TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Susan Tullai-McGuinness Chair	8.00	X	X			0	0
(2) Bruce Kephart Vice Chair	8.00	X	X			0	0
(3) Greg D Taylor Treasurer	8.00	X	X			0	0
(4) Daniel B Cudnik Secretary	8.00	X	X			0	0
(5) Lillie Mae Wilson Trustee	8.00	X				0	0
(6) Thomas P Jubeck Trustee	8.00	X				0	0
(7) John F Platz Trustee	8.00	X				0	0
(8) I James Hackenberg Trustee	8.00	X				0	0
(9) Timothy P Doyle Trustee	8.00	X				0	0
(10) Robert G Schiebli Trustee	8.00	X				0	0
(11) Cynthia Moore-Hardy President & CEO	40.00		X			621,187	38,941
(12) Robert Tracz Senior VP Finance & CFO	40.00		X			319,915	32,592
(13) Theodore Nichols Senior VP Medical Affairs	40.00			X		268,758	24,003
(14) Steven R Karns Senior VP Administrative Services	40.00			X		291,648	31,035
(15) Richard D Cicero Senior VP Business Development	40.00			X		245,067	15,184
(16) Mary L Orgrinc Chief Nursing Officer	40.00			X		249,274	36,916
(17) Jerrold M Peters Chief Information Officer	40.00				X	162,708	6,631

(A) Name and business address	(B) Description of services	(C) Compensation
McKesson Inc 1 Post St San Francisco,CA94104	Medical Services	11,202,148
Cardinal Health 7000 Cardinal Pl Dublin,OH43017	Medical Services	8,330,668
Gilbane Building Company 7 Jackson Walkway Providence,RI02903	Construction	8,098,131
Medtronic Inc 710 Medtronic Pkwy Minneapolis,MN55432	Medical Services	4,151,055
Draeger Medical Inc 3135 Quarry Rd Telford,PA18969	Medical Services	3,689,273
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 183

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	3,045,844		3,045,844
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	129,980,031	119,723,287	10,256,744
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	3,640,532	3,276,479	364,053
9	Other employee benefits .......	13,688,347	12,319,512	1,368,835
10	Payroll taxes ...........	7,874,907	7,087,416	787,491
11	Fees for services (non-employees):
a	Management ......	2,889,619		2,889,619
b	Legal .........	473,425		473,425
c	Accounting ...........	129,000		129,000
d	Lobbying ...........
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......
g	Other ..........	18,109,147	16,298,242	1,810,905
12	Advertising and promotion ....	2,025,680	2,025,680
13	Office expenses .......	51,024,486	45,922,037	5,102,449
14	Information technology ......	6,053,489	5,448,140	605,349
15	Royalties ..
16	Occupancy ...........	16,072,509	14,465,258	1,607,251
17	Travel ............	676,683	169,171	507,512
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	569,047	142,262	426,785
20	Interest ...........	5,660,451	5,660,451
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	26,639,388	26,639,388
23	Insurance ..............	1,404,684	936,391	468,293
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	Bad Debt Expense	26,064,187	26,064,187
b	Hospital Franchise Fee	2,627,317		2,627,317
c	Print and Publications	359,003	323,103	35,900
d	Other Expenses	287,898	143,949	143,949
e	Postage and Shipping	263,410	237,069	26,341
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	319,559,084	286,882,022	32,677,062	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	11,055,288	1	18,569,470
2	Savings and temporary cash investments .......		2
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	38,953,784	4	36,187,079
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	4,483,405	8	4,217,281
9	Prepaid expenses and deferred charges ............	6,949,697	9	9,190,117
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	455,483,926
b	Less: accumulated depreciation. .....	10b	192,011,786	276,246,195	10c	263,472,140
11	Investments—publicly traded securities ..........	157,039,493	11	160,946,010
12	Investments—other securities. See Part IV, line 11 ......		12
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	11,741,865	15	12,650,287
16	Total assets. Add lines 1 through 15 (must equal line 34)...	506,469,727	16	505,232,384
	17	Accounts payable and accrued expenses .	41,277,695	17	26,091,905
18	Grants payable ..........		18
19	Deferred revenue ..........	304,002	19	386,100
20	Tax-exempt bond liabilities ..........	242,374,767	20	247,769,632
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	7,719,185	25	8,756,311
26	Total liabilities. Add lines 17 through 25.....	291,675,649	26	283,003,948
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	214,794,078	27	222,228,436
28	Temporarily restricted net assets .....		28
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	214,794,078	33	222,228,436
34	Total liabilities and net assets/fund balances .....	506,469,727	34	505,232,384

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

Lake Hospital System Inc

Employer identification number

34-1425870

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

Lake Hospital System Inc

Employer identification number

34-1425870

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization Lake Hospital System Inc
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization Lake Hospital System Inc
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
Lake Hospital System Inc

Employer identification number

34-1425870

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Lake Hospital System Inc

Employer identification number

34-1425870

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated Group Totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? If "Yes," describe in Part IV ..........................

Yes

12,467

Total. lines 1c through 1i ...................................

