2011-08-15T13:07:33-05:00 2010-09-30 PLANTE & MORAN PLLC 511 RENAISSANCE DRIVE ST JOSEPH MI 49085 990 2009-10-01 382156872 LAKELAND HOSPITALS AT NILES AND ST JOSEPH INC LAKE 2699838166 1234 NAPIER AVENUE ST JOSEPH MI 49085 TIM Calhoun 2699838166 2011-08-15 1 2699828000 2009 2016-02-24 21:20:13Z lakeland healthcare tim calhoun 1234 NAPIER AVENUE ST JOSEPH MI 49085 561901716 0 X lakelandhealth.org X 1985 MI Lakeland Hospital is a 339 bed acute care hospital and provides a full continium of healthcare services to it's tri-county area. Lakeland Regional Health System is the parent company for Lakeland Hospitals, nursing homes, and other health-related service corporations serving the tri-county area. 23 21 3239 700 3258720 -707467 1616414 1608150 298023697 309517192 4974461 11610312 1164434 1154402 305779006 323890056 0 0 132901125 133217530 0 0 149228999 151533151 282130124 284750681 23648882 39139375 555963366 596426051 203084418 198238065 352878948 398187986 To be Southwestern Michigan's leader in safe, high quality, patient centered, compassionate, health-related services. 0 0 216410517 306489599 HOSPITAL SERVICES PROVIDED TO 17,545 INPATIENTS AND 315,707 OUTPATIENTS. 216410517 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 89 0 1 3239 1 1 1 0 0 0 0 0 0 0 0 23 21 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X TIMOTHY J CALHOUN 2699838166 1234 NAPIER AVENUE st joseph MI 49085 Jeff Edmunds 3.00 X X 0 0 0 Terrence Allen 3.00 X X 0 0 0 len amat 2.00 X 0 0 0 David Binkley 2.00 X 0 0 0 Patricia Hall 2.00 X 0 0 0 George Heenan MD 2.00 X 0 0 0 Daniel Hopp 5.00 X X 0 0 0 J Douglas Huggett DO 2.00 X 0 0 0 George Kolettis MD 2.00 X 0 0 0 Gene Maddock MD 2.00 X 0 0 0 niels-erik andreAsen 2.00 X 0 0 0 Michael Mortimore 2.00 X 0 0 0 Kenneth O'Neill MD 2.00 X 0 0 0 Jeffrey Schmidt DDS 2.00 X 0 0 0 Kenneth Edwards md 2.00 X 15000 0 0 beth dodge 2.00 X 0 0 0 Judith Zacha 2.00 X 0 0 0 loren hamel md 40.00 X X 471865 0 25444 laurianne davis 2.00 X 0 0 0 dennis thompson md 2.00 X 0 0 0 marcus robinson 2.00 X 0 0 0 michael welch 2.00 X 0 0 0 thomas yeager 2.00 X 0 0 0 timothy calhoun 40.00 X 340060 0 22819 dennis mack 40.00 X 184839 0 27626 gerald guinane 40.00 X 221988 0 28973 mary ann pater 40.00 X 149037 0 25880 lowell hamel 16.00 X 167715 0 0 eileen willits 40.00 X 254826 0 31169 emil gallay 40.00 X 177445 0 20780 Robin Mack 40.00 X 164028 0 8059 laurie fleming 40.00 X 172063 0 27247 joseph wasserman 40.00 X 2089531 0 30120 james schlaman 40.00 X 144821 0 26934 Mark Paulson 40.00 X 137046 0 18956 patrick dudding 40.00 X 131242 0 26141 mike kastner 40.00 X 134893 0 18729 neil johnson 40.00 X 128406 0 26115 jann totzke 40.00 X 133383 0 18804 5073367 0 356862 59 0 1 0 Sunset coast anesthesia assoc 1234 napier ave st joseph MI 49085 st. joseph anesthesia fees 1686335 south bend medical foundation 530 north lafayette blvd south bend IN 46601 lab work 1225219 EDEN ANESTHESIA SERVICES PC 900 PEELER ST PO BOX 4095 KALAMAZOO MI 490004095 ANESTHESIA SERVICES 899131 LAKELAND PHYSICIAN CARE NETWORK PO BOX 458 NILES MI 49120 PHYSICIAN AND DIRECTOR CONTRACT PAYMENTS 485411 RADIOLOGY ASSOCIATES OF BERRIEN COUNTY 416 STATE STREET SUITE A ST joseph MI 49085 RADIOLOGY SERVICES 454247 10 1320865 287285 1608150 PATIENT SERVICE REVENU 541380 308850327 305750712 3099615 CAFETERIA AND NUTRITIO 541380 599642 599642 MEDICAL RECORD FEES 541380 67223 67223 309517192 8776063 8776063 72022 72022 72022 72022 239082081 1763828 238011660 1070421 1763828 2834249 2834249 CAFETERIA SALES 722210 913978 913978 GRAPHIC SERVICES 519100 159105 159105 VENDING MACHINES 445100 9297 9297 1082380 323890056 306417577 3258720 12605609 2584965 1968173 616792 100194116 76143928 24050188 4123234 3133658 989576 18803701 