2018-02-14T17:18:19-06:00 2017-03-31 381357951 PLANTE & MORAN PLLC 750 Trade Centre Way Ste 300 Portage MI 49002 990 2016-04-01 381359265 MARY FREE BED REHABILITATION HOSPITAL MARY 8005288989 235 WEALTHY ST SE GRAND RAPIDS MI 495035247 RANDALL L DENEFF CHIEF FINANCIAL OFFICER 8005288989 2018-02-08 1 Carol LaLonde CPA P00181637 2695674500 2018-02-08 67.59.56.32 2018-02-08 11:02:10 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 58F74DC53CB874483B207ADF23CD6921384352E9 2016 2021-01-29 14:40:06Z MARY FREE BED HOSPITAL AND REHABILITATION CENTER RANDALL L DENEFF 235 WEALTHY ST SE GRAND RAPIDS MI 495035247 101247777 0 X www.maryfreebed.com X 1913 MI HELPING PEOPLE WITH DISABILITIES ACHIEVE INDEPENDENCE THROUGH REHABILITATION SERVICES. EDUCATING THE COMMUNITY ON DISABLING DISEASES AND INJURY PREVENTION. CARRYING OUT MEDICAL AND SCIENTIFIC RESEARCH TO IMPROVE THE CARE AND OUTCOMES FOR PEOPLE WITH DISABILITIES. 26 24 1355 193 0 0 5554156 4420000 79234240 92930028 2034711 795343 454952 523637 87278059 98669008 3341622 60000 0 0 54194831 63907216 0 0 0 20815435 25027958 78351888 88995174 8926171 9673834 119243072 133654270 37958374 38840701 81284698 94813569 X RESTORING HOPE AND FREEDOM THROUGH REHABILITATION. 0 0 24051265 36121346 PROVIDE NURSING SERVICES AND INFECTION CONTROL FOR 31,735 PATIENT DAYS. 15683650 16304291 PROVIDE OUTPATIENT REHABILITATION AND CLINIC SERVICES FOR APPROXIMATELY 92,736 PATIENT VISITS. 13083259 23633179 PROVIDE THERAPY AND OTHER MEDICAL SERVICES FOR 31,735 PATIENT DAYS. 20111043 60000 16871212 REHABILITATION STAFFING AND MANAGEMENT SERVICES; MEDICAL SERVICES REHABILITATION PROGRAM ADMINISTRATION; OFFICE EXPENSES FOR PROGRAM SERVICES; MEDICAL RECORDS; SUPPLIES; UTILITIES, MAINTENANCE, DEPRECIATION RELATED TO PROGRAM SERVICES AND ASSETS; PATIENT MEALS; INSURANCE; DRIVER REHABILITATION SERVICES; MOTION ANALYSIS/GAIT LAB SERVICES; BENEFIT COSTS AND PAYROLL TAXES ON PROGRAM SALARIES NOT SPECIFICALLY LISTED; OTHER PROGRAM SERVICES AND MEDICAL SERVICES NOT SPECIFICALLY LISTED; BAD DEBTS; TRAVEL/CONFERENCES. 20111043 60000 16871212 72929217 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 83 0 1 1355 1 0 0 0 0 0 0 0 0 0 0 X 26 24 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X RANDALL DENEFF 6168408317 235 WEALTHY ST SE GRAND RAPIDS MI 49503 KENT RIDDLE PRESIDENT 50.00 3.00 X X 595852 0 29039 MIKE JAKUBOWSKI MD TRUSTEE 50.00 4.00 X 431332 0 35812 DAVID MUIR CHAIRMAN 1.00 0.00 X X 0 0 0 MOLLY KRAUSS VICE CHAIRMAN 1.00 1.00 X X 0 0 0 CAROL SPRINGER SECRETARY - THROUGH 12/18, DIRECTOR - AFTER 12/18 1.00 0.00 X X 0 0 0 LAURA PUFF SECRETARY - AFTER 12/18 1.00 1.00 X X 0 0 0 CHAD BUSH TREASURER 1.00 0.00 X X 0 0 0 MARGARET NAULT ASSISTANT TREASURER 1.00 1.00 X X 0 0 0 GREG CONWAY DIRECTOR 1.00 1.00 X 0 0 0 JAMES MOYER DIRECTOR 1.00 0.00 X 0 0 0 TERRENCE O'ROURKE DIRECTOR 1.00 0.00 X 0 0 0 MIKE WILLIAMS DIRECTOR 1.00 0.00 X 0 0 0 MIKE ANDARY MD DIRECTOR 1.00 0.00 X 0 0 0 ANN CHAPMAN DEBES DIRECTOR 1.00 0.00 X 0 0 0 ROGER SPOELMAN DIRECTOR 1.00 0.00 X 0 0 0 SUE TAYLOR DIRECTOR 1.00 0.00 X 0 0 0 JULIE RIDENOUR DIRECTOR 1.00 1.00 X 0 0 0 KIM RIDINGS DIRECTOR 1.00 3.00 X 0 0 0 MICHELLE SUCHOVSKY-GABROSEK DIRECTOR 1.00 0.00 X 0 0 0 JEANNE SKILTON DIRECTOR 1.00 0.00 X 0 