12,467

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Explanation of Other Lobbying Activities:	Part II-B, Line 1i:	Annual Membership Dues to AHA, OHA, GCP: Exempt organizations on various levels operating to lead, represent, and serve health care provider organizations committed to community health improvement. Lobbying activities comprise approximately 10% of annual member dues.

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Lake Hospital System Inc

Employer identification number

34-1425870

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Investment earnings or losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	11,354,186		11,354,186
b	Buildings ................	184,299,075	35,402,113	148,896,962
c	Leasehold improvements ............	1,757,979	563,559	1,194,420
d	Equipment ................	237,290,001	152,634,573	84,655,428
e	Other .................	20,782,685	3,411,541	17,371,144
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				263,472,140

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes
Lease Obligation		838,574
Third Party Settlements		3,209,856
Payable to affiliate		1,287,143
Deferred Compensation		659,918
Workers Comp Liability		2,760,820




Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		8,756,311
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV) .................................	8
9	Total adjustments (net). Add lines 4 - 8 .............................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV): ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV): ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Lake Hospital System Inc

Employer identification number

34-1425870

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	10,425,385	4,839,489	5,585,896	1.900 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .	23,381,026	18,799,769	4,581,257	1.560 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	33,806,411	23,639,258	10,167,153	3.460 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	486,941		486,941	0.170 %
f Health professions education (from Worksheet 5) ..
g Subsidized health services (from Worksheet 6) ..	2,595,143		2,595,143	0.880 %
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	286,704		286,704	0.100 %
jTotal Other Benefits ...	3,368,788		3,368,788	1.150 %
kTotal. Add lines 7d and 7j. ..	37,175,199	23,639,258	13,535,941	4.610 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members	7,000	7,000	0 %
6	Coalition building	1,000	1,000	0 %
7	Community health improvement advocacy
8	Workforce development
9	Other	74,433	74,433	0.030 %
10	Total	82,433	82,433	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense (at cost).....

7,851,236

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

2,590,908

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

80,471,670

Enter Medicare allowable costs of care relating to payments on line 5.....

92,965,324

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-12,493,654

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 Mentor Surgery Center	Same Day Surgery	44.900 %	55.100 %
22 MMC Physicians Office Building	Medical Office Building	40.000 %	60.000 %
34 Lake West Physicians Office	Medical Office Building	10.000 %	90.000 %
45 Concord Medical Campus Physicians	Medical Office Building	51.470 %	48.530 %
56 Lake PHO	Physicians Med Group	50.000 %	50.000 %
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?2 Name and address		Other (Describe)
1	LakeWest Medical Center 36000 Euclid Avenue Willoughby,OH44094	X	X	X
2	TriPoint Medical Center 7590 Auburn Rd Concord,OH44077	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:NOT APPLICABLE

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?35
Name and address		Type of Facility (Describe)
1	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
2	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
3	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
4	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
5	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
6	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
7	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
8	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
9	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
10	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
11	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
12	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
13	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
14	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
15	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
16	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
17	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
18	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
19	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
20	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
21	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
22	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
23	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
24	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
25	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
26	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
27	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
28	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
29	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
30	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
31	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
32	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
33	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
34	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient
35	Mentor Medical Campus 9485 Mentor Avenue Suite 101 Mentor,OH44060	General Medical & Surgical Center-Outpatient

