COREWELL HEALTH: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COREWELL HEALTH (EIN 38-2539929)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-07-16
IRS object ID
201211989349300901
Schema version
2010v3.4
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)
Timestamp2012-07-16T12:11:01-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-10-01TaxPeriodBeginDate

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 Signed2012-07-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKENLEY G PENNER CPAName
Phone2699828000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
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 Receipts7499695GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization OtherXTypeOfOrganizationOther
Year Formation1984YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionPROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM.ActivityOrMissionDescription
Nbr Voting Members Governing Body27NbrVotingMembersGoverningBody
Nbr Independent Voting Members26NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2923180ContributionsGrantsPriorYear
Contributions Grants Current Year1345122ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year192057InvestmentIncomePriorYear
Investment Income Current Year367061InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year47199OtherRevenueCurrentYear
Total Revenue Prior Year3115237TotalRevenuePriorYear
Total Revenue Current Year1759382TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1467267GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2396991GrantsAndSimilarAmntsCY
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 Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year66624OtherExpensePriorYear
Other Expenses Current Year49047OtherExpensesCurrentYear
Total Expenses Prior Year1533891TotalExpensesPriorYear
Total Expenses Current Year2446038TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1581346RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-686656RevenuesLessExpensesCY
Total Assets BOY8231002TotalAssetsBOY
Total Assets EOY7400698TotalAssetsEOY
Total Liabilities BOY802349TotalLiabilitiesBOY
Total Liabilities EOY977115TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7428653NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6423583NetAssetsOrFundBalancesEOY
Mission DescriptionPROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense2343189Expense
Grants2343189Grants
Revenue0Revenue
DescriptionTHE FOUNDATION DISTRIBUTED FUNDS TO A LOCAL AREA HOSPITAL FOR BETTER EQUIPMENT AND FACILITIES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense53802Expense
Grants53802Grants
DescriptionTHE FOUNDATION DISTRIBUTED FUNDS TO 58 LOCAL HEALTH CARE INDIVIDUALS FOR TUITION RELATED EXPENSES.Description
FieldValueIRS element (for citing)
Total Program Service Expense2396991TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members27NbrVotingGoverningBodyMembers
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 (29 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
MARGE WIATROWSKI
DIRECTOR3.00X000
ED CONRAD
DIRECTOR3.00X000
JERRY ALBERTS
DIRECTOR2.00X000
SANDI BOWMAN
DIRECTOR2.00X000
RICHARD BUCKALEW
DIRECTOR2.00X000
JAMES CLEVER
DIRECTOR2.00X000
MARC FLORIAN
DIRECTOR2.00X000
BILL HANLEY
VICE CHAIRMAN2.00X000X
KURT MARKZE
DIRECTOR2.00X000
TIM PASSARO
DIRECTOR2.00X000
DON RADDE
DIRECTOR2.00X000
KAY VARGA-SMITH
DIRECTOR2.00X000
KATHLEEN SNYDER
DIRECTOR2.00X000
CAROL STARKS
DIRECTOR2.00X000
DENNIS SZYMANSKI MD
PAST CHAIRPERSON2.00X000X
PAT MOODY
DIRECTOR2.00X000
RANDY BETTICH
SECRETARY/TREASURER2.00X000X
WENDY EDWARDS
DIRECTOR2.00X000
GYL KASEWURM
DIRECTOR2.00X000
RANDALL MILLER
DIRECTOR2.00X000
JOHN PROOS MD
DIRECTOR2.00X000
LEO SOORUS
CHAIRPERSON2.00X000X
LUCAS BROWN
DIRECTOR2.00X000
RICK DYER
DIRECTOR3.00X000
ROBERT GOTTLIEB
DIRECTOR2.00X000
LOREN HAMEL MD
DIRECTOR AND CEO1.00X06432109860X
EBON SANDERS
DIRECTOR1.00X000
TIMOTHY CALHOUN
VP - FINANCE/CFO1.00034475017954X
DAVID BURGHART
PRESIDENT2.0001407591609X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1128719TotalReportableCompFrmRltdOrgs
Total Other Compensation29423TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations57894RelatedOrganizations
All Other Contributions1287228AllOtherContributions
Total Contributions1345122TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column119160TotalRevenueColumn
Exclusion$119,160ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities5988214Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5740313Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities247901Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column247901TotalRevenueColumn
Exclusion$247,901ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionBAD DEBT RECOVERYDescription
Business Code900099BusinessCode
Total Revenue Column47199TotalRevenueColumn
Exclusion$47,199ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue47199TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1759382TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$414,260ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2343189Total
Program Services2343189ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total53802Total
Program Services53802ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3750Total
Management And General3750ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total28020Total
Management And General28020ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total15079Total
Management And General15079ManagementAndGeneral

