2014-08-11T15:25:23-05:00 2013-09-30 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2012-10-01 381360562 PENNOCK HOSPITAL PENN 2699453451 1009 WEST GREEN STREET HASTINGS MI 49058 CONNIE S DOWNS 2699453451 2014-08-05 1 CAROL LALONDE CPA P00181637 2695674500 2012 2015-11-30 17:44:51Z PENNOCK HEALTH SYSTEMS CONNIE S DOWNS 1009 WEST GREEN STREET HASTINGS MI 49058 73438617 0 X WWW.PENNOCKHEALTH.COM X 1923 MI THE HOSPITAL'S PRIMARY MISSION IS TO PROVIDE HEALTHCARE SERVICES TO THE CITIZENS OF BARRY COUNTY. ALL ACTIVITIES ASSOCIATED WITH THIS PURPOSE ARE INCLUDED IN DETERMINATION OF THE OPERATING INCOME. NET ASSETS OF THE HOSPITAL ARE GENERALLY UNRESTRICTED AND ARE AVAILABLE FOR THE DELIVERY OF HEALTHCARE SERVICES, WITH THE EXCEPTION OF CONTRIBUTIONS FROM INDIVIDUAL DONORS, WHICH ARE TEMPORARILY RESTRICTED FOR THE PURPOSE INTENDED BY THE DONOR. THE HOSPITAL PROVIDES CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY RECEIVE CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECUASE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. 12 10 669 165 122425 -3654 59106 41441 62147623 59292525 2494651 1756875 344098 447515 65045478 61538356 0 0 0 0 29685771 30429164 0 0 0 30730386 31472181 60416157 61901345 4629321 -362989 93950623 97838476 14367918 13900025 79582705 83938451 PENNOCK HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH SERVICES IN A PERSONAL, PROFESSIONAL AND PROGRESSIVE MANNER IN PARTNERSHIP WITH THE COMMUNITY. 0 0 44057039 59292525 PENNOCK CONTINUES TO INVEST IN PHYSICIAN INTEGRATION IN ORDER TO BETTER SERVE THE RURAL SECTIONS OF THE MARKET. PRIMARY CARE PHYSICIAN ADJUSMENTS AND GROWTH OCCURRED IN THE WEST AND NORTH AS WELL AS THE EASTERN BOUNDARIES OF BARRY COUNTY. IN ADDITION, INVESTMENTS IN NEW TECHNOLOGY INCLUDING A ROBOTIC SURGERY PROGRAM DEMONSTRATES OUR ABILITY TO PROVIDE QUALITY CARE IN A LOCAL ENVIRONMENT. OUR CONTINUOUS INVESTMENTS IN THE ELECTRONIC MEDICAL RECORD, THE IMPROVEMENTS IN OUR CURRENT FACILITY AND THE DEVELOPMENT OF A SEAMLESS CIRCLE OF CARE HELP TO ENHANCE PENNOCK'S SERVICE TO THE COMMUNITY. 44057039 1 1 0 1 0 0 0 0 0 0 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 1 0 1 0 0 0 0 0 1 1 1 0 0 1 64 0 1 669 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CONNIE DOWNS 2699483122 1009 W GREEN ST HASTINGS MI 49058 MAGGIE COLEMAN 0.50 X X 0 0 0 DAVID BAUM 0.50 X X 0 0 0 SCOTT BRASSEUR MD 0.50 X X 47540 0 0 BRAD JOHNSON CPA 0.50 X X 0 0 0 CHRIS NOAH MD 0.50 X 0 0 0 NANCY GOODIN 0.50 X 0 0 0 BONNIE HILDRETH 0.50 X 0 0 0 DAN KING 0.50 X 0 0 0 JAMES HORTON DO 0.50 X 0 0 0 KIMBERLY NORRIS MD 0.50 X 0 0 0 NATHAN TAGG 0.50 X 0 0 0 SAM WATSON 0.50 X 0 0 0 JEFF WEIDEN 0.50 X 0 0 0 SHERYL LEWIS BLAKE 40.00 X 360269 0 32376 CONNIE S DOWNS 40.00 X 230645 0 22465 DOUGLAS SMENDIK 40.00 X 0 0 0 CARLA WILSON NEIL 40.00 X 197095 0 14498 STEVE A MARZOLF 40.00 X 160008 0 9695 JAMES WINCEK 40.00 X 150447 0 6462 BRIDGIT BRENNAN MD 40.00 X 299423 0 4054 MAX RAPPAPORT MD 40.00 X 288683 0 1780 ANITA ASADORIAN 40.00 X 284499 0 6750 ANDREW PARSONS MD 40.00 X 220535 0 2964 CARRIE SANDBORN 40.00 X 192915 0 0 2432059 0 101044 25 0 1 0 ROCKFORD CONSTRUCTION 601 FIRST ST NW GRAND RAPIDS MI 49504 CONSTRUCTION SERVICES 2227555 PROGRESSIVE BUILDING SERVICES INC PO BOX 88235 KENTWOOD MI 49518 HOUSE KEEPING SERVICES 690739 HASTINGS ANESTHESIOLOGY PC PO BOX 4095 KALAMAZOO