2011-08-15T12:31:54-05:00 2010-09-30 Plante & Moran PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2009-10-01 383584572 GREAT LAKES CANCER INSTITUTE GREA 8103421290 401 S BALLENGER HWY FLINT MI 48532 JANIS RIZZO TREASURER 8103421290 2011-08-11 1 Carol LaLonde CPA 2695674500 2009 2016-02-24 21:20:13Z JANIS RIZZO 401 S BALLENGER HWY flint MI 48532 1969075 0 X WWW.GLCI.org X 2000 MI TO OVERSEE AND ADMINISTER A NETWORK OF CERTIFIED/ACCREDITED PROVIDERS OF CANCER CARE, PROVIDE FOR CANCER RESEARCH & CANCER EDUCATION IN THE COMMUNITY 9 0 0 0 0 0 1578806 1709523 415104 259552 0 0 1993910 1969075 0 0 349580 0 0 0 1623470 2024442 1973050 2024442 20860 -55367 316994 207525 259787 205685 57207 1840 TO OVERSEE AND ADMINISTER A NETWORK OF CERTIFIED/ACCREDITED PROVIDERS OF CANCER CARE, PROVIDE FOR CANCER RESEARCH AND CANCER EDUCATION IN THE COMMUNITY. 0 0 1969013 259552 TO OVERSEE AND ADMINISTER A NETWORK OF CERTIFIED/ACCREDITED PROVIDERS OF CANCER CARE, PROVIDE FOR CANCER RESEARCH AND CANCER EDUCATION IN THE COMMUNITY. 1969013 1 1 0 0 0 0 0 0 0 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 0 0 1 13 0 1 0 0 0 0 0 0 0 0 0 0 0 9 0 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X JANIS RIZZO 8103422091 401 S BALLENGER HWY FLINT MI 48532 PHILIP INCARNATI 1.00 X X 0 14617609 520640 DON KOOY 1.00 X 0 841089 141288 JANIS RIZZO 1.00 X X 0 262850 43643 ROBERT WRIGHT 1.00 X 0 649761 74672 RAYMOND DEMERS MD 40.00 X X 0 349326 24352 BART BUXTON 1.00 X 0 661037 48729 ALICE GERARD 1.00 X 0 526079 46367 MARK O'HALLA 1.00 X 0 625351 53280 patrick lamberti 1.00 X 0 599870 51843 0 19132972 1004814 0 0 1 0 MCLAREN HEALTH CARE CORPORATION 401 S BALLENGER HWY FLINT MI 48532 LABOR & BENEFITS 811574 MICHIGAN STATE UNIVERSITY 412 ADMINISTRATION BUILDING EAST LANSING MI 48824 LABOR & BENEFITS 549955 2 1330430 379093 1709523 clinical trials 621500 259552 259552 259552 1969075 259552 0 0 1682454 1682454 258025 258025 37969 37969 17460 17460 12695 12695 15839 15839 2024442 1969013 55429 0 35613 35613 224161 166225 57220 5687 316994 207525 202567 199998 57220 5687 259787 205685 X 57207 1840 57207 1840 316994 207525 X 0 1 1 X 0 X 1352382 1255294 1327727 1578806 1709523 7223732 1352382 1255294 1327727 1578806 1709523 7223732 7223732 7223732 1197307 1.00000 1.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 RESTRICTED GRANTS 5687 5687 1969075 2024442 -55367 -55367 0 1 0 0 0 0 0 0 0 PHILIP INCARNATI 0 1247074 0 1119378 0 12251157 0 507159 0 13481 0 15138249 0 2998959 DON KOOY 0 476000 0 155750 0 209339 0 121151 0 20137 0 982377 0 0 JANIS RIZZO 0 212784 0 50066 0 0 0 30000 0 13643 0 306493 0 0 ROBERT WRIGHT 0 524164 0 0 0 125597 0 59222 0 15450 0 724433 0 0 RAYMOND DEMERS MD 0 296727 0 52599 0 0 0 12250 0 12102 0 373678 0 0 BART BUXTON 0 368000 0 142375 0 150662 0 30694 0 18035 0 709766 0 0 ALICE GERARD 0 381702 0 105313 0 39064 0 30800 0 15567 0 572446 0 0 MARK O'HALLA 0 448577 0 123750 0 53024 0 33650 0 19630 0 678631 0 0 patrick lamberti 0 403510 0 152660 0 43700 0 31500 0 20343 0 651713 0 0 Part I, Line 1a THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 1 BOXES HAVE BEEN CHECKED. THE CORPORATE CEO, SUBSIDIARY CEO'S AND CORPORATE VICE-PRESIDENTS