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2198Total
Management And General2198ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2446038Total
Program Services2396991ProgramServices
Management And General49047ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY818452BOY
EOY880682EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY2670319BOY
EOY1799744EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4742231BOY
EOY4720272EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8231002BOY
EOY7400698EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY802349BOY
EOY977115EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY802349BOY
EOY977115EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3051126BOY
EOY2877690EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3678827BOY
EOY2847193EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY698700BOY
EOY698700EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7428653BOY
EOY6423583EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8231002BOY
EOY7400698EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-686656ReconcilationRevenueExpenses
Reconcilation Other Changes-318414ReconcilationOtherChanges
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 Years1463011CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1882496CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years392059CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2923180CurrentTaxYearMinus1Year
Current Tax Year1345122CurrentTaxYear
Total8005868Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1463011CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1882496CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years392059CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2923180CurrentTaxYearMinus1Year
Current Tax Year1345122CurrentTaxYear
Total8005868Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total1936512AmountsSubstContributorsTotal
Public Support Total1706069356PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years324360CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years241404CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years154774CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year145044CurrentTaxYearMinus1Year
Current Tax Year119160CurrentTaxYear
Total984742Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years42105CurrentTaxYearMinus3Years
Current Tax Year47199CurrentTaxYear
Total89304Total
FieldValueIRS element (for citing)
Total Support9079914TotalSupport
Public Support Pertcentage1700.66840PublicSupportPertcentage170
Public Support Pertcent Prior Year0.69350PublicSupportPertcentPriorYear
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 Balance821475BeginningOfYearBalance
Contributions0Contributions
Investment Earnings Or Losses92383InvestmentEarningsOrLosses
Other Expenditures59517OtherExpenditures
End Of Year Balance854341EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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 Balance0.01500BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.16800PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.81700TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Total Revenue1759382TotalRevenue
Total Expenses2446038TotalExpenses
Excess Or Deficit For Year-686656ExcessOrDeficitForYear
Net Unrealized GL On Investments-318414NetUnrealizedGLOnInvestments
Total Adjustments-318414TotalAdjustments
Excess Or Deficit Per FS-1005070ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt1393769TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-318414NetUnrealizedGainsInvestments
Revenue Not Rptd F990-318414RevenueNotRptdF990
Revenue Subtotal1712183RevenueSubtotal
Other Revenues Not Included47199OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt47199RevenueNotRptdOnFinStmt
Total Revenue Per Form9901759382TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2398839TotExpensesEtcAuditedFinclStmt
Other Expenses Included-47199OtherExpensesIncluded
Expenses Not Rptd F990-47199ExpensesNotRptdF990
Expenses Subtotal2446038ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9902446038TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:TO PROVIDE SCHOLARSHIPS FOR HEALTHCARE RELATED 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, 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, 2008.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT - PLEDGE RECOVERY 47,199.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT - PLEDGE RECOVERY -47,199.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistancePurpose Of GrantPurposeOfGrant
LAKELAND HOSPITAL AT NILES AND ST JOSEPH INC
1234 NAPIER AVEST JOSEPHMI49085382156872501(C)32059505N/AN/ADISTRIBUTED FUNDS TO LOCAL HOSPITAL TO PROVIDE BETTER EQUIPMENT AND FACILITIES
LAKELAND SPECIALITY HOSPITAL AT BERRIEN CENTER
1234 NAPIER AVEST JOSEPHMI49085383452303501(C)334875N/AN/AGENERAL SUPPORT
LAKELAND HEALTH FOUNDATION NILES
1234 NAPIER AVEST JOSEPHMI49085383130558501(C)37000N/AN/AGENERAL SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients58NumberOfRecipients
Amount Of Cash Grant53802AmountOfCashGrant
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 LAKELAND HOSPITALS AT NILES AND ST. JOSEPH, INC., A RELATED ORGANIZATION, 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 (2 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
049038201396500131780735002510065307000
TIMOTHY CALHOUN
027845405368301261301470003254036270400