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
		Part I, Line 3c: The following steps will be followed to evaluate patient's requests for consideration under the Uninsured/Uncompensated Care Guidelines. Financial Interview: A hospital representative will discuss with patients their individual financial position and obtain from them information regarding their finances. This information will be recorded on the HCAP application. Patients will be requested to supply copies of their two most recent pay stubs for all family members employed, copies of the previous year's tax return and any other pertinent documentation supporting their financial position.Evaluation Process: The hospital representative will complete the Financial Interview Form. The hospital representative will evaluate the application to determine whether the patient may be eligible for welfare or Medicaid coverage. If this coverage is available, the representative will make arrangements with the patient for completion of the Medicaid eligibility forms. If welfare or Medicaid eligibility is not available, the patient will be sent an application and will be considered for uncompensated care. A copy of the application will be forwarded to the Patient Accounting department.Determination of Eligibility: The Patient Accounting department will review the application and the patient's qualification status under the uninsured/uncompensated care guidelines. If the patient qualifies for uninsured/uncompensated care and services are provided, then the adjustment will be recorded as an adjustment from charges for Lake Hospital's Uninsured/Uncompensated Charity Care.Patients Not Eligible: patients who are determined not to be eligible under the guidelines will be requested to pay a deposit equal to 50% of the estimated patient responsibility for either the elective inpatient or outpatient services, and to make arrangements for a payment plan to satisfy the remaining balance after services are provided.Incomplete Applications: Admission/treatment, if deemed medically appropriate, will be deferred until the application process has been completed.Eligibility: Each admission represents a separate financial encounter and will be evaluated with new data to determine if a change has taken place. Each outpatient application will be reviewed to determine if there has been any change in financial status. A new application will be required each month.
		Part I, Line 6a: An annual community benefit report sumarizing the activities of the organization is prepared. The report is written in user-friendly language and distributed at all community presentations.
		Part I, Line 7g: Cost Associated With Physicians ClinicsLake Health is the only hospital providing obstetrics, geropsychiatry, and inpatient rehabilitation services in Lake County. While each of these services operates at a financial loss, these services fill a community need that otherwise would be unmet. While the Centers for Geropsychiatry and Comprehensive Rehabilitation are only located only at the Lake West campus, obstetrics services are offered at both the Lake West and TriPoint campuses to ensure residents have access points on both east and west sides of the county. The reported loss on subsidized health services excludes losses attributable to Medicaid and charity patients as these losses are reported separately.
		Part I, L7 Col(f): Charity care and other community benefits as a percentage of expenses is calculated using total expenses from Form 990, Part IX less bad debt expense of $26,064,187 from Part IX.
		Part II: Community advisory groups have been in place for 9 years. These distinct groups represent women, seniors and past patients of the system. Each group is made up of approximately 20 members. Quarterly meetings are held in which education is followed by input on specific programs or improvements being considered. The groups are moderated by a third-party facilitator to avoid biasing the groups. The information from these groups have been used to inform Lake Health management on issues ranging from way-finding in current facilities to design and program development at the new TriPoint Medical Center .Community leaders are also invited to participate in a physician shadowing experience. In 2010 approximately 8 members of the community spent the day with a physician. The participants were exposed to the challenges faced by providers in delivering care. In exchange, physicians are invited to then shadow the community leaders during their normal day.Coalition BuildingLake Health is involved in many community coalitions and partnerships to improve the health of individuals in the service area. Some of these include participation in the Lake County Strategic Plan, ACHIEVE (a community coalition to improve the environment in Lake County), and United Way programs designed to improve health, particularly in vulnerable communities.Workforce development Lake Health also engages in the ongoing training and education of health care professionals. While the two nursing programs are identical in philosophy and curriculum, Lake Health provides the majority of the clinical training for the evening/weekend program at its facilities. In turn, the hope is that nursing students will feel welcomed and comfortable, pursuing careers right here in Lake County after graduation, meeting the local need.
		Part III, Line 4: Bad Debt ExpenseUncompensated care includes charity care and bad debts. The System provides care to patients who meet criteria under its charity care policy without charge or at amounts less than its established rates. The System does not pursue collection of amounts determined to qualify as charity care. The provision for uncollectible accounts represents estimated uncollectible charges for patients unwiling to pay. The amount of uncompensated care for services provided was approximately $51.9 million and $48.4 million in 2010 and 2009, respectively, of which $25.9 million and $23.9 million in 2010 and 2009, respectively, represents charity care measured at established charge rates. The System accepts all patients covered by Medicare, Medicaid, and other assistance programs and treats all patients requiring emergency care regardless of their ability to pay. In addition to providing direct patient charity care and in furtherance of its exempt purpose to benefit the community, the System operates two full time emergency rooms open to the public, provides various community screenings for the detection of diseases and disorders and provides various community health education classes, lectures, and literature. The System maintains an allowance for uncollectible accounts. The allowance for uncollectible accounts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverages, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category.
		Part III, Line 8: Based on a cost to charge ratio determined in accordance with Medicare cost report requirements, the costs of providing care to the Medicare population in 2010 was $92,965,324. The payments related to these services were $80,471,670, leaving a Medicare shortfall of $12,493,654 for the year. The Medicare shortfall is a community benefit because providing services to the elderly is a tax-exempt purpose consistent with the Hospital's overall exempt status, and the Hospital accepts these patients regardless of its impact on overall profitability.
		Part III, Line 9b: Provisions On Collection Practices For Qualified Patients:Patients who do not have the means to pay for services provided at Lake Hospital System request to be considered under the Uninsured/Uncompensated Charity Care Guidelines. These guidelines define Lake Hospital System's commitment to providing care to patients who are in the greatest financial need. Patients who do not have insurance coverage, or whose out of pocket responsibility is substantial after insurance coverage, or whose income level is at or below 250% of the Federal Income Poverty Guidelines, are eligible to apply for uninsured charity care assistance.The uninsured/uncompensated charity care program does not relieve nor forgive point-of-service copayments that the patient may be required to pay under the terms of their insurance benefit plan. Per visit copayments will be collected at the point of service in compliance with the insurance benefit terms.ProcedureEligibility for Lake's uninsured/uncompensated care is determined by the following two-part test. The Lake Hospital Systems Uninsured/Uncompensated Care Program requires patients to meet at least one condition in both part one and part two:Part One: Insurance Test1. Patient does not have governmental or private insurance coverage; or 2. Patient's insurance does not cover the medically necessary service; or3. Patient's insurance benefits are exhausted (i.e. Lifetime Reserve Days, Medicare); or4. Patient has or will obtain medically necessary services from the Hospital for which they do not have the financial mean to pay; or5. Patient is responsible for co-payments and deductibles, carries no secondary insurance coverage and only source of income is Social SecurityPart Two: Income test (relative to Lake Hospital charges)1. Family income is compared to the Federal Poverty Income Guidelines (family includes patient, patient's spouse, and all of the patient's children, natural or adoptive, under the age of eighteen who live in the home). The schedule shown below will be used to compare family income to a sliding scale base upon the Federal Poverty Income Guidelines. If family income is at or below the designated threshold, the patient is eligible for the percent charity discount associated with that level of income; or2. The relationship between the patient's medical bills, family income and family assets (including, but not limited to such items as bank accounts, trusts, property, home equity, estate or investments) indicates that the pursuit of payment