2013-08-13T08:56:45-05:00 2012-09-30 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2011-10-01 381360562 PENNOCK HOSPITAL PENN 2699453451 1009 WEST GREEN STREET HASTINGS MI 49058 CONNIE S DOWNS 2699453451 2013-08-08 1 CAROL LALONDE CPA P00181637 2695674500 2011 2016-02-24 21:20:13Z PENNOCK HEALTH SYSTEMS CONNIE S DOWNS 1009 WEST GREEN STREET HASTINGS MI 49058 86471851 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. 11 10 686 146 115028 -24434 485639 59106 56329865 62147623 1379094 2494651 856715 344098 59051313 65045478 0 0 0 0 29522310 29685771 0 0 0 26350227 30730386 55872537 60416157 3178776 4629321 84824995 93950623 14044836 14367918 70780159 79582705 PENNOCK HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH SERVICES IN A PERSONAL, PROFESSIONAL AND PROGRESSIVE MANNER IN PARTNERSHIP WITH THE COMMUNITY. 0 0 44973776 62147623 PENNOCK CONTINUED TO DEMONSTRATE VALUE DURING 2012 THROUGH BOTH INPATIENT AND OUTPATIENT PROGRAMS. PENNOCK DEVELOPED A HOSPITALIST PROGRAM AND COMPLETED CONSTRUCTION ON THE GUN LAKE MEDICAL CENTER WHICH INCLUDES PRIMARY CARE PHYSICIANS, OUTPATIENT REHABILITATION AND IMAGING. PENNOCK CONTINUED TO ADD PHYSICIAN AND MID-LEVEL PROVIDERS TO MEET THE PENNOCK MARKET AREA DEMAND. PENNOCK'S COMMITMENT TO PROVIDE QUALITY HEALTH CARE CONTINUES TO BE THE OVERARCHING THEME. AS SUCH, INVESTMENTS IN FACILITIES, TECHNOLOGY AND MEDICAL STAFF CONTINUED TO TAKE PLACE DURING 2012. 44973776 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 67 0 1 686 1 1 1 0 0 0 0 0 0 0 0 0 X 11 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 X BONNIE HILDRETH 0.50 X 0 0 0 SCOTT BRASSEUR MD 0.50 X X 70089 0 0 DREW CHAPPLE 0.50 X 0 0 0 MAGGIE COLEMAN 0.50 X X 0 0 0 NANCY GOODIN 0.50 X 0 0 0 AL JARVIS 0.50 X 0 0 0 BRAD JOHNSON CPA 0.50 X X 0 0 0 DAVID BAUM 0.50 X X 0 0 0 DAVID PARKER MD 0.50 X X 60180 0 0 DAN KING 0.50 X 0 0 0 JEFF WEIDEN 0.50 X 0 0 0 JAMES HORTON 0.50 X X 0 0 0 SHERYL LEWIS BLAKE 40.00 X 326912 0 30408 CONNIE S DOWNS 40.00 X 210928 0 22028 CARLA WILSON NEIL 40.00 X 200230 0 14236 STEPHAN A MARZOLF 40.00 X 148992 0 22138 JAMES J WINCEK 40.00 X 138490 0 5568 LAWRENCE HAWKINS MD 40.00 X 132474 0 3753 ANITA ASADORIAN DO 40.00 X 187099 0 5737 FREDERICK BEAN MD 40.00 X 170726 0 3692 CARRIE SANDBORN 40.00 X 180922 0 1339 1827042 0 108899 16 0 1 0 JOHNSON CONSTRUCTION COMPANY 2442 28TH ST SW WYOMING MI 49519 CONSTRUCTION SERVICES 1533296 HASTINGS ANESTHESIA PLC PO BOX 4095 KALAMAZOO MI 49003 ANESTHESIA SERVICES 679847 PROGRESSIVE BUILDING SERVICES PO BOX 88235 KENTWOOD MI 49518 HOUSEKEEPING SERVICES 658570 SPECTRUM HEALTH 100 MICHIGAN GRAND RAPIDS MI 49503 REFERENCE LAB/SLEEP STUDY 453338 SCHLEY ARCHITECTS PO BOX 19640 KALAMAZOO MI 49019 CONSTRUCTION SERVICES 318185 15 24390 34716 59106 PATIENT SERVICE REVENU 621110 60260969 60260969 MEANINGFUL USE PROJECT 621110 1886654 1886654 62147623 213578 213578 707625 883230 -175605 -175605 -175605 22824216 20202391 340752 2621825 -340752 2281073 2281073 CAFETERIA REVENUE 722100 307330 307330 LAB COURIER SERVICE 621500 115028 115028 MISCELLANEOUS 900099 97345 97345 519703 65045478 62147623 115028 2723721 1276738 1161831 114907 23270967 15126128 8144839 1148183 803728 344455 2266575 1586593 679982 1723308 1206315 516993 59125 59125 123964 123964 5022 5022 134102 134102 5623847 3231037 2392810 275231 68808 206423 1340410 1152146 188264 1728751 1319616 409135 335914 218346 117568 208134 208134 4341170 3689994 651176 375595 244137 131458 SUPPLIES 8605302 7947930 657372 BAD DEBTS 3767330 3767330 QUALITY ASSURANCE ASSES 2645881 2645881 MAINTENANCE AND REPAIRS 689174 536697 152477 471434 471434 60416157 44973776 15442381 0 1416272 455550 