRIBUTION FROM LAKELAND HEALTH FOUNDATION, NILES 717,120. PART XIII, LINE 4B - OTHER ADJUSTMENTS: GRANT TO LAKELAND REGIONAL HEALTH SYSTEM, INC. 16,620,636. 1 1 X 1 X 1 X 225.000000000000 1 1 1 0 1 1 1 4527 5695289 0 5695289 0.01790 1 63946 49322508 47339359 1983149 0.00620 2 68473 55017797 47339359 7678438 0.02410 692 175798 2443915 206 2443709 0.00770 106 1655 2838702 0 2838702 0.00890 137 3783 285675 0 285675 0.00090 935 181236 5568292 206 5568086 0.01750 937 249709 60586089 47339565 13246524 0.04160 38 212 2798 0 2798 0.00000 1 68 387 0 387 0.00000 3 280 131 0 131 0.00000 2 130 888 0 888 0.00000 17 10 988 0 988 0.00000 61 700 5192 5192 1 18521375 9260688 115896072 120012940 -4116868 X 1 0 2 1 LAKELAND HOSPITALS AT NILES

31 N STREET JOSEPH AVENUE NILES MI 49120

X X X 2 LAKELAND HOSPITALS AT ST JOSEPH

1234 NAPIER AVENUE ST JOSEPH MI 49085

X X X LAKELAND HOSPITALS AT NILES 1 0 1 1 150.000000000000 1 225.000000000000 1 X X X X 1 1 X X X 1 0 1 X 0 0 LAKELAND HOSPITALS AT ST JOSEPH 2 0 1 1 150.000000000000 1 225.000000000000 1 X X X X 1 1 X X X 1 0 1 X 0 0 PART I, LINE 7: THE COST TO CHARGE RATIO WAS USED BASED ON WORKSHEET 2 OF THE INSTRUCTIONS. PART I, L7 COL(F): ACCOUNTS RECEIVABLE FROM PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL LOSS RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $18,521,375. PART I, LINES 7F AND 7I HEALTH PROFESSIONS EDUCATION - INCLUDES PROVIDING A CLINICAL SETTING FOR UNDERGRADUATE AND GRADUATE STUDENTS, VOCATIONAL TRAINING, AND THE PROFESSIONAL HEALTH CAREERS ACADEMY FOR ELEVENTH AND TWELFTH GRADE STUDENTS. CASH & IN-KIND DONATIONS TO COMMUNITY GROUPS - REPRESENTS LAKELANDS FINANCIAL AND IN-KIND CONTRIBUTIONS TO SOCIAL SERVICES OR COMMUNITY AGENCIES FOR HEALTHCARE RELATED ACTIVITIES, DONATION OF MEDICAL SUPPLIES, UNITED WAY LEADERSHIP, GIRLS ON THE RUN, AND MEMBERSHIP ON COMMUNITY BOARDS. FINANCIAL ASSISTANCE - COVERS THE FREE OR DISCOUNTED CARE THAT LAKELAND OFFERS TO THOSE WHO CANNOT AFFORD TO PAY OR ARE NOT ELIGIBLE FOR PUBLIC PROGRAMS.FINANCIAL ASSISTANCE DOES NOT INCLUDE THE BAD DEBT COST, WHICH TOTALED $8,641,629 IN FY 2012 OR THE UNPAID COSTS OF MEDICARE, WHICH TOTALED $4,116,868. UNREIMBURSED MEDICAID- REPRESENTS THE COST OF CARING FOR PEOPLE COVERED BY MEDICAID MINUS THE AMOUNT LAKELAND RECEIVES FROM THOSE PROGRAMS. PART II: COMMUNITY BUILDING ACTIVITIES INCLUDE HOSTS MENTORING PROGRAM FOR YOUNG CHILDREN, HEALTH CAREER PRESENTATIONS TO AREA STUDENTS, DISASTER READINESS, AND YOUNG ENTREPRENEURS DAY FOR AREA HIGH SCHOOL STUDENTS PART III, LINE 4: ACCOUNTS RECEIVABLE FROM PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL LOSS RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.THE AMOUNT OF BAD DEBT EXPENSE DETERMINED TO BE COMMUNITY BENEFIT IS APPROXIMATELY 50% OF BAD DEBT EXPENSE. PART III, LINE 8: IT IS ESTIMATED THAT 80% OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BASED ON THE NUMBER OF PATIENTS THAT MAY HAVE QUALIFIED FOR FREE OR DISCOUNTED CARE HAD THEY NOT BEEN COVERED BY MEDICARE. LAKELAND HOSPITALS AT NILES PART V, SECTION B, LINE 3: THE CHNA INCLUDED INPUT AND DATA COLLECTED FROM PEOPLE AND ORGANIZATIONS THROUGHOUT THE COUNTY REPRESENTING THE BROAD INTERESTS OF BERRIEN COUNTY-PUBLIC HEALTH, GOVERNMENT, COMMUNITY LEADERS, MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS.PARTICIPATING ORGANIZATIONS INCLUDED:- BERRIEN COUNTY HEALTH DEPARTMENT- BERRIEN COUNTY DEPARTMENT OF HUMAN SERVICES- BERRIEN HEALTH PLAN- HEAL HEALTH EQUITY ALLIANCE- HEALTHY COMMUNITY PARTNERSHIP- BERRIEN COUNTY INTERMEDIATE SCHOOL DISTRICT- UNITED WAY OF SOUTHWEST MICHIGAN- AREA AGENCY ON AGING REGION 4- SOUTHWEST MICHIGAN PLANNING COMMISSION- BENTON HARBOR ST. JOSEPH YMCA- PUBLICLY AVAILABLE DATA FROM THE CENTER FOR DISEASE CONTROL AND PREVENTION(CDC), MICHIGAN DEPARTMENT OF COMMUNITY HEALTH(MDCH), US CENSUS, AMERICAN COMMUNITY SURVEY, MICHIGAN HOSPITAL ASSOCIATION(MHA) AND COUNTY HEALTH RANKINGS(UNIVERSITY OF WISCONSIN) LAKELAND HOSPITALS AT ST. JOSEPH PART V, SECTION B, LINE 3: THE CHNA INCLUDED INPUT AND DATA COLLECTED FROM PEOPLE AND ORGANIZATIONS THROUGHOUT THE COUNTY REPRESENTING THE BROAD INTERESTS OF BERRIEN COUNTY-PUBLIC HEALTH, GOVERNMENT, COMMUNITY LEADERS, MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS.PARTICIPATING ORGANIZATIONS INCLUDED:- BERRIEN COUNTY HEALTH DEPARTMENT- BERRIEN COUNTY DEPARTMENT OF HUMAN SERVICES- BERRIEN HEALTH PLAN- HEAL HEALTH EQUITY ALLIANCE- HEALTHY COMMUNITY PARTNERSHIP- BERRIEN COUNTY INTERMEDIATE SCHOOL DISTRICT- UNITED WAY OF SOUTHWEST MICHIGAN- AREA AGENCY ON AGING REGION 4- SOUTHWEST MICHIGAN PLANNING COMMISSION- BENTON HARBOR ST. JOSEPH YMCA- PUBLICLY AVAILABLE DATA FROM THE CENTER FOR DISEASE CONTROL AND PREVENTION(CDC), MICHIGAN DEPARTMENT OF COMMUNITY HEALTH(MDCH), US CENSUS, AMERICAN COMMUNITY SURVEY, MICHIGAN HOSPITAL ASSOCIATION(MHA) AND COUNTY HEALTH RANKINGS(UNIVERSITY OF WISCONSIN) LAKELAND HOSPITALS AT NILES PART V, SECTION B, LINE 5C: THE CHNA WILL BE MADE AVAILABLE TO THE PUBLIC BY A NUMBER OF MARKETING TACTICS: NEWS RELEASES TO BERRIEN COUNTY NEWSPAPERS, COMMUNITY EMAIL BLAST TO OVER 1,000 SUBSCRIBERS, MYLAKELAND INTRANET POSTING TO OVER 4,500 LAKELAND ASSOCIATES, VOLUNTEERS AND PHYSICIANS, DISTRIBUTED AT COMMUNITY EDUCATION EVENTS, PHYSICIAN SPEAKER SERIES AND MANY OTHER COMMUNITY HEALTH/WELLNESS PROGRAMS.BEGINNING JUNE 30, PAPER COPIES WILL BE AVAILABLE UPON REQUEST USING THE 800 LAKELAND PHONE NUMBER. LAKELAND HOSPITALS AT ST. JOSEPH PART V, SECTION B, LINE 5C: THE CHNA WILL BE MADE AVAILABLE TO THE PUBLIC BY A NUMBER OF MARKETING TACTICS: NEWS RELEASES TO BERRIEN COUNTY NEWSPAPERS, COMMUNITY EMAIL BLAST TO OVER 1,000 SUBSCRIBERS, MYLAKELAND INTRANET POSTING TO OVER 