Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 05-01-2010 and ending 04-30-2011
BCheck if applicable:
CName of organization
LAKE REGIONAL HEALTH SYSTEM
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
54 HOSPITAL DRIVE
 
Room/suite
City or town, state or country, and ZIP + 4
OSAGE BEACH, MO65065
D Employer identification number

23-7339737
E Telephone number

G Gross receipts $ 157,793,918
F Name and address of principal officer:
MICHAEL E HENZE
54 HOSPITAL DRIVE
OSAGE BEACH,MO65065
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.LAKEREGIONAL.COM
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1973
M State of legal domicile: MO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: LAKE REGIONAL HLTH SYSTEM PROVIDES AN EXTENSIVE VARIETY OF OUTPATIENT & INPATIENT HLTH CARE SERVICES AS WELL AS AN EMERGENCY DEPARTMENT TO RESIDENTS & VISITORS OF THE LAKE REGION. SEE SCHEDULE O FOR MORE INFO.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 14
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 6
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 1,141
6 Total number of volunteers (estimate if necessary) .... 6 401
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 154,328 819,907
9 Program service revenue (Part VIII, line 2g) ......... 155,426,399 160,273,614
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,519,673 1,733,573
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -4,209,557 -6,332,946
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 152,890,843 156,494,148
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 157,522 110,074
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) 57,766,253 60,347,837
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 89,475,804 88,615,726
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 147,399,579 149,073,637
19 Revenue less expenses. Subtract line 18 from line 12...... 5,491,264 7,420,511
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 168,899,989 176,979,780
21 Total liabilities (Part X, line 26)............ 73,112,645 71,977,895
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 95,787,344 105,001,885
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: LAKE REGIONAL HEALTH SYSTEM WILL PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS AND VISITORS OF THE LAKE REGION WITH EMPHASIS ON QUALITY OUTCOMES AND SERVICE SATISFACTION WHILE OPERATING IN A SOUND FISCAL MANNER.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 59,245,639 including grants of $   ) (Revenue $ 64,553,939 )
LAKE REGIONAL HEALTH SYSTEM PROVIDES OUTPATIENT SERVICES SUCH AS DIAGNOSTIC IMAGING, LABORATORY AND PHYSICAL THERAPY SERVICES TO THE COMMUNITY AND SURROUNDING RURAL AREAS. THE HOSPITAL PROVIDED A TOTAL OF 238,807 OUTPATIENT SERVICES VISITS.
4b (Code:   ) (Expenses $ 50,973,211 including grants of $   ) (Revenue $ 60,246,772 )
LAKE REGIONAL HEALTH SYSTEM PROVIDES INPATIENT SERVICES TO THE COMMUNITY AND SURROUNDING RURAL AREAS. THE HOSPITAL PROVIDED 22,308 INPATIENT DAYS, 3,976 SKILLED NURSING FACILITY INPATIENT DAYS AND 1,141 NURSERY PATIENT DAYS FOR A TOTAL OF 27,425 INPATIENT DAYS.
4c (Code:   ) (Expenses $ 13,556,032 including grants of $   ) (Revenue $ 31,373,302 )
LAKE REGIONAL HEALTH SYSTEM'S EMERGENCY DEPARTMENT IS A LEVEL III TRAUMA CENTER (GRANTED THROUGH A SPECIAL STATE CREDENTIALING PROCESS REQUIRING EXTENSIVE EDUCATION AND SERVICE REVIEW) PROVIDING 24-HOUR EMERGENCY MEDICAL SERVICE TO A FIVE COUNTY AREA. THE UNIVERSITY OF MISSOURI STAFF FOR LIFE HELICOPTER IS BASED HERE. THE EMERGENCY DEPARTMENT PROVIDED 36,993 VISITS.
4d Other program services. (Describe in Schedule O.)
(Expenses $ 5,451,755 including grants of $ 110,074 ) (Revenue $ 4,099,601 )
4e Total program service expensesMediumBullet$ 129,226,637
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I........................... Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
148
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,141
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
14
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
6
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
 
No
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
 
No
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
Yes
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
DAN PROBSTFIELD
54 HOSPITAL DR
OSAGE BEACH,MO65065
(573) 348-8000
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) KEVIN BYRNE DO
PRESIDENT
 1.0 X   X       0 0 0
(2) CHARLES MCELYEA
ASSISTANT SECRETARY
 1.0 X   X       0 0 0
(3) ROBERT G SCHWENDINGER
SECRETARY
 1.0 X   X       0 0 0
(4) GREG GAGNON
TREASURER
 1.0 X   X       0 0 0
(5) GREG ANDERSON
DIRECTOR
 1.0 X           0 0 0
(6) SUSAN BROWN
DIRECTOR
 1.0 X           0 0 0
(7) JOHN CAINE
DIRECTOR
 1.0 X           0 0 0
(8) WAYNE COMPTON
DIRECTOR
 1.0 X           0 0 0
(9) ROBERT MASON DO
DIRECTOR
 1.0 X           0 56,612 0
(10) OTIS MOSELEY MD
DIRECTOR
 1.0 X           0 0 0
(11) JOHN PARRISH
DIRECTOR
 1.0 X           0 0 0
(12) LARRY SHIELDS
DIRECTOR
 1.0 X           0 0 0
(13) DENNIS MICHAELREE
VICE PRESIDENT
 1.0 X   X       0 0 0
(14) ANDREW MCKIBBEN MD
DIRECTOR
 1.0 X           0 315,330 0
(15) MICHAEL HENZE
CEO
 40.0     X       482,343 0 73,062
(16) VICKI L FRANKLIN
SENIOR VP/COO
 40.0     X       247,272 0 31,985
(17) M DANIEL PROBSTFIELD
SENIOR VP/CFO
 40.0     X       286,907 0 32,028
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) JANICE L DUNGAN
SENIOR VP - CLINICAL SERVICES
 40.0       X     239,316 0 27,459
(19) F JOE BUTTS
SENIOR VP - FACILITY SERVICES
 40.0       X     220,833 0 30,565
(20) KEVIN G MCROBERTS
SENIOR VP - BUSINESS DEVELOP.
 40.0       X     211,208 0 27,765
(21) CINDY J OTRADOVEC
CIO THROUGH 02/11
 40.0       X     166,828 0 22,587
(22) ROBERT HYATT
SENIOR VP - MEDICAL AFFAIRS
 40.0       X     338,622 0 24,708
(23) STEVEN GROTEWIEL
DIRECTOR OF DIAGNOSTIC IMAGING
 40.0         X   184,373 0 9,635
(24) THOMAS MYLER
DIRECTOR OF PHARMACY
 40.0         X   170,462 0 17,544
(25) MICHAEL DOW
CLINICAL COORDINATOR
 40.0         X   159,874 0 14,724
(26) KELLY PHILLIPS
REGISTERED NURSE
 40.0         X   154,676 0 11,240
(27) JOE SCOTT
PHARMACIST
 40.0         X   146,220 0 11,322