would adversely affect the well being of the patient and family members, and where the payment of Lake Hospital's bill would result in undue hardship; or3. Patient's family income exceeds 250% of the Federal Income Poverty Guidelines, however patient has supplied information to support exceptional living circumstances (i.e. terminal illness, excessive medical bills and/or medications, etc.) or 100% of incurred charges greater than 25% of annual family income (including bank accounts, trusts and investments; but excluding primary residence)Before Uninsured/ Uncompensated Care can be awarded, the following conditions must be met:1. If Lake Hospital determines that the patient is potentially eligible for medical assistance, the patient must cooperate with Lake Hospital's efforts to establish eligibility for government assistance programs.2. If Lake Hospital awards Uninsured/Uncompensated Care, it will only cover the services provided under the account number(s) shown on the accompanying application.3. Proof of income and financial documentation will be requested. (See Hospital Care Assurance Policy)Steps for Evaluating Uninsured/Uncompensated CareThe following steps will be followed to evaluate patient's requests for consideration under the Uninsured/Uncompensated Care Guidelines.Financial Interview: A hospital representative will discuss with patients their individual financial position and obtain from them information regarding their finances. This information will be recorded on the HCAP application.
		Part V, Section A: Lake Health's growth as a community-based health care system continues to build on its long history of providing progressive, personalized care that you normally wouldn't expect to find at a community hospital. Lake Health is comprised of sixteen facilities in Lake and Geauga and Cuyahoga counties, which includes two acute care facilities - TriPoint Medical Center in Concord Township and West Hospital in Willoughby; three outpatient medical campuses - the Mentor Campus, the Chardon Campus and the Madison Campus, which includes a free standing ED; two urgent care centers - Tyler Boulevard, and inside the Willowick Campus; four walk-in care clinics - Painesville Quick Care, the Perry Walk-in Care Center located inside the Perry Community Fitness Center and The Clinic at Middlefield and the Clinic at Madison both located inside Walmart Supercenters; and two Physical Therapy locations inside the Mentor and Willoughby Fitworks.Accessibility is key to our mission. We have contracted with most insurance providers to insure a vast array of primary care physicians and specialists. Lake Health also operates three full-service emergency rooms within Lake County at TriPoint Medical Center in Concord Township, West Hospital in Willoughby, and the new Madison Emergency Department. These emergency rooms are open to all persons regardless of ability to pay.
		Part VI, Line 2: As an independent, community-based hospital system, Lake Health has had a long-standing tradition of providing services and programs based on the health care needs of the communities we serve. We are guided by our mission to provide local access, healing with compassion and superior quality and our core values - respect, innovation, teamwork, stewardship and integrity. Guided by a collaborative health needs assessment conducted in cooperation with the Lake County Health District, Lake Health has developed programs, services and partnerships to address the most pressing health issues. The high priority areas included obesity, inactive lifestyles and smoking. Programs designed to address weight management span from early childhood through mature adults. Get Healthy Lake County is now in its eighth year of operation and has nearly 2,500 members. And for the tenth year in a row, we were honored as one of Northcoast 99's "Best Places to Work in Northeast Ohio." Our growth as a health system reflects the many ways we are building on our mission and how we aspire to be more than your typical community hospital. We want our patients to receive superior patient care without having to leave the community, and that's why we are committed to bringing the best resources together to provide an expanded level of community care to meet the needs of the community.
		Part VI, Line 3: 1. Signage posted at facility access points for patients who cannot afford to pay for medical care.2. Charity/HCAP application forms given to self-pay patients at time of registration. Explanation of assistance provided to complete application if needed.3. Uninsured inpatients are visited bedside to assist Charity/HCAP application and also to provide application assistance with other programs such as Medicaid, food stamps, etc.4. Uninsured patients who receive outpatient services are contacted by phone to assist with Charity/HCAP application and other programs listed above.5. Charity/HCAP application appears on the back of all patient statements.6. Charity/HCAP application appears on Lake Health website.
		Part VI, Line 4: Lake Health's primary service area is Lake County (population of 235,000) and selected zip codes in its secondary service areas (Cuyahoga, Ashtabula and Geauga counties with a population in the defined zip codes of 268,113).
		Part VI, Line 6: Prior to 1985, Lake Health's facilities were publicly operated as Lake County Memorial Hospitals. However, in 1985 the board of county commissioners and hospital trustees agreed to privatize the hospital to ensure the viability of a technologically progressive hospital system for Lake County residents. County commissioners serve as members of the Lake Hospital Corporation and, as such, appoint the community leaders who serve on the system's governing board.Lake Health has an open medical staff with privileges available to all qualified physicians in the area. Over 550 physicians comprise Lake Health's medical staff.Lake Health's commitment to the community is readily apparent in the Board of Trustees which is comprised solely of community members, appointed by the County Commissioners. The Board of Trustees oversees and organization that is comprised primarily of an open medical staff. All proceeds are reinvested in capital or other programs and services designed to meet the communities we serve.Lake Health provides services and programs based on the health care needs of the communities we serve. In fact, taking health programs and screenings to where people live, work and play is fundamental to our mission. In 2010, we provided over $530,000 in community benefits through our health system operations in Lake and Geauga counties. This includes community education programs, including blood drives. During these community events and health fairs, we performed over 5,000 blood pressure checks, cholesterol screenings and heel screenings for free or at low cost. Lake Health's commitment to health improvement services that provide a demonstrated community benefit can be broadly categorized into three areas; Community Health Education, Community-Based Clinical Services and Cash and In-Kind Gifts. Some of the programs and events are highlighted below.Community Health EducationLake Health has an extensive community health program that provides health screenings, physician lectures, self-help and exercise programs in multiple commmunity locations throughout Lake County and surrounding areas. Our support groups help meet educational and emotional needs related to a variety of conditions. We also partner with many local organizations, including the United Way, the American Red Cross and the American Heart Association to increase awareness of health issues in the community. These programs and services include:Community Calendars and NewslettersBOH Magazine & BOH Community CalendarNH Community CalendarHealth TasksEducation on Specific Disease ConditionsSenior Connection Lunch and LearnsSurgical Innovations Lecture SeriesRed Hot Mamas/LifeCyclesWear Red EventRunner's ClinicWillowick Community Open HouseHealth Promotion and Wellness ProgramsGet Healthy Lake County 10,000 Steps ProgramHealth Education Lectures and Workshops by staff to community groupsUnion Commmunity ChurchAARPD-6 Group - Willoughby Hills Friends ChurchOrchard Hollow ElementaryPerry LibraryEducation to the public about health issuesInformation through media releasesRadio call-in programs with health professionals WELWSchool health education programsHealthy Heart School ProgramWeb-based consumer heatlh informationADAME-NewsletterCarePagesSelf-HelpLabel Reading ToursBoning Up on OsteoporosisStanding Tall: Exercising to Help Prevent OsteoporosisWeight 4 Life Weight Management ProgramGolf ProgramsOne of the many ways Lake Health is building the community is through strong partnerships with others who share our commitment to local access, healing with compassion and superior quality. Lake Health joined forces with Lake Metroparks, Lake County YMCA and the Lake County Health District to launch B Fit 4 Life.Support GroupsBreast Cancer Support GroupBreast Feeding Support GroupCPAP Support GroupEpilepsy Support GroupIDEAS Insulin Support GroupLook Good, Feel BetterMended Hearts Cardiac Support GroupProstate Cancer Support GroupPulmonary Support GroupStroke Support GroupReach to RecoveryWeight 4 Life Support GroupCash and in-kind contributions to community groupsContributions including cash and non-cash items made to individuals or non-profit organizations for charitable purposes: Golf outings, community walks/runs and other community events that benefit Lake County and the surrounding area's growth and cultural wealth comprise this category.ScreeningsTotal Cholesterol, Glucose, HDLBlood PressureHeel Bone DensityHeart Check MachineSkin Cancer ScreeningProstate Cancer ScreeningPeripheral Vascular Disease ScreeningCarotid Artery ChecksHeight and Weight ChecksPrenatal/Childbirth classes serving at-risk population
Reports Filed With States	Part VI, Line 7	OH

