2016-02-15T09:05:27-07:00 2015-06-30 990 2014-07-01 381368360 PINE REST CHRISTIAN MENTAL HEALTH SERVICES PINE 6164555000 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 Paul Karsten Vice President & CFO 6164555000 2016-01-29 2014 2016-08-17 19:52:53Z Paul H Karsten 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 150829451 0 X pinerest.org X 1908 MI Pine Rest Christian Mental Health Services is called to express the healing ministry of Jesus Christ by providing behavioral health services with professional excellence, Christian integrity, and compassion. 22 19 2252 150 0 0 2032805 3803883 95199317 103965840 8453166 1784779 3200742 2699820 108886030 112254322 0 0 0 0 77797615 85267363 0 0 753722 22749899 25751595 100547514 111018958 8338516 1235364 113066314 115022115 21439762 22160199 91626552 92861916 X Pine Rest Christian Mental Health Services is called to express the healing ministry of Jesus Christ by providing behavioral health services with professional excellence, Christian integrity, and compassion. 1 0 40437450 0 52722674 Hospital-based Services inpatient and partial hospitalization programs include dedicated psychiatric services for children, adolescents, adults, and older adults. Clinical conditions addressed included the full array of psychiatric diagnoses, co-occurring substance abuse diagnoses, and psychiatric disorders where treatment is complicated by co-existing medical conditions. Patients experience professional assessment and individualized treatment including: diagnosis, medication management and education, individual and group therapies, individual and family consultations and therapy, case management, discharge planning and aftercare. The inpatient and partial hospitalization programs are accredited by the Joint Commission of Accreditation of Healthcare Organizations (JCAHO). The Pine Rest's Board of Directors entered into a Joint Operating Agreement ("Agreement") effective July 1, 1998 with Saint Mary's Health Services and Metropolitan Hospital to manage the financial and clinical aspects of inpatient and partial hospitalization behavioral health services in the greater West Michigan area. The Agreement combines the inpatient and partial hospitalization mental health services of all three organizations under common management and operations. The parties to the Agreement also entered into a series of contractual agreements to provide specific clinical, financial, or support services. The Joint Operating Agreement of which Pine Rest is managing/operating has 200 beds available and had 6,526 admissions during the year ended June 30, 2015 encompassing 61,818 days of patient care resulting in an average length of stay of 9.47 days. The partial hospitalization program had 1,501 admissions with 6,599 days of care. 30601364 293123 30086001 Clinic Network through its twenty clinics, offers outpatient, ambulatory care at locations throughout West and Northern Michigan, and in Pella and Des Moines, Iowa. For people who do not require the structured environment of the inpatient or residential care settings, outpatient services are at the center of the behavioral health continuum. Nearly 75% of all persons who come to Pine Rest are served through outpatient care. Clinicians provide a broad spectrum of intervention across the age continuum in convenient, non-restrictive environments. In addition to traditional outpatient care, Pine Rest provides a variety of specialty services including assessment through the Psychological Consultation Center, intensive outpatient substance abuse/addictions services, court-related services and assessments, and more. On an average day in FY2015, 1,107 patients were seen throughout the Clinic Network. In total, there were 282,173 outpatient visits in FY2015." 3066631 0 3395007 Homes for the Developmentally Disabled helps adults with developmental disabilities experience exceptional residential settings and care with multiple opportunities for engaging in on-site and community activities that match abilities. On average the Developmentally Disabled Homes cares for 65 patients a day resulting in 23,567 days of patient care in a year. 3594637 6938 3270271 The Pine Rest Adult Residential Division offers longer term psychiatric services to adults with mental health needs in a residential setting. These services include both locked and unlocked settings. These services and facilities are licensed and accredited by the State of Michigan as well as the Commission on Accreditation of Rehabilitation Facilities (CARF). The Caring Communities Program brings Pine Rest into invited partnerships with established community organizations to introduce behavioral health services to under-served populations. Clients typically have limited resources and limited access to behavioral healthcare. With partners like Baxter Community Center, Belknap Commons, Dwelling Place, Grand Rapids Public Schools, Heartside Ministries, Grand Rapids Housing Commission and many more, Pine Rest addresses behavioral health needs in a non-traditional model. 