COREWELL HEALTH: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COREWELL HEALTH (EIN 38-1360562)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-05-15
IRS object ID
201201369349305030
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-15T13:25:04-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1750 TRADE CENTRE WAY STE 300AddressLine1
CityPORTAGECity
StateMIState
ZIP Code49002ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN381360562EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PENNOCK HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPENNNameControl
Phone2699453451Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11009 WEST GREEN STREETAddressLine1
CityHASTINGSCity
StateMIState
ZIP Code49058ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCONNIE S DOWNSName
TitleCHIEF FINANCIAL OFFICERTitle
Phone2699453451Phone
Date Signed2012-05-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCAROL LALONDE CPAName
Phone2695674500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1PENNOCK HEALTH SYSTEMSBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonCONNIE S DOWNSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11009 WEST GREEN STREETAddressLine1
CityHASTINGSCity
StateMIState
ZIP Code49058ZIPCode
FieldValueIRS element (for citing)
Gross Receipts75891526GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PENNOCKHEALTH.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1923YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionTHE 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 DETERMINE TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees665TotalNbrEmployees
Total Nbr Volunteers145TotalNbrVolunteers
Total Gross UBI113747TotalGrossUBI
Net Unrelated Business Txbl Income-21883NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year55983ContributionsGrantsPriorYear
Contributions Grants Current Year485639ContributionsGrantsCurrentYear
Program Service Revenue Prior Year54409950ProgramServiceRevenuePriorYear
Program Service Revenue CY56329865ProgramServiceRevenueCY
Investment Income Prior Year964594InvestmentIncomePriorYear
Investment Income Current Year1379094InvestmentIncomeCurrentYear
Other Revenue Prior Year472714OtherRevenuePriorYear
Other Revenue Current Year856715OtherRevenueCurrentYear
Total Revenue Prior Year55903241TotalRevenuePriorYear
Total Revenue Current Year59051313TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year27325922SalariesEtcPriorYear
Salaries Etc Current Year29522310SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year27226850OtherExpensePriorYear
Other Expenses Current Year26350227OtherExpensesCurrentYear
Total Expenses Prior Year54552772TotalExpensesPriorYear
Total Expenses Current Year55872537TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1350469RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3178776RevenuesLessExpensesCY
Total Assets BOY80558605TotalAssetsBOY
Total Assets EOY84824995TotalAssetsEOY
Total Liabilities BOY10862743TotalLiabilitiesBOY
Total Liabilities EOY14044836TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY69695862NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY70780159NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPENNOCK HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH SERVICES IN A PERSONAL, PROFESSIONAL AND PROGRESSIVE MANNER IN PARTNERSHIP WITH THE COMMUNITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense40557128Expense
Revenue56329865Revenue
DescriptionPENNOCK CONTINUED TO DEMONSTRATE VALUE DURING 2011 THROUGH THE EXTENSION OF SERVICES TO OUR OUTLYING MARKETS AS NURSE PRACTITIONERS WERE ADDED TO INCREASE THE AVAILABILTY OF FAMILY MEDICAL CARE TO PATIENTS IN CLARKSVILLE AND A NEW ORTHOPEDIC SURGEON AND FAMILY PHYSICIAN WERE ADDED 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 CONTINUE TO BETTER SERVE OUR COMMUNITY.ADULT AND PEDIATRIC ADMISSION 2,682AVERAGE DAILY CENSUS 28AVERAGE LENGTH OF STAY (DAYS) 4BIRTHS (NUMBER OF DELIVERIES) 347CARDIOPULMONARY TREATMENTS 44,216DIETARY (MEALS SERVED) 196,002EMERGENCY ROOM VISITS 18,705EMPLOYEES 603HOMECARE VISITS 9,885LABORATORY PROCEDURES 340,056 PHARMACY (DOSES DISPENSED) 426,991RADIOLOGY (ALL PROCEDURES) 52,844 REHABILITATION SERVICES 37,071SURGICAL PROCEDURES 3,108URGENT CARE VISITS 13,390OCCUPATIONAL THERAPY 9,966PENNOCK TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.Description
Total Program Service Expense40557128TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109641NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees665NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CONNIE DOWNSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2699483122TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11009 W GREEN STAddressLine1
CityHASTINGSCity
StateMIState
ZIP Code49058ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
BONNIE HILDRETH
MEMBER0.50X000
SCOTT BRASSEUR MD
SECRETARY0.50X6088100X
DREW CHAPPLE
MEMBER0.50X000
MAGGIE COLEMAN
CHAIRMAN0.50X000X
NANCY GOODIN
MEMBER0.50X000
AL JARVIS
MEMBER0.50X000
BRADLEY JOHNSON CPA
TREASURER0.50X000X
DAVID BAUM
VICE CHAIR0.50X000X
DAVID PARKER MD
MEMBER0.50X5605800X
DAN KING