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Lake Hospital System Inc

Employer identification number

34-1425870

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) Cynthia Moore-Hardy	(i) (ii)	601,670 0	0 0	19,517 0	34,566 0	4,375 0	660,128 0	0 0
(2) Robert Tracz	(i) (ii)	289,782 0	15,000 0	15,133 0	26,217 0	6,375 0	352,507 0	0 0
(3) Theodore Nichols	(i) (ii)	251,253 0	5,000 0	12,505 0	18,268 0	5,735 0	292,761 0	0 0
(4) Steven R Karns	(i) (ii)	252,168 0	25,000 0	14,480 0	25,759 0	5,276 0	322,683 0	0 0
(5) Richard D Cicero	(i) (ii)	227,333 0	11,138 0	6,596 0	11,308 0	3,876 0	260,251 0	0 0
(6) Mary L Orgrinc	(i) (ii)	222,517 0	15,000 0	11,757 0	35,104 0	1,812 0	286,190 0	0 0
(7) Jerrold M Peters	(i) (ii)	152,452 0	5,000 0	5,256 0	2,755 0	3,876 0	169,339 0	0 0
(8) Barbara J Moran	(i) (ii)	156,490 0	0 0	4,533 0	22,278 0	0 0	183,301 0	0 0
(9) Andrea M Wasdovich	(i) (ii)	156,273 0	0 0	4,614 0	13,322 0	3,778 0	177,987 0	0 0
(10) Gary J Robinson	(i) (ii)	152,232 0	2,500 0	7,961 0	18,974 0	382 0	182,049 0	0 0
(11) Theodore F Hoffman	(i) (ii)	138,518 0	0 0	4,692 0	5,604 0	1,489 0	150,303 0	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
	Part I, Line 1a	Relevant Information Regarding Compensation Benefits Lake Hospital System, Inc. policy allows for use of first class travel only in situations when coach or business class is not available or flexibility is required for refundable tickets when circumstances indicate the potential for an immediate change in scheduled travel. Lake Hospital System, Inc.'s CEO received first class travel and reimbursement for country club and social club dues in 2010. The club dues were included in taxable income and the first class travel was not included.