3424780 96 3083443 The Pine Rest Community Services Division provides outpatient mental health services as part of the community mental health system. The Community Case Management Program provides intensive case management services to adults with chronic mental health needs. The Integrated Medical Clinic offers immediate psychiatric services to the public patient as needed through a psychiatrist and a team of mid-level practitioners. In addition, a variety of outpatient substance abuse services as well as services to the homeless are provided. Residential Supports Coordinators work in a number of community settings to support individuals with disabilities to maintain stable housing as well. 4461091 0 4992870 Pine Rest Adolescent Services offers 24/7 supervision by experienced professionals to guide the activities of daily life for adolescents aged 12 to 18 years when hospitalization is not required. With capacity for 48, referrals are accepted based on age and behavioral criteria. A supportive milieu in both a locked and unlocked setting helps adolescents develop relationship skills in anticipation of return to their families and in preparation for their own parenting roles. Social skills training is geared toward promoting positive relationships with peers and adults. Residents in treatment attend Kentwood Public Schools and receive homework help; they engage in on-campus and community activities to reinforce skills and foster goal achievement. The Center for Psychiatric Residential Services served and average of 43 patients per day providing 15,563 patient days of care in 2015. 2387433 0 2288205 Addiction Treatment Services offers a wide range of addiction and recovery services including outpatient, intensive outpatient and residential services for those with co-occurring substance use and mental health disorders. Professional services are designed to provide a safe, caring environment where persons gain insight and acquire skills for ongoing recovery. Transitional housing is available for clients who need safe, substance-free housing while transitioning to community living. Addiction facilities are state-licensed where appropriate and accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). On average each day the Addiction Treatment Services cares for 78 patients resulting in 28,409 days of care in 2015. 2298689 0 2614310 Service offered to provide hospital management services to West Michigan psychiatric inpatient and clinic operations. Regional capacity to serve difficult inpatient psychiatric cases is very limited and has resulted in Pine Rest being viewed as the regional care center for these patients. Less difficult cases must still be served and Pine Rest is devoted to enhancing and maintaining the ability of community based inpatient psychiatric units to care for these patients near home and close to family. Regionally, this process creates a hospital network and referral process focused on appropriate care in the proper location. Essentially, Pine Rest is reimbursed, at a break-even level, as a means to assure long-term availability of program and operations oversight, psychiatrists and consultation at the local level. 613339 429792 492537 Education and Prevention offers a range of education and prevention activities that help promote community wellness. Pine Rest is the recipient of several grants that promote education and prevention activities around mental health as well as perform research to further determine best practice models of care. An internship program for graduate students studying psychology is offered. In addition, a new residency program for medical school graduates has been initiated. 