2011-02-09T09:27:02-06:00 2010-03-31 Plante & Moran PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2009-04-01 381359265 MARY FREE BED HOSPITAL & REHABILITATION CENTER MARY 6162420300 235 WEALTHY ST SE GRAND RAPIDS MI 495035247 RANDALL L DENEFF 6162420300 2011-02-09 1 Carol LaLonde CPA 2695674500 2009 2016-02-24 21:20:13Z Mary Free Bed Rehabilitation Hospita wILLIAM h bLESsing 235 WEALTHY ST SE GRAND RAPIDS MI 495035247 53555247 0 X www.maryfreebed.com X 1913 MI HELPING PEOPLE WITH DISABILITIES ACHIEVE INDEPENDENCE THROUGH REHABILITATION SERVICES. EDUCATING THE COMMUNITY ON DISABLING DISEASES AND INJURY PREVENTION. CARRYING OUT MEDICAL AND SCIENTIFIC RESEARCH TO IMPROVE THE CARE AND OUTCOMES FOR PEOPLE WITH DISABILITIES. 24 22 735 52 0 0 1812844 1826077 35184755 41588836 686486 1723056 538361 516666 38222446 45654635 1390990 0 27264014 31891959 0 0 9889810 9693011 37153824 42975960 1068622 2678675 54723271 68657422 10306896 8710570 44416375 59946852 Restoring hope and freedom through rehabilitation. 0 0 7000086 1390990 7316490 Provide therapy and other medical services for 16,067 patient days. 7597055 8195812 Provide outpatient rehabilitation services for approximately 37,585 patient visits. 6473288 6765881 Provide nursing services and infection control for 16,067 patient days. 16165367 19362113 rehabilitation staffing and management services; Outpatient Clinics; Medical Services Rehabilitation Program Administration; office expenses for program services; Medical Records; Supplies; Utilities, Maintenance, Depreciation related to program services and assets; Patient Meals; Insurance; Driver Rehabilitation services; Psychology Inpatient services; Motion Analysis/Gait Lab services; Benefit costs and payroll taxes on program salaries not specifically listed; Other Program Services and medical services not specifically listed; Bad Debts; Travel/Conferences; 16165367 19362113 37235796 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 23 0 735 1 0 0 0 0 0 0 0 0 0 24 22 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 0 1 1 1 1 1 X Randall DeNeff 6162420403 235 Wealthy St Se Grand Rapids MI 49503 William H Blessing 45.00 X X 357498 0 46520 John F Butzer MD 50.00 X X X 380586 0 48350 Kent Riddle 1.00 X X 0 0 0 julie Ridenour 1.00 X X 0 0 0 Dan Jones 1.00 X X 0 0 0 Steve Landstra 1.00 X X 0 0 0 Kay kress 1.00 X X 0 0 0 Jean Blossfield 1.00 X 0 0 0 benjanmin bruinsma md 1.00 X 0 0 0 linda conway 1.00 X 0 0 0 bert Crandall 1.00 X 0 0 0 marianne Delavan 1.00 X 0 0 0 dianne deroseau 1.00 X 0 0 0 stephen drew 1.00 X 0 0 0 bill grice 1.00 X 0 0 0 melissa hall 1.00 X 0 0 0 paula hendricksen 1.00 X 0 0 0 doug kindschi 1.00 X X 0 0 0 molly krauss 1.00 X 0 0 0 david muir 1.00 X X 0 0 0 ellen nelson 1.00 X 0 0 0 judy palmer 1.00 X 0 0 0 linda patterson 1.00 X 0 0 0 susan steketee 