2015-02-12T11:23:22-07:00 2014-06-30 990 2013-07-01 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 6162816363 2015-02-12 2013 2016-02-25 16:41:14Z Paul H Karsten 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 144615777 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. 19 16 2155 216 0 0 1807831 2032805 86687661 95199317 5858174 8453166 896109 3200742 95249775 108886030 0 0 0 0 70495767 77797615 0 0 697932 19749030 22749899 90244797 100547514 5004978 8338516 100978799 113066314 17690763 21439762 83288036 91626552 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. 0 0 36079327 0 48616288 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 5,938 admissions during the year ended June 30, 2014 encompassing 58,062 days of patient care resulting in an average length of stay of 9.78 days. The partial hospitalization program had 1,460 admissions with 5,860 days of care. 28283550 28277131 Clinic Network through its twenty-one 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 2014, 1,012 patients were seen throughout the Clinic Network. In total, there were 257,933 outpatient visits in 2014. 2749105 0 2906372 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 66 patients a day resulting in 23,993 days of patient care in a year. 3590963 0 3381766 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. In addition, day treatment services in a drop-in center are also available where psychiatric services can be accessed immediately. 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. 3649638 0 3250957 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. 4691206 0 4977627 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 52, 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 42 patients per day providing 15,478 patient days of care in 2014. 2176822 0 1977955 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 70 patients resulting in 25,457 days of care in 2014. 1522061 0 1698056 Service offered to provide key 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 providing appropriate care in the proper location. Essentially, Pine Rest is reimbursed, at a break-even level, as a means to assure the long-term availability of program and operations oversight, psychiatrists and consultation at the local level. 628096 0 169032 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 students is being developed. 16258786 0 15455393 83370768 1 1 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 1 102 0 1 2155 1 0 0 0 0 0 1 1 0 0 0 0 X 19 16 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 Ginny VanderHart Chairperson 1 0 X X 0 0 0 Wes Granberg-Michaelson Vice Chairperson 1 0 X X 0 0 0 Jon Swets Treasurer 1 0 X X 0 0 0 Nicolas Kroeze Secretary 1 0 X X 0 0 0 Mark C Eastburg PhD President & CEO 60 0 X X 321558 0 29297 Alan M Armstrong MD Chief Medical Officer 40.00 0 X X 255868 0 25091 Valerie Mathis-Allen MD President of Medical Staff 40.00 0 X 309440 0 26847 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 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 Hon Joseph Scoville Board Member 1 0 X 0 0 0 Kathleen Vogelsang Board Member 1 0 X 0 0 0 Gary Werkman Board Member 1 0 X 0 0 0 Paul H Karsten Vice President & CFO 60 0 X 205951 0 16993 Robert L Nykamp Vice President & COO 60 0 X 201703 0 5515 Scott A Wagner Vice President Behavioral Health Solutions 60 0 X 114822 0 8611 Carleen Crawford Vice President Marketing 60 0 X 104434 0 26511 Thomas Elzinga Vice President General Services 60 0 X 119879 0 24172 Jack A Mahdasian MD Medical Staff 55 0 X 495863 0 29236 William J Sanders Medical Staff 65.30 0 X 339545 0 26919 Gilbert A Masterson Medical Staff 86 0 X 314909 0 29641 Verle L Bell Medical Staff 71.50 0 X 311424 0 13466 Louis Nykamp Medical Staff 50 0 X 309085 0 18229 3404481 0 280528 76 0 1 0 Pioneer Construction 550 Kirkland SW Grand Rapids MI 49546 Construction Services 1942528 Unidine 1000 Washington Street Suite 510 Boston MA 021182798 Patient dietary and cafeteria Services 1119816 Qualifacts Systems Inc 200 2nd Avenue South Nashville TN 37201 Electronic Medical Records Contractor 544282 Millennia Telecom 3145 Prairie Street SW Suite 101 Grandville MI 49418 Telecom Provider 349880 Work Squared 4633 Patterson SE Suite A Kentwood MI 49512 Maintenance 308224 48 0 0 0 960000 0 1072805 2093 2032805 Outpatient Clinics 621400 26704293 26704293 0 0 Inpatient Contracted Services 622000 20654336 20654336 0 0 Inpatient Care 622000 28534877 28534877 0 0 Residential Care 623000 18343665 18343665 0 0 Partial Hospitalization 622000 962146 962146 0 0 0 0 0 0 95199317 523964 0 0 523964 0 0 0 0 0 0 0 0 274561 0 9450 0 265111 0 265111 0 0 265111 43649499 0 35720297 0 7929202 0 7929202 0 0 7929202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rustic Market and Thrift Store 624000 13538 13538 0 0 Pastoral and Other Training 611710 105837 105837 0 0 2816256 2816256 0 0 2935631 108886030 98134948 0 8718277 0 0 0 0 0 0 0 0 1665747 617246 1048501 0 0 0 0 0 61938156 55993762 5514067 430327 537645 464210 70960 2475 9199552 8192840 930221 76491 4456515 3961300 463430 31785 0 0 0 0 159808 0 159808 0 80600 0 80600 0 14064 0 14064 0 0 358790 