2012-05-15T08:20:08-05:00 2011-06-30 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2010-07-01 383022945 PORTAGE HEALTH FOUNDATION PORT 9064878000 500 CAMPUS DRIVE HANCOCK MI 49930 BRIAN DONAHUE 9064878000 2012-05-11 1 2319477800 2010 2016-02-24 21:20:13Z JAMES BOGAN 500 CAMPUS DRIVE HANCOCK MI 49930 1243907 0 X WWW.PORTAGEHEALTH.ORG X 1990 MI TO SUPPORT AND ASSIST THE MISSION OF PORTAGE HEALTH, A TAX-EXEMPT HEALTHCARE ORGANIZATION, THROUGH FINANCIAL ASSISTANCE. 13 12 0 12 0 0 55225 59843 0 0 45731 114366 11269 1283 112225 175492 106289 80890 0 0 0 0 0 0 0 23909 12764 130198 93654 -17973 81838 1603405 1829426 0 0 1603405 1829426 TO SUPPORT AND ASSIST THE MISSION OF PORTAGE HEALTH, A TAX EXEMPT HEALTHCARE ORGANIZATION, THROUGH FINANCIAL ASSISTANCE. 0 0 82218 79440 0 PROMOTION OF CHARITABLE MISSION OF RELATED TAX-EXEMPT HEALTHCARE ENTITY 1200 1200 0 DONATION TO COPPER COUNTRY COMMUNITY ART COUNCIL FUNDRAISER 250 250 0 OUTSTANDING NURSING AWARD 83668 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 13 12 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 0 0 1 0 0 MI X BRIAN DONAHUE CFO 9064831503 500 CAMPUS DRIVE HANCOCK MI 49930 X PAUL OLLILA 1.00 X 0 0 0 NANCY FENTON 1.00 X 0 0 0 TERRY KINZEL MD 1.00 X 0 127176 11947 JEANNE KURTZ 1.00 X 0 0 0 LENNON MATTILA HUGHES 1.00 X X 0 0 0 WILLIAM POLKINGHORNE 1.00 X 0 0 0 GERARD QUELLO 1.00 X X 0 0 0 ROGER HELMAN JD CFP 1.00 X X 0 0 0 DANA JOHNSON PHD 1.00 X 0 0 0 MICHELE BLAU 1.00 X 0 0 0 BOB MIKESCH 1.00 X 0 0 0 BRENT PETERSON 1.00 X 0 0 0 BERNADETTE YEOMAN-QUELLETTE 1.00 X 0 0 0 JAMES BOGAN 1.00 X 0 315399 35621 BRIAN DONAHUE 1.00 X 0 177083 20385 0 619658 67953 0 0 1 0 0 38627 21216 59843 63968 63968 1113888 1063490 50398 50398 50398 6208 38627 4925 1283 1283 175492 0 0 115649 80640 80640 250 250 9986 9986 ENDOWMENT FUND TRANSFER 1976 1976 ACCOUNTING CORRECTION 700 700 EVENTBRITE FEES 102 102 93654 83668 9986 0 42819 56077 501235 444887 18615 18615 0 0 1047266 1312407 12085 16055 1603405 1829426 0 0 X 1603405 1829426 1603405 1829426 1603405 1829426 X 81838 144183 X X 0 1 1 X 0 X X X 0 0 0 PORTAGE HEALTH INC 381381288 3 0 0 1 79440 1 79440 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1557595 20390 205536 10173 1773348 1501685 27263 38238 9591 1557595 1672098 21989 -183299 9103 1501685 0.99100 0.00900 0.00000 1 0 18615 18615 0 0 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE TO BE USED FOR GRANTING WITHIN PORTAGE HEALTH, INC. SPRING BALL 28350 24075 4275 4275 AUCTION 16485 14552 1933 650 44835 38627 6208 650 4275 4925 1283 1 PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 16427 FETAL MONITOR PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 20100 DIALYSIS EQUIPMENT PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 1913 EXPRESS CARE EQUIPMENT PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 7000 SENTRI 7 CLINICAL SURVEILLANCE & REPORTING SYSTEM PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 9000 PEDIATRIC REHAB EQUIPMENT PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 25000 DONATION TO THE 2010 BALL TO BE USED FOR HEALTH EDUCATION COPPER COUNTRY COMMUNITY ARTS CENTER 126 QUINCY STREET HANCOCK MI 49930 382888911 501(C)3 1200 DONATION TO THE MOSAIC ART FUNDRAISER 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: A FINAL REPORT DETAILING THE NUMBER OF CLIENTS SERVED AND THE IMPACT OF GRANT FUNDS IS SUBMITTED TO PORTAGE HEALTH FOUNDATION AND RETAINED. 