2011-08-15T13:07:33-05:00 2010-09-30 PLANTE & MORAN PLLC 511 RENAISSANCE DR SUITE 120 ST JOSEPH MI 49085 990 2009-10-01 382748035 Mercy Memorial Health Services Inc MERC 2699836501 3425 Lakeshore Dr St Joseph MI 49085 TIMothy CALHOUN 2699836501 2011-08-15 1 2699828000 2009 2016-02-24 21:20:13Z Lakeland Continuing Care Center TIMOTHY CALHOUN 3425 lakeshore dr st joseph MI 49085 8188656 0 X lakelandhealth.org X 1987 MI To provide homecare and long-term healthcare to patients in the southwest Michigan area. 8 7 137 0 0 0 2924 42 7999044 8187759 1701 855 0 8003669 8188656 0 0 4300984 4308235 0 0 2653151 3008299 6954135 7316534 1049534 872122 5957253 6666247 2786821 2623693 3170432 4042554 To be Southwestern Michigan's leader in safe, high quality, patient centered, compassionate, health-related services. 0 0 6323722 8187759 NURSING HOME OPERATIONS WERE PROVIDED TO 108 inpatients and 108 outpatients. 6323722 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 4 0 1 137 1 0 0 0 0 0 0 0 0 0 8 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X chuck piechocki 2694282416 1234 NAPIER AVE St Joseph MI 49085 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 david village 1.00 X 0 0 0 loren hamel md 1.00 X X 0 471865 25444 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 lad stacey 1.00 X 0 0 0 timothy calhoun 1.00 X 0 340060 22819 dennis mack 1.00 X 0 184839 27626 joseph wasserman 1.00 X 0 2079531 30120 james schlaman 10.00 X 0 144821 26934 0 3221116 132943 0 0 1 0 rehabcare group po box 503534 st louis MO 63150 rehabilitation services 507077 1 42 42 PatIENT SERVICE REVENU 621400 8187759 8187759 8187759 855 855 8188656 8187759 0 855 3652301 3104456 547845 412700 346668 66032 243234 206749 36485 867 737 130 726533 615023 111510 772797 656877 115920 90149 75725 14424 77899 65435 12464 226458 192489 33969 57366 48761 8605 QAAP Assessment 750019 750019 Miscellaneous 211950 178038 33912 Repair and MAintenance 36066 30295 5771 Physician Fees 23488 19965 3523 Bad Debts 20706 20706 0 14001 11779 2222 7316534 6323722 992812 0 257162 36260 264148 531738 4182 2439 5786968 3462663 2493145 2324305 2938616 3771505 5957253 6666247 131389 100609 1574357 1617856 1037576 948727 2786821 2623693 X 3170432 4042554 3170432 4042554 5957253 6666247 X 0 1 1 X 0 X 868 3373 15582 2924 42 22789 6396138 6911262 7630742 7999044 8187759 37124945 6397006 6914635 7646324 8001968 8187801 37147734 0 0 0 37147734 10477 18267 5553 1701 855 36853 10477 18267 5553 1701 855 36853 6407483 6932902 7651877 8003669 8188656 37184587 0.99900 0.99880 0.00100 0.00120 X 162800 162800 4630517 2742503 1888014 899020 662451 236569 94631 57709 36922 2324305 BOND ISSUE COSTS 57050 Due From Lakeland hospitals at niles & st. joseph, inc. 3714455 3771505 ACCRUED LIABILITIES 248727 cost report settlement payable 700000 948727 8188656 7316534 872122 872122 0 1 0 0 0 0 0 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 dennis mack 0 152503 0 29448 0 2888 0 9344 0 18282 0 212465 0 0 joseph wasserman 0 524793 0 254760 0 1299978 0 14250 0 15870 0 2109651 0 0 james schlaman 0 138185 0 1800 0 4836 0 8390 0 18544 0 171755 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, Loren Hamel, and Dennis Mack. hospital finance authority of the City of St Joseph (Michigan) 800596186 790678BZ8 2003-12-16 1806337 FACILITY CONSTRUCTION AND IMPROVEMENTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 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 BOTH SENIOR MANAGEMENT AND 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: JOSEPH WASSERMAN, LOREN HAMEL, TIM CALHOUN, AND DENNIS MACK EACH WORKED AN AVERAGE OF AT LEAST 40 HOURS AND JAMES SCHLAMAN WORKED 0 HOURS AT THE RELATED ORGANIZATION FROM WHICH THEY WERE COMPENSATED. FORM 990, PART XI, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS 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 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 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 OFFICE 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 564078