2012-03-26T15:17:20-07:00 2011-06-30 990 2010-07-01 381368360 PINE REST CHRISTIAN MENTAL HEALTH SERVICES PINE 6164555000 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 Paul Karsten 6162816363 2012-02-15 2010 2016-02-24 21:20:13Z Mark Eastburg 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 113182880 0 X pinerest.org X 1908 MI Pine Rest Christian Mental Health Services is called to express the healing ministry of Jesus Christ by providing behavioral health services with professional excellence, Christian integrity, and compassion. 21 18 1712 170 0 0 711830 2409148 71397579 79202563 4554797 9271467 726157 688315 77390363 91571493 0 0 0 0 57235849 61732135 0 0 369067 17348841 19210110 74584690 80942245 2805673 10629248 83585588 94046209 16967988 16799361 66617600 77246848 Pine Rest Christian Mental Health Services is called to express the healing ministry of Jesus Christ by providing behavioral health services with professional excellence, Christian integrity, and compassion. 0 0 27382579 0 38341119 Hospital-based Services inpatient and partial hospitalization programs include dedicated services for children, adolescents, adults, and older adults. Clinical conditions addressed included the full array of psychiatric diagnoses, co-occurring substance abuse diagnoses, and psychiatric disorders where threatment is complicated by co-existing medical conditions. Patients experience professional assessment and individualized treatment including: diagnosis, medication management and education, individual and group therapies, individual and family consultations and therapy, case management, discharge planning and aftercare. The inpatient and partial hospitalization programs are accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The Pine Rest's Board of Directors entered into a Joint Operating Agreement ("Agreement") effective July 1, 1998 with Saint Mary's Health Services and Metropolitan Hospital to manage the financial and clinical aspects of inpatient and partial hospitalization behavioral health services in the greater West Michigan area. The Agreement combines the inpatient and partial hospitalization mental health services of all three organizations under common management and operations. The parties to the Agreement also entered into a series of contractual agreements to provide specific clinical, financial, or support services. Pine Rest has 170 inpatient beds available and had 5,403 admissions during the year ended June 30 2011 encompasing 51,666 days of patient care resulting in an average length of stay of 9.56 days. There ar e 14 partial hospitalization beds available resulting in 1,277 partial hospitalization admissions with 4,492 days of care. 23541972 50068 23954919 Clinic Network through its network of more than twenty clinics, offers outpatient, ambulatory care at locations throughout West Michigan, and in Pella and Des Moines, Iowa. For people who do not require the structured environment of the inpatient or residential care settings, outpatient services are at the center of the behavioral health continuum. Nearly 75% of all persons who come to Pine Rest are served through outpatient care. Clinicians provide a broad spectrum of intervention across the age continuum in convenient, non-restrictive environments. In addition to traditional outpatient care, Pine Rest provides a variety of specialty services including assessment through the Psychological Consultation Center, intensive outpatient substance abuse/addictions services, court-related services and assessments, Psychiatric Home Health Care, and more. On an average day in 2011, 963 patients were seen throughout the Clinic Network. In total, there were 244,389 outpatient visits in 2011. 5776403 198399 5204499 Pine Rest offers a wide range of addiction and recovery services including outpatient, intensive outpatient and residential services for those with co-occurring substance abuse and mental health disorders. Professional services are designed to provide a safe, caring environment where persons gain insight and acquire skills for ongoing recovery. Residential treatment services are available at three locations throughout greater Grand Rapids. Transitional housing is available for clients who need safe, substance-free housing while transitionaing to community living. Addiction facilities are state-licensed where appropriate and accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). Community Case Management represents a partnership with Network 180, a local expression of Community Mental Health Services. Based in Grand Rapids core city areas, the program services adults experiencing mental illness and co-occurring disorders. Recipients of mental health services can choose Pine Rest case managers to support them in their homes and apartments. Services include medication support and education, coordination of care, assistance accessing public assistance and benefits, and help with symptom management. The Caring Communities Program brings Pine Rest into invited partnerships with established community organizations to introduce behavioral health services to underserved populations. Clients typically have limited resources and limited access to behavioral healthcare. With partners like Baxter Community Center, Belknap Commons, Dwelling Place, Grand Rapids Public Schools, Heartside Ministries, Grand Rapids Housing Commission and many more, Pine Rest addresses behavioral health needs in a non-traditional model. On an average day over 22 patients are served resulting in over 7,217 day of care plus numerous visits outside the days of care continuum. 