1242143 0 1721880 Pine Rest has operated a psychiatry residency program since July 2014, successfully beginning the second year of the program on July 1, 2015. The initial class of 9 residents have begun the second year of rotations and didactics. These rotations include, Addictions, Network180 (Emergency Psychiatry), Child and Adolescent, and Outpatient Clinic Services. The Pine Rest OP Residency Clinic will open in October, 2015. The new class of 8 residents have begun the year one rotations and lectures/presentations. These rotations include, adult inpatient, older adult inpatient, primary care (OP family practice locations) and neurology (Spectrum Health and Mercy Health). Residents spend two half days in lectures and individual supervision. The remaining time is on their rotations, working under the supervision of a psychiatrist to provide care to patients. In the fall, applications are received for next year's residents and 65 interviews are already scheduled. Interviews occur on Fridays from mid October to mid January. Up to 10 candidates are interviewed each day and we anticipate about 80 total interviews. The Pine Rest Residency Program has 17 residents currently. Pine Rest is pleased that our residents come from a variety of excellent medical schools located throughout the country. In the fall, applications are received for next year's residents and approximately 80 of these will be selected to interview for the Pine Rest program. Interviews occur on Fridays from mid October to mid January and up to 10 candidates are interviewed each day. The candidates are then ranked based on their past record in medical school, test scores, and performance on their interviews with faculty. The Graduate Medical Education match system then assigns the residents to Pine Rest. The Pine Rest Psychiatry Residency Program is currently accredited by both the ACGME and the AOA. The ACGME accreditation is valid through 2025. The AOA is merging with the ACGME and Pine Rest anticipates combining these two accredited programs under ACGME in the near future. 18022112 436826 18463516 92127557 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 97 0 1 2252 1 0 0 0 0 0 0 0 0 0 1 0 X 22 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA MI X Paul H Karsten 6162816363 300 68th St SE Grand Rapids MI 495010165 Hon Joseph Scoville Chairperson 3 0 X X 0 0 0 Jon Swets Vice Chairperson and Treasurer 3 0 X X 0 0 0 Nicolas Kroeze Secretary 2 0 X X 0 0 0 Mark C Eastburg PhD President & CEO 60 0 X X 335312 0 38630 Alan M Armstrong MD Chief Medical Officer 40 0 X X 269140 0 27217 Gary Rich MD President of Medical Staff 32 0 X 177136 0 25537 Scott Bolinder Board Member 1 0 X 0 0 0 Randall Christenson MD Board Member 1 0 X 0 0 0 Sylvia Daining Board Member 1 0 X 0 0 0 Honorable Patricia Gardner Board Member 1 0 X 0 0 0 Wes Granberg-Michaelson Board Member 1 0 X 0 0 0 LaRissa Hollingsworth Board Member 1 0 X 0 0 0 Art Jongsma Board Member 1 0 X 0 0 0 Ron Kool Board Member 1 0 X 0 0 0 Stephanie Leonardos Board Member 1 0 X 0 0 0 John Lichtenberg Board Member 1 0 X 0 0 0 Glenn Mitcham Board Member 1 0 X 0 0 0 Victor Proctor-Gibbs Board Member 1 0 X 0 0 0 Ginny VanderHart Board Member 1 0 X 0 0 0 Kathleen Vogelsang Board Member 2 0 X 0 0 0 Gary Werkman Board Member 2 1 X 0 0 0 Suzanne Keep Board Member 1 1 X 0 0 0 Robert L Nykamp Vice President & COO 60 0 X 225805 0 10897 Paul H Karsten Vice President & CFO 60 0 X 223262 0 28216 Scott A Wagner Vice President Behavioral Health Solutions 60 0 X 119777 0 21254 Thomas Elzinga Vice President General Services 60 0 X 124987 0 33681 Jack A Mahdasian MD Medical Staff 58 0 X 500311 0 39229 William J Sanders DO Medical Staff 72 0 X 363247 0 32381 Verle L Bell MD Medical Staff 71 0 X 356929 0 18012 Bibhas Singla MD Medical Staff 52 0 X 333735 0 30589 Gilbert A Masterson MD Medical Staff 86 0 X 326142 0 37271 3355783 0 342914 82 0 1 0 Elzinga & Volkers 86 East 6th Street Holland MI 494232912 Construction Services 2380280 Unidine 1000 Washington Street Suite 510 Boston MA 021182798 Patient dietary and cafeteria services 1995043 Qualifacts Systems Inc 200 2nd Avenue South Nashville TN 37201 Electronic Medical Records Contractor 487267 Lauren James Studio 801 Monroe Ave NW Suite 102 Grand Rapids MI 49503 Construction Services 410495 Custer Workplace Interiors 217 Grandville Avenue Grand Rapids MI 495032602 Construction Services 392292 42 0 0 0 2438723 0 1365160 0 3803883 Outpatient Clinics 621400 29853970 29853970 0 0 Inpatient Contracted Services 622000 23948805 23948805 0 0 Inpatient Care 622000 30459740 30459740 0 0 Residential Care 623000 18323302 18323302 0 0 Partial Hospitalization 622000 1380023 1380023 0 0 0 0 0 0 103965840 541813 0 0 541813 0 0 