2012-07-16T12:11:01-05:00 2011-09-30 PLANTE & MORAN PLLC 511 RENAISSANCE DRIVE ST JOSEPH MI 49085 990 2010-10-01 382539929 LAKELAND HEALTH FOUNDATION BENTON HARBOR/ST JOSEPH LAKE 2699838300 1234 NAPIER AVENUE SAINT JOSEPH MI 49085 TIMOTHY CALHOUN 2699838300 2012-07-13 1 KENLEY G PENNER CPA 2699828000 2010 2016-02-24 21:20:13Z DAVID BURGHART 1234 NAPIER AVENUE SAINT JOSEPH MI 49085 7499695 0 X N/A X 1984 MI PROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM. 27 26 0 0 0 0 2923180 1345122 0 0 192057 367061 0 47199 3115237 1759382 1467267 2396991 0 0 0 0 0 0 0 66624 49047 1533891 2446038 1581346 -686656 8231002 7400698 802349 977115 7428653 6423583 PROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM. 0 0 2343189 2343189 0 THE FOUNDATION DISTRIBUTED FUNDS TO A LOCAL AREA HOSPITAL FOR BETTER EQUIPMENT AND FACILITIES. 53802 53802 THE FOUNDATION DISTRIBUTED FUNDS TO 58 LOCAL HEALTH CARE INDIVIDUALS FOR TUITION RELATED EXPENSES. 2396991 1 1 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 1 1 0 0 0 0 X 27 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 MARGE WIATROWSKI 3.00 X 0 0 0 ED CONRAD 3.00 X 0 0 0 JERRY ALBERTS 2.00 X 0 0 0 SANDI BOWMAN 2.00 X 0 0 0 RICHARD BUCKALEW 2.00 X 0 0 0 JAMES CLEVER 2.00 X 0 0 0 MARC FLORIAN 2.00 X 0 0 0 BILL HANLEY 2.00 X X 0 0 0 KURT MARKZE 2.00 X 0 0 0 TIM PASSARO 2.00 X 0 0 0 DON RADDE 2.00 X 0 0 0 KAY VARGA-SMITH 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 X 0 0 0 PAT MOODY 2.00 X 0 0 0 RANDY BETTICH 2.00 X X 0 0 0 WENDY EDWARDS 2.00 X 0 0 0 GYL KASEWURM 2.00 X 0 0 0 RANDALL MILLER 2.00 X 0 0 0 JOHN PROOS MD 2.00 X 0 0 0 LEO SOORUS 2.00 X X 0 0 0 LUCAS BROWN 2.00 X 0 0 0 RICK DYER 3.00 X 0 0 0 ROBERT GOTTLIEB 2.00 X 0 0 0 LOREN HAMEL MD 1.00 X X 0 643210 9860 EBON SANDERS 1.00 X 0 0 0 TIMOTHY CALHOUN 1.00 X 0 344750 17954 DAVID BURGHART 2.00 X 0 140759 1609 0 1128719 29423 0 0 1 0 0 57894 1287228 1345122 119160 119160 5988214 5740313 247901 247901 247901 BAD DEBT RECOVERY 900099 47199 47199 47199 1759382 0 0 414260 2343189 2343189 53802 53802 3750 3750 28020 28020 15079 15079 2198 2198 2446038 2396991 49047 0 0 0 818452 880682 2670319 1799744 4742231 4720272 8231002 7400698 802349 977115 802349 977115 X 3051126 2877690 3678827 2847193 698700 698700 7428653 6423583 8231002 7400698 X -686656 -318414 X X 0 1 1 X 0 X 1463011 1882496 392059 2923180 1345122 8005868 1463011 1882496 392059 2923180 1345122 8005868 1936512 6069356 324360 241404 154774 145044 119160 984742 42105 47199 89304 9079914 0.66840 0.69350 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 821475 0 92383 59517 854341 2903675 30080 48478 2160758 821475 3815278 389004 3568 1304175 2903675 0.01500 0.16800 0.81700 0 0 0 1759382 2446038 -686656 -318414 -318414 -1005070 1393769 -318414 -318414 1712183 47199 47199 1759382 2398839 -47199 -47199 2446038 0 2446038 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. 0 LAKELAND HOSPITAL AT NILES AND ST JOSEPH INC 1234 NAPIER AVE ST JOSEPH MI 49085 382156872 501(C)3 2059505 N/A N/A DISTRIBUTED FUNDS TO LOCAL HOSPITAL TO PROVIDE BETTER EQUIPMENT AND FACILITIES LAKELAND SPECIALITY HOSPITAL AT BERRIEN CENTER 1234 NAPIER AVE ST JOSEPH MI 49085 383452303 501(C)3 34875 N/A N/A GENERAL SUPPORT LAKELAND HEALTH FOUNDATION NILES 1234 NAPIER AVE ST JOSEPH MI 49085 383130558 501(C)3 7000 N/A N/A GENERAL SUPPORT 3 SCHOLARSHIPS 58 53802 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 LAKELAND HOSPITALS AT NILES AND ST. JOSEPH, INC., A RELATED ORGANIZATION, THEREFORE THE USE OF THE FUNDS ARE NOT MONITORED. 0 1 0 0 0 0 0 0 0 LOREN HAMEL MD 0 490382 0 139650 0 13178 0 7350 0 2510 0 653070 0 0 TIMOTHY CALHOUN 0 278454 0 53683 0 12613 0 14700 0 3254 0 362704 0 0 PART I, LINE 4B LAKELAND 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. 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 GIVEN TO THE BOARD OFFICERS PRIOR TO FILING AND HAS BEEN MADE AVAILABLE TO ALL OTHER 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 C, LINE 19 THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART VII: 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -318,414. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN AUDIT OVERSIGHT PROCESS FROM THE PRIOR YEAR. FORM 990, PART VI, SECTION B, LINE 15: 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. LAKELAND HOSPITAL 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 MERCY MEMORIAL HEALTH SERVICES 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 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 LAKELAND HEALTH SERVICES INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 203007464 TO PROVIDE SKILLED PRIVATE NURSING CARE TO THE SOUTHWESTERN MICHIGAN AREA MI 501(C)(3) LINE 9 LAKELAND REGIONAL HEALTH SYSTEM INC 1 HOME INFUSION SERVICES INC DBA LAKELAND HOME INFUSION 1234 NAPIER AVENUE ST JOSEPH MI 49085 382969335 PROVIDE IN-HOME INTRAVENOUS THERAPY SERVICES MI 501(C)(3) LINE 9 LAKELAND REGIONAL HEALTH SYSTEM INC 1 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 MERCY HEALTH CLINIC INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 383178765 TO PROVIDE HEALTH CARE FOR THE COUNTY OF BERRIEN AND THE SURROUNDING AREA MI 501(C)(3) LINE 3 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 3 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELAND HOSPITAL AUXILIARY ST JOSEPH 1234 NAPIER AVENUE ST JOSEPH MI 49085 383674457 TO RENDER VOLUNTEER SERVICES TO LAKELAND REGIONAL HEALTH SYSTEM, ST JOSEPH MI 501(C)(3) LINE 9 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELAND AUXILIARY BERRIEN GENERAL 6418 DEANS HILL ROAD BERRIEN CENTER MI 49102 237025742 TO RENDER SERVICE TO LAKELAND SPECIALTY HOSPITAL, BERRIEN CENTER MI 501(C)(3) LINE 9 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELAND NILES AUXILIARY 1234 NAPIER AVENUE ST JOSEPH MI 49085 386076112 TO ENGAGE IN CHARITABLE ACTIVITIES TO ASSIST LKLD COMMUNITY HOSPITAL, NILES MI 501(C)(3) LINE 9 LAKELAND REGIONAL HEALTH SYSTEM INC 1 LAKELINE ASSOCIATES LLC 910 S WASHINGTON AVENUE ROYAL OAK MI 48067 383306318 PROPERTY MANAGEMENT/RENTAL MI N/A CLIFFSIDE COMPANY LLC DBA CARETEL INNS OF ROYALTON 910 S WASHINGTON AVENUE ROYAL OAK MI 48067 383306320 ASSISTED LIVING MI N/A LIBERTY DIALYSIS LAKELAND LLC 7650 SE 27TH STREET SUITE 200 MERCER ISLAND WA 98040 272099855 MEDICAL SERVICES WA N/A VAN'S MEDICAL EQUIPMENT OF LAKELAND LLC 1234 NAPIER AVENUE ST JOSEPH MI 49085 261497708 MEDICAL EQUIPMENT MI N/A NILES PROFESSIONAL SERVICES INC 31 NORTH ST JOSEPH AVENUE NILES MI 49120 382633419 MEDICAL ADMINISTRATIVE SERVICES MI N/A C THE PHARMACY SHOPPE INC DBA LAKELAND PHARMACY SHOPPE 1234 NAPIER AVENUE ST JOSEPH MI 49085 382929090 PHARMACEUTICALS MI N/A C FOUR FLAGS PROPERTIES INC 122 GRANT STREET NILES MI 49120 364501639 PROPERTY MANAGEMENT/RENTAL MI N/A C LAKELAND PHYSICIAN CARE NETWORK 1234 NAPIER AVENUE ST JOSEPH MI 49085 208513031 MEDICAL SERVICES MI N/A C LAKELAND MEDICAL PRACTICES 1234 NAPIER AVENUE ST JOSEPH MI 49085 270381199 MEDICAL ADMINISTRATIVE SERVICES MI N/A C LAKELAND HEALTH ENTERPRISE INC 31 NORTH ST JOSEPH AVENUE NILES MI 49120 382669798 ACCOUNTING AND BILLING MI N/A C SOUTHWESTERN MEDICAL CLINIC PHYSICIANS INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 272589359 PHYSICIAN OFFICE MI N/A C LAKELAND PERSONAL CARE SERVICES INC 1234 NAPIER AVENUE ST JOSEPH MI 49085 272990797 HEALTH CARE SERVICES MI N/A C 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 LAKELAND HOSPITAL AT NILES AND ST JOSEPH INC B 2059505 GRANT TO FURTHER MISSION LAKELAND HOSPITAL AT NILES AND ST JOSEPH INC O 977000 ESTIMATE LAKELAND HEALTH ENTERPRISES DBA LAKELAND PRACTICE SOLUTIONS O 19000 REIMB FOR ACCOUNTING SERVICES LAKELAND SPECIALITY HOSPITAL AT BERRIEN CENTER B 34874 GRANT TO FURTHER MISSION LAKELAND SPECIALITY HOSPITAL AT BERRIEN CENTER O 44000 ESTIMATE LAKELAND HOSPITAL AT NILES AND ST JOSEPH INC O 16000 ESTIMATE LAKELAND HOSPITAL AUXILIARY ST JOSEPH C 32894 ACTUAL