1936606 -19 2299451 Addiction Treatment Services offers a wide range of addiction and recovery services including outpatient, intensive outpatient and residential services for those with co-occurring substance use and mental health disorders. Professional services are designed to provide a safe, caring environment where persons gain insight and acquire skills for ongoing recovery. Residential treatment services are available at three locations throughout greater Grand Rapids. Transitional housing is available for clients who need safe, substance-free housing while transitioning to community living. Addiction facilities are state-licensed where appropriate and accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). Community Case Management represents a partnership with Network 180, a local expression of Community Mental Health Services. Based in Grand Rapids core city area, the program serves adults experiencing mental illness and co-occurring disorders. Recipients of mental health services can choose Pine Rest case managers to support them in their homes and apartments. Services include medication support and education, coordination of care, assistance accessing public assistance and benefits, and help with symptom management. On average each day the Addiction Treatment Services cares for 83 patients resulting in 30,306 days of care in a year. 2316496 10001 2553758 Homes for the Developmentally Disabled helps adults with developmental disabilities experience exceptional residential settings and care with multiple opportunities for engaging in on-site and community activities that match abilities. On average the Developmentally Disabled Homes cares for 68 patients a day resulting in 24,871 days of patient care in a year. 475630 293371 79976 Education and Prevention offers a range of education and prevention activities that help promote community wellness. Through its Employee Assistance Program, Church Assistance Program and Speakers Bureau, Pine Rest educates the community on topics related to mental illness, wellness, treatment, parenting, interpersonal relationships and more. Pine Rest professionals and partners can be found in area schools and neighborhoods providing services and education in urban, underserved areas. The DeMey Clinic provides services for individuals in the criminal justice system, helping people readjust after incarceration, encouraging vocational development, addressing mental health needs, and promoting lifestyle changes to reduce recidivism. The clinic also provides services for adolescents and families. It partners with School to Career Progressions to offer a Juvenile Success Center, a program that provides early intervention to juveniles referred by the juvenile court system. Clinicians teach skills, offer mentorship, provide academic support, and enlist parental participation. The clinic has expanded youth services through Pine Rest's school consultation program. Services in the Ottawa Hills area include staffing a clinician within the schools as well as services and workshops for the community. 4214969 200 4714101 The Center for Psychiatric Residential Services (CPRS) offers 24/7 supervision by experienced professionals to guide the activities of daily life for adolescents aged 12 to 18 years when hospitalization is not required. With capacity for 52, referrals are accepted based on age and behavioral criteria. A supportive milieu helps adolescents develop relationship skills in anticipation of return to their families and in preparation for their own parenting roles. Social skills training is geared toward promoting positive relationships with peers and adults. Residents in treatment attend Kentwood Public Schools and receive homework help; they engage in on-campus and community activities to reinforce skills and foster goal achievement. Through Pine Rest Christian Homes, adults experience exceptional residential settings and care with multiple opportunities for engaging in on-site and community activities that match abilities. The residential service extends Pine Rest's fifty-plus year history of providing services for people with developmental disabilities. The Center for Psychiatric Residential Services served and average of 46 patients per day providing 16,783 patient days of care in 2011. 1148215 0 1278092 Service offered to provide key hospital management services to West Michigan psychiatric inpatient and clinic operations. 