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,008,934 371,942 334,624
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet42
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
LAKE EMERGENCY SPECIALISTS
 
  		PHYSICIAN SERVICES 4,302,255
NATIONAL THERAPEUTIC ASSOCIATES
 
  		MEDICAL SERVICES 2,456,175
LAKE OZARK ANESTHESIA ASSOC
 
  		PHYSICIAN SERVICES 625,755
NATIONAL WOUND CARE HYPERBARIC
 
  		WOUND CARE MGMT SRVC 450,999
REVENUE CYCLE PARTNERS HOLDINGS LL
 
  		BILLING SERVICES 413,033
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet15
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 283,622
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		536,285
g Noncash contributions included in lines 1a-1f:$ 594,656
h Total. Add lines 1a-1f.......MediumBullet 819,907
Program Service Revenue Business Code
2a PATIENT SERVICE 624,100 156,174,013 156,174,013    
b AUXILIARY 900,099 421,577 421,577    
c CAFETERIA INCOME 722,210 964,135 964,135    
d OTHER 624,100 2,713,889 2,713,889    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 160,273,614
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 1,733,573     1,733,573
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 989,586  
b Less: rental expenses 1,153,933  
c Rental income or (loss) -164,347  
d Net rental income or (loss).......MediumBullet -164,347     -164,347
(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)..........MediumBullet 0      
8a Gross income from fundraising events (not including
$ 283,622
of contributions reported on line 1c). See Part IV, line 18 ...
a 53,254
b Less: direct expenses ...b 145,837
c Net income or (loss) from fundraising events..MediumBullet -92,583   -92,583
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...MediumBullet 0      
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..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CHANGE IN INTEREST IN EQUITY INVESTEES 900,099 -5,306,639     -5,306,639
b LOSS ON EXTINGUISHMENT OF DEBT 900,099 -769,377     -769,377
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet -6,076,016
12 Total revenue. See Instructions....MediumBullet 156,494,148 160,273,614   -4,599,373
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
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 69,658 69,658
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 40,416 40,416
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 2,463,488 555,405 1,908,083  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 141,290 141,290    
7 Other salaries and wages 45,606,403 39,707,743 5,898,660  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 1,722,514 1,593,300 129,214  
9 Other employee benefits ....... 6,876,094 5,794,671 1,081,423  
10 Payroll taxes ........... 3,538,048 2,976,456 561,592  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 377,365   377,365  
c Accounting ........... 155,722   155,722  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 109,202   109,202  
g Other .......... 16,062,465 11,710,530 4,351,935  
12 Advertising and promotion .... 503,674   503,674  
13 Office expenses ....... 5,277,086 4,160,744 1,116,342  
14 Information technology ...... 683,213   683,213  
15 Royalties .. 0      
16 Occupancy ........... 1,953,917 1,725,168 228,749  
17 Travel ............ 246,093 128,997 117,096  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 39,287 2,050 37,237  
20 Interest ........... 2,733,768 2,442,341 291,427  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 8,131,358 7,264,532 866,826  
23 Insurance .............. 1,142,489   1,142,489  
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 MEDICAL SUPPLIES & DRUGS 26,097,907 26,096,563 1,344  
b BAD DEBT 16,071,466 16,071,466    
c PROVIDER TAX 7,891,364 7,891,364    
d CAFETERIA/VENDING 817,750 730,576 87,174  
e LICENSES, DUES & SUBSCRIPTIONS 231,685 86,247 145,438  
f All other expenses 89,915 37,120 52,795  
25 Total functional expenses. Add lines 1 through 24f 149,073,637 129,226,637 19,847,000 0
26 Joint costs. Check here MediumBullet 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 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 2,468 1 2,818
2 Savings and temporary cash investments ....... 53,689,040 2 46,374,525
3 Pledges and grants receivable, net ......... 14,091 3 21,540
4 Accounts receivable, net ......... 13,063,732 4 15,120,389
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 .............. 4,867,294 8 4,791,215
9 Prepaid expenses and deferred charges ............ 1,600,502 9 866,298
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 144,749,103
b Less: accumulated depreciation. ..... 10b 86,724,808 59,840,015 10c 58,024,295
11 Investments—publicly traded securities .......... 32,289,474 11 46,401,270
12 Investments—other securities. See Part IV, line 11 ...... 3,284,265 12 5,044,166
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 249,108 15 333,264
16 Total assets. Add lines 1 through 15 (must equal line 34)... 168,899,989 16 176,979,780
Liabilities 17 Accounts payable and accrued expenses . 12,862,775 17 12,052,112
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 55,450,000 20 51,410,000
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 .. 3,522,831 23 3,225,233
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 1,277,039 25 5,290,550
26 Total liabilities. Add lines 17 through 25..... 73,112,645 26 71,977,895
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 95,770,086 27 104,984,627
28 Temporarily restricted net assets ..... 17,258 28 17,258
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet 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 ..... 95,787,344 33 105,001,885
34 Total liabilities and net assets/fund balances ..... 168,899,989 34 176,979,780
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
156,494,148
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
149,073,637
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
7,420,511
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
95,787,344
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
1,794,030
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
105,001,885
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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.
right arrow 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 REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
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)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(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?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
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).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
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.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
LAKE REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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—
Special Rules
......................... 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)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
LAKE REGIONAL HEALTH SYSTEM
  		Employer identification number

23-7339737
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




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
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 II
Name of organization
LAKE REGIONAL HEALTH SYSTEM
  		Employer identification number

23-7339737
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 REGIONAL HEALTH SYSTEM
  		Employer identification number

23-7339737
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		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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:  
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 REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
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.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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

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
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(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? ......................................

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


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
No
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
11,471
j
Total. lines 1c through 1i ...................................
11,471
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
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”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
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).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
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
OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1(I) A PORTION OF THE DUES PAID TO THE MISSOURI HOSPITAL ASSOCATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING PURPOSES: $ 6,985 MISSOURI HOSPITAL ASSOCIATION 4,486 AMERICAN HOSPITAL ASSOCIATION ------- $11,471
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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 REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
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 .......    
5
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? ............
6
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. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
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)? ....................................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
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 ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 530,500 4,272,244 4,802,744
b Buildings ................   82,067,266 43,901,778 38,165,488
c Leasehold improvements ............        
d Equipment ................   53,229,576 40,979,453 12,250,123
e Other .................   4,649,517 1,843,577 2,805,940
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 58,024,295
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other 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.)Small Bullet  
Part VIII
Investments—Program 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.)Small Bullet  
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.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
EST AMT DUE TO 3RD PTY PYR 5,290,550








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 5,290,550
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