5412612 3232749 5966416 8109436 19000 47500 5446456 5879002 405097 844610 504624 553219 81687732 58105138 24653648 23582594 40070282 50320394 930588 925569 84824995 93950623 4569131 5132783 7506355 7971069 1969350 1264066 14044836 14367918 X 69938113 78740659 842046 842046 70780159 79582705 84824995 93950623 X 4629321 4173225 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5022 5022 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 42262589 30968410 11294179 2401382 1509168 892214 31881332 25627560 6253772 1681999 1681999 23582594 THIRD PARTY PAYOR SETTLEMENTS 1264066 1264066 65045478 60416157 4629321 4173225 4173225 8802546 61144045 0 61144045 134103 3767330 3901433 65045478 56514724 0 56514724 134103 3767330 3901433 60416157 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2007. 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 XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NETTED WITH REVENUE 3,767,330. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NETTED WITH REVENUE 3,767,330. 1 1 X 1 X 350.000000000000 1 X 1 1 1 0 1 1 0 0 596383 0 596383 0.01050 0 0 7096804 7222249 -125445 0.00000 0 0 1350389 895115 455274 0.00800 9043576 8117364 926212 0.01850 176 6260 27352 0 27352 0.00050 12 54 9535 0 9535 0.00020 0 0 0 0 0 0 0 0 301 7563 82475 0 82475 0.00150 489 13877 119362 119362 0.00220 489 13877 9162938 8117364 1045574 0.02070 2 207946 1 207945 0.00370 1 3361 3361 0.00010 3 185 185 0.00000 176 2473 99555 99555 0.00180 182 2473 311047 1 311046 0.00560 0 1341258 275455 12150331 11592401 557930 X 1 1 1 BARRY HEALTH PARTNERS LTD TO INEGRATE PHYSICIAN AND HOSPITAL CLINICAL PRACTICES AND PAYOR CONTRACTING 0.50000 0.50000 1 1 PENNOCK HOSPITAL

1009 W GREEN ST HASTINGS MI 49058

X X PENNOCK HOSPITAL 1 0 1 1 350.000000000000 1 350.000000000000 1 X 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 7: THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET #2 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 $ 3767330. 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: FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED.THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING MEDICAID, MEDICAID HMO, BARRY COUNTY HEALTH PLAN AND OTHER COMMUNITY HEALTH PLAN CHARGES. THE CRITERIA USED FOR DETERMINING PATIENT ELIGIBILITY FOR THESE PAYORS IS DOCUMENTED WITHIN OUR CHARITY CARE POLICY. PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. PART III, LINE 8: THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET #2 WAS USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS.THE AMOUNTS REPORTED IN PART III, LINES 5 AND 6 ARE FROM THE ORGANIZATION'S COST REPORT, AS OUTLINED IN THE FORM INSTRUCTIONS. HOWEVER, THERE ARE SEVERAL MEDICARE PROGRAMS WHICH HAVE SIGNIFICANT ACTIVITY THAT IS NOT REFLECTED IN THE AMOUNTS REPORTED, INCLUDING THE ADVANTAGE PROGRAMS AND THE HOME HEALTH PROGRAM. THE INCLUSION OF THIS ACTIVITY WOULD RESULT IN AN INCREASE TO LINE 5 TO $20,590,031 AND LINE 6 TO $21,232,326, RESULTING IN A SHORTFALL OF $(642,295). PART III, LINE 9B: IT IS THE POLICY OF PENNOCK HOSPITAL 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. ONCE THE DECISION IS MADE TO PROVIDE FINANCIAL ASSISTANCE, THE PATIENT IS NOTIFIED IN WRITING AND THE FINANCIAL COUNSELOR/CUSTOMER SERVICE REPRESENTATIVE ADJUSTS THE PATIENT'S OUTSTANDING BILL(S). UNEXPECTED SERVICES RENDERED AFTER A PRELIMINARY WRITE-OFF AND WITHIN NINETY DAYS OF A FINANCIAL REVIEW, WILL BE TREATED AS PART OF THE INITIAL AMOUNT AND ADJUSTED. PENNOCK HOSPITAL PART V, SECTION B, LINE 19D: PENNOCK HEALTH SERVICES PROVIDES CHARITY CARE TO INDIVIDUALS UNABLE TO PAY THEIR BILL.ALL MEDICALLY NECESSARY SERVICES