10091916 303553 10925378 66792870 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 140 0 1 1712 1 0 0 0 0 0 0 X 21 18 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA MI X X Paul H Karsten 6162816363 300 68th St SE Grand Rapids MI 495010165 Honorable Joseph Scoville 0 X X 0 0 0 Ginny VanderHart 0 X X 0 0 0 Ross Hoezee 0 X X 0 0 0 Nicolas Kroeze 0 X X 0 0 0 Mark C Eastburg PhD 60 X X X 244056 0 18255 Alan M Armstrong MD 40 X X X 203628 0 13798 Jeffrey Jackson MD 60 X X 202802 0 12643 Daniel DeVries MD 0 X 0 0 0 Roxanne DeWeerd 0 X 0 0 0 Honorable Patricia Gardner 0 X 0 0 0 Wes Granberg-Michaelson 0 X 0 0 0 Vicki Harris 0 X 0 0 0 Stephanie Leonardos 0 X 0 0 0 John Lichtenberg 0 X 0 0 0 Victoria Proctor-Gibbs 0 X 0 0 0 Charlie Selmon 0 X 0 0 0 Joseph Sweeney 0 X 0 0 0 Jon Swets 0 X 0 0 0 Kathleen Vogelsang 0 X 0 0 0 Gary Werkman 0 X 0 0 0 Ron Hoffman 0 X 0 0 0 Paul H Karsten 60 X X 165929 0 17780 Robert L Nykamp 60 X X 146319 0 17684 Scott A Wagner 60 X X 108747 0 11203 Douglas P Vance 60 X X 106194 0 11725 Jack A Mahdasian MD 55 X 380698 0 12145 Dhanu T Mahesh 36 X 318811 0 11216 Norman S Miller 36 X 318077 0 602 Gilbert A Masterson 45 X 308657 0 11781 Valerie E Mathis-Allen 48 X 300297 0 12168 Dan Schellenburg MD 55 X 338844 0 13171 Carey A Krause MD 48 X 283334 0 13276 Richard E Myers MD 20 X 138006 0 0 William J Sanders DO 50 X 294289 0 12673 Michael M Thebert MD 68 X 270483 0 12035 Michael Fusillo MD 24 X 269284 0 12823 William H Beute MD 40 X 254301 0 2939 Carolyn M King MD 50 X 220962 0 3528 Michael A Michelakis MD 65 X 199098 0 10840 Virgilio F Vasquez MD 42 X 148986 0 8451 5221802 0 240736 50 1 1 0 Unidine Corporation One Gateway Center Suite 751 Newton MA 02458 Cafeteria Services 1035750 CDW Government Inc 200 North Milwaukee Avenue Vernon Hill IL 60061 Network Services 706389 Michigan Professional Insurance Exchange 221 Michigan St SE Suite 403 Grand Rapdis MI 495032538 Insurance 643006 Open Systems Technologies 605 Seqard Ave NW Suite 101 Grand Rapids MI 49504 Information Systems 355732 Buiten & Associates LLC 5738 Foremost Drive SE Grand Rapids MI 49546 Insurance 339756 15 0 0 99698 872223 480150 957077 1581 2409148 Outpatient Clinics 621400 21704390 21704390 0 0 Inpatient Contracted Services 622000 21386051 21386051 0 0 Inpatient Care 622000 18446685 18446685 0 0 Residential Care 623000 17176695 17176695 0 0 Partial Hospitalization 622000 488742 488742 0 0 0 0 0 0 79202563 685877 685877 0 0 1477 1477 0 0 0 0 0 0 186259 0 84804 0 101455 0 101455 101455 0 0 30110696 0 21526583 0 8584113 0 8584113 8584113 0 0 0 Rustic Market 624000 337721 337721 0 0 Pastoral and other training 611710 99234 99234 0 0 149905 149905 0 0 586860 91571493 89162345 0 0 0 0 0 0 0 0 0 0 5572464 4614647 957817 0 46169475 41712020 4227320 230135 0 0 0 0 247933 211675 34857 1401 6069850 5352051 686406 31393 3672413 3310551 343980 17882 0 0 0 0 125069 0 125069 0 70067 0 70067 0 7536 0 7536 0 0 0 326687 0 326687 0 734694 734694 0 0 225769 0 225769 0 5422005 2338345 3068734 14926 1832482 1559095 263528 9859 0 0 0 0 2871818 2570947 298296 2575 221327 193986 24740 2601 0 0 0 0 248732 189096 59332 304 332999 0 332999 0 0 0 0 0 2670053 2506625 162029 1399 542852 0 542852 0 Patient Assistance Expense 1099707 1099707 0 0 Other 2478313 399431 2022290 56592 80942245 66792870 13780308 369067 2908075 3739362 0 0 49319 50159 6387468 7921326 0 0 0 0 0 0 47911 19656 836845 603093 66064732 37747323 27856688 28317409 44874462 52573493 0 0 0 0 0 0 624820 821711 83585588 94046209 5285904 5019157 0 0 5587 93080 11330000 10030000 0 0 0 0 189325 189325 0 0 157172 1467799 16967988 16799361 X 59354070 69702244 3557657 3838731 3705873 3705873 66617600 77246848 83585588 94046209 10629248 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7536 7536 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Verbal and written communication with public officials regarding legislation and proposals affecting the delivery of health care in Michigan 17017192 614207 3608310 872223 30279 0 20337207 16233603 361684 1454920 995049 37966 0 17017192 20469760 420240 -3556025 983481 116891 0 16233603 0.818 0.182 0 0 1 1 0 108148 108148 0 46144814 1626766 44518048 0 0 0 0 0 15401780 26731319 -11329539 0 4409990 9389238 -4979248 28317409 0 Earned Time Off Liabiltiy 597733 Deferred Compensation - 457(b) 347252 Interest Rate Swap Liability 248568 Capital Lease Obligation L/T 204732 Capital Lease Obligaiton S/T 67471 Due Third Parties 2043 1467799 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The spending policy allows for annual spending of 5% of the average fair market value of the Foundation's net assets for the prior three years. This amount is transferred from the Foundation to the opeating funds of the Corporation to provide for the care of patients and other initiatives that benefit the organization. The spending policy allows for the use of investment earnings on permanently restricted endowment funds in accordance with donor wishes. SchD_P10_S00_L02 Schedule D, Part X, Line 2 The Coporation is a not-for-profit corporation pursuant to Section 501(C)(3) of the Internal Revenue Code and is exempt from income taxes on related income pursuant to Section 501(a). The Corporation recognizes interest and penalties related to unrecognized tax positions and includes these in interest and income tax expense. The Corporation has no amounts accrued for interest and penalties as of June 30, 2011 and 2010. The Corporation does not expect the total amount of unrecognized tax benefits to significantly change over the next twelve months. The Corporation is no longer subject to examination by taxing authorities for years before 2009. Annual Foundation Golf Classic 99698 0 99698 0 0 0 0 0 27194 0 0 99698 0 99698 0 0 0 0 0 27194 27194 72504 1 1 X 1 X 2.5 1 X 1 1 0 1 1 1099707 0 1099707 0.0147 17755436 19443999 -1688564 0 0 0 0 0 0 0 18855143 19443999 -588857 0.0147 140469 0 140469 0.0019 0 0 0 0 41975283 38663095 3312188 0.0444 0 0 0 0 417870 0 417870 0.0056 0 0 42533622 38663095 3870527 0.0519 0 0 61388765 58107094 3281670 0.0666 0 560893 0 4567447 5785840 -1218393 X 1 0 1 1 Pine Rest Christian Mental Health Services