IN SOME INSTANCES HAVE RECEIVED TAX INDEMNIFICATION FOR THE FOLLOWING BENEFITS: VEHICLE COSTS, GROUP TERM LIFE INSURANCE, SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS, AND HEALTH CLUB OR SOCIAL DUES. THESE BENEFITS HAVE BEEN INCLUDED IN TAXABLE COMPENSATION. THE FOLLOWING INDIVIDUAL HAS RECEIVED THESE BENEFITS: PHIL INCARNATI, DONALD KOOY, ROBERT WRIGHT, AND BART BUXTON. Part I, Line 4b: McLaren maintains two supplemental nonqualified retirement plans for a select group of management or highly compensated employees (the "SERPs"). The Old SERP was closed to new participants on October 1, 2006, and the New SERP became effective as of January 1, 2007. No employee may participate in both of the SERPs. The Old SERP is structured as a defined benefit plan that essentially replaces the benefits the participant is not permitted to receive under McLaren's qualified retirement plan due to IRS limitations applicable to qualified plans. The benefit under the Old SERP is payable in either the form of a single sum distribution or in monthly payments equal to the actuarial equivalent of the participant's accrued benefit. The benefit is paid at age 55, and if the participant remains employed, the benefit is paid upon termination of employment, reduced to take into account the benefit previously paid. The New SERP is structured as a defined contribution plan, and McLaren contributes 15 percent of each participant's compensation to the plan each year for allocation to the participant's account. Participants in the New SERP become vested in their accounts upon the earlier of five years of participation in the plan or attainment of age 60. Participants in the New SERP self-direct the investment of their accounts and have the actual investment return credited or debited to their accounts. The benefit under the New SERP is equal to the participant's account balance, and the benefit is paid in a single sum within 60 days of the participant's termination date. Benefits under both SERPs are provided on a tax-neutral basis. Both SERPS are designed to comply with Internal Revenue Code sections 457(f) and 409A. The individuals listed in Part VII who participated in the Old SERP are Philip Incarnati, Donald Kooy, and Barton Buxton The individuals listed in Part VII who participated in the New SERP are Alice Gerard, Mark O'Halla, and Patrick Lamberti. Part I, Line 6 MCLAREN HEALTH CARE CORPORATION (MHCC) HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION, SUBSIDIARY EXECUTIVES AND DIRECTORS, AND CORPORATE MANAGERS. THE PURPOSE OF THE PLAN IS TO ENHANCE THE ORGANIZATION'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING TOP OFFICIALS AND THE BOARD OF DIRECTORS WITH A TOOL FOR (A) CLEARLY COMMUNICATING PERFORMANCE ON THE PART OF KEY LEADERS, (B) STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE ON THE PART OF KEY LEADERS WHICH WILL ULTIMATELY BENEFIT THE COMMUNITIES MHCC SERVES, AND (C) PROTECTING MHCC'S ABILITY TO COMPETE WITH OTHER EMPLOYERS FOR HIGH-TALENT LEADERS. Supplemental Information Part III SCHEDULE J, PART I, LINE 3: THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 3 BOXES HAVE BEEN CHECKED. THE RELATED