MI 49003 ANASTHESIA SERVICES 573307 SPECTRUM HEALTH 100 MICHIGAN GRAND RAPIDS MI 49503 REFERENCE LAB/SLEEP STUDY 560184 JOHNSON CONSTRUCTION COMPANY 2442 28TH ST SW WYOMING MI 49519 CONSTRUCTION SERVICES 339677 13 10547 30894 41441 PATIENT SERVICE REVENUE 621110 57951648 57951648 MEANINGFUL USE PROJECTS 621110 1340877 1340877 59292525 229871 229871 669677 788525 -118848 -118848 -118848 12633285 5455 11111736 0 1521549 5455 1527004 1527004 CAFETERIA REVENUE 722100 315856 315856 MISCELLANEOUS 900099 128082 128082 LAB COURIER SERVICE 621500 122425 122425 566363 61538356 59292525 122425 2081965 1061746 966189 95557 24458345 15897924 8560421 1238781 867147 371634 1909811 1336859 572952 1760481 1232330 528151 125938 125938 133172 133172 4980 4980 191916 191916 5986917 3472412 2514505 239237 59809 179428 1630763 1378133 252630 1776144 1361296 414848 316435 205683 110752 213719 213719 4011894 3410110 601784 346544 225254 121290 SUPPLIES 8682175 7940744 741431 BAD DEBTS 4621250 4621250 QUALITY ASSURANCE ASSES 2254470 2254470 MAINTENANCE AND REPAIRS 936627 742242 194385 61901345 44057039 17844306 0 455550 88059 3232749 1580458 8109436 6987147 47500 56500 5879002 6417999 844610 831767 553219 510094 49231623 25102256 23582594 24129367 50320394 56355858 925569 881227 93950623 97838476 5132783 5669308 7971069 6933651 1264066 1297066 14367918 13900025 X 78740659 83130015 842046 808436 79582705 83938451 93950623 97838476 -362989 4718735 0 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 4980 4980 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF DUES PAID TO MHA AND AHA ARE ALLOCATED TO LOBBYING ACTIVITIES. 3460430 3460430 29197873 16745397 12452476 1694618 911723 782895 13543477 7445136 6098341 1335225 1335225 24129367 THIRD PARTY PAYOR SETTLEMENTS 1297066 1297066 X 56725188 0 56725188 191916 4621252 4813168 61538356 57088177 0 57088177 191916 4621252 4813168 61901345 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE SYSTEM, THE FOUNDATION, AND THE HOSPITAL ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE SYSTEM'S, FOUNDATION'S, AND HOSPITAL'S TAX RETURNS ARE NOT SUBJECT TO EXAMINATION BY TAXING AUTHORITIES FOR YEARS BEGINNING PRIOR TO OCTOBER 1, 2008. VENTURES IS A FOR-PROFIT ORGANIZATION. TAXES PAID BY VENTURES ARE INSIGNIFICANT AND ARE INCLUDED IN THE OPERATING EXPENSES OF THE SYSTEM. THE SYSTEM HAS ADOPTED ACCOUNTING STANDARDS RELATED TO UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, REVIEWED ALL TAX POSITIONS. THE EVALUATED POTENTIAL EXPOSURE RELATED TO UNCERTAIN TAX POSITIONS WAS FOUND TO BE IMMATERIAL. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NETTED WITH REVENUE 4,621,252. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NETTED WITH REVENUE 4,621,252. 1 1 X 1 X 1 X 1 1 1 0 1 1 895551 0 895551 0.01560 7682369 6129954 1552415 0.02710 588544 906314 -317770 0.00000 9166464 7036268 2130196 0.04270 256 4840 32391 32391 0.00060 4 52 8835 8835 0.00020 303 9882 101247 101247 0.00180 563 14774 142473 142473 0.00260 563 14774 9308937 7036268 2272669 0.04530 2 207946 207946 0.00360 232 4098 112312 1500 110812 0.00190 1 12 217 217 0.00000 235 4110 320475 1500 318975 0.00550 0 4621252 281369 12027846 11255917 771929 X 1 1 1 BARRY HEALTH PARTNERS LTD TO INTEGRATE PHYSICIAN AND HOSPITAL CLINICAL PRACTICES AND PAYOR CONTRACTIN 0.50000 0.50000 1 1 PENNOCK HOSPITAL