300 68th Street SE PO Box 165 Grand Rapids MI 495010165

X Pine Rest Christian Mental Health Services 1 1 1 250 1 250 1 X X X 1 1 X 1 X X X 1 X X X X X 1 X 0 0 31 PRCMHS - Campus Clinic

300 68th Street SE PO Box 165 Grand Rapids MI 495010165

Outpatient Clinic, residential detox, screening, assessment, referral and follow up PRCMHS - Cedar

300 68th Street SE Grand Rapids MI 49548

Child Caring Institution PRCMHS - Traverse City Clinic

1050 Silver Drive Traverse City MI 49684

Outpatient Clinic, mental health, addiction treatment, screening, assessment, referral and follow up PRCMHS - Southwest Clinic

4211 Parkway Place Caledonia MI 49418

Outpatient Clinic for screening, assessment, referral and follow up PRCMHS - Northwest Clinic

2118 3 Mile Road Grand Rapids MI 49544

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Jellma Treatment Center

243 68th Street SE Grand Rapids MI 49548

Residential mental health and addiction treatment, screening, assessment, referral and follow up PRCMHS - InterActions Residential Treatment

300 68th Street SE Grand Rapids MI 49548

Adult Foster Care PRCMHS - Kalamazoo Clinic

1530 Nichols Road Kalamazoo MI 49006

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Sub-Acute Detox

300 68th Street SE Grand Rapids MI 49548

Residential mental health and addiction treatment and detox PRCMHS - Northeast Clinic

3225 North Evergreen Drive NE Suite 301 Grand Rapids MI 49525

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Muskegon Clinic

1150 Sherman Blvd Suite 2800 Muskegon MI 49444

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Community Case Management

339 South Division Grand Rapids MI 49503

Outpatient Clinic, comm change alternative information training, prevention and mental health PRCMHS - Holland Clinic

926 S Washington Ave Suite 210 Holland MI 49423

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Jellema House

523 Lyon Street NE Grand Rapids MI 49503

Residential mental health, addiction treatment, screening, assessment, referral and follow up PRCMHS - CenterPointe Recovery Center