ORGANIZATION USED THE FOLLOWING METHODOLOGIES TO ESTABLISH THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. Form 990, Part VI, Section A, line 6 the sole member of this organization is mclaren health care corporation. Form 990, Part VI, Section A, line 7a the member shall have the exclusive right to elect or appoint the directors of the corporation. Form 990, Part VI, Section A, line 7b decisions by the governing body are subject to the powers of the member. Form 990, Part VI, Section B, line 11 THE FORM 990 DATA IS PREPARED INTERNALLY AND SUBMITTED TO OUR AUDITING FIRM FOR RETURN PREPARATION. ONCE THE RETURNS HAVE BEEN COMPLETED, THE FORMS ARE REVIEWED BY THE CORPORATE DIRECTOR OF BUDGET, THE CORPORATE SENIOR VICE PRESIDENT AND CFO OF MCLAREN HEALTH CARE CORPORATION (MHCC). COPIES OF THE RETURNS ARE MADE AVAILABLE TO THE MHCC BOARD MEMBERS, WHO SERVE AS THE OVERALL GOVERNING BOARD. RETURNS ARE AVAILABLE FOR ALL CORPORATIONS OF WHICH MHCC IS THE SOLE MEMBER AS WELL AS OTHER RELATED ENTITIES OF THOSE CORPORATIONS FOR REVIEW RATHER THAN HAVING THE LOCAL BOARDS REVIEW THE RETURNS. THE BOARD OF MHCC IS THE ULTIMATE ACCOUNTABLE ORGANIZATION FOR THE SYSTEM; AS SUCH IT IS THE OVERALL GOVERNING BOARD OF OUR SYSTEM WHOSE RESPONSIBILITIES INCLUDES BUT ARE NOT LIMITED TO: APPROVING ALL SUBSIDIARY BOARD MEMBERS, FINANCIAL BUDGETS, AND ISSUANCE OF DEBT. Form 990, Part VI, Section B, line 12c THE CORPORATE COMPLIANCE DEPARTMENT, IN ACCORDANCE WITH THE MCLAREN HEALTH CARE (MHC) BOARD CONFLICT OF INTEREST POLICY, ANNUALLY DISTRIBUTES THE CONFLICT OF INTEREST DISCLOSURE SURVEY TO ALL MHC 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 MHC GOVERNANCE COMMITTEE AND EACH SUBSIDIARY CEO AND BOARD CHAIR RECEIVES A REPORT SPECIFIC TO THEIR ORGANIZATION'S BOARD MEMBERS AND EXECUTIVES. CONFLICTS ARE DISCLOSED TO THE FULL BOARD AND BOARD COMMITTEES SO APPROPRIATE ACTIONS CAN BE TAKEN. ACTIONS MAY INCLUDE PROHIBITING A BOARD MEMBER FROM PARTICIPATING IN DELIBERATIONS INVOLVING TRANSACTIONS WITH A COMPANY WITH WHICH THEY CONDUCT FINANCIAL TRANSACTIONS; 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 THE COMPENSATION OF THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF MCLAREN HEALTH CARE CORPORATION BASED UPON THE PERFORMANCE OF THE CEO. THE COMPENSATION OF THE CEO IS WITHIN THE SALARY RANGES DETERMINED BY THE COMPENSATION COMMITTEE OF MCLAREN HEALTH CARE CORPORATION. THE PROCESS OF THE COMPENSATION COMMITTEE IS AS FOLLOWS: THE COMPENSATION COMMITTEE IS APPOINTED BY THE BOARD OF DIRECTORS TO REVIEW THE PERFORMANCE AND RECOMMEND THE TOTAL COMPENSATION PACKAGE OF THE MCLAREN HEALTH CARE CORPORATIONS CEO'S TO THE BOARD. FURTHER THE COMMITTEE ESTABLISHES THE SALARY RANGES AND PREREQUISITES OF THE CORPORATION'S OTHER MOST HIGHLY COMPENSATED OFFICERS (MHC VICE-PRESIDENTS AND MHC HOSPITAL/SUBSIDIARIES CEO'S) TO THE BOARD. THE MEMBERS OF THE COMMITTEE MUST MEET THE INDEPENDENCE REQUIREMENTS OF THE APPLICABLE PROVISIONS OF SECTION 4958 OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND FINAL TREASURY REGULATIONS SECTION 53.4956-6(C)(1)(III). THE COMMITTEE RETAINS THE SERVICES OF AN INDEPENDENT FIRM WITH SIGNIFICANT QUALIFICATIONS AND