2023-03-12T12:31:42-07:00 2022-06-30 990 2021-07-01 381368360 PINE REST CHRISTIAN MENTAL HEALTH SERVICES PINE 6164555000 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 Paul Karsten Vice President & CFO 6164555000 2023-03-13 1 11 1 AAL2 2021 2023-04-26 12:10:37Z Mark Eastburg 300 68th Street SE Grand Rapids MI 49548 195885273 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. 25 22 2389 125 0 0 4894027 7066448 157485633 169241762 6468703 -4439980 5624922 1983739 174473285 173851969 0 0 0 0 125109113 133173402 0 0 586583 38675985 44353258 163785098 177526660 10688187 -3674691 128907137 122666043 56535608 53483654 72371529 69182389 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 66965232 0 88798091 Hospital Based Services inpatient and partial hospitalization programs include dedicated psychiatric 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 treatment 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 of Accreditation of Healthcare Organizations (JCAHO). Hospital Based Services, had 66,630 patient days of care in Fiscal year 2022. 57534837 0 58095834 Clinic Network through its 19 clinics, offers outpatient, ambulatory care at locations throughout West and Northern Michigan, and in 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 and residential substance abuse/addictions services, court-related services and assessments, and more. The Clinic Network had 363,773 patient visits in fiscal year 2022. 8211042 0 10844008 Pine Rest has operated a psychiatry residency program since July 2014 and since then has also started fellowships in Child and Adolescent, Geriatric, Forensic, and Addiction Psychiatry. There are currently 50 residents and fellows that spend time each week in 3-5 lectures, mentorship, and on clinical rotations, working under the supervision of a psychiatrist to provide care to patients. Rotations include working with patients in the following settings: substance use, community mental health, child and adolescent, adult inpatient, older adult inpatient, primary care, neurology, outpatient clinic services, and numerous other clinical rotation opportunities. The Pine Rest outpatient residency clinic opened in October 2015 and is currently conducting over 10,700 appointments annually for patients throughout the state of Michigan. Additionally, residents and fellows also see patients in a variety of other settings in both Grand Rapids and Traverse City. Pine Rest is pleased that our residents and fellows come from a wide variety of excellent medical schools. Additionally, all of the training programs are currently accredited by the ACGME, most with commendation for excellence. Research has shown that over 60% of psychiatry residents stay and work in the community where they train. Pine Rest's goal is to ensure over time that the state of Michigan has a sufficient amount of psychiatry to serve our community for years to come. To date, around 60% of the Pine Rest graduates have remained in the state to continue to serve the communities of Michigan. 4770575 0 6233478 The Pine Rest Adult Residential Division offers longer term psychiatric services to adults with mental health needs in a residential setting. These programs include both locked and unlocked settings. These services and facilities are licensed and accredited by the State of Michigan as well as the Commission on Accreditation of Rehabilitation Facilities (CARF). The Caring Communities Program brings Pine Rest into invited partnerships with established community organizations to introduce behavioral health services to under-served 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. Adult Residential services had 12,790 patient days of care in fiscal year 2022. 3172225 0 3421337 Homes for the Developmentally Disabled serves adults with developmental disabilities in exceptional residential settings with multiple opportunities for engaging in on-site and community activities that match abilities. Homes for the Developmentally Disabled services program had 21,271 patient days of care in fiscal year 2022. 