RENDERED BY PENNOCK HOSPITAL, PENNOCK HOMECARE/HOSPICE ANDPENNOCK FAMILY MEDICINE MAY QUALIFY FOR CHARITY CARE.PATIENTS MAY REQUEST A WRITTEN DETERMINATION OF ELIGIBILITY THROUGH PENNOCK HOSPITAL'S PATIENTFINANCIAL 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 CARESLIDING SCALE' TO MAKE A CHARITY CARE DETERMINATION. PART VI, LINE 2: PENNOCK HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE UTILIZING INTERNAL DATA, DATA COLLECTED FROM TRUVEN HEALTH, 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. TRUVEN HEALTH ANALYTICS 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. 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. PART VI, LINE 4: BARRY COUNTY, MICHIGAN IS THE COMMUNITY PENNOCK SERVES. BARRY COUNTY BOASTS 58,999 RESIDENTS, DOWN 0.3% SINCE 2011. WITH 15% 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 $52,061. 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 1 0 0 0 0 0 0 0 SHERYL LEWIS BLAKE 270772 0 14393 0 41747 0 0 0 30408 0 357320 0 0 0 CONNIE S DOWNS 184927 0 6852 0 19149 0 0 0 22028 0 232956 0 0 0 CARLA WILSON NEIL 159860 0 4212 0 36158 0 0 0 14236 0 214466 0 0 0 STEPHAN A MARZOLF 131940 0 6110 0 10942 0 0 0 22138 0 171130 0 0 0 ANITA ASADORIAN DO 143168 0 41309 0 2622 0 0 0 5737 0 192836 0 0 0 FREDERICK BEAN MD 162455 0 6291 0 1980 0 0 0 3692 0 174418 0 0 0 CARRIE SANDBORN 145018 0 35673 0 231 0 0 0 1339 0 182261 0 0 0 PART I, LINE 1A THE HEALTH AND WELLNESS CENTER IS AVAILABLE TO ALL OFFICERS AND IS NOT TREATED AS TAXABLE COMPENSATION. MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2003 382889417 59465E5V1 2003-12-10 4300000 HEALTHCARE EQUIPMENT #03 0 0 0 MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2004 382889417 59465E6T5 2004-05-26 6000000 HEALTHCARE EQUIPMENT #26 0 0 0 MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2006 382889417 59465HDY9 2006-09-27 3031165 HEALTHCARE EQUIPMENT #58 0 0 0 MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2011 382889417 59447PDT5 2011-03-23 2734921 HEALTHCARE EQUIPMENT #81 0 0 0 4300000 51600 4300000 2003 0 0 1 1 6000000 72000 6000000 2005 0 0 1 1 3031165 36374 3031165 2006 0 0 1 1 2734921 41675 2693246 2012 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 X MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2011 382889417 59447PFB2 2011-06-29 2430865 HEALTHCARE EQUIPMENT #81 0 0 0 2430865 30019 2400846 2012 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 CONNIE DOWNS CFO HIGHER EDUCATION X 47500 47500 0 1 1 47500 DAVID PARKER MD PROVIDER/BOARD MEMBER 35759 CONTRACT SERVICE 0 SCOTT BRASSEUR MD PROVIDER/BOARD MEMBER 48921 CONTRACT SERVICE 0 HASTINGS CITY BANK NANCY GOODIN, BOARD MEMBER OF HOSPITAL AND DIRECTOR OF MARKETING AT BANK 62184 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 30, 2013 THE COMPLETED IRS FORM 990 WILL BE REVIEWED PRIOR TO FILING THE RETURN. THE BOARD OF TRUSTEES WILL VOTE 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 2012. 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 VII SHERYL LEWIS BLAKE WORKED AN AVERAGE OF AT LEAST 2 HOURS PER WEEK AT A RELATED ORGANIZATION. MAGGIE COLEMAN, DAVID BAUM, CONNIE DOWNS, AND BRAD JOHNSON WORKED AN AVERAGE OF AT LEAST 1 HOUR PER WEEK AT A RELATED ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 4,173,225. 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 1 0 1 1 1 0 0 0 1 1 0 0 1 1 0 1 0 0 PENNOCK VENTURES J 436493 FMV PENNOCK VENTURES I 30456 FMV PENNOCK FOUNDATION C 24390 CASH PENNOCK VENTURES D 493442 CASH PENNOCK VENTURES A 55466 FMV PENNOCK FOUNDATION M 10000 FAIR MARKET VALUE PENNOCK FOUNDATION N 23147 CASH PENNOCK FOUNDATION P 30390 CASH PENNOCK FOUNDATION E 92432 CASH