EXPERIENCE TO CONDUCT A REVIEW OF THE CORPORATION'S EXECUTIVE COMPENSATION PROGRAM. THE RETAINED FIRM UTILIZES APPROPRIATE COMPENSATION COMPARABILITY DATA. THE RETAINED FIRM CONDUCTS ANALYSIS OF THE COMPETITIVENESS OF THESE PROGRAMS AND EXPRESSES AN OPINION TO THE REASONABLENESS OF THESE COMPENSATION PROGRAMS. ALL DATA UTILIZED BY THE COMMITTEE, DELIBERATIONS OF THE COMMITTEE, AND FINAL COMPENSATION DECISIONS BY THE COMMITTEE ARE DOCUMENTED IN FORMAL REPORTS AND MINUTES. THE CORPORATE COMPENSATION COMMITTEE WORKS UNDER AND PERIODICALLY RENEWS THE MCLAREN HEALTH CARE CORPORATION COMPENSATION COMMITTEE CHARTER AND MCLAREN HEALTH CARE CORPORATION COMPENSATION PHILOSOPHY. FOR SUBSIDIARY VICE PRESIDENTS AND DIRECTORS, THE CORPORATE HUMAN RESOURCES COMMITTEE COORDINATES THE GATHERING OF MARKET INFORMATION FROM A NUMBER OF INDEPENDENT SOURCES. THIS DATA IS ANALYZED ALONG WITH EXPECTED BUDGETARY GUIDELINES. THE CORPORATE VICE PRESIDENT OF HUMAN RESOURCES DETERMINES THE AMOUNT, IF ANY, THAT PAY RANGES INCREASE. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS 2010. Form 990, Part VI, Section C, line 19 documents are available upon request. FORM 990, PART VII, SECTION A: THESE INDIVIDUALS DEVOTE THE FOLLOWING HOURS PER WEEK TO A RELATED ORGANIZATION FOR WHICH COMPENSATION IS REPORTED IN COLUMNS E & F: PHIL INCARNATI 40 HOURS MCLAREN HEALTH CARE CORPORATION DON KOOY 40 HOURS MCLAREN REGIONAL MEDICAL CENTER JANIS RIZZO 40 HOURS MCLAREN HEALTH CARE CORPORATION ROBERT WRIGHT 40 HOURS INGHAM REGIONAL MEDICAL CENTER RAYMOND DEMERS 40 HOURS MCLAREN HEALTH CARE CORPORATION BART BUXTON 40 HOURS LAPEER REGIONAL MEDICAL CENTER ALICE GERARD 40 HOURS BAY REGIONAL MEDICAL CENTER MARK O'HALLA 40 HOURS MOUNT CLEMENS REGIONAL MEDICAL CENTER PATRICK LAMBERTI 40 HOURS PONTIAC OSTEOPATHIC HOSPITAL FORM 990, PART XI, LINE 2C: NO CHANGE IN PROCESS FROM PRIOR YEAR. BAY MEDICAL FOUNDATION 1900 COLUMBUS AVE BAY CITY MI 48708 382156534 FOUNDATION MI 501(c)(3) Line 11a, I BAY REGIONAL MEDICAL CENTER BAY REGIONAL MEDICAL CENTER 1900 COLUMBUS AVE BAY CITY MI 48708 381976271 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION BAY REGIONAL MEDICAL CENTER AUXILIARY 1908 COLUMBUS AVENUE BAY CITY MI 48708 386081235 SUPPORTING ORGANIZATION MI 501(c)(3) Line 11a, I BAY REGIONAL MEDICAL CENTER BAY SPECIAL CARE HOSPITAL 1900 COLUMBUS AVE BAY CITY MI 48708 383161753 HOSPITAL MI 501(c)(3) Line 3 BAY REGIONAL MEDICAL CENTER CENTRAL MICHIGAN COMMUNITY HOSPITAL 1221 SOUTH DRIVE MT PLEASANT MI 48858 381420304 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION CENTRAL MICHIGAN COMMUNITY HOSPITAL RADIATION ONCOLOGY 1000 HARRINGTON MT PLEASANT MI 48858 300312172 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION INGHAM REGIONAL HEALTHCARE FOUNDATION 401 S GREENLAWN AVE LANSING MI 48910 382463637 FOUNDATION MI 501(c)(3) Line 7 INGHAM REGIONAL MEDICAL CENTER INGHAM REGIONAL MEDICAL CENTER 401 S GREENLAWN AVE LANSING MI 48910 381434090 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION LAPEER REGIONAL MEDICAL CENTER 1375 N MAIN ST LAPEER MI 48446 382689033 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION LAPEER REGIONAL MEDICAL CENTER FOUNDATION 1375 N MAIN