MEMBER0.50X000
JEFF WEIDEN
MEMBER0.50X000
JAMES HORTON
MEMBER - NON-VOTING0.50X000
SHERYL LEWIS BLAKE
CEO40.00268360030519X
CONNIE S DOWNS
CFO40.00189157022125X
CARLA WILSON-NEIL
COO40.00161893014228X
STEPHAN A MARZOLF
CHIEF NURSING OFFICER40.00130580020252X
JAMES J WINCEK
VICE PRESIDENT SUPPORT SER40.0012096704871X
DONALD GINGERICH DO
PHYSICIAN40.0013439407142X
LAWERENCE HAWKINS MD
PHYSICIAN40.0013811103820X
CRAIG JONES
PHARMACIST40.0011849107850X
ANITA ASADORIAN DO
PHYSICIAN40.0014620205608X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1525094TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation116415TotalOtherCompensation
Number Individuals GT100 K12NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HASTINGS ANESTHESIA PLC
900 PEELER STKALAMAZOOMI49008ANESTHESIA SERVICES683730
PROGRESSIVE BUILDING SERVICES
440 36TH STREETWYOMINGMI49548HOUSEKEEPING SERVICES647371
SPECTRUM HEALTH
4600 BRETON ROAD SEKENTWOODMI49508REFERENCE LAB/SLEEP STUDY419447
HASTINGS EMERGENCY PHYSICIANS
PO BOX 232GRAND RAPIDSMI49501ER MANAGEMENT391917
ALLIANCE HNI LLC
525 S GOULDOWOSSOMI48867MRI MAINTENANCE290037
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Related Organizations485557RelatedOrganizations
All Other Contributions82AllOtherContributions
Total Contributions485639TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUDescription
Business Code621110BusinessCode
Total Revenue Column56329865TotalRevenueColumn
Related Or Exempt Function Income56329865RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue56329865TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column236917TotalRevenueColumn
Exclusion$236,917ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real574816Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real827802Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-252986Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-252986TotalRevenueColumn
Exclusion-$252,986ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities17147895Securities
Other6693Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities15931181Securities
Other81230Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1216714Securities
Other-74537Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1142177TotalRevenueColumn
Exclusion$1,142,177ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
MISCELLANEOUS900099719212$719,212
CAFETERIA REVENUE722100276742$276,742
LAB COURIER SERVICE621500113747113747
FieldValueIRS element (for citing)
Total Other Revenue1109701TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column59051313TotalRevenueColumn
Related Or Exempt Function Income56329865RelatedOrExemptFunctionIncome
Unrelated Business Revenue113747UnrelatedBusinessRevenue
Exclusion$2,122,062ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1096187Total
Program Services992078ProgramServices
Management And General104109ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21554372Total
Program Services14010342ProgramServices
Management And General7544030ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1080806Total
Program Services756564ProgramServices
Management And General324242ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4187053Total
Program Services2930937ProgramServices
Management And General1256116ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1603892Total
Program Services1122724ProgramServices
Management And General481168ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total75482Total
Program Services75482ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total140375Total
Management And General140375ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total5098Total
Management And General5098ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total134574Total
Management And General134574ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6539436Total
Program Services3795830ProgramServices
Management And General2743606ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total135071Total
Program Services33768ProgramServices
Management And General101303ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1108591Total
Program Services937970ProgramServices
Management And General170621ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1628687Total
Program Services1252315ProgramServices
Management And General376372ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total285988Total
Program Services185892ProgramServices
Management And General100096ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total132907Total
Program Services132907ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3907175Total
Program Services3321099ProgramServices
Management And General586076ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total363902Total
Program Services236536ProgramServices
Management And General127366ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES72190966566543652553
BAD DEBTS37193763719376
MAINTENANCE AND REPAIRS641055486765154290
COLLECTIONS313414313414

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total55872537Total
Program Services40557128ProgramServices
Management And General15315409ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1118844BOY