0 0 0 0 0 0 0 0 0 JAMES BOGAN 0 253591 0 56066 0 5742 0 17150 0 18471 0 351020 0 0 BRIAN DONAHUE 0 155292 0 21741 0 50 0 12396 0 7989 0 197468 0 0 SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I, LINE 3: THE FOLLOWING INDIVIDUALS ARE COMPENSATED BY RELATED ORGANIZATION PORTAGE HEALTH, INC.: JAMES BOGAN, PRESIDENT AND CEO BRIAN DONAHUE, VICE PRESIDENT AND CFO THEY UTILIZE A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANTS, WRITTEN EMPLOYEMENT CONTRACTS, COMPENSATION SURVEY OR STUDIES, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THEIR COMPENSATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTION AND RE-ELECTION OF ALL MEMBERS OF THE FOUNDATION BOARD OF DIRECTORS SHALL BE, INDIVIDUALLY OR COLLECTIVELY, BY AFFIRMATIVE ACTION OF THE BOARD OF DIRECTORS OF PORTAGE HEALTH. THE FOUNDATION BOARD SHALL NOMINATE CANDIDATES FOR ELECTION OR RE-ELECTION AS DIRECTORS BY RESOLUTION AND SUBMIT SUCH NOMINATIONS TO THE PORTAGE HEALTH BOARD OF DIRECTORS FOR RATIFICATION. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF THE FOUNDATION MAY PROPOSE AMENDMENTS TO THE BOARD BYLAWS, WHICH MUST BE THEN SUBMITTED FOR APPROVAL BY THE BOARD OF DIRECTORS OF PORTAGE HEALTH. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER WITH BOARD MEMBERS AT A REGULARLY SCHEDULED BOARD MEETING. COPIES OF THE FORM 990 ARE PROVIDED TO EACH BOARD MEMBER FOR REVIEW AFTER THE RETURN HAS BEEN FILED. FORM 990, PART VI, SECTION B, LINE 12C AN ANNUAL CONFLICT OF INTEREST STATEMENT IS COMPLETED AND SIGNED BY EACH BOARD MEMBER. THE PRESIDENT AND CEO REVIEWS THE COMPLETED CONFLICT OF INTEREST FORMS. IF A CONFLICT IS IDENTIFIED, THAT BOARD MEMBER IS EXCUSED FROM ANY DICUSSION OR VOTE RELATING TO THE IDENTIFIED CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A OCCASIONALLY, AN INDEPENDENT CONSULTANT IS RETAINED TO RESEARCH THE MARKET DATA AND PERFORM COMPARISONS FOR THE CEO POSITION SHARED BY PORTAGE HEALTH FOUNDATION AND PORTAGE HEALTH, INC. THE RESULTS OF THE COMPARISON AND MARKET DATA ARE PRESENTED TO THE COMPENSATION COMMITTEE. IF NO OUTSIDE CONSULTANT IS RETAINED, MARKET SURVEYS ARE UTILIZED TO DETERMINE ADJUSTMENTS TO THE CEO'S COMPENSATION. IN EITHER CASE, THE COMPENSATION COMMITTEE RECOMMENDS ANY ADJUSTMENT TO PORTAGE HEALTH, INC.'S BOARD OF TRUSTEES. THE INDEPENDENT BOARD MEMBERS VOTE ON THE COMPENSATION AMOUNT AND IF APPROVED, IT IS FORMALLY PUT INTO A WRITTEN EMPLOYMENT CONTRACT AND DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE AND OF THE BOARD OF TRUSTEES. THIS PROCESS WAS LAST UNDERTAKEN IN OCTOBER 2010. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: THESE INDIVIDUALS DEVOTE THE FOLLOWING HOURS PER WEEK TO, RELATED ORGANIZATION, PORTAGE HEALTH, INC. FOR WHICH COMPENSATION IS REPORTED IN COLUMNS E & F: JAMES BOGAN 40 HOURS BRIAN DONAHUE 40 HOURS TERRY KINZEL, MD 24 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 144,183. FORM 990, PART XII, LINE 2B: THE FINANCIAL STATEMENTS WERE AUDITED BY AN INDEPENDENT ACCOUNTANT ON A CONSOLIDATED BASIS. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, SECTION B, LINES 13 AND 14: THE FOUNDATION DOES NOT HAVE WRITTEN WHISTLEBLOWER OR DOCUMENT RETENTION AND DESTRUCTION POLICIES. THE FOUNDATION WOULD DEFER TO THE POLICIES OF PORTAGE HEALTH, INC. IN THESE CIRCUMSTANCES. PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 IMPROVING HEALTH OF COMMUNITY BY PROVIDING HIGH QUALITY HEALTHCARE SERVICES MI 501(C)3 LINE 3 N/A 0 PORTAGE HEALTH RESOURCES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383041729 SENIOR MEALS MI 501(C)3 LINE 11A, I PORTAGE HEALTH INC 1 PORTAGE HEALTH HOME SERVICES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383565553 PRIVATE DUTY CARE MI 501(C)3 LINE 9 PORTAGE HEALTH INC 1 COPPER COUNTRY APOTHECARIES INC 500 CAMPUS DRIVE HANCOCK MI 49930 302083778 RETAIL PHARMACY MI N/A C 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 PORTAGE HEALTH INC B 79440 CASH