ST LAPEER MI 48446 382689603 FOUNDATION MI 501(c)(3) Line 11a, I LAPEER REGIONAL MEDICAL CENTER MCLAREN HEALTH CARE CORPORATION 401 S BALLENGER HWY FLINT MI 48532 382397643 SUPPORTING ORG MI 501(c)(3) Line 11a, I N/A MCLAREN HEALTH PLAN G-3245 BEECHER ROAD FLINT MI 48532 383383640 HEALTH CARE SERVICES MI 501(c)(4) MCLAREN HEALTH CARE CORPORATION MCLAREN HEALTH CARE VILLAGE FOUNDATION 401 S BALLENGER HIGHWAY FLINT MI 48532 262693350 FOUNDATION MI 501(c)(3) Line 11a, I MCLAREN HEALTH CARE CORPORATION MCLAREN MEDICAL MANAGEMENT INC 401 S BALLENGER HWY FLINT MI 48532 382988086 MANAGEMENT COMPANY MI 501(c)(3) Line 11a, I MCLAREN HEALTH CARE CORPORATION MCLAREN REGIONAL MEDICAL CENTER 401 S BALLENGER HWY FLINT MI 48532 382383119 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION MOUNT CLEMENS REGIONAL HEALTHCARE FOUNDATION PO BOX 326 MOUNT CLEMENS MI 48046 382578873 FOUNDATION MI 501(c)(3) Line 9 MOUNT CLEMENS REGIONAL MEDICAL CENTER MOUNT CLEMENS REGIONAL MEDICAL CENTER 1000 HARRINGTON MOUNT CLEMENS MI 48043 381218516 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION POH REGIONAL MEDICAL CENTER 50 NORTH PERRY STREET PONTIAC MI 48342 381428164 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION POH RILEY FOUNDATION 50 NORTH PERRY STREET PONTIAC MI 48342 200442217 FOUNDATION MI 501(c)(3) Line 11c, III-FI POH REGIONAL MEDICAL CENTER VISITING NURSE SERVICE OF MICHIGAN 401 S BALLENGER HWY FLINT MI 48532 383491714 HEALTH CARE SERVICES MI 501(c)(3) Line 9 MCLAREN HEALTH CARE CORPORATION WOMENS HOSPITAL ASSOCIATION OF FLINT MICHIGAN 401 S BALLENGER HIGHWAY FLINT MI 48532 381358053 SUPPORTING ORGANIZATION MI 501(c)(3) Line 11a, I MCLAREN HEALTH CARE CORPORATION REGIONAL EMERGENCY MEDICAL SERVICE INC 25400 W 8 MILE ROAD SOUTHFIELD MI 48034 383255499 AMBULANCE SERVICE MI 501(c)(3) Line 9 MCLAREN MEDICAL MANAGEMENT INC NORTH OAKLAND NORTH MACOMB IMAGING INC 355 BARCLAY CIR STE A ROCHESTER HILLS MI 48307 382807040 MRI IMAGING MI 501(c)(3) Line 3 PRIMARY CARE 1900 COLUMBUS AVE BAY CITY MI 48708 202443604 HEALTH CARE SERVICES MI 501(c)(3) Line 9 BAY REGIONAL MEDICAL CENTER MCLAREN - NORTHERN EQUITIES CANCER CENTER PROJECT LLC 39000 COUNTRY CLUB DRIVE FARMINGTON HILLS MI 48331 263112935 RENTAL REAL ESTATE MI N/A JOINT VENTURE HOSPITAL LABORATORIES LLC 1633 FAIRLANE CIRCLE SUITE 300 ALLEN PARK MI 48101 383018129 LAB PROCEDURES MI N/A MOUNT CLEMENS REGIONAL HEALTH BUILDING HEALTH PARTNERS 1000 HARRINGTON ST MOUNT CLEMENS MI 48043 262524717 BUILDING MANAGEMENT MI N/A HEALTH ADVANTAGE INC G3245 BEECHER ROAD FLINT MI 48532 912141720 HEALTH CARE SERVICES MI N/A C CLARKSTON PROPERTY ASSOCIATES 50 NORTH PERRY STREET PONTIAC MI 48342 432006072 REAL ESTATE MI N/A C HOSPITAL HEALTH CARE INC 50 NORTH PERRY STREET PONTIAC MI 48342 382643070 HEALTH CARE MI N/A C PHYSICIAN ORGANIZED HEALTHCARE SYSTEM 50 NORTH PERRY STREET PONTIAC MI 48342 383136458 MANAGED CARE MI N/A C MCLAREN HEALTH PLAN INSURANCE COMPANY G-3245 BEECHER ROAD SUITE 200 FLINT MI 48532 271780283 INSURANCE MI N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 mclaren health care corporation N 811574 mclaren health care corporation C 1330430 mclaren regional medical center O 649909