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) .................... 1 156,494,148
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 149,073,637
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 7,420,511
4 Net unrealized gains (losses) on investments .......................... 4 1,794,030
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 1,794,030
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 9,214,541
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 159,478,746
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 1,794,030
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 1,794,030
3 Subtract line 2e from line 1..................... 3 157,684,716
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 109,202
b Other (Describe in Part XIV): ........... 4b -1,299,770
c Add lines 4a and 4b....................... 4c -1,190,568
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 156,494,148
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 150,264,205
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 1,299,770
e Add lines 2a through 2d...................... 2e 1,299,770
3 Subtract line 2e from line 1..................... 3 148,964,435
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 109,202
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c 109,202
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 149,073,637
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
UNCERTAIN TAX POSITIONS SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
RECONCILIING ITEMS SCHEDULE D, PART XII, LINE 4B AND PART XIII, LINE 2D THE FOLLOWING ITEMS WERE INCLUDED WITH EXPENSES ON THE AUDIT REPORT; HOWEVER, HAVE BEEN MOVED TO BE PROPERLY INCLUDED ON THE STATEMENT OF REVENUE ON THE TAX RETURN: RENTAL EXPENSES $ 1,153,933 SPECIAL EVENTS EXPENSE 145,837 ---------- $ 1,299,770
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow 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 REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

ANNUAL BALL
(event type) 		(b) Event #2

GOLF TOURNEY
(event type) 		(c) Other Events

0
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 130,428 203,713   334,141
2 Less: Charitable
contributions . . . 		113,974 166,913   280,887
3 Gross income (line 1
minus line 2) . . . 		16,454 36,800   53,254
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .   2,425   2,425
6 Rent/facility costs . .   21,953   21,953
7 Food and beverages . . 28,939 24,543   53,482
8 Entertainment . . . 4,800     4,800
9 Other direct expenses . 16,152 47,025   63,177
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 145,837
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -92,583
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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 REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
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:
3a
Yes
 