0 0 DIANE DEROSEAU DIRECTOR - AFTER 12/18 1.00 0.00 X 0 0 0 ELLEN NELSON DIRECTOR - AFTER 12/18 1.00 0.00 X 0 0 0 SCOTT LEWIS DIRECTOR - AFTER 12/18 1.00 0.00 X 0 0 0 HOLLY MARIE PETERSON DIRECTOR - AFTER 12/18 1.00 0.00 X 0 0 0 SAM HO MD DIRECTOR - AFTER 12/18 1.00 0.00 X 0 0 0 JUDY DUNTEN DIRECTOR - AFTER 12/18 1.00 0.00 X 0 0 0 JOAN KULLGREN DIRECTOR - THROUGH 12/18 1.00 0.00 X 0 0 0 JAN LIPPERT DIRECTOR - THROUGH 12/18 1.00 0.00 X 0 0 0 JENNIFER TAYLOR DIRECTOR - THROUGH 12/18 1.00 0.00 X 0 0 0 WILLIAM VANDENBERG MD DIRECTOR - THROUGH 12/18 1.00 40.00 X 0 202864 31433 SHELLEY MISHLER DIRECTOR - THROUGH 12/18 1.00 1.00 X 0 0 0 RANDALL DENEFF VP OF FINANCE 45.00 3.00 X 273626 0 26314 INGRID CHESLEK CHIEF NURSING OFFICER 45.00 0.00 X 242065 0 12793 THOMAS STRANZ VP OF INPATIENT SERVICES 45.00 0.00 X 238347 0 7542 JEFF GARBER VP OF NETWORK DEVELOPMENT 45.00 0.00 X 241507 0 18236 TIMOTHY PIETRYGA VP OF ADVANCEMENT & DEVELOPMENT 1.00 45.00 X 190911 0 25246 BRUCE BRASSER VP OF NETWORK OPERATIONS 45.00 2.00 X 203092 0 28951 GEORGE MEYER VP OF OUTPATIENT SERVICES 45.00 0.00 X 186893 0 19507 2603625 202864 234873 33 0 1 0 MILLER JOHNSON SNELL & CUMMISKY PO BOX 306 GRAND RAPIDS MI 49501 LEGAL SERVICES 478242 DICKINSON WRIGHT 200 OTTAWA AVE NW STE 1000 GRAND RAPIDS MI 49503 LEGAL SERVICES 158058 J2 INTERACTIVE LLS 2 THIRTEENTH ST CHARLESTOWN MA 02129 TECHNOLOGY CONSULTANTS 117705 SENIOR CARE CENTRAL LLC 183 PUMA LANE RIDGWAY CO 81432 REHABILITATION CONSULTANTS 108957 4 3743638 676362 69784 4420000 Patient Service Revenue 621400 75829157 75829157 Contract Service Revenue 621400 16691013 16691013 Program Expense Reimbursement 621400 409858 409858 92930028 491879 491879 404228 0 404228 404228 404228 2882233 2578769 303464 303464 303464 Computer/System Support 541519 111720 111720 Donation Processing Support 541900 7689 7689 119409 98669008 92930028 0 1318980 60000 60000 1316867 1316867 49903374 42594845 7308529 2220340 1931696 288644 6793343 5881139 912204 3673292 3176906 496386 298800 298800 60631 60631 22605 22605 937756 918047 19709 738389 738389 734139 607272 126867 2516039 2516039 190771 190771 160690 113103 47587 318975 284605 34370 292798 292798 5007736 4371610 636126 424598 369400 55198 PURCH - LAB & PHARMACY 5888831 5888831 BAD DEBT 1360758 1360758 UTILITIES 979010 868197 110813 GENERAL SUPPLIES 621655 562557 59098 4473777 3749480 724297 88995174 72929217 16065957 0 500 500 6725121 5568248 13637647 14833583 96360 91295 419807 1075962 83443352 24482010 44892129 58961342 20741865 20477265 32729643 32646075 119243072 133654270 22391401 25029418 15566973 13811283 37958374 38840701 X 80101522 94302136 1183176 511433 81284698 94813569 119243072 133654270 X 9673834 1425836 2429201 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 22605 22605 0 Part II-B, Line 1: PORTION OF MEMBERSHIP FEES IDENTIFIED BY THE AMERICAN HOSPITAL ASSOCIATION, MICHIGAN HEALTH & HOSPITAL ASSOCIATION, COALITION PROTECTING AUTO NO FAULT, AMERICAN MEDICAL REHABILITATION PROVIDERS ASSOCIATION, AND PUBLIC AFFAIRS ASSOCIATES ARE ALLOCATED TO LOBBYING. CONTACTS WITH STATE AND FEDERAL LEGISLATORS THROUGH E-MAIL. 1102670 1102670 42099286 9979204 32120082 395497 381414 14083 31541446 14054352 17487094 8304453 67040 8237413 