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
Lake Hospital System Inc

Employer identification number
34-1425870

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	County of Lake Ohio Series 2008	31-6001618	50943PBL2	06-26-2008	187,820,719	Construct a hospital, refunding issue		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .
2 Amount of bonds defeased . . . .
3 Total proceeds of issue . . . .	187,820,719
4 Gross proceeds in reserve funds . .	5,984,333
5 Capitalized interest from proceeds.
6 Proceeds in refunding escrow. . . . .
7 Issuance costs from proceeds . . .	1,808,396
8 Credit enhancement from proceeds.	57,940
9 Working capital expenditures from proceeds . .
10 Capital expenditures from proceeds . .	183,896,741
11 Other spent proceeds . .
12 Other unspent proceeds. . .
13 Year of substantial completion . . .	2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?	X
15 Were the bonds issued as part of an advance refunding issue?		X
16 Has the final allocation of proceeds been made? . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2010

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use?	X
b Are there any research agreements that may result in private business use of bond-financed property? . .		X
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .	X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . .	0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .	0 %
6 Total of lines 4 and 5 . . .. . . . . .	0 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?	X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X
2 Is the bond issue a variable rate issue?	X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?	X
b Name of provider .	UBS
c Term of hedge . .	33.600000000000
d Was the hedge superintegrated? .		X
e Was a hedge terminated? .		X
4a Were gross proceeds invested in a GIC? .	X
b Name of provider .	FSA Capital Management Services
c Term of GIC . .	1.100000000000
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .	X
5 Were any gross proceeds invested beyond an available temporary period? .		X
6 Did the bond issue qualify for an exception to rebate? . . .	X

Schedule K (Form 990) 2010

Page 3

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

Lake Hospital System Inc

Employer identification number

34-1425870

Identifier	Return Reference	Explanation
Form 990, Part VI		Current address of Robert Tracz: 6832 Convent Blvd. Sylvania, OH 43560 419-882-8373
Form 990, Part VI, Section B, line 11		The process followed before filing the Lake Hospital System, Inc. Form 990 includes a detailed review completed by an independent outside CPA firm, presentation to and review by the LHS CFO and CEO, presentation and review by the LHS Finance Committee, and presentation to the LHS Board of Trustees.
	Form 990, Part VI, Section B, line 12c	The Lake Hospital System, Inc. Board of Trustees completes a conflict of interest questionnaire annually, which is then reviewed by the LHS CFO and Director of the Board of Trustees. Board Members will excuse themselves from the Board Meeting when a topic of potential conflict is presented and return to the meeting following the completion of discussion, motion, and vote. Compliance with the LHS Conflict of Interest Policy is monitored and enforced by the Board Chair, Committee Chairs, and the Director responsible for Board of Trustee matters.
	Form 990, Part VI, Section B, line 15	The process for determing compensation of the Lake Hospital System, Inc. CEO, other officers, and key employees includes market research, review, and assessment by an independent consulting firm to make a recommendation to the LHS Board of Directors. The Board reviews the report provided in conjunction with annual performance assessments, and utilizes this information to determine compensation level. In addition, the procedure for other officers and key employees includes review by the CEO.
	Form 990, Part VI, Section C, line 18	Lake Hospital System, Inc. makes its Form 990, Form 990-T, and Form 1023 available to the public upon request.
	Form 990, Part VI, Section C, line 19	Lake Hospital System, Inc. makes available governing documents, conflict of interest policy, and financial statements to the public upon request, in addition to filing quarterly financial information with NRMSIRs for compliance with bond issues and annual financial information with the Attorney General of the State of Ohio. Governing documents for LHS are available through the website of the Ohio Secretary of State.
Changes in Net Assets or Fund Balances:	Form 990, Part XI, line 5:	Net unrealized gains on investments: 6,053,789. Underwriting support to Lake Hospital Foundation, Inc. -429,899. Contributions from Lake Hospital System, Inc. -241,134. Loss on disposal of assets -673. Cash payments on swap instrument -5,100,617. Loss on change of derivative -6,452,533. Passthrough Income -221,012. Total to Form 990, Part XI, Line 5: -6,392,079.
		Form 990, Part XII, line 2c: Lake Hospital System, Inc. has an audit committee responsible for oversight of the audit and selection of the independent accounting firm. The process has not changed from the prior year.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Lake Hospital System Inc

