2012-05-15T13:25:04-05:00 2011-09-30 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2010-10-01 381360562 PENNOCK HOSPITAL PENN 2699453451 1009 WEST GREEN STREET HASTINGS MI 49058 CONNIE S DOWNS 2699453451 2012-05-15 1 CAROL LALONDE CPA 2695674500 2010 2016-02-24 21:20:13Z PENNOCK HEALTH SYSTEMS CONNIE S DOWNS 1009 WEST GREEN STREET HASTINGS MI 49058 75891526 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 DETERMINE TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. 10 8 665 145 113747 -21883 55983 485639 54409950 56329865 964594 1379094 472714 856715 55903241 59051313 0 0 0 0 27325922 29522310 0 0 0 27226850 26350227 54552772 55872537 1350469 3178776 80558605 84824995 10862743 14044836 69695862 70780159 X PENNOCK HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH SERVICES IN A PERSONAL, PROFESSIONAL AND PROGRESSIVE MANNER IN PARTNERSHIP WITH THE COMMUNITY. 0 0 40557128 56329865 PENNOCK 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. 40557128 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 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 41 0 1 665 1 1 1 0 0 0 0 0 0 0 0 0 X 10 8 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 BONNIE HILDRETH 0.50 X 0 0 0 SCOTT BRASSEUR MD 0.50 X X 60881 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 BRADLEY 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 56058 0 0 DAN KING 0.50 X 0 0 0 JEFF WEIDEN 0.50 X 0 0 0 JAMES HORTON 0.50 X 0 0 0 SHERYL LEWIS BLAKE 40.00 X 268360 0 30519 CONNIE S DOWNS 40.00 X 189157 0 22125 CARLA WILSON-NEIL 40.00 X 161893 0 14228 STEPHAN A MARZOLF 40.00 X 130580 0 20252 JAMES J WINCEK 40.00 X 120967 0 4871 DONALD GINGERICH DO 40.00 X 134394 0 7142 LAWERENCE HAWKINS MD 40.00 X 138111 0 3820 CRAIG JONES 40.00 X 118491 0 7850 ANITA ASADORIAN DO 40.00 X 146202 0 5608 1525094 0 116415 12 0 1 0 HASTINGS ANESTHESIA PLC 900 PEELER ST KALAMAZOO MI 49008 ANESTHESIA SERVICES 683730 PROGRESSIVE BUILDING SERVICES 440 36TH STREET WYOMING MI 49548 HOUSEKEEPING SERVICES 647371 SPECTRUM HEALTH 4600 BRETON ROAD SE KENTWOOD MI 49508 REFERENCE LAB/SLEEP STUDY 419447 HASTINGS EMERGENCY PHYSICIANS PO BOX 232 GRAND RAPIDS MI 49501 ER MANAGEMENT 391917 ALLIANCE HNI LLC 525 S GOULD OWOSSO MI 48867 MRI MAINTENANCE 290037 15 485557 82 485639 PATIENT SERVICE REVENU 621110 56329865 56329865 56329865 236917 236917 574816 827802 -252986 -252986 -252986 17147895 6693 15931181 81230 1216714 -74537 1142177 1142177 MISCELLANEOUS 900099 719212 719212 CAFETERIA REVENUE 722100 276742 276742 LAB COURIER SERVICE 621500 113747 113747 1109701 59051313 56329865 113747 2122062 1096187 992078 104109 21554372 14010342 7544030 1080806 756564 324242 4187053 2930937 1256116 1603892 1122724 481168 75482 75482 140375 140375 5098 5098 134574 134574 6539436 3795830 2743606 135071 33768 101303 1108591 937970 170621 1628687 1252315 376372 285988 185892 100096 132907 132907 3907175 3321099 586076 363902 236536 127366 SUPPLIES 7219096 6566543 652553 BAD DEBTS 3719376 3719376 MAINTENANCE AND REPAIRS 641055 486765 154290 COLLECTIONS 313414 313414 55872537 40557128 15315409 0 1118844 1416272 5256826 5412612 5878283 5966416 19000 5196061 5446456 637299 405097 625542 504624 78288690 53635042 22894615 24653648 38075963 40070282 875172 930588 80558605 84824995 3897422 4569131 5282877 7506355 1682444 1969350 10862743 14044836 X 68857690 69938113 838172 842046 69695862 70780159 80558605 84824995 X 3178776 -2094479 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 5098 5098 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PORTION OF DUES PAID TO MHA AND AHA ARE ALLOCATED TO LOBBYING ACTIVITIES. 3321127 3321127 39238500 29581377 9657123 2346321 1387117 959204 28623356 22666548 5956808 4759386 4759386 24653648 THIRD PARTY CONTRACTUALS 1969350 1969350 59051313 55872537 3178776 -2094479 -2094479 1084297 56822259 -2094479 -2094479 58916738 134575 134575 59051313 55737962 0 55737962 134575 134575 55872537 1 1 1 X 1 X 1 1 1 0 1 1 339509 339509 0.00650 6385066 6464429 -79363 0.00000 703157 416139 287018 0.00550 7427732 6880568 547164 0.01200 208 2416 45582 8240 37342 0.00070 361 3468 259257 259257 0.00500 569 5884 304839 8240 296599 0.00570 569 5884 7732571 6888808 843763 0.01770 2 207946 1 207945 0.00400 2 1048 1048 0.00000 1 1748 1748 0.00000 12 3571 3571 0.00010 117 581 55198 55198 0.00110 33 3569 3569 0.00010 9 60 1367 1367 0.00000 176 641 274447 1 274446 0.00530 0 1491516 187607 12129192 11373344 755848 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 NOT REQUIRED 1 10 PENNOCK HOSPICE