1145 Oakland Drive Kalamazoo MI 49008

Adult Foster Care PRCMHS - Caledonia Clinic

9090 S Rogers Court SE Caledonia MI 49316

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Pella Clinic

2611 Washington Street Pella IA 50219

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Grand Haven Clinic

1445 Sheldon Road Grand Haven MI 49417

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Zeeland Clinic

8333 Felch Suite 210 Zeeland MI 49464

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Des Moines Clinic

6200 Aurora Ave Urbandale IA 50322

Outpatient Clinic, screening, assessment, referral and follow up PRCMHS - Freedom House

300 68th Street SE Grand Rapids MI 49548

Residential mental health, addiction, case management, screening, assessment, referral, follow up PRCMHS - Maple

300 68th Street SE Grand Rapids MI 49548

Child Caring Institution PRCMHS - Cameron

6680 Adrian SE Grand Rapids MI 49548

Adult Foster Care PRCMHS - DeMey Clinic

620 Century SW Grand Rapids MI 49503

Outpatient Clinic, comm change alternative info training, screening, assessment, referral, follow up PRCMHS - Westwood

7047 Madison SE Grand Rapids MI 49548

Adult Foster Care PRCMHS - Pine Grove

7051 Madison SE Grand Rapids MI 49548

Adult Foster Care PRCMHS - Adrian

6700 Adrian SE Grand Rapids MI 49548

Adult Foster Care PRCMHS - Hispanic Recovery Program

223 68th Street SE Grand Rapids MI 49548

Residential mental health, addiction treatment, case mngt, comm change alternative info training PRCMHS - Eastwood

