2011-05-12T13:29:15-05:00 2010-09-30 Plante & Moran PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2009-10-01 381360562 PENNOCK HOSPITAL PENN 2699453451 1009 WEST GREEN STREET HASTINGS MI 49058 Connie S Downs 2699453451 2011-05-12 1 Carol LaLonde CPA 2695674500 2009 2016-02-24 21:20:13Z PENNOCK HEALTH SYSTEMS Connie S Downs 1009 WEST GREEN STREET HASTINGS MI 49058 80642570 0 X WWW.PENNOCKHEALTH.COM X 1923 MI THE HOSPITAL'S MOST SIGNIFICANT ROLE IS TO PROVIDE HEALTHCARE SERVICES TO THE CITIZENS OF BARRY COUNTY. ALL ACTIVITIES ASSOCIATED WITH THIS PURPOSE ARE INCLUDED IN THE 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. PENNOCK TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 11 9 665 150 404599 -6854 99451 55983 52991852 54409950 4077397 964594 509638 472714 57678338 55903241 0 0 27616083 27325922 0 0 26512469 27226850 54128552 54552772 3549786 1350469 79524235 80558605 13419765 10862743 66104470 69695862 PENNOCK HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH SERVICES IN A PERSONAL, PROFESSIONAL AND PROGRESSIVE MANNER IN PARTNERSHIP WITH THE COMMUNITY. 0 0 39544324 54409950 PENNOCK CONTINUED TO DEMONSTRATE VALUE DURING 2010 THROUGH THE EXTENSION OF SERVICES TO OUR OUTLYING MARKETS. THE FACILITIES PROVIDED OUR PATIENTS WITH EASIER ACCESS TO ROUTINE SERVICES SUCH AS LAB, RADIOLOGY, ORTHOPEDICS, SURGERY CONSULTATION, OCCUPATIONAL MEDICINE, REHABILITATION, AND FAMILY MEDICINE. PENNOCKS 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 2,794AVERAGE DAILY CENSUS 29AVERAGE LENGTH OF STAY (DAYS) 4BIRTHS (NUMBER OF DELIVERIES) 356CARDIOPULMONARY TREATMENTS 43,566DIETARY (MEALS SERVED) 186,416EMERGENCY ROOM VISITS 19,916EMPLOYEES 596HOMECARE VISITS 9,359LABORATORY PROCEDURES 318,661 PHARMACY (DOSES DISPENSED) 413,693RADIOLOGY (ALL PROCEDURES) 52,134 REHABILITATION SERVICES 36,453SURGICAL PROCEDURES 3,210URGENT CARE VISITS 13,697OCCUPATIONAL THERAPY 10,682PENNOCK TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 39544324 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 41 0 1 665 1 1 1 0 0 0 0 0 0 0 0 11 9 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 81052 0 0 Drew Chapple 0.50 X 0 0 0 Maggie Coleman 0.50 X X 0 0 0 Bruce Gee 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 0 0 0 John Walker 0.50 X X 0 0 0 David Baum 0.50 X 0 0 0 KIMBERLY NORRIS MD 0.50 X X 0 0 0 DAVID PARKER MD 1.00 X X 66504 0 0 Sheryl Lewis Blake 40.00 X 262670 0 42203 Connie S Downs 40.00 X 186895 0 29932 Carla Wilson-Neil 40.00 X 163864 0 35354 ROSEANNE WOODLIFF 40.00 X 118550 0 1312 James J Wincek 40.00 X 119366 0 27008 DONALD GINGRICH 40.00 X 121135 0 9279 Lawerence Hawkins 40.00 X 133125 0 3752 Craig Jones 40.00 X 113179 0 24591 ANITA ASADORIAN MD 40.00 X 140294 0 3108 1506634 0 176539 12 0 1 0 Johnson Contruction 2442 28th street southwest WYOMING MI 49519 Construction 1120365 PROGRESSIVE BUILDING SERVICES 440 36th street wyOMING MI 49548 HOUSEKEEPING SERVICES 778758 Hastings Anesthesia PLC 900 Peeler St Kalamazoo MI 49008 Anesthesia Services 686812 Hastings Emergency Physicians PO Box 232 Grand Rapids MI 49501 ER Management 482795 Spectrum Health 4600 Breton Road SE Kentwood MI 49508 Reference Lab/Sleep Study 308986 14 49463 6520 55983 Patient Service Revenu 621110 54409950 54409950 54409950 254364 254364 610374 849236 -238862 -238862 -238862 24600323 23890093 710230 710230 710230 Lab Courier Service 621500 404599 404599 Cafeteria Revenue 722100 259986 259986 Miscellaneous 900099 46991 46991 711576 55903241 54409950 404599 1032709 815211 737787 77424 20100238 12884325 7215913 969104 678373 290731 3957398 2748483 1208915 1483971 1038780 445191 100944 25236 75708 159419 90609 68810 119252 119252 7569320 4389912 3179408 155024 38756 116268 945016 807784 137232 1530158 1169928 360230 253460 164749 88711 132148 132148 3698786 3143968 554818 287691 186999 100692 Supplies 7111392 6580930 530462 Bad Debts 4241304 4241304 Maintenance and Repairs 612163 484253 127910 collections 305971 305971 michigan business tax 4802 4802 54552772 39544324 15008448 0 662803 1118844 6987967 5256826 6932774 5878283 5394935 5196061 682707 637299 779977 625542 72535892 49641277 23670518 22894615 