4,500 LAKELAND ASSOCIATES, VOLUNTEERS AND PHYSICIANS, DISTRIBUTED AT COMMUNITY EDUCATION EVENTS, PHYSICIAN SPEAKER SERIES AND MANY OTHER COMMUNITY HEALTH/WELLNESS PROGRAMS.BEGINNING JUNE 30, PAPER COPIES WILL BE AVAILABLE UPON REQUEST USING THE 800 LAKELAND PHONE NUMBER. LAKELAND HOSPITALS AT NILES PART V, SECTION B, LINE 7: THE HOSPITAL DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENT NEEDS ASSESSMENT BECAUSE THE NEED TO REDUCE EXCESSIVE DRINKING, MOTOR VEHICLE CRASH DEATHS, AND SEXUALLY TRANSMITTED INFECTIONS ARE SPECIFIC HEALTH BEHAVIORS THAT ARE ADDRESSED BY THE BERRIEN COUNTY HEALTH DEPARTMENT. LAKELAND HOSPITALS AT ST. JOSEPH PART V, SECTION B, LINE 7: THE HOSPITAL DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENT NEEDS ASSESSMENT BECAUSE THE NEED TO REDUCE EXCESSIVE DRINKING, MOTOR VEHICLE CRASH DEATHS, AND SEXUALLY TRANSMITTED INFECTIONS ARE SPECIFIC HEALTH BEHAVIORS THAT ARE ADDRESSED BY THE BERRIEN COUNTY HEALTH DEPARTMENT. LAKELAND HOSPITALS AT NILES PART V, SECTION B, LINE 13G: FINANCIAL ASSISTANCE AVAILABILITY IS REFERENCED ON OUR BILLING INVOICES AND IN BROCHURES LOCATED IN OUR EMERGENCY DEPARTMENT, ADMISSION'S OFFICE, PATIENT WAITING ROOMS, AND IN THE PATIENT DISCHARGE PACKET. LAKELAND HOSPITALS AT ST. JOSEPH PART V, SECTION B, LINE 13G: FINANCIAL ASSISTANCE AVAILABILITY IS REFERENCED ON OUR BILLING INVOICES AND IN BROCHURES LOCATED IN OUR EMERGENCY DEPARTMENT, ADMISSION'S OFFICE, PATIENT WAITING ROOMS, AND IN THE PATIENT DISCHARGE PACKET. PART VI, LINE 2: THE ORGANIZATION USES NEEDS ASSESSMENT PREPARED BY THE COUNTY HEALTH DEPARTMENT AND PARTICIPATE IN A REGIONAL HEALTHY BERRIEN COMMUNITY COMMITTEE TO ADDRESS HEALTH NEEDS. PART VI, LINE 3: THE ORGANIZATION EMPLOYS MORE THAN 12 FINANCIAL COUNSELORS WHO ASSIST PATIENTS WITH ELIGIBILITY. PART VI, LINE 4: THE SYSTEM SERVES APPROXIMATELY 160,000 RESIDENTS IN BERRIEN COUNTY AND SURROUNDING AREAS. APPROXIMATELY 12% OF FAMILIES AND 17% OF INDIVIDUALS ARE BELOW POVERTY LEVEL. PART VI, LINE 5: COMMUNITY HEALTH IMPROVEMENT SERVICES & COMMUNITY BENEFIT OPERATIONS - REPRESENTS ACTIVITIES THAT HELP IMPROVE THE HEALTH AND QUALITY OF LIFE FOR PEOPLE IN THE COMMUNITY. HEALTH PRESENTATIONS INCLUDE: ACT IN TIME TO HEART ATTACK AND STROKE, EXPECTANT PARENT, SMOKE FREE LIFE, TEEN PREGNANCY PREVENTION BABY THINK IT OVER AND POSTPONING SEXUAL INVOLVEMENT - ADVANCED DIRECTIVES, SENIOR-EXPO, PRE-DIABETES, FALLS PREVENTION, MEDICATION SAFETY, HEARTSAFE AND HEART LESSONS. CANCER SCREENINGS INCLUDE PROSTATE, BREAST AND COLORECTAL, CANCER SUPPORT PROGRAMS SUCH AS: LOOK GOOD...FEEL BETTER, THE ANNUAL CARE FAIR, AND BREAST HEALTH AWARENESS. LAKELAND SUPPORTS TWO HEALTH RESOURCE LIBRARIES AT ST. JOSEPH AND NILES, PARISH AND SENIOR CENTER NURSES, AND NUMEROUS HEALTH SCREENINGS ARE SOME EXAMPLES. IN 2012 LAKELAND OFFERED MEDICAL SUPPORT TO THE 