EOY1416272EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5256826BOY
EOY5412612EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5878283BOY
EOY5966416EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY19000EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY5196061BOY
EOY5446456EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY637299BOY
EOY405097EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY625542BOY
EOY504624EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis78288690LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec53635042LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY22894615BOY
EOY24653648EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY38075963BOY
EOY40070282EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY875172BOY
EOY930588EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY80558605BOY
EOY84824995EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3897422BOY
EOY4569131EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5282877BOY
EOY7506355EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1682444BOY
EOY1969350EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY10862743BOY
EOY14044836EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY68857690BOY
EOY69938113EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY838172BOY
EOY842046EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY69695862BOY
EOY70780159EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY80558605BOY
EOY84824995EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3178776ReconcilationRevenueExpenses
Reconcilation Other Changes-2094479ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Other Activities1OtherActivities
Other Activities$5,098OtherActivitiesAmount
Total Lobbying Expenditures IIB5098TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationA PORTION OF DUES PAID TO MHA AND AHA ARE ALLOCATED TO LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis3321127OtherCostOrOtherBasis
Book Value3321127BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis39238500OtherCostOrOtherBasis
Depreciation29581377Depreciation
Book Value9657123BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2346321OtherCostOrOtherBasis
Depreciation1387117Depreciation
Book Value959204BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis28623356OtherCostOrOtherBasis
Depreciation22666548Depreciation
Book Value5956808BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4759386OtherCostOrOtherBasis
Book Value4759386BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings24653648TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionTHIRD PARTY CONTRACTUALSDescription
Amount$1,969,350Amount
FieldValueIRS element (for citing)
Total Of Amounts1969350TotalOfAmounts
Total Revenue59051313TotalRevenue
Total Expenses55872537TotalExpenses
Excess Or Deficit For Year3178776ExcessOrDeficitForYear
Net Unrealized GL On Investments-2094479NetUnrealizedGLOnInvestments
Total Adjustments-2094479TotalAdjustments
Excess Or Deficit Per FS1084297ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt56822259TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-2094479NetUnrealizedGainsInvestments
Revenue Not Rptd F990-2094479RevenueNotRptdF990
Revenue Subtotal58916738RevenueSubtotal
Investment Expenses Not Included134575InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt134575RevenueNotRptdOnFinStmt
Total Revenue Per Form99059051313TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt55737962TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal55737962ExpensesSubtotal
Investment Expenses Not Included2134575InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt134575ExpensesNotRptdOnFinStmt
Total Expenses Per Form99055872537TotalExpensesPerForm990

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent350XPcent350
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense339509TotalCommunityBenefitExpense
Net Community Benefit Expense339509NetCommunityBenefitExpense
Percent Of Total Expense0.00650PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense6385066TotalCommunityBenefitExpense
Direct Offsetting Revenue6464429DirectOffsettingRevenue
Net Community Benefit Expense-79363NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense703157TotalCommunityBenefitExpense
Direct Offsetting Revenue416139DirectOffsettingRevenue
Net Community Benefit Expense287018NetCommunityBenefitExpense
Percent Of Total Expense0.00550PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense7427732TotalCommunityBenefitExpense
Direct Offsetting Revenue6880568DirectOffsettingRevenue
Net Community Benefit Expense547164NetCommunityBenefitExpense
Percent Of Total Expense0.01200PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs208NumberOfActivitiesOrPrograms
Persons Served2416PersonsServed
Total Community Benefit Expense45582TotalCommunityBenefitExpense
Direct Offsetting Revenue8240DirectOffsettingRevenue
Net Community Benefit Expense37342NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs361NumberOfActivitiesOrPrograms
Persons Served3468PersonsServed
Total Community Benefit Expense259257TotalCommunityBenefitExpense