26931276 38075963 6612626 868652 875172 79524235 80558605 5065713 3897422 6979453 5282877 1374599 1682444 13419765 10862743 X 65272818 68857690 831652 838172 66104470 69695862 79524235 80558605 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3341127 3341127 39155673 28150957 11004716 2317814 1259179 1058635 26536745 20231141 6305604 1184533 1184533 22894615 Third Party Contractuals 1682444 1682444 55903241 54552772 1350469 2240923 2240923 3591392 58024912 2240923 2240923 55783989 119252 119252 55903241 54433520 0 54433520 119252 119252 54552772 1 1 1 X 1 X 1 1 1 0 1 1 187796 187796 0.00340 6616987 5953604 663383 0.01220 1294830 745072 549758 0.01010 8099613 6698676 1400937 0.02570 83797 21387 62410 0.00110 46762 46762 0.00090 31757 31757 0.00060 162316 21387 140929 0.00260 8261929 6720063 1541866 0.02830 1 178545 178545 0.00330 1 2592 2592 0.00000 10 172 3632 3632 0.00010 1 2643 2643 0.00000 175 3751 48263 48263 0.00090 2 16 30072 30072 0.00060 2 688 688 0.00000 192 3939 266435 266435 0.00490 0 1702035 189999 12526868 12350153 176715 X 1 1 BARRY HEALTH PARTNERS LTD TO INEGRATE PHYSICIAN AND HOSPITAL CLINICAL PRACTICES AND PAYOR CONTRACTING 0.50000 0.50000 PENNOCK HOSPITAL

1009 W GREEN ST HASTINGS MI 49058

X X 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 Part I, Line 7: COST TO CHARGE RATIO WAS USED TO DETERMINE PATIENT SERVICE COSTS. Part I, Line 7f: 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: PENNOCK HOSPITAL DOES NOT EXPERIENCE A MEDICARE SHORTFALL. THE MEDICARE COST REPORT WAS USED TO REPORT MEDICARE ALLOWABLE COSTS. 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 58,434 RESIDENTS, UP 3% SINCE 2000. WITH 13.7% 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 $54,177. BARRY COUNTY IS UNIQUELY LOCATED IN THE MIDDLE OF FOUR (4) LARGER METROPOLITAN AREAS: GRAND RAPIDS, LANSING, KALAMAZOO, AND BATTLE CREEK. Part VI, Line 5: 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 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. MI X 1 1 X X X 0 0 0 0 0 0 0 0 0 Sheryl Lewis Blake 258880 0 0 0 3790 0 22000 0 20203 0 304873 0 0 0 Connie S Downs 180595 0 0 0 6300 0 16000 0 13932 0 216827 0 0 0 Carla Wilson-Neil 160118 0 0 0 3746 0 20668 0 14686 0 199218 0 0 0 Part I, Line 1a THE HEALTH AND WELLNESS CENTER IS AVAILABLE TO ALL EXECUTIVE, DIRECTORS, AND OFFICERS. Michigan State Hospital Finance Authority Healthcare Equipment Loan 2003 382889417 59465E5V1 2003-12-10 4300000 Healthcare Equipment #03 0 0 Michigan State Hospital Finance Authority Healthcare Equipment Loan 2004 382889417 59465E6T5 2004-05-26 6000000 Healthcare Equipment #26 0 0 Michigan State Hospital Finance Authority Healthcare Equipment Loan 2006 382889417 59465HDY9 2006-09-27 3031165 Healthcare Equipment #58 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 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 KIM NORRIS MD PROVIDER/BOARD MEMBER/COUNTY HEALTH PLAN 730168 PAYMENTS UNDER THE INDIGENT CARE AGREEMENT TO THE BARRY EATON HEALTH PLAN 0 DAVID PARKER MD PROVIDER/BOARD MEMBER 66504 CONTRACT SERVICE OF PROFESSIONAL FEES 0 SCOTT BRASSEUR MD PROVIDER/BOARD MEMBER/TREASURER 81052 CONTRACT SERVICE OF PROFESSIONAL FEES 0 HASTINGS CITY BANK NANCY GOODIN/BOARD MEMBER/MARKETING AND TRAINING DIRECTOR 46054 INVESTMENT SERVICES 0 BRUCE GEE CHAIRMAN/ATTORNEY 1680 LEGAL SERVICES 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 26, 2011 THE COMPLETED IRS FORM 990 WILL BE REVIEWED. THE BOARD OF DIRECTORS 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. Form 990, Part VI, Section C, line 19 THE 990 IS AVAILABLE UPON REQUEST. Pennock Foundation 1009 WEST GREEN STREET HASTINGS MI 49058 382713275 FOUNDATION MI 501(C)(3) 11 PENNOCK HEALTH SYSTEMS Pennock Healthcare System 1009 WEST GREEN STREET HASTINGS MI 49058 382713276 Parent Organization MI 501(C)(3) 11 PENNOCK VENTURES 1009 WEST GREEN STREET HASTINGS MI 49058 382712819 REAL ESTATE MI Pennock Healthcare System C 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 PENNOCK VENTURES J 428814 PENNOCK VENTURES P 11659 PENNOCK FOUNDATION C 49463 PENNOCK FOUNDATION M 10000 PENNOCK FOUNDATION N 23773 PENNOCK VENTURES D 544000 PENNOCK VENTURES A 112046