1.00 X 0 0 0 dan vaughAn 1.00 X 0 0 0 SHELLY MISHLER 1.00 X X 0 0 0 KIM RIDINGS 1.00 X X 0 0 0 NANCY ALBERS 1.00 X 0 0 0 STEPHAN BLOOM DO 1.00 X 0 0 0 SUSAN BLOSS 1.00 X 0 0 0 CHAD BUSH 1.00 X 0 0 0 CHARLES DUBOSE JR MD 1.00 X 0 0 0 JOAN KULLGREN 1.00 X 0 0 0 JAN LIPPERT 1.00 X 0 0 0 JENNIFER TAYLOR 1.00 X 0 0 0 randall deneff 45.00 X X 161595 0 33725 dayle maples 30.00 X 274420 0 25881 bruce brasser 45.00 X 140829 0 30885 bill sonday 45.00 X 124211 0 14053 frances dietrich 45.00 X 117548 0 19426 bruce hart 45.00 X 109747 0 13439 robert bosch 40.00 X 0 0 0 kelli miller 40.00 X 0 0 0 1666434 0 232279 10 0 1 0 FRICANO CONSTRUCTION PO BOX 276 CALEDONIA MI 49316 CONSTRUCTION MANAGEMENT 696502 TOWERS WATSON 1079 SOLUTIONS CENTER CHICAGO IL 60677 PENSION ACTUARIAL/CONSULTING 219464 Rehab & Physical Medicine Specialists 350 Lafayette SE Grand Rapids MI 49503 Rehab Program Administration 157800 ADVANTAGE HEALTH PHYSICIANS NETWORK 245 STATE STREET SE Grand Rapids MI 49503 PHYSICIAN MEDICAL SERVICES 152578 REHABILITATION MEDICINE ASSOCIATES 245 CHERRY STREET SE Grand Rapids MI 49503 MEDICAL PROGRAM ADMINISTRATION 134777 6 1106736 89267 630074 5950 1826077 Patient Service Revenu 621400 36526440 36526440 Contract Service Reven 621400 4773641 4773641 Program Expense Reimbu 621400 155712 155712 Equity in Income of Jo 900099 133043 133043 41588836 1036744 1036744 463563 463563 463563 463563 5974451 2612473 7900612 -1926161 2612473 686312 686312 Computer/System Suppor 541519 43260 43260 Donation Processing Su 541900 8200 8200 Coverage Services 900099 1643 1643 53103 45654635 41588836 0 2239722 1390990 1390990 735615 735615 23620208 21081795 2538413 2629972 2287859 342113 3009859 2618330 391529 1896305 1649629 246676 45382 13012 32370 31850 31850 72628 72628 635615 553880 81735 49460 44227 5233 94842 75807 19035 1924531 1607546 316985 215707 187647 28060 Purch - Lab & Pharmacy 2669269 2023475 645794 qaap 1063959 1063959 Supplies (Program) 982977 928956 54021 Utilities 581048 485148 95900 Bad Debt Expense 518312 518312 807431 632596 174835 42975960 37235796 5740164 0 2288 500 5934039 7207360 5808573 8375834 127702 100458 519389 391519 32715603 23078675 10784424 9636928 28626052 40261709 123917 2796887 2683114 54723271 68657422 6678673 7743354 3628223 967216 10306896 8710570 X 43560109 59088182 856266 858670 44416375 59946852 54723271 68657422 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 6092 0 0 0 6092 0 1102670 1102670 16699240 12312472 4386768 522622 385129 137493 13834164 10051547 3782617 556907 329527 227380 9636928 Accrued Pension Costs 967216 967216 45654635 42975960 2678675 10660249 2191553 12851802 15530477 56314884 10660249 10660249 45654635 0 45654635 42975960 0 42975960 0 42975960 Part XI, Line 8 - Other Adjustments: Pension RElated Changes: 2191553. 1 1 1 X 145.000000000000 1 X 1 1 0 0 461596 461596 0.01070 6380143 4497479 1882664 0.04380 6841739 4497479 2344260 0.05450 69077 69077 0.00160 84920 84920 0.00200 41653 41653 0.00100 195650 195650 0.00460 7037389 4497479 2539910 0.05910 1 392466 10000 3038109 3549706 -511597 X 1 1 PORTER HILLS REHABILITATION LLC REHABILITATION SERVICES 0.50000 MARY FREE BED HOSPITAL & REHABILITATION