1351486 0 955168 Pine Rest has a Grants Management Program designed to introduce new research and programs to the organization and provide better services to our patients and community. 1031994 0 893846 Education and Prevention offers a range of education and prevention activities that help promote community wellness. Pine Rest is the recipient of several grants that promote education and prevention activities around mental health as well as perform research to further determine best practice models of care. An internship program for graduate students studying psychology is offered. 10326280 0 11503829 143037391 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 193 0 1 2389 1 0 0 0 0 0 0 0 0 X 25 22 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Paul H Karsten 6162816363 300 68th St SE Grand Rapids MI 495010165 Bibhas Singla Medical Staff 55 0 X 599458 0 28820 Mark C Eastburg PhD President & CEO 58 2 X 592853 0 32284 Amandeep S Saluja Medical Staff 55 0 X 567531 0 25487 William Sanders Chief Medical Officer 55 0 X 561023 0 30138 James Eicher Medical Professional 55 0 X 516328 0 29006 Marwan Tabbara Medical Staff 55 0 X 436213 0 26294 Jack Mahdasian Medical Staff 55 0 X 412787 0 28145 Louis Nykamp Medical Staff 55 0 X 414777 0 26096 Paul H Karsten VP & CFO 58 2 X 393174 0 26120 Robert L Nykamp VP & COO 60 0 X 384678 0 27413 Katherine Jawor Medical Staff 55 0 X 400355 0 11056 Daniel Schellenberg Medical Staff 55 0 X 311075 0 25796 Valerie MathisAllen Medical Staff 55 0 X 314890 0 14356 Susan Langeland Chief Information Officer 60 0 X 268421 0 27027 Harmony Gould Director of HBS 50 0 X 261053 0 12675 Brian Hesler Medical Professional 55 0 X 229293 0 7811 Thomas Scott Halstead Director of PPG 50 0 X 204165 0 23675 Ryan LaRue Vice President of Contracts 50 0 X 137578 0 27808 Jody Vanderwel Chairperson 2 0 X 0 0 0 Scott Bolinger Vice Chairperson and Secretary 2 0 X 0 0 0 Gil Segovia Treasurer 2 0 X 0 0 0 Mary Ann Cartwright Board Member 1 0 X 0 0 0 LaRissa Hollingsworth Board Member 1 0 X 0 0 0 Art Jongsma PhD Board Member 1 0 X 0 0 0 Doug Josephson Board Member 1 0 X 0 0 0 Glenn Mitcham Board Member 1 0 X 0 0 0 David McKeague Board Member 1 0 X 0 0 0 Laurie Murphy Board Member 1 0 X 0 0 0 Susan Valcq Board Member 1 0 X 0 0 0 Kirk Lambers Board Member 1 0 X 0 0 0 Marilyn Litka-Klein Board Member 1 0 X 0 0 0 Abbey Slakick Board Member 1 0 X 0 0 0 Stacia Ford-Spicer Board Member 1 0 X 0 0 0 Mina Breuker Board Member 1 0 X 0 0 0 Robert Connors Board Member 1 0 X 0 0 0 Omar Cuevas Board Member 1 0 X 0 0 0 Jack DeBoer Board Member 1 0 X 0 0 0 Brett Holleman Board Member 1 0 X 0 0 0 Stella Michael Board Member 1 0 X 0 0 0 Kevin Nichols Board Member 1 0 X 0 0 0 7005652 0 430007 167 1 1 0 Dan Vos Construction 6160 Fulton street E Ada MI 49301 Construction 3170146 Unidine Corporation PO Box 360639 Pittsburgh PA 152516639 Patient Dietary and Cafeteria Services 3132393 Epic Systems Corporation 1979 Milky Way Verona WI 53593 Electronic Medical Record 2954176 US Signal LLC 201 Ionia Avenue SW Grand Rapids MI 49503 Cloud Data Hosting 1996702 Institutional Pharmacy Solutions 3480 EAstern Boulevard Montgomery AL 36116 Pharmacy 1436468 80 0 0 0 3964339 3102109 0 0 7066448 Inpatient Care 622000 99011833 99011833 0 0 Outpatient Clinic 621400 57493030 57493030 0 0 Residential Programs 623000 12736899 12736899 0 0 0 0 0 0 169241762 -5991901 0 0 -5991901 0 0 0 0 0 0 0 0 12973 0 20008 0 -7035 0 -7035 0 0 -7035 23565217 0 22013296 0 1551921 0 1551921 0 0 1551921 0 CARES Act Provider Relief Fund 624230 373911 373911 0 0 Medical Record Transcription 622210 98724 98724 0 0 Rustic Market Sales 624000 261499 261499 0 0 1256640 1256640 0 0 1990774 173851969 171232536 0 -4447015 0 0 0 0 0 0 0 0 7435657 4425573 3010084 0 0 0 0 0 107517900 96621917 10504771 391212 0 0 0 0 18219845 16191715 1954470 73660 0 0 0 0 0 0 0 0 288612 43365 245247 0 100584 3500 97084 0 57000 0 57000 0 0 0 212830 0 212830 0 10746174 7231943 3477006 37225 806214 44711 743284 18219 1358363 727736 612269 18358 4382437 21491 4360858 88 0 0 0 0 3961501 2846109 1115327 65 109249 80323 28880 46 0 0 0 0 0 0 0 0 1455059 0 1455059 0 0 0 0 0 7009157 3417200 3566051 25906 535421 0 535421 0 Food 2882497 2852861 29361 275 QAAP 2322195 2322195 0 0 Pharmacy 1521297 1521297 0 0 Medical Supplies 1361394 1360357 1037 0 5243274 3325098 1896647 21529 177526660 143037391 33902686 586583 5679408 3263730 0 0 269601 418960 21136737 20382378 0 0 0 0 40969 28676 161207 191249 2926576 2968041 153448723 91052583 60181531 62396140 36140043 30678860 0 0 823355 2338009 0 0 1547710 0 128907137 122666043 19280403 19983151 0 0 147223 1054466 30200000 28120000 0 0 0 0 0 0 2845571 1021946 4062411 3304091 56535608 53483654 X 70362356 66687665 2009173 2494724 72371529 69182389 128907137 122666043 X -3674691 0 0 0 0 485551 X 0 1 X 1 1 1 X 0 0 0 0 0 0 1 57000 0 0 57000 0 Schedule C, Part II-B, Line 1 Verbal and written communication with public officials regarding legislation and proposals affecting the delivery of healthcare in Michigan and Nationally. 30454204 123914 -4707914 1360139 114854 0 24395211 26104515 117946 5332485 1094565 6177 0 30454204 25715850 127880 1481591 1219787 1019 0 26104515 24572355 704814 1632181 1193500 0 0 25715850 24177318 176400 1366629 1132261 15731 0 24572355 0.85 0.15 0 0 1 1 0 102148 102148 0 81808091 49277277 32530814 0 7043352 1575162 5468190 0 52086471 36389956 15696515 0 12408661 3810188 8598473 62396140 0 457 Liability for Deferred Comp 3304091 3304091 X 173659147 0 0 0 0 0 173659147 212830 -20008 192822 173851969 177333838 0 0 0 20008 20008 177313830 212830 0 212830 177526660 Schedule D, Part V, Line 4 The spending policy allows for annual spending of 5% of the average fair market value of the net assets for the prior three years. This amount is transferred from the Foundation to the operating funds of the Corporation to provide for the care of patients and initiatives that benefit the organization. The spending policy allows for use of investment earnings on restricted endowment funds in accordance with donor wishes. Schedule D, Part X, Line 2 The Corporation is 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, 2022. 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 tax authorities for years before 2017. Schedule D, Part XI, Line 4b This is net rental expense Schedule D, Part XII, Line 2d Net Rental Expenses 1 1 X 1 X 2.5 1 X 1 1 0 0 1922454 1093000 829000 0.00005 38468164 27252004 11216160 0.00064 0 0 0 0 0 0 40390618 28345004 12045160 0.00069 3198855 2969736 229119 0.00001 10120860 11092754 0 41744712 33561364 8183348 0.00047 605997 339624 266373 0.00002 0 0 0 0 0 0 55670424 47963478 8678840 0.00050 0 0 96061042 76308482 20724000 0.00119 0 5541755 15393 24064075 29082430 -5018355 X 1 1 1 1 Pine Rest Christian Mental Health Services 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 www.pinerest.org X Pine Rest Christian Mental Health Services 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X https://www.pinerest.org/about-us/#KCCNA X https://accesskent.com/Health/CHNA/pdf/FINAL-2020-CHNA-REPORT.pdf 1 22 1 https://www.pinerest.org/media/pine-rest-strategy-for-community-needs-assessment-report.pdf 0 0 1 X 1 1 X X X X 1 X https://www.pinerest.org/about-us/financial-assistance/ X https://www.pinerest.org/about-us/financial-assistance/ X https://www.pinerest.org/about-us/financial-assistance/ X X X X X X 1 X 0 X X X X 0 X X X X 0 0 Schedule H, Part V, Section B, Line 5-Pine Rest Christian Mental Health Services The process of assessing community health need is undertaken on a collaborative basis. The process (called CHNA) involved more than 50 local community organizations in 2020. Through community engagement and participation, this process identifies and prioritizes health-related needs and analyzes a broad range of social, economic, environmental and behavioral factors that may contribute to health needs or influence health outcomes of residents. Pine Rest Christian Mental Health Services is a principal participant in the CHNA process as it relates to behavioral health in all aspects. See https://accesskent.com/Health/CHNA/pdf/FINAL-2020-CHNA-REPORT.pdf for details on methods employed, data collected, sources of input and key findings. Information from the CHNA is used to develop a Community Health Improvement Plan (CHIP) which aims to address the prioritized needs. Pine Rest Christian Mental Health Services uses the CHIP to establish strategic initiatives addressing the needs identified in the behavioral health field. See https://www.pinerest.org/about-us/#KCCNA Schedule H, Part V, Section B, Line 6a-Pine Rest Christian Mental Health Services Mary Free bed Rehabilitation, Mercy Health, University of Michigan Metro Health & Corewell Health Schedule H, Part V, Section B, Line 6b-Pine Rest Christian Mental Health Services see https://accesskent.com/Health/CHNA/pdf/FINAL-2020-CHNA-REPORT.pdf for a full list of participants Schedule H, Part V, Section B, Line 11-Pine Rest Christian Mental Health Services For each year of the CHNA, Pine Rest assesses and updates a response to the most recent CHNA. Consequently, Pine Rest CMHS has selected issues from the CHNA that can and should be addressed by Pine Rest CMHS. Schedule H, Part V, Section B, Line 13h-Pine Rest Christian Mental Health Services In determining financial assistance eligibility, Pine Rest CMHS evaluates the patient/guarantor's ability to reimburse Pine Rest CMHS for the services being requested or previously provided. Pine Rest CMHS evaluates information such as: income level, net worth, employment status, other financial obligations and amount and frequency of healthcare costs. Schedule H, Part V, Section B, Line 21c-Pine Rest Christian Mental Health Services Pine Rest CMHS is a Behavioral Health facility. We do not provide emergency medical care and do not fall under EMTALA Schedule H, Part V, Section B, Line 21d-Pine Rest Christian Mental Health Services Pine Rest CMHS is a Behavioral Health facility. We do not provide emergency medical care and do not fall under EMTALA. 29 Pine Rest - Campus Clinic 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 Outpatient clinic, residential detox, screening, assessment, referral Pine Rest - Southwest Clinic 4211 Parkway Place Grandville MI 49418 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Traverse City Clinic 1050 Silver Drive Traverse City MI 49684 Outpatient Clinic, mental health, addiction treatment and follow up Pine Rest - Northeast Clinic 3225 North Evergreen Drive NE Suite 301 Grand Rapids MI 49525 Outpatient Clinic, screening, assessment, referal and follow up Pine Rest - Northwest Clinic 2118 3 Mile Road Grand Rapids MI 49544 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Northshore Clinic 17325 VanWagoner Road Spring Lake MI 49456 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Neuromodulation Clinic ECT/TMS 300 68th Street SE Grand Rapids MI 49508 Outpatient and Inpatient, screening, assessment, referral and follow up Pine Rest - Christian Counseling Center 1870 Leonard NE Grand Rapids MI 49505 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - PCC Psychological Consolation Center 300 68th St Grand Rapids MI 49548 PCC Psychological Consolation Center Pine Rest - InterActions Residential Treatment 300 68th Street SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - Recovery Outpatient 300 68th Street SE Grand Rapids MI 49548 Residential mental health and addiction treatment and detox Pine Rest - Holland Clinic 926 S Washington Ave Suite 210 Holland MI 49423 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Kalamazoo Clinic 1530 Nichols Road Kalamazoo MI 49006 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Community Case Management 320 Commerce Avenue SW Grand Rapids MI 49503 Outpatient Clinic, comm change alternative informatin training, prevention and mental health Pine Rest - Zeeland Clinic 8333 Felch Suite 210 Zeeland MI 49464 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Caledonia Clinic 6505 Cherry Meadow Dr Caledonia MI 49316 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - CenterPointe Recovery Center 1145 Oakland Drive Kalamazoo MI 49008 Adult Foster Care Pine Rest - Cameron 6680 Adrian SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - SEQUOIA Program 300 68th Street SE Grand Rapids MI 49548 Education, awareness, access and non-traditional services to the community Pine Rest - Westwood 7047 Madison SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - Pine Grove 7051 Madison SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - Portage Clinic 1350 W Centre Avenue Portage MI 49024 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Adrian 6700 Adrian SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - Eastwood 7041 Madison SE Grand Rapids MI 49548 Adult Foster Care Pine Rest - Supported Independent Living 821 68th Street SE Grand Rapids MI 49508 Residential supervised independent living Pine Rest - Forest Hills Clinic 877 Forest Hill Ave SE Grand Rapids MI 49546 Outpatient clinic, residential detox, screening, assessment, referral Pine Rest - Hastings Clinic 450 Meadow Run Hastings MI 49058 Outpatient clinic, residential detox, screening, assessment, referral Pine Rest - Transition Clinic 300 68th Street SE Grand Rapids MI 49548 Assist youth in transitioning from Foster care Pine Rest - Psychological Consultation Center 300 68th Street SE Grand Rapids MI 49548 Providing Psychological Urgent Care to Adults Schedule H, Part I, Line 7 Utilizing prescribed worksheets 1 thru 8 as defined by the IRS Schedule H, Part III, Section A, Line 4 The provision for bad debt is based upon management's assessment of historical and expected collections of accounts receivable considering business and economic conditions, trends in healthcare coverage and other collection indicators. Accounts receivables are written off and charged to bad debt after collection efforts have been made in accordance with organizational policies. Recoveries are treated as a reduction to bad debt. Accounts receivables are reduced by an allowance for doubtful accounts. The allowance for doubtful accounts is reviewed frequently based upon historical data regarding collection. Schedule H, Part III, Section B, Line 8 The sources is the Medicare cost report Schedule H, Part III, Section C, Line 9b If a patient is eligible for financial assistance for their care, Pine Rest CMHS will inform them of the amount that they will receive through financial assistance and what reduced amount that they are responsible to pay, if any. The patient will be refunded any amounts he or she paid for their care up to the approved assistance amount unless less than $10.00. Schedule H, Part VI, Line 2 Each year, Pine Rest CMHS assesses and updates a response to the CHNA. Pine Rest CMHS is a Behavioral Health hospital. Consequently, Pine Rest CMHS is selecting issues from the CHNA that can and should be addresses by Pine Rest CMHS. Schedule H, Part VI, Line 3 At admission, the organization communicates to the patient or family as appropriate the benefits both public and private that are available for the prescribed care. Once the patient responsibility is established, the patient status relative to charity care is reviewed and a decision is made regarding a patient assistance application. Schedule H, Part VI, Line 4 Pine Rest CMHS is a multi-service behavioral health organization serving a diverse group of people in multiple settings throughout West Michigan. Its network of inpatient, residential and outpatient services reaches people of all ages. The majority of people served by Pine Rest CMHS are identified as being from counties within the state of Michigan. Schedule H, Part VI, Line 5 To ensure a strategic focus on the health needs of the community served, the majority of the governing body is composed of people who reside in the organizations primary service are and who are neither employees nor contractors of the organization. In addition, the organization has an open medical staff allowing hospital staff membership to all Physicians in the community who meet membership and clinical privilege requirements. This improves care to the community served through greater availability of medical staff within the service area. Since 1908, the organization has consistently applied surplus funds to the improvement 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 CMHS has board designated funds that fund outreach services improving access in the community. Pine Rest CMHS also provides educational opportunities to the community on various behavioral health topics. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 Bibhas Singla Medical Staff 281729 0 280575 0 18577 0 3143 0 25677 0 609701 0 605716 0 Mark C Eastburg PhD President & CEO 410996 0 141942 0 19958 0 5671 0 26613 0 605180 0 402714 0 Amandeep S Saluja Medical Staff 300426 0 266145 0 480 0 3786 0 21701 0 592538 0 649942 0 William Sanders Chief Medical Officer 307226 0 193396 0 30200 0 4424 0 25714 0 560960 0 442131 0 James Eicher Medical Professional 251962 0 224450 0 19958 0 3603 0 25404 0 525377 0 450253 0 Marwan Tabbara Medical Staff 241939 0 193397 0 440 0 3881 0 22414 0 462071 0 487317 0 Louis Nykamp Medical Staff 323103 0 62631 0 14522 0 4928 0 21168 0 426352 0 0 0 Jack Mahdasian Medical Staff 267841 0 106072 0 19437 0 5134 0 23011 0 421495 0 412633 0 Katherine Jawor Medical Staff 313097 0 47308 0 19975 0 4523 0 6533 0 391436 0 396620 0 Paul H Karsten VP & CFO 303378 0 88921 0 437 0 4952 0 21168 0 418856 0 257402 0 Robert L Nykamp VP & COO 294581 0 89210 0 443 0 4403 0 23011 0 411648 0 278052 0 Valerie MathisAllen Medical Staff 188197 0 86848 0 19923 0 3610 0 10746 0 309324 0 351627 0 Daniel Schellenberg Medical Staff 169865 0 107219 0 16996 0 3268 0 22528 0 319876 0 361303 0 Susan Langeland Chief Information Officer 204257 0 63356 0 404 0 1613 0 25414 0 295044 0 210183 0 Harmony Gould Director of HBS 200459 0 59862 0 366 0 2929 0 9746 0 273362 0 0 0 Brian Hesler Medical Professional 138628 0 38600 0 26032 0 2423 0 5388 0 211071 0 400894 0 Thomas Scott Halstead Director of PPG 155273 0 47943 0 474 0 2624 0 21051 0 227365 0 0 0 Ryan LaRue Vice President of Contracts 130930 0 6156 0 246 0 2094 0 25714 0 165140 0 0 0 Schedule J, Part I, Line 1a Taxable term life premiums added to taxable income were grossed up to compensate for taxes on these premiums. Grossed up amounts were taxed. Schedule J, Part I, Line 3 The Board of Directors has adopted a written executive compensation plan and has delegated to the Compensation Committee the responsibility for implementing and overseeing compensation issues with regular reporting to the board. In setting and reviewing executive compensation for the COO, CFO, CMO and Vice Presidents, the Compensation Committee relies on market data for similarly situated hospital executives in comparable organizations. The Compensation Committee also reviews salary market information for the CEO and makes recommendation to the Executive Committee. The Executive Committee relies on market data for similarly situated professionals serving comparable institutions. The organization regularly commissions studies by Integrated Healthcare Strategies to ensure that the total compensation paid to Physicians is reasonable, consistent with objective market data and in the best interest of the organization. The compensation model for Physicians was adopted by the organization based upon those studies. Review and approval of all new Physician employment contracts by both the CFO And Chairman of the Compensation Committee is required to ensure that all compensation packages are within the approval limits. Documentation and supporting detail are maintained for all compensation decisions. Schedule J, Part I, Line 7 Employment contracts with officers of the organization allow for performance-based incentives. Each year, the Board of Directors articulates and approves objective, measurable performance criteria. If performance criteria are met, then performance-based incentives are paid. A Kent Hospital Finance Authority 381603110 490576AC9 2015-10-01 