2011-08-15T13:07:33-05:00 2010-09-30 PLANTE & MORAN PLLC 511 RENAISSANCE DRIVE ST JOSEPH MI 49085 990 2009-10-01 382539929 LAKELAND HEALTH FOUNDATION BENTON HARBORST JOSEPH LAKE 2699838300 1234 NAPIER AVENUE SAINT JOSEPH MI 49085 timothy calhoun 2699838300 2011-08-12 1 2699828000 2009 2016-02-24 21:20:13Z DAVID BURGHART 1234 NAPIER AVENUE SAINT JOSEPH MI 49085 4816508 0 X N/A X 1984 MI PROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM. 28 27 0 1 0 0 392059 2923180 0 -81870 192057 0 310189 3115237 1435889 1467267 0 0 0 0 58081 66624 1493970 1533891 -1183781 1581346 5948145 8231002 422193 802349 5525952 7428653 PROMOTE AND ASSIST IN PROVIDING HEALTH CARE BY ACCEPTING CONTRIBUTIONS FOR LAKELAND REGIONAL HEALTH SYSTEM. 0 0 1428968 1428968 0 THE FOUNDATION DISTRIBUTED FUNDS TO A LOCAL AREA HOSPITAL FOR BETTER EQUIPMENT AND FACILITIES. 38299 38299 0 THE FOUNDATION DISTRIBUTED FUNDS TO 39 LOCAL HEALTH CARE INDIVIDUALS FOR TUITION RELATED EXPENSES. 1467267 1 1 0 0 0 0 0 0 1 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 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 28 27 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X STACY WAHLSTROM 2696871147 1234 NAPIER AVE St Joseph MI 49085 marge wiatrowski 3.00 X 0 0 0 edward 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 marilyn mckinney 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 a 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 joseph wasserman 1.00 X X 0 2079531 30120 PAT MOODY 2.00 X 0 0 0 JAMES RIEMLAND 2.00 X 0 0 0 Randy Bettich 2.00 X 0 0 0 Wendy Edwards 2.00 X 0 0 0 Gyl Lasewurm 2.00 X 0 0 0 RAndall Miller 2.00 X 0 0 0 John Proos 2.00 X 0 0 0 Leo Soorus 2.00 X X 0 0 0 LUKE BROWN 2.00 X 0 0 0 RICHARD DYER 3.00 X 0 0 0 BOB GOTTLIEB 2.00 X 0 0 0 LOREN HAMEL MD 1.00 X X 0 471865 25444 william johnson 2.00 X 139300 0 0 DAVID BURGHART 2.00 X 30059 0 523 timothy calhoun 1.00 X 0 340060 22819 169359 2891456 78906 1 0 1 0 0 2923180 2923180 145044 145044 1748284 1701271 47013 47013 47013 3115237 0 0 192057 1428968 1428968 38299 38299 4000 4000 28161 28161 12461 12461 BAD DEBTS-PLEDGES 20539 20539 MISCELLANEOUS 1463 1463 1533891 1467267 66624 0 48322 666961 76280 151491 1489304 2670319 4334239 4742231 5948145 8231002 422193 802349 422193 802349 X 2622277 3051126 2217475 3678827 686200 698700 5525952 7428653 5948145 8231002 X 0 1 1 X 0 X 1769168 1463011 1882496 392059 2923180 8429914 1769168 1463011 1882496 392059 2923180 8429914 1783344 6646570 246837 324360 241404 154774 145044 1112419 42105 42105 9584438 0.69350 0.71480 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2903675 30080 48478 2160758 821475 3815278 389004 3568 1304175 2903675 0.01500 0.85100 0.13400 1 0 0 3115237 1533891 1581346 321355 321355 1902701 3436592 321355 321355 3115237 0 3115237 1533891 0 1533891 0 1533891 Part V, Line 4: Description of Intended Use of Endowment Funds: To provide scholarships for healthcare related study/work. 0 lakeland hospital at niles and st joseph inc 1234 NAPIER AVE St Joseph MI 49085 382156872 501(c)3 959447 0 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 14983 0 N/A N/A GENERAL SUPPORT 1 0 Scholarships 39 38299 0 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 joseph wasserman 0 524793 0 254760 0 1299978 0 14250 0 15870 0 2109651 0 0 LOREN HAMEL MD 0 379427 0 79260 0 13178 0 6900 0 18544 0 497309 0 0 timothy calhoun 0 274567 0 52920 0 12573 0 11800 0 11019 0 362879 0 0 Part I, Line 4a 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: Joseph Wasserman, Retired CEO (Paid $1,263,989 at age 63 after 35 years of service), 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 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 2010. 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, JOSEPH WASSERMAN, 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 XII, LINE 2C: THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR. 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 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 lakeland continuing care center 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 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 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 home infusion services inc 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 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 3 N/A 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 niles professional services inc 31 north st joseph avenue niles MI 49120 382633419 medical administrative services MI N/A the pharmacy shoppe inc dba lakeland pharmacy shoppe 1234 napier avenue st joseph MI 49085 382929090 pharmaceuticals MI N/A family care of niles formerly lakeland prof services inc 1234 napier avenue st joseph MI 49085 383325133 medical administrative services MI N/A lakeland ear nose and throat 1234 napier avenue st joseph MI 49085 261397387 medical treatment for ear, nose, and throat MI N/A four flags properties inc 122 grant street niles MI 49120 364501639 property management/rental MI N/A family care of coloma watervliet 1234 napier avenue st joseph MI 49085 263452411 medical administrative services MI N/A C lakeland family resource center pc 1234 napier avenue st joseph MI 49085 743104137 medical services MI N/A C lakeland rheumatology 1234 napier avenue st joseph MI 49085 261397078 rheumatology services MI N/A C lakeland general surgery 1234 napier avenue st joseph MI 49085 261397484 medical administrative services MI N/A C lakeland neurosurgery 1234 napier avenue st joseph MI 49085 261397536 neurosurgery 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 four flags health ventures 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 OFFICER MI N/A C 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 lakeland hospital at niles and st joseph inc B 959447 lakeland hospital at niles and st joseph inc O 754000 lakeland speciality hospital at berrien center N 44000