b
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: .....
3b
Yes
 
c
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.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
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?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) .. 		    3,933,819   3,933,819 2.640 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    23,663,062 22,734,680 928,382 0.620 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    27,596,881 22,734,680 4,862,201 3.260 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    98,574 32,335 66,239 0.040 %
f Health professions education
(from Worksheet 5) .. 		    247,226   247,226 0.170 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    240,372   240,372 0.160 %
jTotal Other Benefits ...     586,172 32,335 553,837 0.370 %
kTotal. Add lines 7d and 7j. ..     28,183,053 22,767,015 5,416,038 3.630 %
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     5,292   5,292  
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     39,603   39,603 0.030 %
9 Other            
10 Total     44,895   44,895 0.030 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
4,829,503
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
753,403
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
60,710,907
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
70,051,065
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-9,340,158
8
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:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
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......
9b
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 % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1LAKE REG IMAGING PTR
  		DIAGNOSTIC IMAGING SERVICES 51.000 %   49.000 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
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?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 LAKE REGIONAL HEALTH SYSTEM
54 HOSPITAL DR
OSAGE BEACH,MO65065 		X X         X    
Schedule H (Form 990) 2010
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:LAKE REGIONAL HEALTH SYSTEM
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
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
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
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?5
Name and address Type of Facility (Describe)
1 LAKE REGIONAL IMAGING PARTNERS
54 HOSPITAL DR
OSAGE BEACH,MO65065 		IMAGING CENTER
2 LAKE REGIONAL IMAGING PARTNERS
54 HOSPITAL DR
OSAGE BEACH,MO65065 		IMAGING CENTER
3 LAKE REGIONAL IMAGING PARTNERS
54 HOSPITAL DR
OSAGE BEACH,MO65065 		IMAGING CENTER
4 LAKE REGIONAL IMAGING PARTNERS
54 HOSPITAL DR
OSAGE BEACH,MO65065 		IMAGING CENTER
5 LAKE REGIONAL IMAGING PARTNERS
54 HOSPITAL DR
OSAGE BEACH,MO65065 		IMAGING CENTER
6
7
8
9
10
Schedule H (Form 990) 2010
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 III, LINE 4   THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH IS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. LINE 2 WAS DETERMINED BY TAKING THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TIMES THE RATIO OF PATIENT CARE COST TO CHARGES FROM WORKSHEET 2, LINE 11. LINE 3 WAS DETERMINED BY TAKING THE BAD DEBT EXPENSE AT COST (LINE 2) TIMES THE PERCENT OF PERSONS BELOW THE POVERTY LEVEL FOR 2009 BASED ON US CENSUS BUREAU DATA.
PART III, LINE 8   MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT, AS LRHS IS CLASSIFIED AS A RURAL REFERRAL CENTER AND MEDICARE-DEPENDENT HOSPITAL, AND ALTERNATIVELY COULD QUALIFY AS A SOLE COMMUNITY HOSPITAL. THIS DEMONSTRATES THAT LRHS IS THE ONLY REASONABLE SOURCE OF HOSPITAL CARE AVAILABLE TO MEDICARE BENEFICIARIES IN OUR SERVICE AREA, AND LIKEWISE TREATS ALL BENEFICIARIES IN OUR SERVICE AREA THAT PRESENT THEMSELVES FOR CARE, DESPITE KNOWING WE WILL GENERALLY LOSE MONEY CARING FOR MEDICARE PATIENTS. ADDITIONALLY, SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
PART III, LINE 9B   COLLECTION ACTIVITY WILL BE SUSPENDED DURING THE CONSIDERATION OF A COMPLETED FINANCIAL ASSISTANCE APPLICATION OR AN APPLICATION FOR ANY OTHER HEALTHCARE BRACKET (I.E. MEDICARE, MEDICAID, ETC.) A NOTE WILL BE ENTERED INTO THE PATIENT'S ACCOUNT TO SUSPEND COLLECTION ACTIVITY UNTIL THE FINANCIAL ASSISTANCE PROCESS IS COMPLETE. IF THE ACCOUNT HAS BEEN PLACED WITH A COLLECTION AGENCY, THE AGENCY WILL BE NOTIFIED TO SUSPEND COLLECTION EFFORTS UNTIL A DETERMINATION IS MADE. THIS NOTIFICATION WILL BE DOCUMENTED IN THE ACCOUNT NOTES. THE PATIENT WILL BE NOTIFIED VERBALLY THAT THE COLLECTION ACTIVITY WILL BE SUSPENDED DURING CONSIDERATION. IF A FINANCIAL ASSISTANCE DETERMINATION ALLOWS FOR A PERCENT REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE, PAYMENT TERMS WILL BE ESTABLISHED ON THE BASIS OF DISPOSABLE INCOME.
NEEDS ASSESSMENT   LRHS USES DATA COMPILED BY AN INDEPENDENT ENTITY, HOSPITAL INDUSTRY DATA INSTITUTE (HIDI), ON INPATIENTS AND OUTPATIENT PROVIDER USE DIVIDED BY DEMOGRAPHIC AND GEOGRAPHIC SUBSET. LRHS PERFORMS A BIENNIAL COMMUNITY ASSESSMENT WHICH IS A RANDOM SAMPLE, FACE-TO-FACE SURVEY, WHICH ASKS WHAT SERVICES LRHS SHOULD ADD AND WHY. OTHER COMMUNITY DATA IS COLLECTED AT HEALTH FAIRS AND SCREENINGS AS WELL AS CIVIC ORGANIZATIONS. THESE SURVEYS PROFILE PARTICIPANTS BY ZIP CODE AND IDENTIFY DESIRED SERVICES.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE   SIGNAGE WILL BE POSTED IN ALL PATIENT INTAKE AREAS, INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY ROOM, AND THE ADMISSION/PATIENT REGISTRATION AREAS. ALL PUBLIC INFORMATION AND/OR FORMS REGARDING THE PROVISION OF FINANCIAL ASSISTANCE WILL USE LANGUAGES THAT ARE APPROPRIATE FOR LRHS SERVICE AREA IN ACCORDANCE WITH THE STATE'S LANGUAGE ASSISTANCE SERVICES ACT. THIS POLICY WILL BE MADE AVAILABLE IN SPANISH. THE FINANCIAL ASSISTANCE APPLICATION IS POSTED ON THE LRHS WEBSITE. LRHS HAS FINANCIAL COUNSELORS IN THE PATIENT FINANCIAL SERVICES DEPARTMENT. THESE COUNSELORS MEET WITH SELF PAY PATIENTS WHEN THEY ARE IN THE FACILITY TO DISCUSS THE POLICY, AS WELL AS EDUCATE PATIENTS ON ASSISTANCE THEY MAY BE ELIGIBLE FOR UNDER FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS.
COMMUNITY INFORMATION   LRHS IS LOCATED IN OSAGE BEACH, MISSOURI, AND SERVES THE AREA SURROUNDING THE LAKE OF THE OZARKS, A 54,000 ACRE MAN-MADE LAKE LOCATED IN CENTRAL MISSOURI. LRHS' SERVICE AREA ENCOMPASSES A THREE COUNTY AREA: CAMDEN, MILLER, AND MORGAN COUNTIES. THE SECONDARY SERVICE INCLUDES LACLEDE AND PULASKI COUNTIES. THE OVERALL SERVICE AREA 2009 POPULATION IS ESTIMATED AT 167,899. IN ADDITION TO THE RESIDENT POPULATION OF NEARLY 168,000, IN THE OVERALL SERVICE AREA, THE EVER-INCREASING VISITOR POPULATION IS A SIGNIFICANT FACTOR FOR THIS POPULAR TOURIST DESTINATION. THE LAKE OF THE OZARKS CONVENTION AND VISITORS BUREAU ESTIMATES THAT 5.0 MILLION VISITORS WILL TRAVEL TO THE REGION IN 2010. THE PROJECTED POPULATION GROWTH OF LRHS' SERVICE AREA AND ESPECIALLY THE CONTINUING MIGRATION INTO THE LAKE AREA OF RETIREES AND THE EVER-INCREASING VISITOR POPULATION, IS A SIGNIFICANT FACTOR IN THE RISING NEED FOR ACCESSIBLE AND EXPANDED MEDICAL SERVICES FOR THE LAKE AREA. THE MEDIAN HOUSEHOLD INCOME FOR EACH COUNTY IS AS FOLLOWS: CAMDEN = $43,720, LACLEDE = $35,325, MILLER = $36,069, MORGAN = $35,533 AND PULASKI = $44,540. THE CAMDEN COUNTY 2009 ANNUAL UNEMPLOYMENT RATE WAS 9.6%, ABOVE THE STATE (9.3%) AND NATIONAL (9.3%) AVERAGES. CAMDEN COUNTY HAS APPROXIMATELY 15.6% OF PERSONS BELOW POVERTY LEVEL. THE IMMEDIATE 3-COUNTY AREA OF CAMDEN, MILLER, & MORGAN ESTIMATES UNINSURED INDIVIDUALS AT 20.97%. THERE ARE NO OTHER HOSPITALS WITHIN A 25-MILE RADIUS. USING HOSPITAL INDUSTRA DATA INSTITUTE DATA, THE LRHS MARKET IS PRIMARILY SHARED WITH 4 HOSPITALS IN THE AREA.
COMMUNITY BUILDING ACTIVITIES   LRHS SHOWS ITS SUPPORT OF THE COMMUNITY BY PROVIDING A TRIM KIDS PROGRAM. TRIM KIDS IS A 12-WEEK PLAN TO BUILD HEALTHY KIDS, HEALTHY FAMILIES, AND HEALTHY COMMUNITIES. THE TRIM KIDS PROGRAM IS A PROVEN, PRACTICAL GUIDE FOR PARENTS TO TAKE SPECIFIC SEQUENTIAL STEPS TO ENCOURAGE HEALTHY HABITS IN THEIR CHILDREN SUCH AS MAKING HEALTHY FOOD CHOICES AND ONGOING PHYSICAL ACTIVITY. THE PROGRAM IS FACILITATED BY A DIETITIAN, EXERCISE PHYSIOLOGIST, REGISTERED NURSE, AND BEHAVIOR MODIFICATION PROFESSIONAL ASSOCIATED WITH LRHS. LRHS' WORKFORCE DEVELOPMENT PROGRAM INCLUDES A TWO-DAY CAREER CAMP FOR STUDENTS 10-14. THE STUDENTS LEARN ABOUT CAREERS IN NURSING, REHAB THERAPIES, LABORATORY, SURGERY AND RESPIRATORY THERAPY. CAMP INSTRUCTORS ALSO COVER TOPICS SUCH AS PATIENT CONFIDENTIALITY, INFECTION CONTROL, DISASTER MANAGEMENT, DATA MANAGEMENT, PROFESSIONAL SCHOOLS IN MISSOURI AND SCHOLARSHIP OPPORTUNITIES. ANOTHER WORKFORCE DEVELOPMENT PROGRAM AVAILABLE TO HIGH SCHOOL STUDENTS AND ADULTS INTERESTED IN PURSUING NURSING CAREERS IS A FIVE-DAY NURSING CAMP. PARTICIPANTS GAIN AN UNDERSTANDING OF NURSING FUNDAMENTALS AS THEY VISIT NURSING UNITS, JOB SHADOW EXPERIENCED NURSES, LEARN ABOUT STATE-OF-THE-ART EQUIPMENT, RECEIVE CPR TRAINING, PARTICIPATE IN DISASTER MANAGEMENT TRAINING AND INTERACT WITH STAFF.
OTHER ACTIVITIES   LRHS MAINTAINS AN OPEN MEDICAL STAFF BY ALLOWING ANY PHYSICIAN, DENTIST, ORAL SURGEON OR PODIATRIST ENTRY WHO CONTINUOUSLY MEET THE QUALIFICATIONS, STANDARDS, AND REQUIREMENTS SET FORTH BY LRHS. MEMBERS OF THE BOARD OF DIRECTORS MUST BE REPRESENTATIVE OF THE COMMUNITIES AND POPULATION SERVED BY LRHS. NO DIRECTOR RECEIVES COMPENSATION FOR ANY SERVICE THEY MAY RENDER AS A DIRECTOR. ALL SURPLUS FUNDS ARE RE-INVESTED INTO THE CORPORATION BY PURCHASING CAPITAL EQUIPMENT.
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
LAKE REGIONAL HEALTH SYSTEM
 