1009 W GREEN ST HASTINGS MI 49058

X X PENNOCK HOSPITAL 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X X X X 0 0 1 1 150.000000000000 1 350.000000000000 1 X X X X X 1 1 X X 1 0 1 X X 0 0 10 STATE STREET URGENT CARE CENTER

1108 W STATE STREET HASTINGS MI 49058

URGENT CARE CENTER PENNOCK HOME HEALTH

1230 W STATE STREET HASTINGS MI 49058

HOME HEALTH CARE AGENCY HASTINGS GENERAL SURGEONS

1009 W GREEN ST HASTINGS MI 49058

SURGEON PRACTICE OFFICE GUN LAKE FAMILY MEDICINE

77 124TH AVE SHELBYVILLE MI 49344

FAMILY PRACTICE OFFICE PENNOCK HOSPICE

1230 W STATE STREET HASTINGS MI 49058

OUTPATIENT HOSPICE CARE CLARKSVILLE FAMILY MEDICINE

155 E CROSS ST CLARKSVILLE MI 48815

FAMILY PRACTICE OFFICE CALEDONIA FAMILY MEDICINE

9090 RODGERS CT CALEDONIA MI 49316

FAMILY PRACTICE OFFICE HASTINGS FAMILY MEDICINE

1009 W GREEN ST HASTINGS MI 49058

FAMILY PRACTICE OFFICE NASHVILLE FAMILY MEDICINE

750 DURKEE NASHVILLE MI 49073

FAMILY PRACTICE OFFICE DR DEGOA

1108 W STATE STREET HASTINGS MI 49058

FAMILY PRACTICE OFFICE PART I, LINE 3C: PENNOCK USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR CHARITY CARE. WE DO NOT USE AN ASSET BASED TEST OR OTHER THRESHOLD. PART I, LINE 7: WORKSHEET NUMBER 2 WAS USED TO CALCULATED THE CHARGE RATIO. THE COST TO CHARGE RATIO WAS USED TO DETERMINE PATIENT SERVICE COSTS. 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 $ 4621252. PART II: THE MISSION OF PENNOCK HEALTH IS TO PROVIDE QUALITY HEALTH SERVICES IN A PERSONAL, PROFESSIONAL, AND PROGRESSIVE MANNER IN PARTNERSHIP WITH OUR COMMUNITY. OUR MISSION IS CLOSELY CORRELATED WITH THE HEALTH AND SOCIOECONOMIC DATA COLLECTED. THIS DATA ALONG WITH OUR MISSION ASSISTS IN STRATEGIC PLANNING EFFORTS TO ALIGN THE SERVICES PROVIDED BY PENNOCK WITH THE TRUE COMMUNITY HEALTH NEED. SPONSORSHIPS AND DONATIONS OR VOLUNTEER TIME IS DIRECTED IN THE AREAS OF HEALTH STATUS IDENTIFICATION, EVALUATION, AND EDUCATION WHERE PREVENTION OR MANAGEMENT IS TAUGHT. PENNOCK COLLEAGUES VOLUNTEER TIME AND MATERIALS TO PROVIDE HEALTH SCREENINGS, FREE OR AT A REDUCED RATED DEPENDING ON THE SERVICE BEING PROVIDED. COLLEAGUES ALSO COLLABORATE WITH LOCAL BUSINESSES TO EDUCATE THEIR EMPLOYEES ON HEALTH IMPROVEMENT AND COST SAVINGS OPTIONS TO EMPLOYERS, WHICH HELPS THE LOCAL ECONOMY AND IMPROVES OVERALL HEALTH OF OUR WORKFORCE. FINALLY, PENNOCK PROVIDES A LOCATION FREE OF CHARGE TO HOUSE THE BARRY COMMUNITY FREE CLINIC AND HABITAT FOR HUMANITY TO ALLEVIATE OVERHEAD AND ALLOW THESE SERVICES TO ASSIST THOSE IN NEED IN OUR COUNTY. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISIONS FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA RELATED TO THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING THE BARRY COUNTY HEALTH PLAN CHARGES. THE CRITERIA USED FOR DETERMINING PATIENT ELIGIBILITY UNDER THE BARRY COUNTY HEALTH PLAN FALLS WITHIN OUR CHARITY CARE POLICY. PART III, LINE 8: PENNOCK HOSPITAL DOES NOT EXPERIENCE A MEDICARE SHORTFALL. THE MEDICARE COST REPORT WAS USED TO REPORT MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: IT IS THE POLICY OF PHS, TO ACKNOWLEDGE AND UNDERSTAND THAT ALL ITS PATIENTS ARE NOT EQUALLY CAPABLE OF WITHSTANDING THE BURDEN OF PAYMENT FOR SERVICES, EITHER BY THEMSELVES OR THROUGH A THIRD PARTY INSURANCE CARRIER. PHS, THROUGH THE PATIENT FINANCIAL SERVICES (PFS) DEPARTMENT, HAVE IMPLEMENTED DETAILED AND ROBUST POLICIES ON CHARITY (PHS CHARITY CARE POLICY) AND COLLECTIONS (PHS CREDIT/COLLECTION POLICY). ONCE THE DECISION IS MADE TO PROVIDE FINANCIAL ASSISTANCE, THE PATIENT IS NOTIFIED AND NECESSARY CHANGES OR ADJUSTMENTS TO A PATIENT ACCOUNT ARE MADE, FOLLOWING POLICY, BY THE PHS STAFF. PENNOCK HOSPITAL PART V, SECTION B, LINE 3: PENNOCK HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE UTILIZING INTERNAL DATA, DATA COLLECTED FROM THOMPSON REUTERS, MICHIGAN HEALTH AND HOSPITAL ASSOCIATION, BARRY EATON HEALTH DEPARTMENT, LOCAL SOCIAL SERVICE AGENCIES, SCHOOL SYSTEMS, NATIONAL HEALTH ASSOCIATIONS (AMERICAN CANCER SOCIETY, AMERICAN HEART ASSOCIATION, AMERICAN DIABETES ASSOCIATION, MARCH OF DIMES), AND OUR PAYORS. PENNOCK COLLECTS DATA INTERNALLY BASED ON INPATIENT AND OUTPATIENT STATISTICS. THOMPSON REUTERS PROVIDES DATA REGARDING THE SERVICES BEING USED BY THE POPULATION WITHIN THE SERVICE AREA SUPPORTED BY PENNOCK HOSPITAL, INCLUDING PROJECTED POPULATION GROWTH TRENDS BY AGE AND SEX. THIS HELPS US TO EXAMINE THE PATIENT NEEDS AT A CLOSER LEVEL. LOCAL SOCIAL SERVICES AGENCIES AND SCHOOL SYSTEMS HELP US IDENTIFY SOCIOECONOMIC FACTORS CONTRIBUTING TO THE IDENTIFIED HEALTH STATUS OF OUR SERVICE AREA. THE NATIONAL HEALTH ASSOCIATIONS PROVIDE DATA AS RELATED TO THEIR DISEASE SPECIFIC AREA FOR OUR COUNTY. PENNOCK HOSPITAL PART V, SECTION B, LINE 5C: THROUGH THE WORKGROUP MEMBERS AND THEIR RELATED AGENCIES. PENNOCK HOSPITAL PART V, SECTION B, LINE 7: THE TOP TEN LEADING CAUSES OF DEATH IN BARRY COUNTY ARE CANCER, HEART DISEASE, DIABETES-RELATED, CHRONIC LOWER RESPIRATORY, STROKE, ALZHEIMERS DISEASE, UNINTENTIONAL INJURY, PNEMONIA & INFLUENZA, INTENTIONAL SELF-HARM (SUICIDE), KIDNEY DISEASE, CHRONIC LIVER DISEASE, INFANT MORTALITY, SEPTICEMIA, ALCOHOL-INDUCED, AIDS, AND ASSAULT (HOMICIDE). DISEASE STATE OR CAUSE OF DEATH WERE NOT CHOSEN BECAUSE