14290813 4512888 7511514 5708751 1802763 203439 154614 48825 10608896 8062761 2546135 389337 295896 93441 2633421 2001400 632021 11178362 8495555 2682807 653683 496799 156884 5643111 4288764 1354347 18344585 13941885 4402700 1923342 1461740 461602 Medical and office supp 52805869 40132460 12673409 BAD DEBTS 13834734 10514398 3320336 PHYSICIAN RELATIONS 9032679 6864836 2167843 qaap assessments 7610134 5783702 1826432 Miscellaneous 5617737 4269480 1348257 11053822 8400904 2652918 284750681 216410517 68340164 0 64360023 60957513 21233640 23059013 6503452 5797145 6742435 3977563 382512293 181240862 206009359 201271431 241080446 289232363 10034011 12131023 555963366 596426051 41991221 34927793 119307144 116525643 6926 41779127 46784629 203084418 198238065 X 350300049 393634633 2578899 4553353 352878948 398187986 555963366 596426051 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 15963 15963 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: A PORTION OF DUES PAID TO MHA HAVE BEEN ALLOCATED TO LOBBYING ACTIVITIES. 5325400 5325400 172149601 53262082 118887519 5357661 3193674 2163987 192198391 124785106 67413285 7481240 7481240 201271431 PROVISION FOR MEDICAL MALPRACTICE 7006000 Provision for Deferred Compensation 4200168 PROVISION FOR POSTRETIREMENT BENEFIT 15884286 INTEREST RATE SWAP AGREEMENTS 19184605 COST REPORT SETTLEMENTS PAYABLE 509570 46784629 323890056 284750681 39139375 18932428 -12762765 6169663 45309038 329869046 18932428 -12953438 5978990 323890056 0 323890056 284750681 0 284750681 0 284750681 Part XI, Line 8 - Other Adjustments: CHANGE IN INTEREST IN FOUNDATION: 1986652. transfer to organization: -11995802. change in swap valuation: -2944288. gain from partnership k-1: 190673. Part XII, Line 2d - Other Adjustments: CHANGE IN FAIR VALUE OF SWAP AGREEMENTS: -2944288. CHANGE IN INTEREST IN FOUNDATIONS: 1986652. TRANSFERS TO AFFILIATES: -11995802. 1 1 X 1 X 1 1 1 1 0 1 1 1 5771 5707535 5707535 0.02110 1 17217 47235337 44758904 2476433 0.00910 2 22988 52942872 44758904 8183968 0.03020 568 143294 2010943 6568 2004375 0.00740 154 1762 147 2166 82311 4 82307 0.00030 869 147222 2093254 6572 2086682 0.00770 871 170210 55036126 44765476 10270650 0.03790 1 5 1688 1688 0.00000 3 60 381 381 0.00000 1 93 1209 1209 0.00000 3 425 3009 200 2809 0.00000 13 8 7087 7087 0.00000 21 591 13374 200 13174 1 6733088 116033072 120291972 -4258900 X lakeland hospitals at niles

31 N Street Joseph Avenue niles MI 49120

X X X lakeland hospitals at st joseph

1234 napier avenue st joseph MI 49085

X X X Part VI, Line 2: THE ORGANIZATION USES NEEDS ASSESSMENT PREPARED BY THE COUNTY HEALTH DEPARTMENT AND PARTICIPATE IN A REGIONAL HEALTHY BERRIEN COMMUNITY COMMITTEE TO ADDRESS HEALTH NEEDS. Part VI, Line 3: THE ORGANIZATION EMPLOYS MORE THAN 12 FINANCIAL COUNSELORS WHO ASSIST PATIENTS WITH ELIGIBILITY. Part VI, Line 4: THE ORGANIZATION SERVES 150,000 RESIDENTS IN BERRIEN COUNTY AND THE SURROUNDING AREAS. Part VI, Line 5: N/A Part VI, Line 6: Community Health Improvement Services & Community Benefit Operations-represents those activities that help improve the health and quality of life of people in the community. Community health presentations, ACT in Time to Heart Attack, Expectant Parent, Teen Pregnancy Prevention Baby Think it Over! and Postponing Sexual Involvement, 5 Wishes, Pre-diabetes, Falls Prevention, Medication Safety, Lakeland HealthLine, HeartSafe and Heart Lessons, Cancer Support programs, such as Look Good...Feel Better, Prostate Cancer Awareness, Skin Cancer Screening, Colorectal Cancer Screening, Breast Health Awareness, Health Resource Libraries at two sites, Parish and Senior Center Nurses, and health screenings are some examples. Part VI, Line 7: THE ORGANIZATION IS PART OF LAKELAND REGIONAL HEALTH SYSTEM WHICH SERVES THE SAME GEOGRAPHIC AREA FOR HEALTHCARE RELATED SERVICES. MI X X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 loren hamel md 379427 0 79260 0 13178 0 6900 0 18544 0 497309 0 0 0 timothy calhoun 274567 0 52920 0 12573 0 11800 0 11019 0 362879 0 0 0 dennis mack 152503 0 29448 0 2888 0 9344 0 18282 0 212465 0 0 0 gerald guinane 195482 0 17320 0 9186 0 10459 0 18514 0 250961 0 0 0 mary ann pater 137417 0 7540 0 4080 0 8574 0 17306 0 174917 0 0 0 lowell hamel 141384 0 26331 0 0 0 0 0 0 0 167715 0 0 0 eileen willits 210304 0 40112 0 4410 0 12628 0 18541 0 285995 0 0 0 emil gallay 157926 0 12429 0 7090 0 9955 0 10825 0 198225 0 0 0 Robin Mack 148116 0 15912 0 0 0 5720 0 2339 0 172087 0 0 0 laurie fleming 152382 0 15843 0 3838 0 8972 0 18275 0 199310 0 0 0 joseph wasserman 534793 0 254760 0 1299978 0 14250 0 15870 0 2119651 0 0 0 Mark Paulson 132192 0 1800 0 3054 0 8001 0 10955 0 156002 0 0 0 patrick dudding 127697 0 901 0 2644 0 7891 0 18250 0 157383 0 0 0 mike kastner 127486 0 1800 0 5607 0 7846 0 10883 0 153622 0 0 0 neil johnson 121883 0 1500 0 5023 0 7710 0 18405 0 154521 0 0 0 jann totzke 128804 0 1800 0 2779 0 7889 0 10915 0 152187 0 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, Laurie Fleming, Gerald Guanine, Loren Hamel, Dennis Mack, Robin Mack, Mary Ann Pater, AND EILEEN WILLITS . hospital authority of the city of st joseph (michigan) 383151499 790678cc8 2003-12-17 41525000 refund bonds issued 1/13/94 and facility construction and improvements 0 0 hospital authority of the city of st joseph (michigan) 383151499 790678Cd6 2006-01-26 50000000 facility construction and improvements 0 0 41643043 193091 31392505 10057446 2004 1 0 1 1 52613405 467500 1012738 51133167 2007 0 0 1 1 0 0 1 0 1 1 0 0 0 0 1 1 0 1 1 ubs ag 28.000000000000 0 0 1 1 1 1 ubs ag 28.900000000000 1 citigroup global markets 2.700000000000 1 0 0 Form 990, Part VI, Section A, line 2 Robin Mack and Dennis Mack have a family relationship. LOREN HAMEL, MD AND LOWELL HAMEL HAVE A FAMILY RELATIONSHIP. 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 XI, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. 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 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 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 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 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 11a, I N/A home infusion servicesinc dba lakeland home infusion services 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 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 C the pharmacy shoppe inc dba lakeland pharmacy shoppe 1234 napier avenue st joseph MI 49085 382929090 pharmaceuticals MI N/A C family care of niles formerly lakeland professional services inc 1234 napier avenue st joseph MI 49085 383325133 medical administrative services MI N/A C lakeland ear nose and throat 1234 napier avenue st joseph MI 49085 261397387 medical treatment for ear, nose, and throat MI N/A C four flags properties inc 122 grant street niles MI 49120 364501639 property management/rental MI N/A C 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 services MI N/A C SOUTHWESTERN MEDICAL CLINIC PHYSICIANS INC 1234 napier avenue St joseph MI 49085 272589359 PHYSICIAN OFFICE MI N/A C 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 lakeland health foundation niles P 61214 Lakeland Regional Health System Q 11995802 home infusion services inc N 127125 lakeland health services inc N 50269 the pharmacy shoppe inc N 334546 lakeland speciality hospital at berrien center N 13146886 lakeland continuing care center N 564078 Lakeland health foundation benton harborst joseph C 959447