0 358790 0 1802474 1802474 0 0 254918 0 254918 0 4638590 2873644 1738867 26079 2530960 2135474 380557 14929 0 0 0 0 3470542 3126755 340844 2943 277341 220167 51553 5621 0 0 0 0 323212 254780 63868 4564 403233 0 403233 0 0 0 0 0 3908450 3678507 227975 1968 435292 0 435292 0 4091625 49609 3941266 100750 100547514 83370768 16478814 697932 396633 2161155 0 0 0 0 9800968 12376346 80000 70000 0 0 0 0 54299 55538 901135 448778 87238434 46914459 36203047 40323975 52261290 56335747 0 0 0 0 0 0 1281427 1294775 100978799 113066314 4999196 8057269 0 0 0 0 8025000 8025000 0 0 0 0 189325 163417 3000000 2250000 1477242 2944076 17690763 21439762 X 77402586 85386972 2179577 2533707 3705873 3705873 83288036 91626552 100978799 113066314 8338516 0 0 0 0 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14064 14064 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. 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 16233603 361684 1454920 995049 37966 0 17017192 0.85 0.15 0 0 1 1 0 3522615 3522615 0 58645906 31111412 27534494 0 0 0 0 0 23309231 13877687 9431544 0 1760682 1925360 -164678 40323975 0 Capital Lease Obligation S/T 55802 Interest Rate Swap S/T 152394 Interest Rate Swap L/T 267070 Deferred Compensation - 457(b) 1167226 Insured IBNR Malpractice 168080 Current Portion Long Term Debt 750000 Amount Payable to Third Party Payors 401080 Other -17576 2944076 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, 2014 and 2013. 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 2011. 1 1 1 X 2.5 1 X 1 1 0 1 1 0 0 1326812 0 1326812 0.0132 0 0 23394359 25116551 -1722191 0 0 0 0 0 0 0 0 0 24721171 25116551 -395379 0.0132 0 0 103324 0 103324 0.001 0 0 0 0 0 0 0 0 54409842 49555995 4853847 0.0483 0 0 0 0 0 0 0 0 462130 0 462130 0.0046 0 0 54975296 49555995 5419301 0.0539 0 0 79696467 74672546 5023922 0.0671 0 816276 0 4920938 5973724 -1052786 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 1 X X X X X X X X X 12 1 1 1 X www.pinerest.org X X X X X X X X 0 0 1 1 250 1 250 1 X X X 1 1 X X 1 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-Pine Rest Christian Mental Health Services 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 an 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. Schedule H, Part V, Section B, Line 4-Pine Rest Christian Mental Health Services Saint Mary's Healthcare, Spectrum Health Systems, Metropolitan Hospital, Mary Free Bed Hospital. Schedule H, Part V, Section B, Line 7-Pine Rest Christian Mental Health Services Pine Rest has collaborated with Saint Mary's Health Care, Spectrum Health System, Metropolitan, and Mary Free Bed hospitals to work with the Kent County Health Department to conduct the Kent county CHNA. The Needs Assessment was conducted using consultants from Michigan Public Health Institute, who were knowledgeable about the requirements of the new law. This process began in the spring of 2011 and included the formation of a CHNA Coalition, the review of data from numerous sources, and comparisons with other counties and with state and federal targets. Focus groups and surveys were used to gather data from community members. The consultants compiled all the data and identified 44 issues for Kent County to consider. Of those issues, the CHNA Coalition prioritized five as Strategic Priorities for community action. The final report, describing the process and all findings, was issued in February 2012. Pine Rest is required to assess and update a response to the CHNA each year. A link to the report can be found on teh Pine Rest web page under the Services tab. Of the forty-four community needs identified in the Kent County 20112 Community Health Needs Assessment and Health Profile, a majority of the needs relate to acute care hospital settings. Pine Rest Christian Mental Health Services (Pine Rest) is a psychiatric hospital. Consequently Pine Rest selected six issues from the assessment that can be addressed by Pine Rest. Please go to http://assets1.mytrainsite.com/501187/kentcochna_final.pdf for the full report. Pine Rest is currently in the process of collaborating an updated report in FY2015. Schedule H, Part V, Section B, Line 12-Pine Rest Christian Mental Health Services Organization utilizes a patient assistance fund agreement and authorized form. 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 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. Bed 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 Pine Rest has collaborated with Saint Mary's Health Care, Spectrum Health System, Metropolitan, and Mary Free Bed hospitals to work with the Kent County Health Department to conduct the Kent County CHNA. The Needs Assessment was conducted using consultants form Michigan Public Health Institute, who were knowledgeable about the requirements of the new law. This process began in the spring of 2011 and included the formation of a CHNA Coalition, the review of data from numerous sources, and comparisons with other counties and with state and federal targets. Focus groups and surveys were used to gather data from community members. The consultants compiled all the data and identified 44 issues for Kent County to