0 0 0 0 0 0 194514 0 23138 0 171376 0 171376 0 0 171376 39794957 0 38551991 0 1242966 0 1242966 0 0 1242966 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rustic Market and Thrift Store 624000 112492 112492 0 0 Pastoral and Other Training 611710 78906 78906 0 0 2337046 2337046 0 0 2528444 112254322 106494284 0 1956155 0 0 0 0 0 0 0 0 1660852 499030 1161822 0 0 0 0 0 69487807 63837796 5179169 470842 607314 540896 62912 3506 8567537 7912013 588144 67380 4943853 4467670 441257 34926 0 0 0 0 178241 0 178241 0 87454 0 87454 0 11205 0 11205 0 0 0 375790 0 375790 0 1864414 1864414 0 0 231083 0 231083 0 5070455 3289662 1769167 11626 2536033 2102796 415634 17603 0 0 0 0 4195066 3846616 345467 2983 308468 270395 30589 7484 0 0 0 0 425226 341417 78780 5029 424683 0 424683 0 0 0 0 0 4265278 4021046 242141 2091 566318 0 566318 0 5211881 -866194 5947823 130252 111018958 92127557 18137679 753722 2161155 2855832 0 0 0 0 12376346 14407682 70000 60000 0 0 0 0 55538 62046 448778 725118 92470689 51140228 40323975 41330461 56335747 54318129 0 0 0 0 0 0 1294775 1262847 113066314 115022115 8057269 8728633 0 0 0 0 8025000 8025000 0 0 0 0 163417 128872 2250000 1500000 2944076 3777694 21439762 22160199 X 85386972 87050802 2533707 2105241 3705873 3705873 91626552 92861916 113066314 115022115 1235364 0 0 0 0 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 11205 11205 0 Schedule C, Part II-B, Line 1 Verbal and written communication with public officials regarding legislation and proposals affecting the delivery of health care in Michigan and nationally. 24711782 1247071 608038 1555088 186036 0 24825767 21949724 298596 3462014 960000 38552 0 24711782 20242440 178065 2463364 893150 40995 0 21949724 20338206 603298 152314 755689 95689 0 20242440 17017192 615206 3608310 872223 30279 0 20338206 0.85 0.15 0 0 1 1 0 4018850 4018850 0 59979625 32894471 27085154 0 0 0 0 0 25595029 16062288 9532741 0 2877185 2183469 693716 41330461 0 Interest Rate Swap S/T 143126 Interest Rate Swap L/T 238069 Deferred Compensation - 457(b) 1426959 Insured IBNR Malpractice 203417 Current Portion Long Term Debt 750000 Amount Payable to Third Party Payors 1015332 Other 791 3777694 X Schedule D, Part V, Line 4 The spending policy allows for annual spending of 5% of the average fair market value of the Foundation's net assets for the prior three years. This amount is transferred from the Foundation to the operating funds of the Corporation to provide for the care of patients and other initiatives that benefit the organization. The spending policy allows for the use of investment earning on permanently restricted endowment funds in accordance with donor wishes. Schedule D, Part X, Line 2 The Corporation is a not-for-profit corporation pursuant to Section 501(C)(3) of the Internal Revenue Code and is exempt from income taxes on related income pursuant to Section 501(a). The Corporation recognizes interest and penalties related to unrecognized tax positions and includes these in interest and income tax expense. The Corporation has no amounts accrued for interest and penalties as of June 30, 2015 and 2014. The Corporation does not expect the total amount of unrecognized tax benefits to significantly change over the next twelve months. The Corporation is no longer subject to examination by taxing authorities for years before 2012. 1 1 1 X 2.5 1 X 1 1 0 1 1 0 0 1264699 0 1264699 0.0114 0 0 23903260 25445031 -1541770 0 0 0 0 0 0 0 0 0 25167959 25445031 -277071 0.0114 0 0 154066 0 154066 0.0014 0 0 0 0 0 0 0 0 61525326 54304214 7221112 0.065 0 0 0 0 0 0 0 0 682866 0 682866 0.0062 0 0 62362258 54304214 8058044 0.0726 0 0 87530217 79749245 7780973 0.0840 0 812707 0 7002047 7401361 -399314 X 1 0 1 1 Pine Rest Christian Mental Health Services 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 www.pinerest.org X Pine Rest Christian Mental Health Services 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X www.pinerest.org 1 15 1 pinerest.org 0 0 1 X 250 250 X X X 1 1 X X X X 1 X www.pinerest.org X www.pinerest.org X X X 1 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Pine Rest Christian Mental Health Services See Kent County Community Needs Assessment for details on methods employed, data collection, sources of input and key findings. Pine Rest collaborates in the development and utilizes these findings to establish strategic initiatives that support the community needs identified and correlate with the services provided and capabilities of Pine Rest. See