Employer identification number
23-7339737
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) ST LOUIS REGIONAL DSH FUNDING AUTHORITYPO BOX 6766
JEFFERSON CITY,MO651026766 		06-1642698 501(C)(3) 69,658       SUPPORT






















2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
1
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) NURSING SCHOLARSHIPS 12 40,416      













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
MONITORING GRANT FUNDS SCHEDULE I, PART I, LINE 2 THE RECIPIENT OF THE SCHOLARSHIP MUST SUBMIT THEIR GRADES TO LAKE REGIONAL HEALTH SYSTEM. IN ORDER FOR THE GRADES TO BE GIVEN TO THE STUDENT, THEIR TUITION MUST BE PAID IN FULL. THROUGH AMENDMENT 3 OF THE ORGANIZATION'S AGREEMENT WITH MHA MANAGEMENT SERVICES CORPORATION AND INCREASED DISPROPORTIONATE SHARE HOSPITAL PAYMENTS TO ALL MISSOURI HOSPITALS UNDER THE FEDERAL REIMBURSEMENT ALLOWANCE PROGRAM, THE HOSPITAL MADE CHARITABLE CONTRIBUTIONS TO THE DSH FUNDING AUTHORITY. THESE CONTRIBUTIONS ARE USED TO SUSTAIN THE VARIOUS CHARITY CARE CLINICS IN THE ST. LOUIS AREA, WITH LOCAL COMMUNITY HOSPITALS ABSORBING THE INPATIENT AND OUTPATIENT NEEDS OF THE COMMUNITY'S MEDICALLY INDIGENT POPULATION.
Schedule I (Form 990) 2010


Additional Data


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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 REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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....
1b
Yes
 
2
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? ....
2
Yes
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
Yes
 
b
Any related organization? .........................
6b
Yes
 
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) MICHAEL HENZE (i)
(ii)		 354,250
0 		86,256
0 		41,837
0 		69,833
0 		3,229
0 		555,405
0 		55,166
0
(2) VICKI L FRANKLIN (i)
(ii)		 184,759
0 		31,521
0 		30,992
0 		30,706
0 		1,279
0 		279,257
0 		16,155
0
(3) M DANIEL PROBSTFIELD (i)
(ii)		 199,820
0 		30,919
0 		56,168
0 		31,442
0 		586
0 		318,935
0 		16,851
0
(4) JANICE L DUNGAN (i)
(ii)		 176,145
0 		26,286
0 		36,885
0 		26,515
0 		944
0 		266,775
0 		13,472
0
(5) F JOE BUTTS (i)
(ii)		 157,208
0 		26,148
0 		37,477
0 		27,979
0 		2,586
0 		251,398
0 		13,401
0
(6) KEVIN G MCROBERTS (i)
(ii)		 166,330
0 		25,314
0 		19,564
0 		22,940
0 		4,825
0 		238,973
0 		13,416
0
(7) CINDY J OTRADOVEC (i)
(ii)		 144,808
0 		18,648
0 		3,372
0 		21,001
0 		1,586
0 		189,415
0 		11,392
0
(8) ROBERT HYATT (i)
(ii)		 325,282
0 		0
0 		13,340
0 		24,000
0 		708
0 		363,330
0 		24,200
0
(9) STEVEN GROTEWIEL (i)
(ii)		 131,842
0 		6,148
0 		46,383
0 		0
0 		9,635
0 		194,008
0 		0
0
(10) THOMAS MYLER (i)
(ii)		 149,553
0 		7,239
0 		13,670
0 		0
0 		17,544
0 		188,006
0 		0
0
(11) MICHAEL DOW (i)
(ii)		 151,472
0 		7,184
0 		1,218
0 		0
0 		14,724
0 		174,598
0 		0
0
(12) KELLY PHILLIPS (i)
(ii)		 136,538
0 		0
0 		18,138
0 		0
0 		11,240
0 		165,916
0 		0
0
(13) JOE SCOTT (i)
(ii)		 128,184
0 		0
0 		18,036
0 		0
0 		11,322
0 		157,542
0 		0
0
(14) ANDREW MCKIBBEN MD (i)
(ii)		 0
315,330 		0
0 		0
0 		0
0 		0
0 		0
315,330 		0
0


Schedule J (Form 990) 2010

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
REIMBURSEMENT POLICY SCHEDULE J, PART I, LINE 1A THE ORGANIZATION HAS A WRITTEN POLICY FOR REIMBURSEMENT RELATED TO TRAVEL FOR COMPANIONS. DIRECTORS AND KEY EMPLOYEES ARE ELIGIBLE TO RECEIVE THIS BENEFIT. THE ORGANIZATION PROVIDES ONE TYPE OF GROSS UP PAYMENT FOR THE CEO'S AUTO ALLOWANCE. THE CEO IS THE ONLY PERSON THAT RECEIVES THIS BENEFIT. THIS PAYMENT IS REPORTED AS TAXABLE COMPENSATION ON THE CEO'S W-2 FORM EACH YEAR.
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE FOLLOWING AMOUNTS: MICHAEL E. HENZE $53,850 VICKI L. FRANKLIN $15,760 M. DANIEL PROBSTFIELD $44,291 F. JOE BUTTS $13,074 JANICE DUNGAN $38,773 KEVIN MCROBERTS $12,657 CINDY OTRADOVEC $10,850 ROBERT HYATT $24,000
COMPENSATION PAID OR ACCRUED CONTINGENT ON NET EARNINGS SCHEDULE J, PART I, LINES 6A & 6B THE CEO AND SENIOR MANAGEMENT ARE ELIGIBLE FOR INCENTIVE COMPENSATION AS PART OF THEIR OVERALL COMPENSATION PLAN. TARGETED BENCHMARKS INCLUDE CONSOLIDATED OPERATING MARGIN, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, CLINICAL OUTCOMES, PATIENT SAFETY AND INDIVIDUAL GOALS. COMPENSATION REPORTED IN PRIOR YEAR FORM 990 SCHEDULE J, PART II, COLUMN F COMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THAT THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS GENERALLY REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS PAID TO THE INDIVIDUAL. AS A RESULT OF THE REPORTING REQUIREMENT, AN ORGANIZATION COULD BE REQUIRED TO REPORT THE SAME COMPENSATION AMOUNTS ON THE FORM 990 FOR TWO CONSECUTIVE YEARS. THE AMOUNTS REPORTED IN COLUMN F: INCLUDE INCENTIVE AMOUNTS AND CAPITAL ACCUMULATION AMOUNTS WHICH WERE REPORTED IN PREVIOUS 990S AS DEFERRED COMPENSATION.
Schedule J (Form 990) 2010