58961342 INVESTMENT IN JOINT VENTURE- REHABILITATION SERVICES 19621207 OTHER RECEIVABLES 7617004 DUE FROM MARY FREE BED FUND 293185 PROCEEDS FROM CONSTRUCTION LOAN 5109904 DUE FROM MARY FREE BED GUILD 4775 32646075 1 1 X 1 X 145.000000000000 1 X 1 1 0 1 1 445012 0 445012 0.00510 13672151 9645657 4026494 0.04590 125913 44815 81098 0.00090 14243076 9690472 4552604 0.05190 6491 0 6491 0.00010 386043 122500 263543 0.00300 0 0 666427 554829 111598 0.00130 4625 0 4625 0.00010 1063586 677329 386257 0.00450 15306662 10367801 4938861 0.05640 9000 9000 0.00010 9000 9000 0.00010 1 1360758 468781 19411997 29258823 -9846826 X 1 1 1 1 MARY FREE BED REHABILITATION HOSPITAL 235 wealthy st se grand rapids MI 495035247 WWW.MARYFREEBED.COM 10600000134 X MARY FREE BED REHABILITATION HOSPITAL 1 0 0 1 X X X X X X X X 15 1 0 1 1 X http://www.maryfreebed.com/about-us/chna/ X HTTPS://WWW.MHA.ORG/NEWSROOM/PUBLICATIONS/COMMUNITY-BENEFIT X X 1 15 1 http://www.maryfreebed.com/about-us/chna/ 0 1 X 145.000000000000 250.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://WWW.MARYFREEBED.COM/ X HTTPS://WWW.MARYFREEBED.COM/ X HTTPS://WWW.MARYFREEBED.COM/ X X X X X 1 X 0 X 0 X X 0 0 MARY FREE BED REHABILITATION HOSPITAL Part V, Section B, Line 5: In an effort to align hospital services with the needs of our community, leaders from Mary Free Bed have analyzed secondary health assessment research conducted by local, state and federal agencies. The goal of this analysis was to ensure essential health needs of our community are being addressed by services available across the Mary Free Bed Rehabilitation Network. Mary Free Bed Rehabilitation Hospital intends to use this Community Health Needs Assessment to address the needs of our community at large in order to implement necessary and productive community-based programs. MARY FREE BED REHABILITATION HOSPITAL Part V, Section B, Line 6b: KENT COUNTY HEALTH DEPARTMENT MARY FREE BED REHABILITATION HOSPITAL Part V, Section B, Line 7d: Submitted to the MHA (Michigan Hospital Association) MARY FREE BED REHABILITATION HOSPITAL Part V, Section B, Line 11: Disability - Implementation Strategy: Provide comprehensive rehabilitation focused on the specialized needs of the increasing number of cancer survivors by increasing cancer rehabilitation and survivorship programs and services across the network - Measureable Outcome: Increase the number of oncology patients who have an encounter with a Mary Free Bed provider or team member across the network - Implementation Strategy: Maintain or increase initiatives and services offered through the Betty Bloomer Ford Cancer Rehabilitation Program - Measureable Outcome: Number of programs offered, [maintain or increase] community partnerships offered through the Betty Bloomer Ford Cancer Rehabilitation Program - Implementation Strategy: Increase patient self-management and awareness of body weight, nutrition, and chronic disease risk - Measureable Outcome: Increase the number of patients enrolled in the Mary Free Bed Weight Management Program - Measureable Outcome: Increase the number of patient encounters with the Outpatient Nutrition Program dietitian - Implementation Strategy: Implement use of the Kent County Health Department Community Nutrition Survey on access to Healthy Food Choices across the continuum (KCCNA 2015) - Measureable Outcome: Obtain and report to Kent County results of access to Healthy Food Choices survey as reported by patients - Implementation Strategy: Improve physical, emotional and mental health of persons with disabilities by receiving Recreational Therapy Services - Measureable Outcome: FIM Scores or other HRQOL pre-post assessments, maintain or improve the functionality and quality of life for persons with disabilities or impairments who receive inpatient Recreational Therapy servicesSpecific Needs Identified in CHNA: Chronic DiseaseSpecific Needs Identified in CHNA: Nutrition & ObesitySpecific Needs Identified in CHNA: Mental Health & Quality of Life - Implementation Strategy: Maintain targeted efforts toward utilizers of Mary Free Bed Rehabilitation Hospital's Wheelchair and Adaptive Sports programs and services - Measurable Outcome: number of participants, maintain or increase the clinics and teams offered by Wheelchair and Adaptive Sports for persons with disabilities or impairments - Implementation Strategy: Promote the health and well-being of persons with disabilities who have the opportunity to take part in the Driver Rehabilitation Program - Measureable Outcome: Maintain or increase the number of persons engaging in the Driver Rehabilitation Program - Implementation Strategy: Using health information technology, improve coordination of care and services across the continuum of care and services - Measureable Outcome: Using health information technology, increase the number of persons with complex care needs who are being medically managed with a nurse case manager or nurse navigator - Measureable Outcome: Reduce delays in access to care through tracking time of inbound calls to conversion to an appointment or speaking with a team member for information (access center) - Implementation Strategy: Expand capacity for NEXT Steps Day Rehab Program for patients who require intensive rehabilitation services in an outpatient setting - Measureable Outcome: Increase access to NEXT Steps Day Rehab Program as measured by patient encounters with program staff - Implementation Strategy: Maintain Universal Access practices to assure access to quality health care in the Post-Acute Care Setting (2013 MFB CHNA) - Measureable Outcome: Accept for treatment, all patients whom are clinically appropriate regardless of their ability to pay (see MFB 2016-2018 CHNA for universal access definition) - Implementation Strategy: Maintain or improve the proportion of community members, including the uninsured and working poor, that access healthcare services at MFB (2013 MFB CHNA) - Measureable Outcome: Maintain or increase the number of charity and Medicaid patients treated over the cycle - Implementation Strategy: Expand out-patient services statewide by 2018 (MFB SO1.8) - Measureable Outcome: Maintain or increase in patient visits seen by outpatient encountersSpecific Needs Identified in CHNA: AccessPAGE 4 - Implementation Strategy: Expand the capacity for post-acute care by increasing the number of referral sources - Measureable Outcome: Increase number of inpatient visits from referral sources seen by MFB providers - Implementation Strategy: Expand capacity for post-acute care through the development of two new subspecialty inpatient programs in our Network (Lansing & Muskegon)(MFB SO1.3) - Measureable Outcome: Increase in inpatient subspecialty visits seen in Lansing & Muskegon by an MFB provider - Implementation Strategy: Maintain or expand MFB Rehabilitation Home & Community Services Program of receiving therapy at home for brain or spinal cord injury patients (new) - Measureable Outcome: Maintain or increase the number of patients seen by Home & Community Services providers - Implementation Strategy: Maintain or increase initiatives and services offered through MFB Wheelchair and adaptive sports - Measureable Outcome: Number of programs offered by Wheelchair and Adaptive Sports - Implementation Strategy: Maintain or increase initiatives, services, and community partnerships offered through the MFB YMCA - Measureable Outcome: Number of visits of guests having a disability or impairment who access the MFB YMCACompetent Workforce - Implementation Strategy: Maintain or increase initiatives and services offered through medical & health education that are focused on post-acute care and rehabilitation - Measureable Outcome: Number of attendees - Measureable Outcome: Number of medical education events and certifications offered at MFB open to MFB and West Michigan Community members that are focused on post-acute care and rehabilitation - Implementation Strategy: Reduce risk of chronic disease, improve cardiovascular health, and promote quality of life in the MFB workforceSpecific Needs Identified in CHNA: DisabilitySpecific Needs Identified in CHNA: Chronic Disease, Nutrition & ObesityPAGE 5through the implementation of a comprehensive Employee Wellness Program (MFB SO4.3) and use of population health management reports (new) - Measureable Outcome: Use population health management values to drive employee wellness initiatives and challenges - Measureable Outcome: Improve nutritional habits by increasing number of employees accessing the Outpatient Registered Dietician via health care claims data or encounters - Measureable Outcome: Improve BMI and weight status awareness by increasing the number of employees who regularly participate in the MFB Healthy! You Wellness Program or other weight management program - Measureable Outcome: Improve physical activity levels among MFB employees through peer exercise/physical activity challenges - Measureable Outcome: Improve employee life satisfaction per self-reported life satisfaction on population health management reportsOther needs identified in CHNA not addressed in this strategyMary Free Bed Rehabilitation Hospital's Community Health Needs Assessment and Implementation Plan will address the three aforementioned community identified health needs. While the CHNA and IP chose to focus on hospital resources that strengthen these three community needs areas, it is important to recognize that these are not the only needs being addressed by the hospital. The Mary Free Bed IP will not address certain community needs identified by the Kent County CHNA- such as substance abuse or violence and safety. While these needs were identified in our community, and Mary Free Bed has an obligation to assess patients for these conditions, however, other area organization are better able to allocate resources to these needs as they relate to persons in the community.Monitoring of Implementation Strategy and reporting of outcomesMary Free Bed has identified individuals within the organization who will be accountable for each strategy. In addition, a workgroup has been established to identify metrics of measurement for each outcome. Systems and processes are being put into place to obtain specific measures and track each health need. These measures will be collected annually and results submitted to the Board and Mary Free Bed Community. Upon review, adjustments or changes will be made to the strategies and measurable outcomes as deemed appropriate or necessary. MARY FREE BED REHABILITATION HOSPITAL Part V, Section B, Line 13h: SELF PAY PATIENTS CHARGE AMOUNTS WERE BASED ON THE OVERALL AVERAGE OF NET COLLECTIONS AND CONSIDERED CHARITY, BAD DEBTS, MEDICARE, MEDICAID, AND ALL OTHER PAYERS. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,360,758. Part III, Line 2: FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES FOR AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THE THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. Part III, Line 3: LOOKED AT HIGHT DOLLAR BAD-DEBT WRITEOFFS ON INPATIENT ACCOUNTS TO DETERMINE WHY THERE WAS NO INSURANCE COVERAGE. A PERCENTAGE OF 34.45% WAS DERIVED BASED ON PATIENT FINANCIAL SERVICE NOTES STATING THE PATIENTS WERE LIKELY ELIGIBLE FOR CFA, BUT THE PATIENT/GUARANTOR DID NOT PROVIDE THE NECESSARY INFORMATION TO MEDICAID, MFB, OR TO ANY OTHER ACUTE HOSPITAL INVOLVED IN THEIR CARE DESPITE REPEATED ATTEMPTS TO OBTAIN THIS INFORMATION. Part III, Line 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. Part III, Line 8: (1) MEDICARE GROSS REIMBURSEMENTS AMOUNTS WERE TAKEN FROM THE CMS PROVIDER STATISTICAL AND REIMBURSEMENT SYSTEM REPORT (PS&R REPORT) LESS SEQUESTRATION DEDUCTIONS PLUS MEDICARE MCO GROSS REVENUES FROM INTERNAL PAYER MIX REPORTS TIMES A CALCULATED REIMBURSEMENT % BASED ON ZERO BALANCE SHEET ACCOUNTS.(2) ALL OF THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE SERVICES ARE PROVIDED WITH THE FULL RECOGNITION THAT MEDICARE REIMBURSEMENT WILL BE INSUFFICIENT TO COVER THE COSTS OF PROVIDING THOSE SERVICES.(3) THE COST TO CHARGE RATIO WAS CALCULATED BASED ON THE FY2017 MEDICARE COST REPORT. Part III, Line 9b: ALL PATIENTS RECEIVING CHARITY CARE HAVE A UNIQUE FINANCIAL CLASS ASSIGNED TO THEM. ALL CHARITY CARE ACCOUNTS ARE EXCLUDED FROM ACCOUNTS BEING SENT TO THE COLLECTION AGENCY. Part VI, Line 2: THE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED ARE DETERMINED THROUGH THE HOSPITAL'S ANNUAL STRATEGIC PLANNING PROCESS AND A COMMUNITY-WIDE SURVEY BY THE KENT COUNTY HEALTH DEPARTMENT. INPUTS FROM PATIENTS, FAMILIES OF PATIENTS, REFERRING PHYSICIANS, HOSPITAL DISCHARGE PLANNERS, AS WELL AS INFORMATION FROM OTHER COMMUNITY HEALTHCARE PROVIDERS ARE USED TO DETERMINE THE REHAB HEALTHCARE NEEDS OF THE COMMUNITIES SERVED. Part VI, Line 3: EACH PATIENT RECEIVES AN INFORMATION PACKET WHICH INCLUDES A COPY OF OUR CHARITY CARE POLICY AND APPLICATION. FURTHER, IF ANY SERVICES ARE NOT COVERED