1230 W STATE STREET HASTINGS MI 49058

OUTPATIENT HOSPICE CARE PENNOCK HOME HEALTH

1230 W STATE STREET HASTINGS MI 49058

HOME HEALTH CARE AGENCY CLARKSVILLE FAMILY MEDICINE

155 E CROSS ST CLARKSVILLE MI 48815

FAMILY PRACTICE OFFICE NASHVILLE FAMILY MEDICINE

750 DURKEE NASHVILLE MI 49073

FAMILY PRACTICE OFFICE DR DEGOA

1108 W STATE STREET HASTINGS MI 49058

OBSTETRICIAN GUN LAKE FAMILY MEDICINE

77 124TH AVE SHELBYVILLE MI 49344

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 STATE STREET URGENT CARE CENTER

1108 W STATE STREET HASTINGS MI 49058

URGENT CARE CENTER HASTINGS GENERAL SURGEONS

1009 W GREEN ST HASTINGS MI 49058

SURGEON 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 $ 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. 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 264992 0 0 0 3368 0 9541 0 20978 0 298879 0 0 0 CONNIE S DOWNS 182707 0 0 0 6450 0 7548 0 14577 0 211282 0 0 0 CARLA WILSON-NEIL 158015 0 0 0 3878 0 11242 0 2986 0 176121 0 0 0 STEPHAN A MARZOLF 130000 0 0 0 580 0 100 0 20152 0 150832 0 0 0 ANITA ASADORIAN DO 140541 0 5239 0 422 0 5608 0 0 0 151810 0 0 0 PART I, LINE 1A THE HEALTH AND WELLNESS CENTER IS AVAILABLE TO ALL EXECUTIVE, DIRECTORS, AND 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 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 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 MICHIGAN STATE HOSPITAL FINANCE AUTHORITY HEALTHCARE EQUIPMENT LOAN 2011 382889417 59447PFB2 2011-06-29 609743 HEALTHCARE EQUIPMENT #81 0 0 0 609743 8368 601375 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 CONNIE DOWNS HIGHER EDUCATION X 19000 19000 0 1 1 19000 DAVID PARKER MD PROVIDER/BOARD MEMBER 64265 CONTRACT SERVICE 0 SCOTT BRASSEUR MD PROVIDER/BOARD MEMBER 68075 CONTRACT SERVICE 0 HASTINGS CITY BANK NANCY GOODIN, BOARD MEMBER OF HOSPITAL AND DIRECTOR OF MARKETING AT BANK 60806 INVESTMENT FEES 0 CHAPPLE REALTY DREW CHAPPLE, BOARD MEMBER OF HOSPITAL AND OWNER OF CHAPPLE REALTY 5000 COMMISSION 0 FORM 990, PART VI, SECTION B, LINE 11 THE 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. 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 2011. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND 990 ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,094,479. 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 1 PENNOCK VENTURES 1009 WEST GREEN STREET HASTINGS MI 49058 382712819 REAL ESTATE MI N/A C 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 PENNOCK VENTURES J 437624 FMV PENNOCK VENTURES I 30456 FMV PENNOCK FOUNDATION C 485557 CASH PENNOCK VENTURES D 252031 CASH PENNOCK VENTURES A 82651 FMV