Additional Data


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Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet 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 REGIONAL HEALTH SYSTEM
 
Employer identification number
23-7339737
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
Yes No Yes No Yes No
A HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF MO
  		43-1178966 60635RH67 12-10-2003 27,463,751 BUILDING & EQUIPMENT   X   X   X
B HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF MO
  		43-1178966 60635R8G5 10-20-2010 28,426,416 REFUND 1996 & 1998 REVENUES BONDS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 3,345,000 695,000    
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 28,309,448 28,426,416    
4 Gross proceeds in reserve funds . . 1,901,821 2,875,426    
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . . 28,188,586 28,188,586    
7 Issuance costs from proceeds . . . 480,231 237,830    
8 Credit enhancement from proceeds.        
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 25,929,727      
11 Other spent proceeds . .        
12 Other unspent proceeds. . .        
13 Year of substantial completion . . . 2007 1998
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X X          
15 Were the bonds issued as part of an advance refunding issue?   X   X        
16 Has the final allocation of proceeds been made? . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   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
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 . . . . . . . . . . . . . SchKMediumBullet 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 . SchKMediumBullet 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   X        
2 Is the bond issue a variable rate issue?   X   X        
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X   X        
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? . X   X          
b Name of provider . BAYERISCHE LANDESBAN
  		JPMORGAN CHASE BANK
  		 
  		 
 
c Term of GIC . . 2.33 12.82    
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .   X   X        
5 Were any gross proceeds invested beyond an available temporary period? . X     X        
6 Did the bond issue qualify for an exception to rebate? . . .   X X          
Schedule K (Form 990) 2010

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
GIC FAIR MARKET VALUE SCHEDULE K, PART IV, LINE 4D 4(D), COLUMN A AND B. THE GUARANTEED INVESTMENT CONTRACT FOR THE 2003 BONDS WAS ENTERED INTO AFTER THE ISSUE DATE OF THE BONDS. THE GUARANTEED INVESTMENT CONTRACT FOR THE 2010 BONDS WAS ORIGINALLY ENTERED INTO WITH RESPECT TO THE 1998 BONDS. THE TAXPAYER BELIEVES THE BIDDING PROCEDURES ESTABLISHED BY 1.148-5(D)(6)(III) OF THE REGULATIONS WERE FOLLOWED IN EACH CASE, BUT HAS BEEN UNABLE TO LOCATE COPIES OF THE BID SOLICITATION FORMS AND RELATED MATERIALS REQUIRED TO BE RETAINED UNDER THE REGULATION SAFE HARBOR. PROCEEDS INVESTED BEYOND TEMPORARY PERIOD SCHEDULE K, PART IV, LINE 5 THE PROJECT FUND WAS INVESTED BEYOND THE 3-YEAR TEMPORARY PERIOD. ALL PROCEEDS IN THE PROJECT FUND HAVE BEEN SPENT. THE YIELD ON INVESTMENTS WAS NOT MATERIALLY HIGHER THAN THE YIELD ON THE ISSUE AND NO YIELD REDUCTION PAYMENT LIABILITY WAS GENERATED ON THE BONDS.
Schedule K (Form 990) 2010

Additional Data


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Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LAKE REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) LAKE REGIONAL MEDICAL MANAGEMENT COMMON DRTRS - SEE PART V 8,995,208 CONTRIBUTIONS, REIMBURSEMENTS   No
(2) MITCHELL SHIELDS FAMILY MEMBER L SHIELDS 38,129 EMPLOYMENT   No
(3) CENTRAL BANK OF LAKE OF THE OZARKS SEE PART V 196,917 BANKING FEES   No
(4) JULIE FRANKLIN FAMILY MEMBER V FRANKLIN 29,981 EMPLOYMENT   No
(5) BARBA PROBSTFIELD FAM MEMBER D PROBSTFIELD 73,180 EMPLOYMENT   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
INTERESTED PERSONS RELATIONSHIP SCHEDULE L, PART IV, COLUMN B GREG GAGNON, BOARD TREASURER, IS THE BANK PRESIDENT AT CENTRAL BANK OF LAKE OF THE OZARKS. IN ADDITION, ROBERT MASON, BOARD DIRECTOR, IS ALSO A BOARD DIRECTOR AT THE BANK.
SHARED DIRECTORS SCHEDULE L, PART IV INTERESTED PERSON, COLUMN A: LAKE REGIONAL MEDICAL MANAGEMENT RELATIONSHIP, COLUMN B: CHARLES MCELYEA, ROBERT G. SCHWENDINGER, GREG GAGNON, JOHN PARRISH, AND DENNIS MICHAELREE ARE OFFICERS OR DIRECTORS OF BOTH LAKE REGIONAL MEDICAL MANAGEMENT AND LAKE REGIONAL HEALTH SYSTEM. ROBERT G. SCHWENDINGER, JOHN PARRISH, DENNIS MICHAELREE, AND CHARLES MCELYEA WERE DETERMINED TO BE NON-INDEPENDENT MEMBERS OF LAKE REGIONAL HEALTH SYSTEM BASED SOLELY ON THEIR ROLE AS COMMON OFFICERS OR DIRECTORS OF LAKE REGIONAL MEDICAL MANAGEMENT AND LAKE REGIONAL HEALTH SYSTEM. LAKE REGIONAL MEDICAL MANAGEMENT IS AN ACTIVE, WHOLLY-OWNED FOR-PROFIT SUBSIDIARY. IT OPERATES SEVEN PRIMARY CARE MEDICAL CLINICS, THREE RETAIL PHARMACIES, AND FOURTEEN SPECIALTY CLINICS. LAKE REGIONAL HEALTH SYSTEM VIEWS THE COMMON OFFICERS AND DIRECTORS AS AN IMPORTANT ROLE IN HELPING BOTH ORGANIZATIONS IN ACHIEVING THEIR MISSIONS WHILE SERVING THE COMMUNITY.
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LAKE REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential . X 1 530,500 APPRAISAL
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies . X 12 26,434 FMV
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( SILENT AUCTION ) X 291 37,722 COST
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
1
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
Yes
 