Net Community Benefit Expense259257NetCommunityBenefitExpense
Percent Of Total Expense0.00500PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs569NumberOfActivitiesOrPrograms
Persons Served5884PersonsServed
Total Community Benefit Expense304839TotalCommunityBenefitExpense
Direct Offsetting Revenue8240DirectOffsettingRevenue
Net Community Benefit Expense296599NetCommunityBenefitExpense
Percent Of Total Expense0.00570PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs569NumberOfActivitiesOrPrograms
Persons Served5884PersonsServed
Total Community Benefit Expense7732571TotalCommunityBenefitExpense
Direct Offsetting Revenue6888808DirectOffsettingRevenue
Net Community Benefit Expense843763NetCommunityBenefitExpense
Percent Of Total Expense0.01770PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Building Expense207946TotalCommunityBuildingExpense
Direct Offsetting Revenue1DirectOffsettingRevenue
Net Community Building Expense207945NetCommunityBuildingExpense
Percent Of Total Expense0.00400PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Building Expense1048TotalCommunityBuildingExpense
Net Community Building Expense1048NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense1748TotalCommunityBuildingExpense
Net Community Building Expense1748NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs12NumberOfActivitiesOrPrograms
Total Community Building Expense3571TotalCommunityBuildingExpense
Net Community Building Expense3571NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs117NumberOfActivitiesOrPrograms
Persons Served581PersonsServed
Total Community Building Expense55198TotalCommunityBuildingExpense
Net Community Building Expense55198NetCommunityBuildingExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs33NumberOfActivitiesOrPrograms
Total Community Building Expense3569TotalCommunityBuildingExpense
Net Community Building Expense3569NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs9NumberOfActivitiesOrPrograms
Persons Served60PersonsServed
Total Community Building Expense1367TotalCommunityBuildingExpense
Net Community Building Expense1367NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs176NumberOfActivitiesOrPrograms
Persons Served641PersonsServed
Total Community Building Expense274447TotalCommunityBuildingExpense
Direct Offsetting Revenue1DirectOffsettingRevenue
Net Community Building Expense274446NetCommunityBuildingExpense
Percent Of Total Expense0.00530PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,491,516BadDebtExpenseAmount
Amount Attributable To187607AmountAttributableTo
Amount Reimbursed By Medicare12129192AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare11373344CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall755848MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 BARRY HEALTH PARTNERS LTDBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityTO INEGRATE PHYSICIAN AND HOSPITAL CLINICAL PRACTICES AND PAYOR CONTRACTINGDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.50000OrganizationProfitOrOwnership
Physicans Profit Or Ownership0.50000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1PENNOCK HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11009 W GREEN STAddressLine1
CityHASTINGSCity
StateMIState
ZIP Code49058ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIREDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities10NumberOfOtherFacilities

Other Facilities OtherFacilities (10 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
PENNOCK HOSPICE
1230 W STATE STREETHASTINGSMI49058OUTPATIENT HOSPICE CARE
PENNOCK HOME HEALTH
1230 W STATE STREETHASTINGSMI49058HOME HEALTH CARE AGENCY
CLARKSVILLE FAMILY MEDICINE
155 E CROSS STCLARKSVILLEMI48815FAMILY PRACTICE OFFICE
NASHVILLE FAMILY MEDICINE
750 DURKEENASHVILLEMI49073FAMILY PRACTICE OFFICE
DR DEGOA
1108 W STATE STREETHASTINGSMI49058OBSTETRICIAN
GUN LAKE FAMILY MEDICINE
77 124TH AVESHELBYVILLEMI49344FAMILY PRACTICE OFFICE
CALEDONIA FAMILY MEDICINE
9090 RODGERS CTCALEDONIAMI49316FAMILY PRACTICE OFFICE
HASTINGS FAMILY MEDICINE
1009 W GREEN STHASTINGSMI49058FAMILY PRACTICE OFFICE
STATE STREET URGENT CARE CENTER
1108 W STATE STREETHASTINGSMI49058URGENT CARE CENTER
HASTINGS GENERAL SURGEONS
1009 W GREEN STHASTINGSMI49058SURGEON PRACTICE OFFICE

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
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 $ 3719376.
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: THE COST TO CHARGE RATIO WAS USED TO DETERMINE BAD DEBT AT COST REPORTED ON LINE 2. 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: 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, FEES FOR SERVICES, 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.
PART VI, LINE 2: 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. 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.
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 59,173 RESIDENTS, UP 1.2% SINCE 2010. WITH 14.6% 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 $63,071. BARRY COUNTY IS UNIQUELY LOCATED IN THE MIDDLE OF FOUR (4) LARGER METROPOLITAN AREAS: GRAND RAPIDS, LANSING, KALAMAZOO, AND BATTLE CREEK.