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4BReturnReference
ExplanationLAKELAND MAINTAINS A SUPPLEMENTAL RETIREMENT AND PRE-RETIREMENT DEATH BENEFIT PLAN FOR THE PURPOSE OF PROVIDING SUPPLEMENTAL RETIREMENT BENEFITS TO EMPLOYEES WHO ARE ELIGIBLE UNDER THE TERMS AND CONDITIONS OF THE PLAN. THE PLAN IS INTENDED TO BE A NONQUALIFIED UNFUNDED DEFERRED COMPENSATION PLAN FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. THE ANNUAL BENEFIT UNDER THE PLAN IS 1% OF FINAL AVERAGE PAY TIMES YEARS OF SERVICE (27.5 YEARS LIMIT) FOR PARTICIPANTS WHO HAVE ACHIEVED NORMAL RETIREMENT AGE OF 63 AND HAVE COMPLETED 10 YEARS OF SERVICE. THE ANNUAL BENEFIT IS PAID AS A LUMP SUM BASED ON 15 YEARS DISCOUNTED AT 6%. THERE IS NO BENEFIT EARNED OR PAID FOR PARTICIPANTS WHO SEPARATE FROM LAKELAND'S EMPLOYMENT BEFORE AGE 63. THE INDIVIDUALS LISTED IN PART VII WHO PARTICIPATED IN THE SERP ARE: TIM CALHOUN AND LOREN HAMEL.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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 GIVEN TO THE BOARD OFFICERS PRIOR TO FILING AND HAS BEEN MADE AVAILABLE TO ALL OTHER BOARD MEMBERS.
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 12C
THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
TIM CALHOUN 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 VII:
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -318,414.FORM 990, PART XI, LINE 5:
THERE HAS BEEN NO CHANGE IN AUDIT OVERSIGHT PROCESS FROM THE PRIOR YEAR.FORM 990, PART XII, LINE 2C:
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 2011.FORM 990, PART VI, SECTION B, LINE 15:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (12 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
LAKELAND HOSPITAL AT NILES AND ST JOSEPH INC
1234 NAPIER AVENUEST JOSEPHMI49085382156872PROVIDE A COMPREHENSIVE SYSTEM OF HEALTH CARE TO CITIZENS OF THE COMMUNITYMI501(C)(3)LINE 3LAKELAND REGIONAL HEALTH SYSTEM INC1
LAKELAND SPECIALITY HOSPITAL AT BERRIEN CENTER
1234 NAPIER AVENUEST JOSEPHMI49085383452303LONGTERM HEALTHCARE/HEALING SERVICESMI501(C)(3)LINE 3LAKELAND REGIONAL HEALTH SYSTEM INC1
MERCY MEMORIAL HEALTH SERVICES
3425 LAKESHORE DRIVEST JOSEPHMI49085382748035PROVIDE HOMECARE AND LONG-TERM HEALTHCARE TO PATIENTS IN SOUTHWEST MICHIGANMI501(C)(3)LINE 9LAKELAND REGIONAL HEALTH SYSTEM INC1
LAKELAND HEALTH FOUNDATION NILES
1234 NAPIER AVENUEST JOSEPHMI49085383130558PROMOTE/ASSIST IN PROVIDING HEALTH CARE SERVICES IN SOUTHWESTERN MICHIGANMI501(C)(3)LINE 7LAKELAND REGIONAL HEALTH SYSTEM INC1
LAKELAND HEALTH SERVICES INC
1234 NAPIER AVENUEST JOSEPHMI49085203007464TO PROVIDE SKILLED PRIVATE NURSING CARE TO THE SOUTHWESTERN MICHIGAN AREAMI501(C)(3)LINE 9LAKELAND REGIONAL HEALTH SYSTEM INC1
HOME INFUSION SERVICES INC DBA LAKELAND HOME INFUSION
1234 NAPIER AVENUEST JOSEPHMI49085382969335PROVIDE IN-HOME INTRAVENOUS THERAPY SERVICESMI501(C)(3)LINE 9LAKELAND REGIONAL HEALTH SYSTEM INC1
LAKELAND REGIONAL HEALTH SYSTEM INC
1234 NAPIER AVENUEST JOSEPHMI49085382609624PROVIDE A COMPREHENSIVE SYSTEM OF HEALTH CARE TO CITIZENS OF THE COMMUNITYMI501(C)(3)LINE 11B, II0N/A
MERCY HEALTH CLINIC INC
1234 NAPIER AVENUEST JOSEPHMI49085383178765TO PROVIDE HEALTH CARE FOR THE COUNTY OF BERRIEN AND THE SURROUNDING AREAMI501(C)(3)LINE 3LAKELAND REGIONAL HEALTH SYSTEM INC1
LAKELAND COMMUNITY HOSPITAL - WATERVLIET
400 MEDICAL PARK DRIVEWATERVLIETMI49098381368745TO PROVIDE GENERAL HEALTH OF THE COMMUNITY THROUGH EDUCATION AND HEALTHCAREMI501(C)(3)LINE 3LAKELAND REGIONAL HEALTH SYSTEM INC1
LAKELAND HOSPITAL AUXILIARY ST JOSEPH
1234 NAPIER AVENUEST JOSEPHMI49085383674457TO RENDER VOLUNTEER SERVICES TO LAKELAND REGIONAL HEALTH SYSTEM, ST JOSEPHMI501(C)(3)LINE 9LAKELAND REGIONAL HEALTH SYSTEM INC1
LAKELAND AUXILIARY BERRIEN GENERAL
6418 DEANS HILL ROADBERRIEN CENTERMI49102237025742TO RENDER SERVICE TO LAKELAND SPECIALTY HOSPITAL, BERRIEN CENTERMI501(C)(3)LINE 9LAKELAND REGIONAL HEALTH SYSTEM INC1
LAKELAND NILES AUXILIARY
1234 NAPIER AVENUEST JOSEPHMI49085386076112TO ENGAGE IN CHARITABLE ACTIVITIES TO ASSIST LKLD COMMUNITY HOSPITAL, NILESMI501(C)(3)LINE 9LAKELAND REGIONAL HEALTH SYSTEM INC1

Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)

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

Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
NILES PROFESSIONAL SERVICES INC
31 NORTH ST JOSEPH AVENUENILESMI49120382633419MEDICAL ADMINISTRATIVE SERVICESMIN/AC
THE PHARMACY SHOPPE INC DBA LAKELAND PHARMACY SHOPPE
1234 NAPIER AVENUEST JOSEPHMI49085382929090PHARMACEUTICALSMIN/AC
FOUR FLAGS PROPERTIES INC
122 GRANT STREETNILESMI49120364501639PROPERTY MANAGEMENT/RENTALMIN/AC
LAKELAND PHYSICIAN CARE NETWORK
1234 NAPIER AVENUEST JOSEPHMI49085208513031MEDICAL SERVICESMIN/AC
LAKELAND MEDICAL PRACTICES
1234 NAPIER AVENUEST JOSEPHMI49085270381199MEDICAL ADMINISTRATIVE SERVICESMIN/AC
LAKELAND HEALTH ENTERPRISE INC
31 NORTH ST JOSEPH AVENUENILESMI49120382669798ACCOUNTING AND BILLINGMIN/AC
SOUTHWESTERN MEDICAL CLINIC PHYSICIANS INC
1234 NAPIER AVENUEST JOSEPHMI49085272589359PHYSICIAN OFFICEMIN/AC
LAKELAND PERSONAL CARE SERVICES INC
1234 NAPIER AVENUEST JOSEPHMI49085272990797HEALTH CARE SERVICESMIN/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 (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
LAKELAND HOSPITAL AT NILES AND ST JOSEPH INC
B2059505GRANT TO FURTHER MISSION
LAKELAND HOSPITAL AT NILES AND ST JOSEPH INC
O977000ESTIMATE
LAKELAND HEALTH ENTERPRISES DBA LAKELAND PRACTICE SOLUTIONS
O19000REIMB FOR ACCOUNTING SERVICES
LAKELAND SPECIALITY HOSPITAL AT BERRIEN CENTER
B34874GRANT TO FURTHER MISSION
LAKELAND SPECIALITY HOSPITAL AT BERRIEN CENTER
O44000ESTIMATE
LAKELAND HOSPITAL AT NILES AND ST JOSEPH INC
O16000ESTIMATE
LAKELAND HOSPITAL AUXILIARY ST JOSEPH
C32894ACTUAL

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