2012-07-16T12:11:01-05:00 2011-09-30 PLANTE & MORAN PLLC 511 RENAISSANCE DR SUITE 120 ST JOSEPH MI 49085 990 2010-10-01 382748035 MERCY MEMORIAL HEALTH SERVICES INC MERC 2699836501 3425 LAKESHORE DR ST JOSEPH MI 49085 TIMOTHY CALHOUN 2699836501 2012-07-13 1 KENLEY G PENNER CPA 2699828000 2010 2016-02-24 21:20:13Z LAKELAND CONTINUING CARE CENTER TIMOTHY CALHOUN 3425 LAKESHORE DR ST JOSEPH MI 49085 8030675 0 X LAKELANDHEALTH.ORG X 1987 MI TO PROVIDE HOMECARE AND LONG-TERM HEALTHCARE TO PATIENTS IN THE SOUTHWEST MICHIGAN AREA. 8 7 144 0 0 0 42 60 8187759 8028555 855 2060 0 0 8188656 8030675 0 0 0 0 4308235 4421230 0 0 0 3008299 3024975 7316534 7446205 872122 584470 6666247 7133235 2623693 2506211 4042554 4627024 TO BE SOUTHWESTERN MICHIGAN'S LEADER IN SAFE, HIGH QUALITY, PATIENT CENTERED, COMPASSIONATE, HEALTH-RELATED SERVICES. 0 0 6446962 8028555 NURSING HOME OPERATIONS WERE PROVIDED TO 131 INPATIENTS AND 0 OUTPATIENTS. 6446962 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 10 0 1 144 1 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X CHUCK PIECHOCKI 2694282416 1234 NAPIER AVE ST JOSEPH MI 49085 X LAURENCE HABENICHT MD 1.00 X 0 0 0 EWANAH JOHNSON MD 1.00 X 0 0 0 MICHAEL MORTIMORE 1.00 X X 0 0 0 DAVE VILLAGE 1.00 X 0 0 0 LOREN B HAMEL MD 1.00 X X 0 643210 9860 LYNN KELLOGG 1.00 X 0 0 0 KAY VARGA-SMITH 1.00 X X 0 0 0 LYNN GRAY MD 1.00 X 0 0 0 TIMOTHY CALHOUN 1.00 X 0 344750 17954 DENNIS MACK 1.00 X 0 186181 14594 JOSEPH WASSERMAN 1.00 X 0 0 0 JAMES SCHLAMAN 10.00 X 0 146356 10936 0 1320497 53344 0 0 1 0 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 631503534 REHABILITATION SERVICES 474865 WEST MICHIGAN SHARED PO BOX 1134 GRAND RAPIDS MI 495011134 LAUNDRY 103905 2 60 60 PATIENT SERVICE REVENU 621400 8028555 8028555 8028555 787 787 1273 1273 1273 1273 8030675 8028555 0 2060 3749672 3187221 562451 422143 354600 67543 249415 212003 37412 19251 16363 2888 740469 626991 113478 793731 674671 119060 112233 94276 17957 73160 61454 11706 219205 186324 32881 7604 6463 1141 QAAP ASSESSMENT 778905 778905 MISCELLANEOUS 128861 108248 20613 BAD DEBTS 73964 73964 REPAIR AND MAINTENANCE 30378 25518 4860 PHYSICIAN FEES 27605 23464 4141 19609 16497 3112 7446205 6446962 999243 0 36260 144787 531738 614300 2439 3018 5970857 3681868 2324305 2288989 3771505 4082141 6666247 7133235 100609 86578 1574357 1529770 948727 889863 2623693 2506211 X 4042554 4627024 4042554 4627024 6666247 7133235 584470 0 X X 0 1 1 X 0 X 3373 15582 2924 42 60 21981 6911262 7630742 7999044 8187759 8028555 38757362 6914635 7646324 8001968 8187801 8028615 38779343 0 0 0 38779343 18267 5553 1701 855 787 27163 18267 5553 1701 855 787 27163 6932902 7651877 8003669 8188656 8029402 38806506 0.99930 0.99900 0.00070 0.00100 X 162800 162800 4630517 2906139 1724378 1004811 714353 290458 172729 61376 111353 2288989 BOND ISSUE COSTS 52627 DUE FROM LAKELAND HOSPITALS AT NILES & ST. JOSEPH, INC. 4029514 4082141 ACCRUED LIABILITIES 254648 COST REPORT SETTLEMENT PAYABLE 635215 889863 8030675 7446205 584470 584470 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: LAKELAND REGIONAL HEALTH SYSTEM, INC. AND ITS WHOLLY OWNED SUBSIDIARIES ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES EXCEPT FOR FOUR FLAGS HEALTH VENTURES, INC. D/B/A LAKELAND HEALTH ENTERPRISES AND SUBSIDIARIES, WHICH ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. INCOME TAX EXPENSE FOR THE FOR-PROFIT CORPORATIONS IS NOT SIGNIFICANT AND HAS BEEN INCLUDED IN OPERATING EXPENSES. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY LAKELAND AND RECOGNIZE A TAX LIABILITY IF LAKELAND 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 OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. LAKELAND IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2008. 0 1 0 0 0 0 0 0 0 LOREN B 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 DENNIS MACK 0 154569 0 27224 0 4388 0 9500 0 5094 0 200775 0 0 JAMES SCHLAMAN 0 140342 0 1140 0 4874 0 8462 0 2474 0 157292 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, LOREN HAMEL, AND DENNIS MACK. FORM 990, PART VI, SECTION B, LINE 11 THE 990 WAS REVIEWED BY AN OFFICER OF THE BOARD AS WELL AS THE FINANCE AND HR COMMITTEE PRIOR TO FILING. A COPY OF THE 990 WAS PROVIDED TO THE OTHER BOARD MEMBERS PRIOR TO FILING. 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, LOREN HAMEL, AND DENNIS MACK EACH WORKED AN AVERAGE OF AT LEAST 40 HOURS PER WEEK AND JAMES SCHLAMAN WORKED 20 HOURS PER WEEK AT THE RELATED ORGANIZATION FROM WHICH THEY WERE COMPENSATED. 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 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 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 LAKELAND HOSPITAL OF NILES AND ST JOSEPH INC N 587579 ALLOCATION OF COST