Employer identification number

34-1425870

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) Lake Health IPHE 7590 Auburn Rd Concord,OH44077 34-1425870	Physician services	OH	0	0	Lake Hospital System Inc

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Lake University Ireland Cancer Center 9485 Mentor Avenue Mentor,OH44060 31-1565964	Treatment of Cancer Patients	OH	501 (c) (3)	3	Lake Hospital System Inc	Yes
(2) Lake Hospital Foundation 7590 Auburn Rd Concord,OH44077 34-1425872	Raise Funds for benefit of Lake Hospital System	OH	501 (c) (3)	11a	Lake Hospital System Inc	Yes
(3) PrimeHealth Inc 7590 Auburn Rd Concord,OH44077 34-1778204	Employment of Physicians	OH	501 (c) (3)	4	Lake Hospital System Inc	Yes

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Mentor Surgery Center LLC 9485 Mentor Avenue Mentor,OH44060 34-1863257	O/P Surgery	OH	N/A	RELATED	270,994	1,791,617		No		Yes		44.898 %
(2) Lake West Medical Specialists LLC 36000 Euclid Avenue Willoughby,OH44094 34-1964657	Office Space	OH	N/A	RELATED	19,955	422,481		No		Yes		10.000 %
(3) Concord Medical Campus Phys Bldg LLC 7580 Auburn Rd Concord,OH44077 26-0550261	Office Space	OH	N/A	UNRELATED	48,577	8,886,510		No			No	51.471 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) Interlake Health Corporation 7590 Auburn Rd Concord,OH44077 34-1510475	Interest Income	OH	Lake Hospital System Inc	C	462	185,000	100.000 %
(2) LHS Assurance Ltd 23 Lime Tree Bay Ave Governors Sq Grand Cayman CJ 98-0456229	Insurance Company	CJ	Lake Hospital System Inc	C			100.000 %

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) Lake University Ireland Cancer Center	I	779,923	per books
(2) Lake Hospital Foundation	C	1,034,685	per books
(3) Lake Hospital Foundation	L	343,919	per books
(4) Lake Hospital Foundation	O	429,889	per books
(5) PrimeHealth Inc	O	18,751,477	per books
(6) Mentor Surgery Center LLC	I	480,804	per books
(7) Mentor Surgery Center LLC	P	252,804	per books
(8) Lake West Medical Specialists LLC	I	103,783	per books
(9) Lake West Medical Specialists LLC	P	59,524	per books
(10) Concord Medical Campus Phys Bldg LLC	I	1,402,524	per books
(11) Concord Medical Campus Phys Bldg LLC	P	101,235	per books

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: To provide health care services to the residents of Lake County and neighboring communities in partnership with those who share a commitment to local access, healing with compassion and superior quality.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	10
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	3,134
6	Total number of volunteers (estimate if necessary) ....	6	1,185
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	-69,937
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-69,937

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,840,267	1,034,685
9	Program service revenue (Part VIII, line 2g) .........	299,641,906	322,305,254
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,561,874	4,519,470
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,612,542	5,526,112
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	309,656,589	333,385,521
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	19,150	0
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	152,159,789	158,229,661
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	122,100,361	161,329,423
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	274,279,300	319,559,084
19	Revenue less expenses. Subtract line 18 from line 12......	35,377,289	13,826,437
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	506,469,727	505,232,384
21	Total liabilities (Part X, line 26)............	291,675,649	283,003,948
22	Net assets or fund balances. Subtract line 21 from line 20 .....	214,794,078	222,228,436