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell non-cash
contributions? ............................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2010
Schedule M (Form 990) 2010
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33. Also complete this part for any additional information.
Identifier Return Reference Explanation
ARRANGEMENTS FOR HOLDING PROPERTY CONTRIBUTED SCHEDULE M, PART 1, LINE 30B THE ORGANIZATION RECIEVED A CONTRIBUTION OF REAL ESTATE THAT WILL BE HELD FOR THREE YEARS. THE HOUSE LOCATED ON THE PROPERTY IS VACANT AT THIS TIME. NEITHER THE HOUSE NOR THE LAND ARE REQUIRED TO BE USED FOR EXEMPT PURPOSES.
Schedule M (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
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 REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 OUR MISSION: LAKE REGIONAL HEALTH SYSTEM WILL PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS AND VISITORS OF THE LAKE REGION WITH EMPHASIS ON QUALITY OUTCOMES AND SERVICE SATISFACTION WHILE OPERATING IN A SOUND FISCAL MANNER. OUR VISION: OUR SHARED VISION IS FOR LAKE REGIONAL HEALTH SYSTEM TO BE RECOGNIZED AS THE FIRST CHOICE FOR PATIENTS, PHYSICIANS, AND WORKFORCE. OUR VALUES: PATIENT CENTERED, CONTINUOUS IMPROVEMENT, TEAMWORK, INTEGRITY, SERVICE QUALITY, SAFETY. THE SYSTEM WAS ORGANIZED IN 1973 FOR THE PURPOSE OF ESTABLISHING A NEW HOSPITAL FOR MEDICAL AND SURGICAL CARE AND FOR THE TREATMENT OF PERSONS RESIDING OR VISITING IN THE LAKE OF THE OZARKS AREA OF CENTRAL MISSOURI. IN THE 30 YEARS SINCE THEN, THE SYSTEM HAS EVOLVED TO PROVIDE MORE COMPREHENSIVE HEALTH CARE, INCLUDING ADDING CARDIAC-CARE, OUTPATIENT SERVICES, CANCER AND ORTHOPEDIC PROGRAMS AND CONTINUALLY EXPANDING SERVICES AND FACILITIES OVER THE YEARS. IT IS NOW DESIGNATED AS A REGIONAL REFERRAL CENTER BY MEDICARE AND HAS NEARLY 1,300 EMPLOYEES. ITS BOARD HAS ADOPTED GOVERNANCE BEST PRACTICES AND A WIDE-RANGING CORPORATE COMPLIANCE PROGRAM. BASED ON PERIODIC COMMUNITY ASSESSMENTS, THE BOARD HAS ALSO COMMITTED TO ENHANCED UNCOMPENSATED CARE POLICIES AND NUMEROUS COMMUNITY PROGRAMS (E.G. HEALTH SCREENINGS, WELLNESS ENHANCED AND RELATED CARE PROGRAMS). THE SYSTEM IS ORGANIZED AS A COMMUNITY-BASED NONPROFIT PUBLIC BENEFIT CORPORATION UNDER THE LAWS OF THE STATE OF MISSOURI. THE SYSTEM OWNS AND OPERATES A 100-LICENSED BED ACUTE CARE HOSPITAL (THE "HOSPITAL") LOCATED ON HIGHWAY 54 IN OSAGE BEACH, MISSOURI. THE HOSPITAL IS LICENSED BY THE MISSOURI DEPARTMENT OF HEALTH AND ACCREDITED BY THE JOINT COMMISSION. THE HOSPITAL IS DESIGNATED AS MEDICARE DEPENDENT, MEANING THAT THE HOSPITAL IS THE PRIMARY HEALTH CARE PROVIDER FOR A MAJORITY OF MEDICARE PATIENTS WITHIN A 35-MILE RADIUS OF THE HOSPITAL. THE CORPORATION HAS ONE ACTIVE, WHOLLY-OWNED FOR-PROFIT SUBSIDIARY, LAKE REGIONAL MEDICAL MANAGEMENT, INC. ("LRMM"), WHICH OPERATES SEVEN PRIMARY CARE MEDICAL CLINICS, THREE RETAIL PHARMACIES AND FOURTEEN SPECIALTY CLINICS. OPERATIONS OF LRMM ARE GOVERNED BY A SEPARATE BOARD OF DIRECTORS. THE SYSTEM IS CURRENTLY GOVERNED BY A FOURTEEN-MEMBER BOARD OF DIRECTORS (THE "BOARD"). THE BOARD HAS GENERAL RESPONSIBILITY FOR THE BUSINESS AND AFFAIRS OF THE SYSTEM, AND MAY DO AND PERFORM ALL ACTS NECESSARY TO CARRY OUT ITS PURPOSES. UNDER THE TERMS OF THE BYLAWS, THE MEMBERS OF THE BOARD SERVE THREE-YEAR STAGGERED TERMS, AND NEW MEMBERS ARE ELECTED BY THE CURRENT BOARD MEMBERS. THE OFFICERS OF THE BOARD ARE ELECTED BY THE BOARD FOR TWO-YEAR TERMS. BOARD MEMBERS SERVE IN A VOLUNTARY CAPACITY AND RECEIVE NO REMUNERATION FOR SERVICE RENDERED IN SUCH CAPACITY.
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINES 4A-C CHARITY CARE IN SUPPORT OF ITS MISSION, THE HOSPITAL VOLUNTARILY PROVIDES FREE CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES AND ARE DEEMED TO BE MEDICALLY INDIGENT. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN NET PATIENT SERVICE REVENUE. IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER CERTAIN GOVERNMENT REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS WHICH ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS AND MANY TIMES THE PAYMENTS ARE LESS THAN THE COST OF RENDERING THE SERVICES PROVIDED. UNCOMPENSATED CHARGES RELATING TO THESE SERVICES ARE AS FOLLOWS: CHARITY CARE AT COST $4,828,708 BAD DEBT AT COST 5,928,186 UNPAID MEDICARE AT COST 12,277,770 FREE MEDICAL SERVICES 323,523 HEALTH PROFESSIONALS EDUCATION 57,592 FINANCIAL CONTRIBUTIONS 203,698 TAXES 4,524,589 ------------- TOTAL $28,144,066 IN ADDITION TO UNCOMPENSATED CHARGES, THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE SELF-SUPPORTING OR FINANCIALLY VIABLE. SUCH PROGRAMS INCLUDE HEALTH SCREENING AND ASSESSMENTS, PRENATAL EDUCATION AND CARE, COMMUNITY EDUCATIONAL SERVICES AND VARIOUS SUPPORT GROUPS. OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D OTHER SERVICES INCLUDE CAFETERIA INCOME AND INCOME FROM THE AUXILIARY.
FAMILY & BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 GREG GAGNON AND ROBERT MASON HAVE A BUSINESS RELATIONSHIP. F JOE BUTTS, M DANIEL PROBTSFIELD, VICKI L FRANKLIN, AND MICHAEL HENZE HAVE A BUSINESS RELATIONSHIP. MICHAEL HENZE & F JOE BUTTS HAVE A BUSINESS RELATIONSHIP.
FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE 990 WAS THOROUGHLY REVIEWED BY THE DIRECTOR OF ACCOUNTING, CFO, AND CEO. AFTER ANY NECESSARY CHANGES WERE MADE, THE MEMBERS OF THE BOARD OF DIRECTORS WERE PROVIDED A COPY. AT THE DECEMBER 2011 BOARD MEETING, THE 990 WAS PRESENTED TO THE BOARD BY THE INDEPENDENT ACCOUNTANTS WHO PREPARED THE 990, AND THE BOARD HAD THE OPPORTUNITY TO ASK ANY QUESTIONS BEFORE THE 990 WAS FILED.
CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR, ALL MEMBERS OF THE BOARD OF DIRECTORS, SENIOR MANAGEMENT, AND DEPARTMENT HEADS ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND PROPERLY DISCLOSE ANY ACTUAL, POTENTIAL, OR PERCEIVED CONFLICT OF INTEREST. A COPY OF THE CONFLICT OF INTEREST POLICY IS PROVIDED TO EACH DIRECTOR AT THE TIME OF APPOINTMENT, TO EACH NEW PRINCIPAL OFFICER AND EMPLOYEE AT THE TIME OF EMPLOYMENT, AND ANNUALLY TO EVERY INTERESTED PERSON. EACH INTERESTED PERSON IS REQUIRED TO SUBMIT A STATEMENT TO THE CEO ANNUALLY VERIFYING THE UNDERSTANDING WITH THE POLICY AND STATING THAT ALL CONFLICTS HAVE BEEN DISCLOSED, OR THAT NO CONFLICTS EXIST. THE CEO SUBMITS HIS ANNUAL STATEMENT TO THE CHAIRMAN OF THE BOARD. IN THE EVENT AN INTERESTED PERSON DEVELOPS A POTENTIAL CONFLICT OF INTEREST, THE PERSON MUST IMMEDIATELY UPON LEARNING ABOUT THE POTENTIAL CONFLICT DISCLOSE THE NATURE OF THE CONFLICT TO THE BOARD OF DIRECTORS. THE PERSON THEN LEAVES THE BOARD OR COMMITTEE MEETING WHILE THE ISSUE IS DISCUSSED AMONG REMAINING BOARD MEMBERS TO DETERMINE WHETHER A CONFLICT EXISTS BY MAJORITY VOTE. IF A CONFLICT DOES EXIST, A SEPARATE PERSON IS ASSIGNED TO INVESTIGATE ALTERNATIVES TO THE CONFLICT AND DETERMINE IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS POSSIBLE. IF THIS IS NOT POSSIBLE, THE BOARD THEN DECIDES BY MAJORITY VOTE IF THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, IS FAIR AND REASONABLE, AND WHETHER IT SHOULD OR SHOULD NOT BE ENTERED. IF THE ORGANIZATION HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, THE PERSON WILL BE INFORMED OF THE BASIS FOR SUCH BELIEF AND WILL BE GIVEN AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE PERSON'S RESPONSE AND CONDUCTING FURTHER INVESTIGATION, THE ORGANIZATION DETERMINES THAT THE PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, APPROPRIATE CORRECTIVE ACTION WILL BE TAKEN. ADDITIONALLY, THE ORGANIZATION HAS IMPLEMENTED A TAX COMPLIANCE QUESTIONNAIRE THAT ASKS DETAILED QUESTIONS, AND PROVIDES RESPONDENTS WITH THE APPROPRIATE DEFINITIONS AND INSTRUCTIONS, TO ENABLE THE ORGANIZATION TO GATHER INFORMATION REQUIRED TO ANSWER QUESTIONS ON THE 990 RELATING TO THE FOLLOWING AREAS: 1) THE NUMBER OF INDEPENDENT VOTING BOARD MEMBERS, 2) RELATIONSHIPS BETWEEN INTERESTED PERSONS, 3) LOANS TO OR FROM INTERESTED PERSONS, 4) GRANTS OR ASSISTANCE BENEFITING INTERESTED PERSONS, AND 5) BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS.
COMPENSATION DETERMINATION FORM 990, PART VI, SECTION B, LINES 15A & 15B DURING 2011, THE ORGANIZATION USED IHSTRATEGIES, AN INDEPENDENT ORGANIZATION, TO HELP THEM EVALUATE AND SET THE COMPENSATION FOR THE ORGANZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES. THE COMPENSATION DELIBERATIONS WERE DOCUMENTED IN THE BOARD MINUTES.
GOVERNING DOCUMENT AVAILABILITY FORM 990, PART VI, SECTION C, LINE 19 CERTAIN ASPECTS OF THE FINANCIAL STATEMENTS ARE AVAILABLE IN THE ORGANIZATION'S ANNUAL REPORT WHICH CAN BE FOUND ON THE ORGANIZATION'S WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE GENERAL PUBLIC. BOARD MEMBER COMPENSATION FORM 990, PART VII BOARD MEMBER ROBERT MASON, DO, IS PAID AS A PRN EMPLOYEE OF LAKE REGIONAL MEDICAL MANAGEMENT AND RECEIVES NO OTHER BENEFITS. ANDREW MCKIBBEN, MD, IS PAID AS A PHYSICIAN OF LAKE REGIONAL MEDICAL MANAGEMENT AND RECEIVES NO OTHER BENEFITS. BOARD MEMBERS DO NOT RECEIVE ANY COMPENSATION FOR THEIR SERVICES PROVIDED AS A MEMBER OF THE BOARD DIRECTORS.
OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 UNREALIZED GAINS & LOSSES $1,794,030
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:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
LAKE REGIONAL HEALTH SYSTEM
 
Employer identification number

23-7339737
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

















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
Yes No












For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
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 V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) LAKE REGIONAL IMAGING PARTNERS

54 HOSPITAL DRIVE
OSAGE BEACH,MO202107048
20-2107048 		DIAGNOSTIC IM MO NA
  		RELATED 530,788 3,454,828   No 0 Yes   51.000 %












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) LAKE REGIONAL MEDICAL MANAGEMENT
54 HOSPITAL DRIVE
OSAGE BEACH,MO65065
43-1473438 		PHYSICIAN SER MO NA
  		C CORP 30,574,434 6,402,292 100.000 %












Schedule R (Form 990) 2010
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
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
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 REGIONAL MEDICAL MANAGEMENT

 Q 7,415,000  
(2) LAKE REGIONAL MEDICAL MANAGEMENT

 A/I 936,180  
(3) LAKE REGIONAL MEDICAL MANAGEMENT

 K 520,222  
(4) LAKE REGIONAL IMAGING PARTNERS LLC

 K 1,158,834  
(5) LAKE REGIONAL MEDICAL MANAGEMENT

 O 2,440,524  
(6)
Schedule R (Form 990) 2010
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 V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
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: