2016-02-15T00:00:00-06:00 2015-03-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2014-04-01 381359265 MARY FREE BED REHABILITATION HOSPITAL MARY 8005288989 235 WEALTHY ST SE GRAND RAPIDS MI 495035247 RANDALL L DENEFF CHIEF FINANCIAL OFFICER 8005288989 2016-02-16 1 CAROL LALONDE CPA P00181637 2695674500 2014 2016-08-17 19:52:53Z MARY FREE BED HOSPITAL AND REHABILITATION CENTER RANDALL L DENEFF 235 WEALTHY ST SE GRAND RAPIDS MI 495035247 89813718 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. 25 22 1184 118 0 0 917573 6335221 68196852 64535239 3843401 3548844 666269 666280 73624095 75085584 925000 2806563 0 0 49072505 51492165 0 0 0 19113463 18525816 69110968 72824544 4513127 2261040 103566357 114903720 24373467 39258710 79192890 75645010 X RESTORING HOPE AND FREEDOM THROUGH REHABILITATION. 0 0 12495448 20906943 PROVIDE THERAPY AND OTHER MEDICAL SERVICES FOR 22,961 PATIENT DAYS. 14280512 15026866 PROVIDE OUTPATIENT REHABILITATION AND CLINIC SERVICES FOR APPROXIMATELY 69,545 PATIENT VISITS. 11305405 17640233 PROVIDE NURSING SERVICES AND INFECTION CONTROL FOR 22,961 PATIENT DAYS. 21420768 2806563 10961197 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. 21420768 2806563 10961197 59502133 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 64 0 1 1184 1 0 0 0 0 0 0 0 0 0 0 X 25 22 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X RANDALL DENEFF 6168408317 235 WEALTHY ST SE GRAND RAPIDS MI 49503 JOHN F BUTZER MEDICAL DIRECTOR - THROUGH 6/23 50.00 2.00 X X 361231 0 42132 KENT RIDDLE PRESIDENT 50.00 2.00 X X 471542 0 19299 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 - AFTER 6/23 1.00 1.00 X X 0 0 0 CHAD BUSH TREASURER 1.00 0.00 X X 0 0 0 VICKIE DODGE ASSISTANT TREASURER 1.00 1.00 X X 0 0 0 KIM RIDINGS DIRECTOR 1.00 2.00 X 0 0 0 JULIE RIDENOUR DIRECTOR 1.00 2.00 X 0 0 0 DAN VAUGHAN DIRECTOR 1.00 0.00 X 0 0 0 SHELLEY MISHLER DIRECTOR 1.00 1.00 X 0 0 0 NANCY ALBERS DIRECTOR 1.00 0.00 X 0 0 0 SUSAN BLOSS DIRECTOR 1.00 0.00 X 0 0 0 JOAN KULLGREN DIRECTOR 1.00 0.00 X 0 0 0 JAN LIPPERT DIRECTOR 1.00 0.00 X 0 0 0 GREG CONWAY DIRECTOR 1.00 0.00 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 JAKUBOWSKI MD MEDICAL DIRECTOR 50.00 2.00 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 JENNIFER TAYLOR DIRECTOR 1.00 0.00 X 0 0 0 SUE TAYLOR DIRECTOR - AFTER 6/23 1.00 0.00 X 0 0 0 CHRIS VANDENBERG MD DIRECTOR - AFTER 6/23 1.00 0.00 X 0 0 0 ELLEN NELSON DIRECTOR - THROUGH 6/23 1.00 0.00 X 0 0 0 SUSAN STEKETEE DIRECTOR - THROUGH 6/23 1.00 0.00 X 0 0 0 JENNIFER LANNON DIRECTOR - THROUGH 6/23 1.00 0.00 X 0 0 0 RANDALL DENEFF VP OF FINANCE 45.00 1.00 X 172971 0 18288 JIM WILSON CHIEF OPERATING OFFICER 45.00 0.00 X 237406 0 9969 JEFF GARBER VP OF STRATEGIC INITIATIVES 45.00 0.00 X 206029 0 17680 GEORGE MEYER VP OF OUTPATIENT SERVICES 45.00 0.00 X 196973 0 12401 TIMOTHY PIETRYGA VP OF ADVANCEMENT & DEVELOPMENT 45.00 1.00 X 184383 0 17930 BRUCE BRASSER VP OF CLINICAL OPERATIONS 45.00 2.00 X 164897 0 20527 1995432 0 158226 20 0 1 0 MILLER JOHNSON SNELL & CUMMISKY PO BOX 306 GRAND RAPIDS MI 49501 LEGAL SERVICES 610672 REHAB & PHYSICAL MEDICINE SPECIALISTS 350 LAFAYETTE STE 301 GRAND RAPIDS MI 49503 MEDICAL SERVICES 557074 DURANGO HEALTH PARTNERS LLC 192 ROCKRIDGE CIRCLE DURANGO CO 81301 HEALTHCARE CONSULTING 229610 INTERPRETER NETWORK 4079 PARK EAST COURT STE 10 GRAND RAPIDS MI 49546 INTERPRETER SERVICES 220340 DICKINSON WRIGHT 200 OTTAWA AVE NW STE 1000 GRAND RAPIDS MI 49503 LEGAL SERVICES 182004 9 6054509 280712 6335221 PATIENT SERVICE REVENUE 621400 51776421 51776421 CONTRACT SERVICE REVENUE 621400 12448152 12448152 PROGRAM EXPENSE REIMBURSEMENT 621400 310666 310666 64535239 982978 982978 643121 0 643121 643121 643121 17294000 14728134 2565866 2565866 2565866 DONATION PROCESSING SUPPORT 541900 13159 13159 COMPUTER/SYSTEM SUPPORT 541519 10000 10000 23159 75085584 64535239 0 4215124 2806563 2806563 1123406 1123406 39987574 33461257 6526317 1499241 1338713 160528 5751648 5046838 704810 3130296 2723358 406938 502663 502663 74611 74611 492264 489077 3187 302447 302447 881409 757452 123957 1732015 1732015 239836 207107 32729 185069 160284 24785 2330311 2027371 302940 285112 248047 37065 PURCH - LAB & PHARMACY 5401475 5401475 BAD DEBT 795494 795494 UTILITIES 672535 595211 77324 SUPPLIES 598629 518190 80439 4031946 2925696 1106250 72824544 59502133 13322411 0 500 500 6979031 1770881 12549262 7338591 134887 102272 902747 924511 70591691 24849984 28944510 45741707 36444034 32268057 17611386 26757201 103566357 114903720 13358493 21710624 11014974 17548086 24373467 39258710 X 71550609 74447808 7642281 1197202 79192890 75645010 103566357 114903720 X 2261040 -1290788 -4518132 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 12623 12623 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. CONTACTS WITH STATE AND FEDERAL LEGISLATORS THROUGH E-MAIL. 1102670 1102670 41095822 10257063 30838759 419031 384011 35020 26351062 13811321 12539741 1623106 397589 1225517 45741707 INVESTMENT IN JOINT VENTURE - REHABILITATION SERVICES 7530965 OTHER RECEIVABLES 5124974 DUE FROM MARY FREE BED FUND 176451 PROCEEDS FROM CONSTRUCTION LOAN 13923945 DUE FROM MARY FREE BED GUILD 866 26757201 X PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL AND ITS SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF MARCH 31, 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO MARCH 31, 2012. 1 1 X 1 X 145.000000000000 1 X 1 1 0 0 684455 0 684455 0.00940 10201020 7628704 2572316 0.03530 0 0 10885475 7628704 3256771 0.04470 3166 0 3166 0.00000 409922 0 409922 0.00560 0 0 1105 0 1105 0.00000 17674 0 17674 0.00020 431867 431867 0.00580 11317342 7628704 3688638 0.05050 0 0 0 0 0 0 0 0 34 133 881 0 881 0.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 34 133 881 881 1 795494 159100 13692772 16704564 -3011792 X 1 1 1 1 MARY FREE BED REHABILITATION HOSPITAL 235 WEALTHY ST SE GRAND RAPIDS MI 495035247 WWW.MARYFREEBED.COM X MARY FREE BED REHABILITATION HOSPITAL 1 0 0 1 X X X X X X X X 12 1 1 1 1 X WWW.MARYFREEBED.COM X 1 13 1 WWW.MARYFREEBED.COM 0 0 1 X 145.000000000000 250.000000000000 X X X X 1 1 X X X 1 X WWW.MARYFREEBED.COM X X X 1 X 0 X X X X 0 X X 0 0 MARY FREE BED REHABILITATION HOSPITAL PART V, SECTION B, LINE 5: 12 FOCUS GROUPS WITH 119 COMMUNITY MEMBERS PARTICIPATING; 395 INTERCEPT INTERVIEWS CONDUCTED IN 3 LANGUAGES BY COMMUNITY MEMBERS; 4 COMMUNITY INPUT WALLS. MARY FREE BED REHABILITATION HOSPITAL PART V, SECTION B, LINE 6A: SPECTRUM HEALTH, METRO HEALTH HOSPITAL, AND MERCY HEALTH ST. MARY'S. MARY FREE BED REHABILITATION HOSPITAL PART V, SECTION B, LINE 7D: AVAILABLE FROM KENT COUNTY HEALTH DEPARTMENT MARY FREE BED REHABILITATION HOSPITAL PART V, SECTION B, LINE 11: MARY FREE BED HAS IMPLEMENTED A PLAN WHICH PRIORITIZES THE ISSUES IDENTIFIED IN THE LAST COMMUNITY NEEDS HEALTH ASSESSMENT REPORT. THE PLAN ADDRESSES EACH ISSUE WITH ALL ITEMS TO BE FULLY ADDRESSED BY 2016. 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. MARY FREE BED REHABILITATION HOSPITAL PART V, SECTION B, LINE 22D: AMOUNTS WERE CALCULATED USING THE AVERAGE PAYMENT RATE OF ALL PAYERS. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY MARY FREE BED REHABILITATION HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.MARYFREEBED.COM 1 MARY FREE BED MEDICAL GROUP 235 WEALTHY ST SE GRAND RAPIDS MI 49503 CLINIC PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCURRED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 795,494. PART II, COMMUNITY BUILDING ACTIVITIES: TWO SISTER CORPORATIONS TO THE MARY FREE BED REHABILITATION HOSPITAL, THE MARY FREE BED FUND AND MARY FREE BED ORTHOTICS AND PROSTHETICS ALSO PROVIDE COMMUNITY BENEFITS. IN ADDITION TO SUPPORTING THE MARY FREE BED REHABILITATION HOSPITAL, MARY FREE BED ORTHOTICS AND PROSTHETICS AND THE MARY FREE BED MEDICAL GROUP, THE MARY FREE BED FUND PROVIDED $312,505 OF SPECIFIC ASSISTANCE TO FAMILIES AND DISABLED FAMILY MEMBERS TO HELP COVER COSTS OF EQUIPMENT, MEDICAL CARE, ORTHOTIC AND PROSTHETIC DEVICES, SEATING SYSTEMS, RECREATION, LODGING SUBSIDIES FOR OUT-OF-TOWN FAMILIES, ADAPTIVE BICYCLES, AND SCHOLARSHIPS TO MINORITY STUDENTS. MARY FREE BED ORTHOTICS AND PROSTHETICS PROVIDED APPROXIMATELY $487,000 OF COMMUNITY BENEFITS TO ITS PATIENTS. THIS AMOUNT INCLUDES $339,000 OF UNPAID COSTS OF MEDICAID PATIENTS AND UNCOLLECTIBLE ACCOUNTS. PART III, LINE 3: MANAGEMENT BELIEVES THAT APPROXIMATELY 20% OF THE TOTAL BAD DEBT EXPENSE SHOULD BE TREATED AS COMMUNITY BENEFIT. 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) ALL OF THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE SERVICES WERE PROVIDED AT LESS THAN OUR COSTS. (2) HOSPITAL COSTS ARE REPORTED USING THE ACCRUAL METHOD TO BETTER MATCH EXPENSES WITH REVENUES. (3) MEDICARE COSTS WERE DETERMINED BY TAKING ALL MEDICARE PROGRAM CHARGES FOR THE YEAR AND MULTIPLYING BY A COST TO CHARGE RATIO PULLED FROM THE 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. APROXIMATELY 75% OF THE RESIDENTS WERE WHITE, AND ABOUT 10% BLACK/AFRICAN AMERICAN. ABOUT 10% OF THE POPULATION HAS NO HIGH SCHOOL DIPLOMA AND 50% HAVE A HIGH SCHOOL DIPLOMA OR GED EQUIVALENT. IN 2009, 14.5% 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. 0 HEART OF WEST MICHIGAN UNITED WAY 118 COMMERCE AVE SW GRAND RAPIDS MI 49503 680480736 501(C)(3) 22500 HEALTH AND HUMAN SERVICES MARY FREE BED MEDICAL GROUP 235 WEALTHY ST SW GRAND RAPIDS MI 49503 271589392 501(C)(3) 2784063 PROGRAM SUPPORT 2 X X X X X 0 0 0 0 0 0 0 0 0 JOHN F BUTZER MEDICAL DIRECTOR - THROUGH 6/23 265481 0 95750 0 0 0 15600 0 26532 0 403363 0 0 0 KENT RIDDLE PRESIDENT 375792 0 95750 0 0 0 7800 0 11499 0 490841 0 0 0 RANDALL DENEFF VP OF FINANCE 172971 0 0 0 0 0 10573 0 7715 0 191259 0 0 0 JIM WILSON CHIEF OPERATING OFFICER 237406 0 0 0 0 0 1661 0 8308 0 247375 0 0 0 JEFF GARBER VP OF STRATEGIC INITIATIVES 206029 0 0 0 0 0 6305 0 11375 0 223709 0 0 0 GEORGE MEYER VP OF OUTPATIENT SERVICES 161973 0 35000 0 0 0 3617 0 8784 0 209374 0 0 0 TIMOTHY PIETRYGA VP OF ADVANCEMENT & DEVELOPMENT 144383 0 40000 0 0 0 5700 0 12230 0 202313 0 0 0 BRUCE BRASSER VP OF CLINICAL OPERATIONS 164897 0 0 0 0 0 8457 0 12070 0 185424 0 0 0 A KENT HOSPITAL FINANCE AUTHORITY 382350002 2012-10-26 14000000 PARTIAL FUNDING OF 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 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 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 11 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, RETURN WILL BE POSTED TO 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. WRITTEN EMPLOYMENT CONTRACTS EXIST ESTABLISHING THE LEVELS OF COMPENSATION. 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 2015. 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 -5,368,866. INCREASE IN EQUITY JOINT VENTURE 850,734. 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 CHARITABLE HEALTHCARE MI 501(C)(3) LINE 9 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 11A, I MARY FREE BED GUILD 1 MARY FREE BED MEDICAL GROUP 235 WEALTHY STREET SE GRAND RAPIDS MI 49503 271589392 CHARITABLE HEALTHCARE MI 501(C)(3) LINE 11A, 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 11A, 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 FUND C 798959 CASH MARY FREE BED ORTHOTICS AND PROSTHETICS O 903000 ACTUAL COSTS INCURRED MARY FREE BED ORTHOTICS AND PROSTHETICS J 238529 ACTUAL COSTS INCURRED MARY FREE BED MEDICAL GROUP B 2784063 CASH MARY FREE BED FUND L 99600 ACTUAL COSTS INCURRED MARY FREE BED ORTHOTICS AND PROSTHETICS M 307348 ACTUAL COSTS INCURRED MARY FREE BED REHABILITATION HOSPITAL FOUNDATION C 5255550 CASH MARY FREE BED FUND R 943645 NET BOOK VALUE