PART VI, LINE 6: 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 TWO ADDITIONAL 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.
MIREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
SHERYL LEWIS BLAKE
2649920003368095410209780298879000
CONNIE S DOWNS
1827070006450075480145770211282000
CARLA WILSON-NEIL
1580150003878011242029860176121000
STEPHAN A MARZOLF
13000000058001000201520150832000
ANITA ASADORIAN DO
14054105239042205608000151810000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 1AReturnReference
ExplanationTHE HEALTH AND WELLNESS CENTER IS AVAILABLE TO ALL EXECUTIVE, DIRECTORS, AND OFFICERS AND IS NOT TREATED AS TAXABLE COMPENSATION.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2003
38288941759465E5V12003-12-104300000HEALTHCARE EQUIPMENT #03000
MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2004
38288941759465E6T52004-05-266000000HEALTHCARE EQUIPMENT #26000
MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2006
38288941759465HDY92006-09-273031165HEALTHCARE EQUIPMENT #58000
MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2011
38288941759447PDT52011-03-232734921HEALTHCARE EQUIPMENT #81000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
430000051600430000020030011
600000072000600000020050011
303116536374303116520060011
27349214167526932460001

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
000011
000011
000011
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
010000
010000
010000
010000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2011BusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN382889417IssuerEIN
CUSIP Number59447PFB2CUSIPNumber
Date Issued2011-06-29DateIssued
Issue Price609743IssuePrice
Description Of PurposeHEALTHCARE EQUIPMENT #81DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds609743TotalProceeds
Issuance Costs From Proceeds8368IssuanceCostsFromProceeds
Capital Expenditures601375CapitalExpenditures
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonCONNIE DOWNSNamePerson
Purpose Of LoanHIGHER EDUCATIONPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$19,000OriginalPrincipalAmount
Balance Due19000BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due19000TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
DAVID PARKER MD
PROVIDER/BOARD MEMBER64265CONTRACT SERVICE0
SCOTT BRASSEUR MD
PROVIDER/BOARD MEMBER68075CONTRACT SERVICE0
HASTINGS CITY BANK
NANCY GOODIN, BOARD MEMBER OF HOSPITAL AND DIRECTOR OF MARKETING AT BANK60806INVESTMENT FEES0
CHAPPLE REALTY
DREW CHAPPLE, BOARD MEMBER OF HOSPITAL AND OWNER OF CHAPPLE REALTY5000COMMISSION0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE BOARD OF TRUSTEES RECEIVED A TRAINING, CONDUCTED BY OUR INDEPENDENT PUBLIC ACCOUNTANTS ON THE RULES AND REQUIREMENTS OF THE IRS FORM 990. ON APRIL 24, 2012 THE COMPLETED IRS FORM 990 WILL BE REVIEWED. THE BOARD OF TRUSTEES WILL VOTE TO APPROVE THE FORM 990 AS A TRUE REPRESENTATION OF THE HOSPITAL'S ACTIVITY DURING THE FISCAL YEAR.
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 12C
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 2011.FORM 990, PART VI, SECTION B, LINE 15
THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND 990 ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -2,094,479.FORM 990, PART XI, LINE 5:
THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR.FORM 990, PART XII, LINE 2C:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
PENNOCK FOUNDATION
1009 WEST GREEN STREETHASTINGSMI49058382713275FOUNDATIONMI501(C)(3)LINE 11B, IIPENNOCK HEALTHCARE SYSTEMS1
PENNOCK HEALTHCARE SYSTEM
1009 WEST GREEN STREETHASTINGSMI49058382713276PARENT ORGANIZATIONMI501(C)(3)LINE 11B, II1N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PENNOCK VENTURESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11009 WEST GREEN STREETAddressLine1
CityHASTINGSCity
StateMIState
ZIP Code49058ZIPCode
FieldValueIRS element (for citing)
EIN382712819EIN
Primary ActivityREAL ESTATEPrimaryActivity
Legal Domicile StateMILegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
PENNOCK VENTURES
J437624FMV
PENNOCK VENTURES
I30456FMV
PENNOCK FOUNDATION
C485557CASH
PENNOCK VENTURES
D252031CASH
PENNOCK VENTURES
A82651FMV

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