10330000 Refinancing of original debt 1 0 0 B Kent Hospital Finance Authority 381603110 2017-12-29 24000000 Expansion of Hospital Facility 1 0 0 C Kent Hospital Finance Authority 382350002 2022-03-25 28120000 Refinance 2015 and 2017 Bonds 0 0 0 A 0 10330000 10346628 0 11628 0 5000 0 0 0 0 0 2022 1 0 1 1 B 0 17790000 17852001 0 44001 0 18000 0 0 0 0 0 2022 1 0 1 1 C 0 0 0 0 0 0 0 0 0 0 0 0 2031 1 0 0 1 A 0 0 0 0 0 0 0 1 0 1 B 0 0 0 0 0 0 0 1 0 1 C A 1 1 1 Macatawa Bank 1.0 0 0 0 0 1 B 1 1 1 Macatawa Bank 1.0 0 0 0 0 1 C 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 William Sanders Chief Medical Officer X 100000 90000 0 1 1 90000 William Sanders Chief Medical Officer 100000 Employee Loan Employee Loan Form 990, Part VI, Section B, Line 11b 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. Each year a copy of the Form 990 is given to the external auditors for review. Recommended changes are made to the form and supporting schedules. The Finance committee votes on a motion to approve the form as amended. The final filed for 990 is made available to all Board members for their review and information. Form 990, Part VI, Section B, Line 12c Ongoing Board of Directors and Board Committee discussions in concert with annual audit and corporate integrity office activities monitor and maintain oversight of this activity. Form 990, Part VI, Section B, Line 15 The Board of Directors has adopted a written Executive compensation plan and has designated the Compensation Committee the responsibility for implementing and overseeing issues with regular reporting to the board. In setting and reviewing executive compensation for the COO, CFO, CMO and Vice Presidents, the Compensation Committee relies on market data for similarly situated hospital executives in comparable institutions. The Compensation Committee also reviews salary market information for the CEO and makes recommendations to the Executive Committee. The Executive Committee oversees CEO compensation. In setting and reviewing compensation of Physicians (both employed and independent contractors), the Compensation Committee relies on market data for similarly situated professionals serving in comparable institutions. The Corporation regularly commissions studies by Integrated Healthcare Strategies to ensure that the total compensation paid to physicians is reasonable, consistent with objective market data and in the best interest of the Corporation. The compensation model for Physicians adopted by the Corporation is based on those studies. Review and approval of all new Physician employment contracts by both the CFO and Chairman of the Compensation Committee is required to ensure that the compensation packages are within the approval limits. Documenation and supporting detail are maintained for all compensation decisions. Form 990, Part VI, Section C, Line 19 This is the change in Net assets with donor restrictions Form 990, Part XI, Line 9 This is the change in net assets with donor restrictions Pine Rest Foundation 300 68th Street SE PO Box 165 Grand Rapids MI 495011065 381676540 Fundraising MI 501(c)(3) Type 1 Pine Rest Christian Mental Health Services 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 Pine Rest Foundation c 1360139 Each Year, following a specific formula, the Pine Rest Foundation awards grants to Pine Rest Christian Mental Health Services to fund various aspects of behavioral healthcare and counseling programs. Pine Rest Foundation m 2152573 The Pine Rest Foundation serves as the single-portal of giving for all donations intended for the Pine Rest Foundation and Pine Rest Christian Mental Health Services. Pine Rest Foundation p 2210 Pine Rest Christian Mental Health Services Accounts Payable department processes all invoices for the Pine Rest Foundation. The Pine Rest Foundation then reimburses Pine Rest CMHS for the amount equal to those invoices processed and paid on their behalf. We inadvertently failed to file the 8868 extension this year and are therefore filing past the deadline.