2011-06-13T15:36:24-05:00 2010-06-30 PLANTE & MORAN PLLC 600 E Front St Suite 300 Traverse City MI 49686 990 2009-07-01 383022945 PORTAGE HEALTH FOUNDATION PORT 9064878000 500 CAMPUS DRIVE HANCOCK MI 49930 BRIAN DONAHUE 9064878000 2011-06-10 1 2319477800 2009 2016-02-24 21:20:13Z JAMES BOGAN 500 CAMPUS DRIVE HANCOCK MI 49930 934501 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. 15 13 0 13 0 0 63948 55225 0 -45531 45731 3282 11269 21699 112225 68900 106289 0 0 0 0 17767 23909 86667 130198 -64968 -17973 1545801 1603405 0 1545801 1603405 TO SUPPORT AND ASSIST THE MISSION OF PORTAGE HEALTH, A TAX EXEMPT HEALTHCARE ORGANIZATION, THROUGH FINANCIAL ASSISTANCE. 0 0 103495 101339 PROMOTION OF CHARITABLE MISSION OF RELATED TAX-EXEMPT HEALTHCARE ENTITY 4700 4700 GRANT TO AGES PROGRAM 12581 250 ALL OTHER PROGRAM SERVICES 12581 250 120776 1 0 0 0 0 0 0 0 0 1 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 1 0 0 0 0 0 0 0 0 1 1 0 0 0 15 13 0 0 0 0 0 1 0 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 38581 238 JEANNE KURTZ 1.00 X 0 0 0 LENNON MATTILA HUGHES 1.00 X X 0 0 0 PETER WICKLEY 1.00 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 PICHAI SRIPAIPAN 1.00 X 0 243543 23339 BERNADETTE YEOMAN-QUELLETTE 1.00 X 0 0 0 JAMES BOGAN 1.00 X 0 282884 35420 BRIAN DONAHUE 1.00 X 0 168980 23862 0 733988 82859 0 0 1 0 0 27683 27542 55225 59161 59161 808196 821626 -13430 -13430 -13430 11919 27683 650 11269 11269 112225 0 0 57000 106039 106039 250 250 9422 9422 2232 2232 ENDOWMENT FUND - OTHER 11000 11000 ENDOWMENT FUND - AUDIOL 600 600 OTHER EXPENSE 500 500 AWARD ENGRAVING 155 155 130198 120776 9422 0 41125 42819 614000 501235 18615 18615 2991 0 876616 1047266 11069 12085 1545801 1603405 0 0 X 1545801 1603405 1545801 1603405 1545801 1603405 X 0 1 1 X 0 X X X 0 0 0 PORTAGE HEALTH INC 381381288 3 0 0 1 101339 1 101339 1501685 27263 38238 9591 1557595 1672098 21989 -183299 9103 1501685 0.99600 0.00400 0.00000 1 0 18615 18615 0 0 112225 130198 -17973 75577 75577 57604 Part V, Line 4: Description of Intended Use of Endowment Funds: THE ENDOWMENT FUNDS ARE TO BE USED FOR GRANTING WITHIN PORTAGE HEALTH, INC. SPRING BALL 21505 16480 5025 AUCTION 18097 11203 6894 650 39602 27683 11919 650 650 11269 1 PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 5181 WIRELESS INTERNET ACCESS SERVICE ENHANCEMENT PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 11176 SPINNING INDOOR CYCLING CLASS PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 58650 GENEXPERT IV MACHINE PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 1332 BABYSENSE FEATURE FOR HUGS SYSTEM PORTAGE HEALTH INC 500 CAMPUS DRIVE HANCOCK MI 49930 381381288 501(C)3 25000 PHYSICIAN RECRUITMENT 1 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 PICHAI SRIPAIPAN 0 133076 0 110367 0 100 0 16832 0 6507 0 266882 0 0 JAMES BOGAN 0 251534 0 18000 0 13350 0 18450 0 16970 0 318304 0 0 BRIAN DONAHUE 0 158464 0 10316 0 200 0 12535 0 11327 0 192842 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 PICHAI SRIPAIPAN, DIRECTOR 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 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 PICHAI SRIPAIPAN 40 HOURS TERRY KINZEL, MD 24 HOURS FORM 990, PART XI, LINE 2B: THE FINANCIAL STATEMENTS WERE AUDITED BY AN INDEPENDENT ACCOUNTANT ON A CONSOLIDATED BASIS. FORM 990, PART XI, 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 PORTAGE HEALTH RESOURCES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383041729 SENIOR MEALS MI 501(C)3 Line 11a, I PORTAGE HEALTH INC PORTAGE HEALTH HOME SERVICES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383565553 PRIVATE DUTY CARE MI 501(C)3 Line 9 PORTAGE HEALTH INC 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 101339