OR PARTIALLY COVERED, PATIENTS ARE CONTACTED AND CHARITY IS AGAIN OFFERED, IF APPROPRIATE. MANY OF OUR PATIENTS COME FROM AN ACUTE CARE HOSPITAL WITH SIMILAR CHARITY POLICIES; WE ARE OFTEN ABLE TO CONTACT THE REFERRING HOSPITAL TO DISCUSS A PATIENT'S ELIGIBILITY. Part VI, Line 4: THE HOSPITAL PRIMARILY SERVES KENT COUNTY IN WESTERN MICHIGAN AND 12 OR SO SURROUNDING COUNTIES. KENT COUNTY HAD 602,600 PEOPLE IN 2010. APPROXIMATELY 75% OF THE RESIDENTS WERE WHITE, AND 10% WERE BLACK/AFRICAN AMERICAN. IN 2014, 14% HAD NO HIGH SCHOOL DIPLOMA, AND 86% HAD A HIGH SCHOOL DIPLOMA OR GED EQUIVALENT. IN 2014, 14.6% OF ITS RESIDENTS LIVED BELOW THE POVERTY LEVEL. Part VI, Line 5: MARY FREE BED REHABILITATION HOSPITAL HAS AN OPEN MEDICAL STAFF AND A COMMUNITY BOARD. THE HOSPITAL AND A SISTER CORPORATION, THE MARY FREE BED FUND, USE SURPLUS AND DONATED FUNDS FOR A VARIETY OF ACTIVITIES TO SUPPORT THE HEALTH OF OUR GENERAL COMMUNITY AND MORE SPECIFICALLY, THE HEALTH AND WELL BEING OF PERSONS WITH DISABILITIES. Part VI, Line 7, Reports Filed With States MI 0 HEART OF WEST MICHIGAN UNITED WAY 118 COMMERCE AVE SW GRAND RAPIDS MI 49503 680480736 501(C)(3) 60000 HEALTH AND HUMAN SERVICES 1 0 X X X X 0 0 0 0 0 0 0 0 0 KENT RIDDLE PRESIDENT 520852 0 75000 0 0 0 14575 0 14464 0 624891 0 0 0 MIKE JAKUBOWSKI MD TRUSTEE 389829 0 41503 0 0 0 18831 0 16981 0 467144 0 0 0 WILLIAM VANDENBERG MD DIRECTOR - THROUGH 12/18 0 202864 0 0 0 0 0 19875 0 11558 0 234297 0 0 RANDALL DENEFF VP OF FINANCE 248549 0 25077 0 0 0 15185 0 11129 0 299940 0 0 0 INGRID CHESLEK CHIEF NURSING OFFICER 242065 0 0 0 0 0 0 0 12793 0 254858 0 0 0 THOMAS STRANZ VP OF INPATIENT SERVICES 212347 0 26000 0 0 0 2510 0 5032 0 245889 0 0 0 JEFF GARBER VP OF NETWORK DEVELOPMENT 227384 0 14123 0 0 0 11460 0 6776 0 259743 0 0 0 TIMOTHY PIETRYGA VP OF ADVANCEMENT & DEVELOPMENT 150911 0 40000 0 0 0 8293 0 16953 0 216157 0 0 0 BRUCE BRASSER VP OF NETWORK OPERATIONS 192850 0 10242 0 0 0 11970 0 16981 0 232043 0 0 0 GEORGE MEYER VP OF OUTPATIENT SERVICES 171893 0 15000 0 0 0 6714 0 12793 0 206400 0 0 0 A KENT HOSPITAL FINANCE AUTHORITY 382350002 2012-10-26 14000000 PARTIAL FUNDING OF NEW HOSPITAL ADDITION 0 0 0 B KENT HOSPITAL FINANCE AUTHORITY 364142114 2014-12-18 8500000 pARTIAL FUNDING OF EXISTING HOSPITAL RENOVATION 0 0 0 A 14000000 14000000 0 0 1 1 B 8500000 8500000 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 A 0 B 0 Date Rebate Computation Performed Issuer Name: KENT HOSPITAL FINANCE AUTHORITY Date the Rebate Computation was Performed: 03/31/2017 Issuer Name: KENT HOSPITAL FINANCE AUTHORITY Date the Rebate Computation was Performed: 03/31/2017 X EQUIPMENT 2 55000 FMV X GOODS 4 14784 FMV 0 0 1 0 Part I, Column (b): THE AMOUNT LISTED IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS. Form 990, Part I, Item C DBA: MARY FREE BED HOSPITAL AND REHABILITATION CENTER DBA: MARY FREE BED TRANSITIONAL CENTER Form 990, Part VI, Section A, line 2 SUE TAYLOR AND JENNIFER TAYLOR HAVE A FAMILY RELATIONSHIP. Form 990, Part VI, Section A, line 6 THE ORGANIZATION HAS ONE SHAREHOLDER, MARY FREE BED GUILD, AS DICTATED BY THE BY-LAWS. Form 990, Part VI, Section A, line 7a THE SOLE SHAREHOLDER, MARY FREE BED GUILD, HOLDS 50% OF THE BOARD POSITIONS WHICH