2012 SENIOR PGA CHAMPIONSHIP. PART VI, LINE 6: THE ORGANIZATION IS PART OF LAKELAND REGIONAL HEALTH SYSTEM WHICH SERVES THE SAME GEOGRAPHIC AREA FOR HEALTHCARE RELATED SERVICES. REPORTS FILED WITH STATES PART VI, LINE 7 MI 1 LAKELAND REGIONAL HEALTH SYSTEM INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 382609624 501(C)(3) 16620636 ACTUAL AMOUNTS GRANTED GENERAL SUPPORT 1 X X X X X 0 1 0 0 0 0 0 0 0 LOREN HAMEL MD 527883 0 167760 0 438312 0 17682 0 2235 0 1153872 0 0 0 STEPHEN HEMPEL MD 279302 0 0 0 5700 0 15860 0 9920 0 310782 0 0 0 KENNETH O'NEILL MD 119488 0 2255 0 103707 0 11772 0 20025 0 257247 0 0 0 TIMOTHY CALHOUN 288184 0 67718 0 320484 0 38500 0 3338 0 718224 0 0 0 RAY CRUSE 128924 0 32625 0 2489 0 6593 0 391 0 171022 0 0 0 LAURIE FLEMING 182000 0 31082 0 110341 0 9895 0 2235 0 335553 0 0 0 LOWELL HAMEL MD 158010 0 33287 0 184480 0 10102 0 103 0 385982 0 0 0 DENNIS MACK 167432 0 34297 0 231908 0 30496 0 4735 0 468868 0 0 0 MARY ANN PATER 149292 0 15403 0 334109 0 24656 0 2491 0 525951 0 0 0 NORMA TIRADO-KELLENBERGER 256142 0 49980 0 41614 0 23636 0 2300 0 373672 0 0 0 WARREN WHITE 194545 0 34405 0 32933 0 24464 0 536 0 286883 0 0 0 EILEEN WILLITS 228212 0 48127 0 291764 0 38500 0 2336 0 608939 0 0 0 DAVID BURGHART 162032 0 1200 0 0 0 18001 0 1373 0 182606 0 0 0 JAMES SCHLAMAN 149807 0 1200 0 2481 0 11695 0 2646 0 167829 0 0 0 BART BERNDT 137592 0 1200 0 1682 0 10010 0 4597 0 155081 0 0 0 NEIL JOHNSON 135616 0 1200 0 151 0 20488 0 8725 0 166180 0 0 0 MARK PAULSON 141266 0 1200 0 3023 0 5652 0 3983 0 155124 0 0 0 TIMOTHY ROBERTS 156018 0 16200 0 698 0 4220 0 2348 0 179484 0 0 0 JANN TOTZKE 138042 0 1200 0 3430 0 6904 0 2954 0 152530 0 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, TIMOTHY CALHOUN, LAURIE FLEMING, LOWELL HAMEL, MD, DENNIS MACK, MARY ANN PATER, NORMA TIRADO-KELLENBERGER, WARREN WHITE, AND EILEEN WILLITS WERE PARTICIPANTS IN THE PLAN. HOSPITAL AUTHORITY OF THE CITY OF ST JOSEPH (MICHIGAN) 383151499 790678CC8 2003-12-17 41525000 REFUND BONDS ISSUED 1/13/94 AND FACILITY CONSTRUCTION AND IMPROVEMENTS 0 0 0 HOSPITAL AUTHORITY OF THE CITY OF ST JOSEPH (MICHIGAN) 383151499 790678CD6 2006-01-26 50000000 FACILITY CONSTRUCTION AND IMPROVEMENTS 0 0 0 41643043 193091 31392505 10057446 2004 1 0 1 1 52613405 467500 1012738 51133167 2007 0 0 1 1 0 0 1 1 0 1 0 0 0 0 1 0 1 1 UBS AG 28.000000000000 0 0 0 0 1 1 1 1 UBS AG 28.900000000000 0 0 1 CITIGROUP GLOBAL MARKETS 2.700000000000 1 0 0 FORM 990, PART VI, SECTION A, LINE 2 LOREN HAMEL, MD AND LOWELL HAMEL HAVE A FAMILY RELATIONSHIP. 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 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 2012. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART VII: LOREN HAMEL, MD WORKED AN AVERAGE OF AT LEAST 20 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. KENNETH O'NEILL, MD WORKED AN AVERAGE OF AT LEAST 44 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. LINDA BEUSHAUSEN WORKED AN AVERAGE OF AT LEAST 45 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. TIMOTHY CALHOUN WORKED AN AVERAGE OF AT LEAST 20 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. RAY CRUSE WORKED AN AVERAGE OF AT LEAST 40 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. LAURIE FLEMING WORKED AN AVERAGE OF AT LEAST 10 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. LOWELL HAMEL, MD WORKED AN AVERAGE OF AT LEAST 15 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. DENNIS MACK WORKED AN AVERAGE OF AT LEAST 2 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. MARY ANN PATER WORKED AN AVERAGE OF AT LEAST 13 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. NORMA TIRADO-KELLENBERGER WORKED AN AVERAGE OF AT LEAST 16 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. WARREN WHITE WORKED AN AVERAGE OF AT LEAST 35 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. EILEEN WILLITS WORKED AN AVERAGE OF AT LEAST 15 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. DAVID BURGHART WORKED AN AVERAGE OF AT LEAST 45 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. JAMES SCHLAMAN WORKED AN AVERAGE OF AT LEAST 20 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. NEAL JOHNSON WORKED AN AVERAGE OF AT LEAST 10 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. MARK PAULSON WORKED AN AVERAGE OF AT LEAST 5 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. TIMOTHY ROBERTS WORKED AN AVERAGE OF AT LEAST 15 HOURS AT RELATED ORGANIZATIONS DURING FISCAL YEAR 2012. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 27,743,080. CHANGE IN INTEREST IN FOUNDATIONS -96,655. CHANGE IN FAIR VALUE OF SWAP AGREEMENTS -1,887,657. CHANGE IN INTEREST FROM PARTNERSHIP K-1 -21,778. CAPITAL CONTRIBUTION TO LAKELAND HEALTH ENTERPRISES -635,793. REIMBURSED EXPENSES NETTED WITH TRANSFERS -663,649. TOTAL TO FORM 990, PART XI, LINE 5: 24,437,548. 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 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 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 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 1 0 0 0 1 0 0 0 0 LAKELAND HEALTH FOUNDATION BENTON HARBORST JOSEPH C 1482087 ACTUAL AMOUNTS GRANTED LAKELAND HEALTH FOUNDATION NILES C 717120 ACTUAL AMOUNTS GRANTED LAKELAND HEALTH ENTERPRISES INC B 635793 NBV OF PROPERTY CONTRIBUTED LAKELAND HEALTH FOUNDATION BENTON HARBORST JOSEPH N 295294 ALLOCATION OF EXPENSE LAKELAND HEALTH FOUNDATION NILES N 148545 ALLOCATION OF EXPENSE LAKELAND COMMUNITY HOSPITAL - WATERVLIET N 99547 ALLOCATION OF EXPENSE HOSPICE AT HOME INC N 120263 ALLOCATION OF EXPENSE LAKELAND REGIONAL HEALTH SYSTEM INC B 16620636 ACTUAL AMOUNTS GRANTED FOUR FLAGS PROPERTIES J 383575 ACTUAL AMOUNT OF RENT