http://www.kentcountychna.org/pdfs/CHNA2014.pdf Schedule H, Part V, Section B, Line 6a-Pine Rest Christian Mental Health Services Mercy Healthcare, Spectrum Health, Metro Health and Mary Free Bed Schedule H, Part V, Section B, Line 6b-Pine Rest Christian Mental Health Services See appendix B: Acknowledgments at http://www.kentcountychna.org/pdfs/CHNA2014.pdf for a complete list of participants which are too numerous to list here effectively Schedule H, Part V, Section B, Line 11-Pine Rest Christian Mental Health Services Each year Pine Rest assesses and updates a response to the most recent CHNA. The latest response was posted at www.pinerest.org in January 2015. Pine Rest is a psychiatric hospital. Consequently Pine Rest has selected issues from the CHNA that can and should be addressed by Pine Rest. Schedule H, Part V, Section B, Line 13h-Pine Rest Christian Mental Health Services Organization utilizes a patient assistance fund agreement and authorized form. Schedule H, Part V, Section B, Line 16a-Pine Rest Christian Mental Health Services www.pinerest.org Schedule H, Part V, Section B, Line 16c-Pine Rest Christian Mental Health Services www.pinerest.org 39 Pine Rest - Caledonia Clinic 9090 S Rogers Court SE Caledonia MI 49316 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Campus Clinic 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 Outpatient clinic, residential detox, screening, assessment, referral Pine Rest - Northshore Clinic 17325 VanWagoner Road Spring Lake MI 49456 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Christian Counseling Center 1870 Leonard NE Grand Rapids MI 49505 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Holland Clinic 926 S Washington Ave Suite 210 Holland MI 49423 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Hastings Clinic 450 Meadow Run Hastings MI 49058 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Pella Clinic 2611 Washington Street Pella IA 50219 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Lake Odessa Clinic 4294 Laurel Drive Lake Odessa MI 48849 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Kalamazoo Clinic 1530 Nichols Road Kalamazoo MI 49006 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Portage Clinic 1350 W Centre Avenue Portage MI 49024 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Northeast Clinic 3225 North Evergreen Drive NE Suite 301 Grand Rapids MI 49525 Outpatient Clinic, screening, assessment, referal and follow up Pine Rest - Northwest Clinic 2118 3 Mile Road Grand Rapids MI 49544 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Southwest Clinic 4211 Parkway Place Grandville MI 49418 Outpatient Clinic for screening, assessment, referral and follow up Pine Rest - Zeeland Clinic 8333 Felch Suite 210 Zeeland MI 49464 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Des Moines Clinic 6200 Aurora Ave Urbandale IA 50322 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Traverse City Clinic 1050 Silver Drive Traverse City MI 49684 Outpatient Clinic, mental health, addiction treatment and follow up Pine Rest - Addictions Medicine 300 68th Street SE Grand Rapids MI 49548 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Sub-Acute Detox 300 68th Street SE Grand Rapids MI 49548 Residential mental health and addiction treatment and detox Pine Rest - Adrian 6700 Adrian SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - Cameron 6680 Adrian SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - Eastwood 7041 Madison SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - Pine Grove 7051 Madison SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - Supported Independent Living 821 68th Street SE Grand Rapids MI 49508 Residential supervised independent living Pine Rest - Westwood 7047 Madison SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - SEQUOIA Program 300 68th Street SE Grand Rapids MI 49548 Education, awareness, access and non-traditional services to the community Pine Rest - InterActions Residential Treatment 300 68th Street SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - CenterPointe Recovery Center 1145 Oakland Drive Kalamazoo MI 49008 Adult Foster Care Pine Rest - Community Case Management 320 Commerce Avenue SW Grand Rapids MI 49503 Outpatient Clinic, comm change alternative informatin training, prevention and mental health Pine Rest - Integrated Med Clinic 349 S Division Grand Rapids MI 49503 Outpatient Clinic, screening, assessment, referral, follow up Pine Rest - DeMey