OF THE FOCUS ON PREVENTION OF CHRONIC DISEASE THROUGH CHANGING BEHAVIORS AND PREVENTING ILLNESS. ADDITIONALLY, PENNOCK HEALTH SERVICES EXPANDED NEPHROLOGY, OFFERS DIABETIC EDUCATION AND HEALTH COACHES TO ADDRESS HEALTH BEHAVIORS AND MANAGEMENT, AND ALL PENNOCK PHYSICIAN NETWORK CLINICS AND MOST OF THE PHYSICIAN OFFICES ARE PATIENT CENTERED MEDICAL HOME (PCMH) DESIGNATED WHERE THEY HAVE A STRONG FOCUS ON PREVENTION AND DISEASE MANAGEMENT. IN 2012, PENNOCK BROUGHT DIALYSIS SERVICES TO BARRY COUNTY. PENNOCK IS EXPANDING HEART AND VASCULAR SERVICES, AND HAS A STRATEGIC INITIATIVE ALREADY IN PLACE TO EXPAND CANCER SERVICES. TOBACCO USE REDUCTION HAS A COALITION WORKING ON THIS INITIATIVE; THE STEERING COMMITTEE FELT IT NEEDED A STRONGER PARTNERSHIP WITH PENNOCK. BARRY SUBSTANCE ABUSE TASKFORCE ADDRESSES ALCOHOL AND DRUG USE. PENNOCK AIDS IN AWARENESS AND THE PENNOCK FOUNDATION PROVIDES SOME FUNDING. IN ADDITION, A GROUP HAS FORMED TO REDUCE SUICIDE. PENNOCK AND THE PENNOCK FOUNDATION ASSIST WITH RESOURCE AWARENESS AND FUNDING. PENNOCK HOSPITAL PART V, SECTION B, LINE 20D: PENNOCK HEALTH SERVICES PROVIDES CHARITY CARE TO INDIVIDUALS UNABLE TO PAY THEIR BILL. ALL MEDICALLY NECESSARY SERVICES RENDERED BY PENNOCK HOSPITAL, PENNOCK HOMECARE/HOSPICE AND PENNOCK FAMILY MEDICINE MAY QUALIFY FOR CHARITY CARE. PATIENTS MAY REQUEST A WRITTEN DETERMINATION OF ELIGIBILITY THROUGH PENNOCK HOSPITAL'S PATIENT FINANCIAL SERVICES DEPARTMENT. ELIGIBILITY DETERMINATIONS WILL BE MADE WITHIN THIRTY (30) DAYS OF THE COMPLETED REQUEST. WE WILL USE THE INFORMATION THAT IS PROVIDED ON THE 'CHARITY CARE APPLICATION' AND THE 'CHARITY CARE SLIDING SCALE' TO MAKE A CHARITY CARE DETERMINATION. PART VI, LINE 3: FOR SCHEDULED PATIENTS, DURING THE PRE-REGISTRATION PROCESS, STAFF MAY CONTACT PATIENTS TO DISCUSS THEIR PATIENT FINANCIAL RESPONSIBILITY, AND AT THAT TIME WILL DISCUSS ASSISTANCE, AND PAYMENT OPTIONS. FOR NON-SCHEDULED PATIENTS WHO ARE ADMITTED, OUR FINANCIAL COUNSELOR/CUSTOMER SERVICE REPRESENTATIVE WILL MEET WITH THE PATIENT. WE PROVIDE EDUCATION REGARDING GOVERNMENT-FUNDED PROGRAMS, INCLUDING MEDICARE AND MEDICAID, WITH ELIGIBILITY SPECIALISTS ON STAFF. WE ALSO WORK CLOSELY WITH COUNTY HEALTH PLAN STAFF TO IDENTIFY ELIGIBLE PATIENTS FOR SERVICES BEYOND THOSE PROVIDED AT PENNOCK HOSPITAL. WE ALSO EDUCATE OUR PATIENTS WITH ALL AVAILABLE PROGRAMS SPONSORED BY PENNOCK HOSPITAL, INCLUDING THE CHARITY POLICY, EXTENSION OF CREDIT THROUGH THE PENNOCK CREDIT PROGRAM OR THE HELP PROGRAM WHICH PROVIDES SHORT-TERM AND LONGER-TERM FINANCING OPTIONS. OPTIONS THAT ARE AVAILABLE ARE INCLUDED ON PRINTED MATERIALS WHICH ARE LOCATED THROUGHOUT THE COMMUNITY AT MANY FAMILY PRACTICE PHYSICIAN OFFICES, AS WELL AS AROUND THE HOSPITAL CAMPUS, AND ON THE HOSPITALS WEBSITE. PART VI, LINE 4: BARRY COUNTY, MICHIGAN IS THE COMMUNITY PENNOCK SERVES. BARRY COUNTY BOASTS 58,434 RESIDENTS, UP 3% SINCE 2000. WITH 13.7% OF THE POPULATION OVER THE AGE OF 65, BARRY COUNTY IS A RELATIVELY YOUNG COMMUNITY. BARRY COUNTY ALSO SERVES AS A STABLE COMMUTER COMMUNITY WHERE THE AVERAGE TRAVEL TIME IS APPROXIMATELY 30 MINUTES AND THE AVERAGE HOUSEHOLD INCOME IS $54,177. BARRY COUNTY IS UNIQUELY LOCATED IN THE MIDDLE OF FOUR (4) LARGER METROPOLITAN AREAS: GRAND RAPIDS, LANSING, KALAMAZOO, AND BATTLE CREEK. PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR ALL OF ITS DEPARTMENTS. SURPLUS FUNDS ARE CONTINUALLY USED TO FUND IMPROVEMENTS IN PATIENT CARE AND MEDICAL EDUCATION.PENNOCK OPERATES OUTPATIENT DIAGNOSTIC CENTERS, IONIA DIAGNOSTIC CENTER, 537 W. MAIN ST., IONIA, MICHIGAN 48846 AND LAKE ODESSA DIAGNOSTIC CENTER, 4294 LAUREL DR., SUITE #4, LAKE ODESSA, MICHIGAN 48849, AND AN URGENT CARE CENTER, STATE STREET CENTER AND DIAGNOSTIC IMAGING CENTER, 1108 W. STATE STREET CENTER, HASTINGS, MICHIGAN 49058. WE ALSO PROVIDE ONSITE OCCUPATIONAL MEDICINE WITH A PARTNER EMPLOYER LOCATED IN MIDDLEVILLE, MICHIGAN. REPORTS FILED WITH STATES PART VI, LINE 7 MI X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 SHERYL LEWIS BLAKE 276223 0 41510 0 42536 0 10524 0 21852 0 392645 0 0 0 CONNIE S DOWNS 185016 0 26480 0 19149 0 7316 0 15149 0 253110 0 0 0 CARLA WILSON NEIL 166917 0 12811 0 17367 0 11537 0 2961 0 211593 0 0 0 STEVE A MARZOLF 135838 0 13022 0 11148 0 4069 0 5626 0 169703 0 0 0 JAMES WINCEK 121533 0 16763 0 12151 0 4753 0 1709 0 156909 0 0 0 BRIDGIT BRENNAN MD 285230 0 0 0 14193 0 4054 0 0 0 303477 0 0 0 MAX RAPPAPORT MD 285230 0 0 0 3453 0 1780 0 0 0 290463 0 0 0 ANITA ASADORIAN 144054 0 13923 0 126522 0 6750 0 0 0 291249 0 0 0 ANDREW PARSONS MD 215890 0 0 0 4645 0 2964 0 0 0 223499 0 0 0 CARRIE SANDBORN 127362 0 11067 0 54486 0 0 0 0 0 192915 0 0 0 PART I, LINE 1A THE HEALTH AND WELLNESS CENTER IS AVAILABLE TO ALL BOARD MEMBERS AND IS TREATED AS TAXABLE COMPENSATION PER POLICY, DATED 9/28/2010. A MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465E3R2 2003-01-08 4300000 HEALTHCARE EQUIPMENT 0 0 1 B MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465E5B5 2003-10-22 6000000 HEALTHCARE EQUIPMENT 0 0 1 C MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465E5V1 2003-12-10 3832599 HEALTHCARE EQUIPMENT 0 0 1 D MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HEP7 2007-03-28 3031165 HEALTHCARE EQUIPMENT 0 0 1 A 3526116 4300000 4300000 0 0 1 1 B 5746469 6000000 6000000 0 0 1 1 C 3832599 3832599 3832599 0 0 1 1 D 1649335 3031165 3031165 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 0 B 0 0 1 0 1 0 0 0 0 C 0 0 1 0 1 0 0 0 0 D 0 0 1 0 1 0 0 0 0 A 1 B 1 C 1 D 1 A MICHIGAN FINANCE AUTHORITY 800596186 59447PDT5 2011-03-23 5618998 HEALTHCARE EQUIPMENT 0 0 1 A 1094234 5618998 5618998 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 0 A 1 CONNIE DOWNS CFO HIGHER EDUCATION X 56500 56500 0 1 1 56500 SCOTT BRASSEUR MD PROVIDER/BOARD MEMBER 40847 CONTRACT SERVICE 0 HASTINGS CITY BANK NANCY GOODIN, BOARD MEMBER OF HOSPITAL AND DIRECTOR OF MARKETING AT BANK 74487 INVESTMENT FEES 0 FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF TRUSTEES RECEIVED TRAINING, CONDUCTED BY OUR INDEPENDENT PUBLIC ACCOUNTANTS ON THE RULES AND REQUIREMENTS OF THE IRS FORM 990. ON JULY 29, 2014 THE COMPLETED IRS FORM 990 WAS REVIEWED PRIOR TO FILING THE RETURN. THE BOARD OF TRUSTEES VOTED TO APPROVE THE FORM 990 AS A TRUE REPRESENTATION OF THE HOSPITAL'S ACTIVITY DURING THE FISCAL YEAR. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY BOARD MEMBERS. MEMBERS ARE RESPONSIBLE FOR FULL DISCLOSURE OF POTENTIAL CONFLICTS WHICH ARE DOCUMENTED IN THE MINUTES. ANY INDIVIDUAL WITH A CONFLICT OF INTEREST MUST ABSTAIN FROM VOTING ON ANY RELEVANT ITEMS. FORM 990, PART VI, SECTION B, LINE 15 PENNOCK USES SALARY SURVEYS ALONG WITH HIRING A CONSULTING COMPANY IN ASSISTING WITH SETTING WAGES FOR THE OFFICER'S AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE IS COMPRISED OF THREE BOARD MEMBERS TO REVIEW COMPENSATION AND ADVISE THE FULL BOARD OF SALARIES, RAISES, AND BENEFITS. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS FISCAL YEAR 2013. ALL DISCUSSIONS FROM THE COMPENSATION COMMITTEE ARE DOCUMENTED IN MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND 990 ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. PENNOCK FOUNDATION 1009 WEST GREEN STREET HASTINGS MI 49058 382713275 FOUNDATION MI 501(C)(3) LINE 11B, II PENNOCK HEALTHCARE SYSTEMS 1 PENNOCK HEALTHCARE SYSTEM 1009 WEST GREEN STREET HASTINGS MI 49058 382713276 PARENT ORGANIZATION MI 501(C)(3) LINE 11B, II N/A 0 PENNOCK VENTURES 1009 WEST GREEN STREET HASTINGS MI 49058 382712819 REAL ESTATE MI N/A C 0 1 0 1 1 1 0 0 0 0 1 1 0 1 1 0 1 0 0 0 PENNOCK VENTURES A 31595 FMV PENNOCK FOUNDATION C 10547 CASH PENNOCK VENTURES D 328052 CASH PENNOCK VENTURES I 30456 FMV PENNOCK VENTURES J 438763 FMV PENNOCK FOUNDATION N 37076 CASH PENNOCK FOUNDATION P 18014 CASH PENNOCK FOUNDATION E 12376 CASH PENNOCK FOUNDATION M 3924 FMV