235 wealthy st se grand rapids MI 495035247

X Part III, Line 8: MARY FREE BED HOSPITAL AND REHABILITATION CENTER HAS ESTIMATED THAT MOST OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS CHARITY CARE AS MANY OF THESE PATIENTS ARE LIVING ON FIXED INCOMES AND HAVE LIMITED MEANS. Part III, Line 9b: ALL PATIENTS RECEIVING CHARITY CARE HAVE A UNIQUE FINANCIAL CLASS ASSIGNED TO THEM. ALL CHARITY CARE ACCOUNTS ARE EXCLUDED FROM ACCOUNTS BEING SENT TO THE COLLECTION AGENCY. Part VI, Line 2: THE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED ARE DETERMINED THROUGH THE HOSPITAL'S ANNUAL STRATEGIC PLANNING PROCESS. INPUTS FROM PATIENTS, FAMILIES OF PATIENTS, REFERRING PHYSICIANS, HOSPITAL DISCHARGE PLANNERS, AS WELL AS INFORMATION FROM OTHER COMMUNITY HEALTHCARE PROVIDERS ARE USED TO DETERMINE THE REHAB HEALTHCARE NEEDS OF THE COMMUNITIES SERVED. Part VI, Line 3: EACH PATIENT RECEIVES AN INFORMATION PACKET WHICH INCLUDES A COPY OF OUR CHARITY CARE POLICY AND APPLICATION. FURTHER, IF ANY SERVICES ARE NOT COVERED OR PARTIALLY COVERED, PATIENTS ARE CONTACTED AND CHARITY IS AGAIN OFFERED, IF APPROPRIATE. MANY OF OUR PATIENTS COME FROM AN ACUTE CARE HOSPITAL WITH SIMILAR CHARITY POLICIES; WE ARE OFTEN ABLE TO CONTACT THE REFERRING HOSPITAL TO DISCUSS A PATIENT'S ELIGIBILITY. Part VI, Line 4: THE HOSPITAL SERVES PRIMARILY THE WESTERN MICHIGAN COMMUNITY. Part VI, Line 5: COMMUNITY BUILDING ACTIVITIES ARE HANDLED PRIMARILY BY A SISTER CORPORATION, THE MARY FREE BED FUND (EIN:38-2643392). Part VI, Line 6: THE HOSPITAL FURTHERS ITS EXEMPT PURPOSES BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH AN OPEN MEDICAL STAFF, A BOARD COMPRISED OF COMMUNITY MEMBERS, AND PERIODIC TRANSFER OF SURPLUS FUNDS TO THE MARY FREE BED FUND WHICH ARE USED FOR SUPPORTING PROGRAMS FOR THE DISABLED IN THE COMMUNITY. STAFF SERVE ON BOARDS OR VOLUNTEER AT OTHER NON-PROFIT AGENCIES. THE HOSPITAL PARTNERS WITH OTHER AGENCIES ON HEALTH ISSUES SUCH AS STROKE PREVENTION AND USE OF HELMETS TO REDUCE HEAD INJURIES. 0 MICHIGAN REHABILITATION SERVICES 750 FRONT NW GRAND RAPIDS MI 49504 386000134 governmental 35000 1500 BOOK STAFF SUPPORT REHABILITATION SERVICES MARY FREE BED FUND 235 WEALTHY ST SE GRAND RAPIDS MI 49503 382643392 501(C)(3) 677245 0 N/A N/A GENERAL PROGRAM SUPPORT 2 X X X X 0 0 0 0 0 1 0 0 0 William H Blessing 314491 0 9177 0 33830 0 0 0 46520 0 404018 0 0 0 John F Butzer MD 335277 0 10962 0 34347 0 0 0 48350 0 428936 0 0 0 randall deneff 156128 0 4602 0 865 0 0 0 33725 0 195320 0 0 0 dayle maples 264453 0 9780 0 187 0 0 0 25881 0 300301 0 0 0 bruce brasser 136307 0 4522 0 0 0 0 0 30885 0 171714 0 0 0 Part I, Line 6 AN INCENTIVE PLAN WITH SPECIFIC MEASURES AND WEIGHTINGS FOR FINANCIAL (BASED ON NET EARNINGS RELATIVE TO BUDGET), QUALITY, CUSTOMER SATISFACTION, AND INDIVIDUAL GOALS IS IN PLACE FOR THE PRESIDENT AND MEDICAL DIRECTOR. Form 990, Part VI, Section A, line 6 THE ORGANIZATION HAS ONE SHAREHOLDER AS DICTATED BY THE BY-LAWS. Form 990, Part VI, Section A, line 7a THE SOLE SHAREHOLDER HOLDS 50% OF THE BOARD POSITIONS WHICH EXERCISE THE RIGHT TO ELECT HOSPITAL BOARD MEMBERS. Form 990, Part VI, Section A, line 7b THE SOLE SHAREHOLDER MUST APPROVE CERTAIN HOSPITAL BOARD TRANSACTIONS SUCH AS REAL ESTATE TRANSACTIONS. Form 990, Part VI, Section B, line 11 NO REVIEW WAS OR WILL BE CONDUCTED PRIOR TO FILING. AFTER COMPLETION OF THE RETURN, RETURN WILL BE POSTED TO INTERNAL WEBSITE PORTAL FOR ALL BOARD MEMBERS. Form 990, Part VI, Section B, line 12c CONFLICT OF INTEREST POLICIES ARE UPDATED ANNUALLY BY ALL BOARD MEMBERS, OFFICERS, AND STAFF. PROCESS IS ADMINISTERED OUT OF THE EXECUTIVE ADMINISTRATION OFFICE. ANY DISCLOSED CONFLICTS OF INTERESTS WOULD BE DISCLOSED TO THE BOARD OF DIRECTORS AND ASSURANCES OBTAINED THAT NO ILLEGAL OR SUBSIDIZED ACTIVITIES ARE OCCURRING. ALL DISCLOSURES REVIEWED BY THE HOSPITAL'S COMPLIANCE COMMITTEE. Form 990, Part VI, Section B, line 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES THE COMPENSATION FOR THE HOSPITAL'S PRESIDENT AND MEDICAL DIRECTOR. MARKET SURVEY DATA OF COMPARABLE SALARIES IS USED TO ESTABLISH BASE SALARY. AN INCENTIVE PLAN WITH SPECIFIC MEASURES AND WEIGHTINGS FOR FINANCIAL, QUALITY, CUSTOMER SATISFACTION, AND INDIVIDUAL GOALS IS ALSO IN PLACE FOR THE PRESIDENT AND MEDICAL DIRECTOR. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FINANCIAL STATEMENTS ARE SUMMARIZED IN AN ANNUAL REPORT WHICH IS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. mary free bed guild of grand rapids 235 wealthy street se grand rapids MI 49503 382649369 charitable healthcare MI 501(c)(3) Line 7 N/A MARY FREE BED BRACE AND CORSET SHOP 235 wealthy street se Grand rapids MI 49503 382643391 Charitable healthcare MI 501(c)(3) Line 9 MARY FREE BED GUILD OF GRAND RAPIDS mary free bed fund 235 wealthy street se grand rapids MI 49503 382643392 supporting organization MI 501(c)(3) Line 11a, I marY FREE BED GUILD OF GRAND RAPIDS porter hills rehabilitation llc 3590 e fulton st grand rapids MI 49546 383545072 rehabilitation services MI related 94538 452130 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 mary free bed BRACE AND CORSET I 163469 MARY FREE BED BRACE AND CORSET P 960012 mary free bed fund P 205718 MARY FREE BEd fund B 677245 MARY FREE BED FUND C 1106736