Clinic 620 Century SE Grand Rapids MI 49503 Outpatient Clinic, comm change alternative info training, screening, assessment, referal, follow up Pine Rest - Streetreach 347 S Division SE Grand Rapids MI 49503 Education, awareness, access and non-traditional services to the community. Pine Rest - Cedar Units 300 68th Street SE Grand Rapids MI 49548 Child Caring Institution Pine Rest - Maple 300 68th Street SE Grand Rapids MI 49548 Child Caring Institution Pine Rest - Hispanic Recovery Program 223 68th Street SE Grand Rapids MI 49548 Residential mental health, addiction treatment, case mngt, comm change alternative info training Pine Rest - Jellema House 523 Lyon Street NE Grand Rapids MI 49503 Residential mental health, addiction treatment, screening, assessment, referral and follow up Pine Rest - Jellema Treatment Center 243 68th Street SE Grand Rapids MI 49548 Residential mental health and addiction treatment, screening, assessment Pine Rest - Recovery Residence 47 Prospect Grand Rapids MI 49503 Residential addictions recovery home Pine Rest - Freedom House 300 68th Street SE Grand Rapids MI 49548 Residential mental health, addiction, case management, screening, assessment, referral, follow up Pine Rest - ECT TMS Clinic 300 68th Street SE Grand Rapids MI 49508 Outpatient and Inpatient, screening, assessment, referral and follow up Schedule H, Part I, Line 7 Utilized prescribed worksheets 1 through 8 as defined by the IRS. Schedule H, Part III, Section A, Line 4 No specific footnote on bad debts. Cost of bad debts arrived at utilizing Worksheet A recommended by the IRS for this calculation. Bad debt x cost-to-charge ratio. Schedule H, Part III, Section B, Line 8 None. Source of Line 6 is the Medicare Cost Report. Schedule H, Part III, Section C, Line 9b Bad debts rarely qualify for charity care as charity care is determined at admission. Schedule H, Part VI, Line 2 Each year Pine Rest assesses and updates a response to the CHNA. The most recent response was posted at www.pinerest.org in January 2015. Pine Rest is currently in the process of collaborating an updated report in response to the 2015 CHNA. Pine Rest is a psychiatric hospital. Consequently Pine Rest is selecting the issues from the CHNA that can and should be addressed by Pine Rest. The next response to the 2015 CHNA will be posted on our site in April 2016. Schedule H, Part VI, Line 3 At admission, the organization attempts to communicate to the patient, or family as appropriate, the benefits, public or private, available for the prescribed care. Once the patient responsibility is established the patient's status relative to charity care is reviewed and a decision is made about the availability of patient assistance funds. Schedule H, Part VI, Line 4 Pine Rest Christian Mental Health Services is a multi-service behavioral health organization, serving a diverse range of people in multiple settings throughout west Michigan, and with two locations in Iowa. Its network of inpatient, residential and outpatient services reach people at all ages, from children to older adults. The majority of people served by Pine Rest were identified as from counties within the state of Michigan, with 46% from Kent County. A small percentage (<5%) are from counties outside the state of Michigan, Kent County, where Pine Rest's main campus is located, has a population of 629,237 making it one of the largest counties in Michigan. The racial makeup of Kent County is 75% White; 10.1% Hispanic or Latino; 10.4% Black or African American; 2.8% Asian; and 1.7% from two or more races. In Kent County 15.5% are below poverty level. Schedule H, Part VI, Line 5 To assure a strategic focus on the health needs of the community served 86% of the governing body is comprised of persons who reside in the organization's primary service area who are neither employees or contractors of the organization. In addition, the organization has an open medical staff allowing hospital medical staff membership to all physicians in the community who meet membership and clinical privilege requirements. An open medical staff broadens the availability of care to the community served by Pine Rest Christian Mental Health Services through the availability of medical staff to all patients in the service area. Since 1908 the organization has consistently applied surplus funds to the improvement of patient care and access, staff education and research designed to expand and improve the level of patient care provided to all patients. Pine Rest has board designated funds that provide outreach to the community to engage them in services. Pine Rest also provides many education opportunities to the community on various behavioral health topics. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 Mark C Eastburg PhD President & CEO 304373 0 30938 0 4089 0 17500 0 17042 0 373942 0 0 0 Alan M Armstrong MD Chief Medical Officer 248820 0 20321 0 0 0 16827 0 10389 0 296357 0 0 0 Gary Rich MD President of Medical Staff 174175 0 2961 0 0 0 0 0 25537 0 202673 0 0 0 Paul H Karsten Vice President & CFO 207981 0 15281 0 3332 0 0 0 24884 0 251478 0 0 0 Robert L Nykamp Vice President & COO 208614 0 17191 0 3332 0 0 0 7565 0 236702 0 0 0 Scott A Wagner Vice President Behavioral Health Solutions 119777 0 0 0 0 0 0 0 21254 0 141031 0 0 0 Thomas Elzinga Vice President General Services 124987 0 0 0 0 0 0 0 33682 0 158669 0 0 0 Jack A Mahdasian MD Medical Staff 494649 0 5661 0 0 0 17500 0 21730 0 539540 0 0 0 William J Sanders DO Medical Staff 297496 0 65751 0 0 0 17500 0 14881 0 395628 0 0 0 Verle L Bell MD Medical Staff 334329 0 22600 0 0 0 0 0 18012 0 374941 0 0 0 Bibhas Singla MD Medical Staff 260647 0 73088 0 0 0 0 0 30589 0 364324 0 0 0 Gilbert A Masterson MD Medical Staff 316932 0 9210 0 0 0 0 0 37271 0 363413 0 0 0 Schedule J, Part I, Line 1a Taxable term life premiums added to taxable income were grossed up to compensate for taxes on premiums. Gross up amounts were taxed. Mark Eastburg, Paul Karsten and Bob Nykamp. Schedule J, Part I, Line 3 The Board of Directors has adopted a written Executive Compensation Plan and has designated the Board Compensation Committee responsibility for implementing and overseeing executive compensation issues, with regular reporting to the Board. In setting and reviewing executive compensation for the COO, CFO, CMO and Corporate Directors, the Compensation Committee relies on market data for similarly situated hospital executives in comparable institutions, including an annual compensation survey conducted by the Michigan Hospital Association. CEO compensation is similarly compared and overseen by the Board Executive Committee. In setting and reviewing compensation for physicians (both employed and independent contractors), the Compensation Committee relies on market data for similarly situated professionals serving comparable institutions. In 2015, the corporation commissioned a study by Integrated Healthcare Strategies to assure that the total compensation paid to physicians is reasonable, consistent with objective market data, and in the best interests of the corporation. The compensation model for physicians adopted by the corporation is based on that study. Review and approval of all new physician employment contracts by both the CFO and the Chairperson of the Board Compensation Committee is required to assure that all compensation packages are within the approval limits. Documentation and supporting detail are maintained for all compensation decisions." Schedule J, Part I, Line 7 Employment contracts with officers of the organization allow for performance based incentives. Each year the Board of Directors articulate and approve specific measurable performance criteria. If performance criteria is met then performance based incentives are paid. A Kent Hospital Finance Authority 381603110 490576AC9 2006-09-26 10030000 Capital Expansion - various projects 0 0 0 A 2005000 0 10030000 0 0 0 218893 0 0 10030000 0 0 2008 0 0 1 1 A 0 0 0 0 0 0 0 1 0 1 A 1 1 1 Fifth Third Bank 1.0 0 0 0 0 1 A 0 William Sanders Physician Recruitment Enhancement X 100000 60000 0 1 1 Kelly Domagala Director Recruitment X 85000 59500 0 1 1 Jonathan Dargo Physician Recruitment X 100000 25000 0 1 1 144500 Form 990, Part III, Line 2 Pine Rest has operated a psychiatry residency program since July 2014, successfully beginning the second year of the program on July 1, 2015. The initial class of 9 residents have begun the second year of rotations and didactics. These rotations include, Addictions, Network180 (Emergency Psychiatry), Child and Adolescent, and Outpatient Clinic Services. The Pine Rest OP Residency Clinic will open in October, 2015. The new class of 8 residents have begun the year one rotations and lectures/presentations. These rotations include, adult inpatient, older adult inpatient, primary care (OP family practice locations) and neurology (Spectrum Health and Mercy Health). Residents spend two half days in lectures and