consider. Of those issues, the CHNA Coalition prioritized five as Strategic Priorities for community action. The final report, describing the process and all findings, was issued in February 2012. Pine Rest is required to assess and update a response to the CHNA each year. A link to the report can be found on the Pine Rest web page under the Services tab. Of the forty-four community needs identified in the Kent County 2011 Community Health Needs Assessment and Health Profile, a majority of the needs relate to acute care hospital settings. Pine Rest Christian Mental Health Services (Pine Rest) is a psychiatric hospital. Consequently Pine Rest selected six issues from the assessment that can be addressed by Pine Rest. Please go to http://assets1.mytrainsite.com/501187/kentcochna_final.pdf for the full report. 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 location in Iowa. Its network of inpatient, residential and outpatient services reach people of all ages, from children to older adults. The majority of people served by Pine Rest were identified as from a county 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 621,700 making it one of the largest counties in Michigan. The racial makeup of Kent County is 75.3% White; 10% Hispanic or Latino; 10.3% Black or African American; 2.6% Asian; and 1.8% from two or more races. In Kent County 15.6% 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 an 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 284716 0 36842 0 4074 0 11404 0 13819 0 350855 0 0 0 Alan M Armstrong MD Chief Medical Officer 235813 0 20055 0 0 0 17402 0 7689 0 280959 0 0 0 Valerie Mathis-Allen MD President of Medical Staff 309440 0 0 0 0 0 17500 0 9347 0 336287 0 0 0 Paul H Karsten Vice President & CFO 190124 0 15828 0 3319 0 0 0 13674 0 222945 0 0 0 Robert L Nykamp Vice President & COO 183188 0 18515 0 3319 0 0 0 2196 0 207218 0 0 0 Scott A Wagner Vice President Behavioral Health Solutions 114822 0 0 0 0 0 0 0 8611 0 123433 0 0 0 Carleen Crawford Vice President Marketing 104434 0 0 0 0 0 0 0 26511 0 130945 0 0 0 Thomas Elzinga Vice President General Services 119879 0 0 0 0 0 0 0 24172 0 144051 0 0 0 Jack A Mahdasian MD Medical Staff 335448 0 160415 0 0 0 17500 0 11737 0 525100 0 0 0 William J Sanders Medical Staff 272069 0 67476 0 0 0 17500 0 9419 0 366464 0 0 0 Gilbert A Masterson Medical Staff 314909 0 0 0 0 0 0 0 29641 0 344550 0 0 0 Verle L Bell Medical Staff 311424 0 0 0 0 0 0 0 13466 0 324890 0 0 0 Louis Nykamp Medical Staff 309085 0 0 0 0 0 0 0 18229 0 327314 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. Grossed 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 a Board Member the responsibility for implementing and overseeing compensation issues, with regular reporting to the Board. The designated Board Member is assisted from time to time in this regard by a special Compensation Committee made up of three outside directors. In setting and reviewing executive compensation for the CEO, COO, CFO, CMO and Vice Presidents, the Board Member and Compensation Committee rely on market data for similarly situated hospital executives in comparable institutions, including an annual compensation survey conducted by the Michigan Hospital Association. In setting and reviewing compensation for physicians (both employed and independent contractors), the Board Member and Compensation Committee rely on market data for similarly situated professionals serving comparable institutions. In 2013, 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 Chairman of the Board (acting pursuit to guidelines set by the designated Board Member) 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 70000 0 1 1 Kelly Domagala Director Recruitment X 85000 68000 0 1 1 Karen Hadley Physician Recruitment X 62500 50000 0 1 1 Jonathan Dargo Physician Recruitment X 100000 50000 0 1 1 238000 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 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 a Board Member the responsibility for implementing and overseeing compensation issues, with regular reporting to the Board. The designated Board Member is assisted from time to time in this regard by a special Compensation Committee made up of three outside directors. In setting and reviewing executive compensation for the CEO, COO, CFO, CMO and Vice Presidents, the Board Member and Compensation Committee rely on market data for similarly situated hospital executives in comparable institutions, including an annual compensation survey conducted by the Michigan Hospital Association. In setting and reviewing compensation for physicians (both employed and independent contractors), the Board Member and Compensation Committee rely on market data for similarly situated professionals serving comparable institutions. In 2013, 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 Chairman of the Board (acting pursuit to guidelines set by the designated Board Member) 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 960000 Pine Rest Foundation p 6700 Pine Rest Christian Mental Health Services received approval for Form 8868 extending the due date to February 15, 2015.