7041 Madison SE Grand Rapids MI 49548

Adult Foster Care PRCMHS - Supported Independent Living

821 68th Street SE Grand Rapids MI 49508

Residential supervised independent living PRCMHS - Recovery Residence

47 Prospect Grand Rapids MI 49503

Residential addicitions recovery home SchH_P01_S00_L06a Schedule H, Part I, Line 6a Pine Rest Christian Mental Health Services annual report SchH_P01_S00_L07 Schedule H, Part I, Line 7 Utilized prescribed worksheets 1 through 8 as defined by IRS. SchH_P01_S00_L07g Schedule H, Part I, Line 7g SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 No specific footnote on bad debts. Cost of bad debts arrived at utilizing Worksheet A recommended by the IRS for this calculation. Bad debt x cost-to-charge ratio. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 None. Source of line 6 is the Medicare Cost Report. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Bad debts rarely qualify for charity care, charity care is determined at admission. SchH_P05_S0B_L11 Schedule H, Part V, Section B, Line 11 Organization utilizes a patient assistance fund agreement and authorization form. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 In response to the new guidelines in the Affordable Care Act requiring hospitals to complete a Community Health Needs Assessment (CHNA), Pine Rest Christian Mental Health Services has collaborated with local health care systems (Saint Mary's Health Care, Spectrum Health System, Metropolitan Hospital and Mary Free Bed Hospital) in coordination with the Kent County Health Department to conduct a Kent County (CHNA). The Kent County (CHNA) started in the spring of 2011 and the final report was issued in February 2012. In defining the service area covered by the (CHNA), Pine Rest Christian Mental Health Services is currently following the approach of Spectrum Health Service the largest regional provider of health care in Kent County. The current goal is to assess a minimum of seventy-five percent (75%) of the organization's patient base. Based on the demographics of patients served in fiscal 2011, seventy-five percent (75%) of Pine Rest Christian Mental Health Service's patients were served in four Michigan counties. The counties are Kent County (46%), Ottawa County (17%), Muskegon County (6%) and Grand Traverse County (6%). The county health departments and hospitals in Ottawa, Muskegon and Grand Traverse counties are completing Community Health Needs Assessments. Pine Rest Christian Mental Health Services will acquire the (CHNA) results from these organizations as they are completed and will integrate the findings into the overall (CHNA) for Pine Rest Christian Mental Health Services. The (CHNA) report completed for Kent County in February 2012 contained two needs related to and served by Pine Rest Christian Mental Health Services. 1. Promote equal access to health care and especially for the uninsured and working poor. 2. Reduce the disparity in health risk factors between students who earn A's and B's versus those who receive D's and E's. Pine Rest Christian Mental Health Services currently provides patient assistance funds in excess of one-million dollars per year to help community members access the services they need. These funds are distributed to families with low incomes who cannot afford care and would not access care without some financial support. In addition, Pine Rest Christian Mental Health Services maintains outreach and community services in middle schools and high schools in Kent County which address the health risk factors of these students. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 At admission, the organization attempts to communicate to the patient, or family as appropriate, the benefits, public or private, available for the prescribed care. Once the patient responsibility is established the patient's status relative to charity care is reviewed and a decision is made about the availability of patient assistance funds. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Pine Rest Christian Mental Health Services is a multi-service behavioral health organization, serving a diverse range of people in multiple settings throughout west Michigan, and with two locations in Iowa. Its network of inpatient, residential and outpatient services reach people of all ages, from children to older adults. The majority of people served by Pine Rest were identified as from a county within the state of Michigan, with 46% from Kent County. A small percentage (<5%) are from counties outside the state of Michigan. Kent County, where Pine Rest's main campus is located, has a population of 602,622 making it one of the largest counties in Michigan. The racial makeup of Kent County is 76% White; 9.7% Hispanic or Latino; 9.7% Black or African American; 2.3% Asian; and 3% from two or more races. In Kent County 14.3% are below poverty level. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 To assure a strategic focus on the health needs of the community served 86% of the governing body is comprised of persons who reside in the organization's primary service area who are neither employees or contractors of the organization. In addition, the organization has an open medical staff allowing hospital medical staff membership to all physicians in the community who meet membership and clinical privilege requirements. An open medical staff broadens the availability of care to the community served by Pine Rest Chistian Mental Health Services through the availability of medical staff to all patients in the service area. Since 1908 the organization has consistently applied surplus funds to the improvment of patient care and access, staff education and research designed to expand and improve the level of patient care provided to all patients. Pine Rest has board designated funds that provide outreach to the community to engage them in services. Pine Rest also provides many education opportunities to the community on various behavioral health topics. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Jack A Mahdasian MD 380698 0 0 0 0 0 0 0 12145 0 392843 0 0 0 Dan Schellenburg MD 338844 0 0 0 0 0 0 0 13171 0 352015 0 0 0 Dhanu T Mahesh 318811 0 0 0 0 0 0 0 11216 0 330027 0 0 0 Gilbert A Masterson 308657 0 0 0 0 0 0 0 11781 0 320438 0 0 0 Norman S Miller 318077 0 0 0 0 0 0 0 602 0 318679 0 0 0 Valerie E Mathis-Allen 300297 0 0 0 0 0 0 0 12168 0 312465 0 0 0 William J Sanders DO 294289 0 0 0 0 0 0 0 12673 0 306962 0 0 0 Carey A Krause MD 283334 0 0 0 0 0 0 0 13276 0 296610 0 0 0 Michael M Thebert MD 270483 0 0 0 0 0 0 0 12035 0 282518 0 0 0 Michael Fusillo MD 269284 0 0 0 0 0 0 0 12823 0 282107 0 0 0 Mark C Eastburg PhD 244056 0 0 0 0 0 0 0 18255 0 262311 0 0 0 William H Beute MD 254301 0 0 0 0 0 0 0 2939 0 257240 0 0 0 Carolyn M King MD 220962 0 0 0 0 0 0 0 3528 0 224490 0 0 0 Alan M Armstrong MD 203628 0 0 0 0 0 0 0 13798 0 217426 0 0 0 Jeffrey Jackson MD 202802 0 0 0 0 0 0 0 12643 0 215445 0 0 0 Michael A Michelakis MD 199098 0 0 0 0 0 0 0 10840 0 209938 0 0 0 Paul H Karsten 165929 0 0 0 0 0 0 0 17780 0 183709 0 0 0 Robert L Nykamp 146319 0 0 0 0 0 0 0 17684 0 164003 0 0 0 Virgilio F Vasquez MD 148986 0 0 0 0 0 0 0 8451 0 157437 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Taxable term life premiums added to taxable income were grossed up to compensate for taxes on premiums. Grossed up amounts were taxed. Mark Eastburg, Paul Karsten and Bob Nykamp. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The Board of Directors has adopted a written Executive Compensation Plan and has delegated to the Executive Committee the responsibility for implementing and overseeing compensation issues, with regular reporting to the Board. The Executive Committee is assisted from time to time in this regard by a special Compensation Committee made up of three outside directors. In setting and reviewing executive compensation for the CEO, COO, CFO, CMO and Vice Presidents, these committees rely on market data for similarlly situated hospital executives in comparable institutions, including an annual compensation survey conducted by the Michigan Hospital Association. In setting and reviewing compensation for physicians (both employed and independent contractors), these committees rely on market data for similarly situated professionals serving comparable institutions. In 2011, the corporation commissioned a study by Integrated Healthcare Strategies to assure that the total compensation paid to physicians is reasonable, consistent with objective market data, and in the best interests of the corporation. The compensation model for physicians adopted by the corporation is based on that study. Prior approval of all new physician employment contracts by both the CFO and the Chairman of the Board (acting pursuit to guidelines set by the Executive Committee) is required to assure that all compensation packages are within the approval limits. Documentation and supporting detail are maintained for all compensation decisions. Kent Hospital Finance Authority 381603110 490576AC9 2006-09-26 10030000 Capital Expansion - various projects 0 0 0 0 0 10030000 0 0 0 218893 0 0 9167583 0 862417 2008 0 0 0 1 0 0 0 0 1 0 0 0 1 1 1 1 Fifth Third Bank 1.0 0 0 0 0 0 William Sanders Recruitment enhancement - assist in purchasing home X 100000 100000 0 1 1 100000 F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 Ross Hoezee, Treasurer of the Board of Directors assisted in placing life insurance with Northwestern Mutual Life for Mark Eastburg, President and CEO, Paul Karsten, Vice President and CFO and Robert Nykamp, Vice President and COO. Aggregate annual premiums equal $5,000 per individual. F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a The Board of Directors has authorized the Finance Committee of the Board of Directors to review and approve the Form 990 each year prior to submission to the IRS. A draft copy of the Form 990 and all supporting schedules are given to the Finance Committee of the Board of Directors for review and comment. Recommended changes are made to the Form 990 and supporting schedules and the Finance Committee votes on a motion to approve the Form 990 and supporting schedules as amended. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Ongoing Board of Director and Board Committee discussions in concert with the annual audit and Coporate Integrity Office activities monitor and maintain an oversight on this activity. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The Board of Directors has adopted a written Executive Compensation Plan and has delegated to the Executive Committee the responsibility for implementing and overseeing compensation issues, with regular reporting to the Board. The Executive Committee is assisted from time to time in this regard by a special Compensation Committee made up of three outside directors. In setting and reviewing executive compensation for the CEO, COO, CFO, CMO and Vice Presidents, these committees rely on market data for similarlly situated hospital executives in comparable institutions, including an annual compensation survey conducted by the Michigan Hospital Association. In setting and reviewing compensation for physicians (both employed and independent contractors), these committees rely on market data for similarly situated professionals serving comparable institutions. In 2011, the corporation commissioned a study by Integrated Healthcare Strategies to assure that the total compensation paid to physicians is reasonable, consistent with objective market data, and in the best interests of the corporation. The compensation model for physicians adopted by the corporation is based on that study. Prior approval of all new physician employment contracts by both the CFO and the Chairman of the Board (acting pursuit to guidelines set by the Executive Committee) is required to assure that all compensation packages are within the approval limits. Documentation and supporting detail are maintained for all compensation decisions. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 All documents are available upon request Pine Rest Foundation 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 381676540 Fundraising and management of investments MI 3320015 20385375 Pine Rest Christian Mental Health Services Pine Rest Christian Community & Residential 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 Provide Residential and community based behavioral health services MI 0 0 Pine Rest Christian Mental Health Services Pine Rest Foundation 300 68th Street SE PO Box 165 Grand Rapids MI 495011065 381676540 Fundraising and management of investments MI 501(c)(3) Type 1 Pine Rest Christian Mental Health Services 0 Pine Rest Christian Community & Residential Services 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 Provide Residential and community based behavioral health services MI 501(c)(3) III Pine Rest Christian Mental Health Services 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 Pine Rest Foundation c 872223 Pine Rest Foundation p 10500 Actual audit fees IRS announced a two month suspension of due dates to allow for the modernization of the e-file operations for 990 filers. According to the IRS announcement, organizations with approved extensions between January 1, 2012 and February 29, 2012 will be considered timely if filed by March 31, 2012. Pine Rest received approval for Form 8868 extending the due date to February 15, 2012.