individual supervision. The remaining time is on their rotations, working under the supervision of a psychiatrist to provide care to patients. In the fall, applications are received for next year's residents and 65 interviews are already scheduled. Interviews occur on Fridays from mid October to mid January. Up to 10 candidates are interviewed each day and we anticipate about 80 total interviews. The Pine Rest Residency Program has 17 residents currently. Pine Rest is pleased that our residents come from a variety of excellent medical schools located throughout the country. In the fall, applications are received for next year's residents and approximately 80 of these will be selected to interview for the Pine Rest program. Interviews occur on Fridays from mid October to mid January and up to 10 candidates are interviewed each day. The candidates are then ranked based on their past record in medical school, test scores, and performance on their interviews with faculty. The Graduate Medical Education match system then assigns the residents to Pine Rest. The Pine Rest Psychiatry Residency Program is currently accredited by both the ACGME and the AOA. The ACGME accreditation is valid through 2025. The AOA is merging with the ACGME and Pine Rest anticipates combining these two accredited programs under ACGME in the near future. Form 990, Part VI, Section B, Line 11b The Board of Directors has authorized the Finance Committee of the Board of Directors to review and approve the Form 990 each year prior to submission to the IRS. A draft copy of the Form 990 and all supporting schedules are given to the external auditors (every other year) as well as the Finance Committee of the Board of Directors for review and comment. Recommended changes are made to the Form 990 and supporting schedules and the Finance Committee votes on a motion to approve the Form 990 and supporting schedules as amended. The final filed Form 990 is made available to all Board members for their review and information. Form 990, Part VI, Section B, Line 12c Ongoing Board of Director and Board Committee discussions in concert with the annual audit and Corporate Integrity Office activities monitor and maintain an oversight on this activity. Form 990, Part VI, Section B, Line 15 The Board of Directors has adopted a written Executive Compensation Plan and has designated the Board Compensation Committee with the responsibility for implementing and overseeing executive compensation issues, with regular reporting to the Board. In setting and reviewing executive compensation for the COO, CFO, CMO and Corporate Directors, the Compensation Committee relies on market data for similarly situated hospital executives in comparable institutions, including an annual compensation survey conducted by the Michigan Hospital Association. CEO compensation is similarly compared and overseen by the Board Executive Committee. In setting and reviewing compensation for physicians (both employed and independent contractors), the Compensation Committee relies on market data for similarly situated professionals serving comparable institutions. In 2015, the corporation commissioned a study by Integrated Healthcare Strategies to assure that the total compensation paid to physicians is reasonable, consistent with objective market data, and in the best interests of the corporation. The compensation model for physicians adopted by the corporation is based on that study. Review and approval of all new physician employment contracts by both the CFO and the Chairperson of the Board Compensation Committee is required to assure that all compensation packages are within the approval limits. Documentation and supporting detail are maintained for all compensation decisions. Form 990, Part VI, Section C, Line 19 All documents are available upon request. Pine Rest Foundation 300 68th Street SE PO Box 165 Grand Rapids MI 495011065 381676540 Fundraising and management of investments MI 501(c)(3) Type 1 Pine Rest Christian Mental Health Services 1 Pine Rest Christian Community & Residential Services 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 Provide Residential and community based behavioral health services MI 501(c)(3) III Pine Rest Christian Mental Health Services 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 Pine Rest Foundation c 2438723 Pine Rest Foundation p 6700 Pine Rest Christian Mental Health Services received approval for Form 8868 extending the due date to February 15, 2016.