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 286,882,022 including grants of $ ) (Revenue $ 322,305,254 )
	See Schedule OAs an independent, community-based hospital system, Lake Hospital System (LHS) has had a long-standing tradition of providing services and programs based on the health care needs of the communities that we serve. We are guided by our mission to provide local access, healing with compassion and superior quality and our core values - respect, innovation, teamwork, stewardship and integrity. Lake Hospital System's growth as a community-based health care system continues to build on its long history of providing progressive, personalized care that you normally wouldn't expect to find at a community hospital. Today, Lake Hospital System is comprised of seventeen facilities in Lake, Geauga, and Cuyahoga counties, including three acute care facilities - TriPoint Medical Center in Concord Township, West Medical Center in Willoughby, and a new stand-alone emergency room in Madison; four outpatient medical campuses - the Mentor Campus, the Madison Campus, the Willowick Campus and the Chardon Campus; three diagnostic imaging sites - Mentor Diagnostics, Willoughby Hills Diagnostics and Lyndhurst Diagnostics; one urgent care center - Lake Health Tyler Boulevard Urgent Care; two Physical Therapy sites located inside the Mentor and Willoughby Fitworks ; and four walk-in care centers - Painesville Quick Care Center, Perry Walk-in Care Center located inside the Perry Community Fitness Center, and the Clinic at Middlefield and the Clinic at Madison both located inside WalMart Supercenters. Accessibility and superior quality throughout our service area is key to our mission. In October of 2009 we opened TriPoint Medical Center, which incorporates a healing environment that puts the patient and family at the center of the experience. We also continue to invest in state-of-the-art technology, such as an imaging-guided system for complex brain surgeries and 64-slice CT scanning. For the ninth year in a row, we were honored as one of Northcoast 99's "Best Places to Work in Northeast Ohio." Our growth as a hospital system reflects the many ways we are building on our mission and how we aspire to be more than your typical community hospital. We want our patients to receive superior patient care without having to leave the community, and that's why we are committed to bringing the best resources together to provide an expanded level of community care.Lake Hospital System provides services and programs based on the health care needs of the communities we serve. In fact, taking health programs and screenings to where people live, work and play is fundamental to our mission. In 2010, we provided over $848,078 in community benefit through our health system operations in Lake and Geauga counties. This includes over 250 community education programs, including 44 blood drives which brought in 1,259 pints of blood for the American Red Cross. During these community events and health fairs, we performed 3198 blood pressure checks, 951 cholesterol screenings and 513 heel screenings for free or at a low cost. We also contributed nearly $286,704 in 2010 in cash and in-kind donations to civic and community events, programs and partnerships with a health and wellness focus. Some of the programs and events are highlighted below. Many of them are facilitated through our Health Promotion Department and/or our community outreach coordinator.Community Programs and Events:Alzeheimer's Education SeriesAmerican Heart WalkCardiac Health Education ProgramsBaby Talk programs including Childbirth Preparation, Infant Care, Breasfeeding Program, Sibling Program, Infant and Child CPR, TEEN Childbirth Preparation, Caring for Kids, and Car Seat Checks.Get Healthy Lake County B Fit 4 LifeHealthy Heart ProgramLifeCycles for WomenOsteoporosis Education & Exercise Prevention ClassesPorter Science Center Digestion ModuleSenior ConnectionSupport Groups which include Breast Cancer, Breastfeeding, Epilepsy, IDEAS Diabetes, Mended Hearts Cardiac, Prostate, Pulmonary, and a Weight Management.United Way Day of CaringWomen's Health Screening ProjectWomen's Heart InitiativeLake Hospital System joined forces with Lake Metroparks, Lake County YMCA and the Lake County General Health District again in 2010 to continue B Fit 4 Life, a corporate challenge in which area businesses vie for the most points as their employees exercise their way to better health. B Fit 4 Life is a part of Get Healthy Lake County, a countywide initiative that features education, prevention and wellness programs to enhance and improve the quality of life in Lake County and neighboring communities.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 286,882,022

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Barbara J Moran VP Clinical Services	40.00	X	161,023	0	22,278
(19) Andrea M Wasdovich VP Periop Critical	40.00	X	160,887	0	17,100
(20) Gary J Robinson VP Government Relations	40.00	X	162,693	0	19,356
(21) Theodore F Hoffman VP Support Services	40.00	X	143,210	0	7,093

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,786,370	0	251,129

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		1,034,685
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			1,034,685
			Business Code
2a	Patient Care		621,110	322,305,254	322,305,254
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			322,305,254
3	Investment income (including dividends, interest
	and other similar amounts).....			3,763,967			3,763,967
4	Income from investment of tax-exempt bond proceeds..			755,503			755,503
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross Rents	2,368,324
b	Less: rental expenses
c	Rental income or (loss)	2,368,324
d	Net rental income or (loss).......			2,368,324			2,368,324
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss)..........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	Food and Service		621,110	1,086,128			1,086,128
b	Passthrough Income		523,000	221,012		-69,937	290,949
c	OB Sales and Rentals		621,110	38,500			38,500
d	All other revenue ....			1,812,148			1,812,148
e	Total. Add lines 11a–11d ......			3,157,788
12	Total revenue. See Instructions....			333,385,521	322,305,254	-69,937	10,115,519


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			11,055,288	1	18,569,470
2	Savings and temporary cash investments .......				2
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			38,953,784	4	36,187,079
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			4,483,405	8	4,217,281
9	Prepaid expenses and deferred charges ............			6,949,697	9	9,190,117
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	455,483,926
b	Less: accumulated depreciation. .....	10b	192,011,786	276,246,195	10c	263,472,140
11	Investments—publicly traded securities ..........			157,039,493	11	160,946,010
12	Investments—other securities. See Part IV, line 11 ......				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			11,741,865	15	12,650,287
16	Total assets. Add lines 1 through 15 (must equal line 34)...			506,469,727	16	505,232,384
17	Accounts payable and accrued expenses .			41,277,695	17	26,091,905
18	Grants payable ..........				18
19	Deferred revenue ..........			304,002	19	386,100
20	Tax-exempt bond liabilities ..........			242,374,767	20	247,769,632
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			7,719,185	25	8,756,311
26	Total liabilities. Add lines 17 through 25.....			291,675,649	26	283,003,948
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			214,794,078	27	222,228,436
28	Temporarily restricted net assets .....				28
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			214,794,078	33	222,228,436
34	Total liabilities and net assets/fund balances .....			506,469,727	34	505,232,384