EXERCISE THE RIGHT TO ELECT HOSPITAL BOARD MEMBERS. Form 990, Part VI, Section A, line 7b THE SOLE SHAREHOLDER MUST APPROVE CERTAIN HOSPITAL BOARD TRANSACTIONS SUCH AS REAL ESTATE TRANSACTIONS. Form 990, Part VI, Section B, line 11b THE VP OF FINANCE REVIEWS THE 990. NO REVIEW WAS OR WILL BE CONDUCTED BY THE GOVERNING BODY PRIOR TO FILING. AFTER COMPLETION OF THE RETURN, THE RETURN WILL BE POSTED TO THE INTERNAL WEBSITE PORTAL FOR ALL BOARD MEMBERS. Form 990, Part VI, Section B, line 12c CONFLICT OF INTEREST POLICIES ARE UPDATED ANNUALLY BY ALL BOARD MEMBERS, OFFICERS, AND STAFF. PROCESS IS ADMINISTERED OUT OF THE EXECUTIVE ADMINISTRATION OFFICE. ANY DISCLOSED CONFLICTS OF INTEREST ARE DISCLOSED TO THE BOARD OF DIRECTORS AND ASSURANCES OBTAINED THAT NO ILLEGAL OR SUBSIDIZED ACTIVITIES ARE OCCURRING. ALL DISCLOSURES ARE REVIEWED BY THE HOSPITAL'S COMPLIANCE COMMITTEE. IF A CONFLICT OF INTEREST IS EXPOSED, THE INDIVIDUAL WHO IS THE SUBJECT OF THE CONFLICT IS EXCUSED FROM THE MEETING SO THE REST OF THE BOARD MAY DISCUSS THE ISSUE AND TAKE APPROPRIATE ACTION. Form 990, Part VI, Section B, line 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES THE COMPENSATION FOR THE HOSPITAL'S PRESIDENT AND MEDICAL DIRECTOR. MARKET SURVEY DATA OF COMPARABLE SALARIES IS USED TO ESTABLISH BASE SALARY. FORM 990S OF SIMILAR ORGANIZATIONS ARE ALSO USED TO ESTABLISH COMPENSATION FOR THE PRESIDENT AND THE MEDICAL DIRECTOR. AN INCENTIVE PLAN WITH SPECIFIC MEASURES AND WEIGHTINGS FOR FINANCIAL, QUALITY, CUSTOMER SATISFACTION, AND INDIVIDUAL GOALS IS ALSO IN PLACE FOR THE PRESIDENT AND MEDICAL DIRECTOR. THIS PROCESS WAS MOST RECENTLY UNDERTAKEN IN 2017. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FINANCIAL STATEMENTS ARE SUMMARIZED IN AN ANNUAL REPORT WHICH IS AVAILABLE TO THE PUBLIC. Form 990, Part XI, line 9: PENSION RELATED CHANGES 1,806,166. INCREASE IN EQUITY JOINT VENTURE 2,073,035. TRANSFER TO MARY FREE BED MEDICAL GROUP -1,450,000. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. MARY FREE BED GUILD 235 WEALTHY STREET SE GRAND RAPIDS MI 49503 382649369 CHARITABLE HEALTHCARE MI 501(c)(3) Line 7 N/A 0 MARY FREE BED ORTHOTICS AND PROSTHETICS 235 WEALTHY STREET SE GRAND RAPIDS MI 49503 382643391 ORTHOTICS & PROSTHETICS MI 501(c)(3) Line 10 MARY FREE BED GUILD 1 MARY FREE BED FUND 235 WEALTHY STREET SE GRAND RAPIDS MI 49503 382643392 SUPPORTING ORGANIZATION MI 501(c)(3) Line 12a, I marY FREE BED GUILD 1 MARY FREE BED MEDICAL GROUP 235 WEALTHY STREET SE GRAND RAPIDS MI 49503 271589392 PHYSICIAN SERVICES MI 501(c)(3) Line 12a, I MARY FREE BED REHABILITATION HOSPITAL 1 MARY FREE BED REHABILITATION HOSPITAL FOUNDATION 235 WEALTHY STREET SE GRAND RAPIDS MI 49503 461164285 SUPPORTING ORGANIZATION MI 501(c)(3) Line 12a, I MARY FREE BED REHABILITATION HOSPITAL 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 1 0 1 1 0 MARY FREE BED ORTHOTICS AND PROSTHETICS O 841805 ACTUAL COSTS INCURRED MARY FREE BED ORTHOTICS AND PROSTHETICS J 73476 ACTUAL COSTS INCURRED MARY FREE BED FUND L 104650 CASH MARY FREE BED ORTHOTICS AND PROSTHETICS M 398883 ACTUAL COSTS INCURRED MARY FREE BED REHABILITATION HOSPITAL FOUNDATION C 2695224 CASH MARY FREE BED MEDICAL GROUP B 1450000 CASH MARY FREE BED FUND C 1048414 CASH