2018-05-10T16:12:50-07:00 2017-06-30 990 2016-07-01 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 2018-05-10 2016 2022-09-23 18:48:47Z Paul Karsten 300 68th St SE PO Box 165 Grand Rapids MI 495010165 145665967 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. 22 20 2348 200 0 0 3306011 7273908 104763143 119648568 -614282 1432946 6362683 1871886 113817555 130227308 0 0 0 0 88902765 94564787 0 0 734695 26589454 30216922 115492219 124781709 -1674664 5445599 90543028 104113426 22657640 28490742 67885388 75622684 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 48127475 0 55972311 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). The Pine Rest's Board of Directors entered into a Joint Operation Agreement ("Agreement") effective July 1, 1998 with Saint Mary's Health Services 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 both 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. The Joint Operating Agreement of which Pine Rest is managing/operating has 200 beds available. Hospital Based Services, had 69,470 patient days of care in Fiscal year 2017. 32701096 0 33938912 Clinic Network through its eighteen clinics, offers outpatient, ambulatory care at locations throughout West and Northern 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 and residential substance abuse/addictions services, court-related services and assessments, and more. The Clinic Network had 276,975 patient visits in fiscal year 2017. 5630741 0 6062375 Hospital Based Services provides assistance to other health systems with behavioral health services. Regionally, this process creates a hospital network and referral process focused on appropriate care in the proper location. Essentially, Pine Rest is reimbursed, at a break-even level, as a means to assure long-term availability of program and operations oversight, psychiatrists and consultation at the local level. 3813723 0 3635647 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 8,416 patient days of care in fiscal year 2017. 3201648 0 2811491 The Pine Rest Community Services Programs provide outpatient mental health services as part of the community mental health system. The Community and Elderly Case Management Programs provide intensive case management services to adults with chronic mental health needs. The Integrated Medical Clinic offers immediate psychiatric services to the public patient as needed through a psychiatrist and a team of mid-level practitioners. In addition, a variety of outpatient substance abuse services as well as services to the homeless are provided. Residential Supports Coordinators work in a number of community settings to support individuals with disabilities to maintain stable housing as well. The Community Services program had 12,979 patient days of care in fiscal year 2017. 4767346 0 4995270 Pine Rest Adolescent Services 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 48, referrals are accepted based on age and behavioral criteria. A supportive milieu in both a locked and unlocked setting helps adolescents develop relationship and independent living skills. 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. The Pine Rest Adolescent services program had 15,676 patient days of care in fiscal year 2017. 2275784 0 2089715 Addiction Treatment Services offers a wide range of addiction and recovery services including 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. 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). The Addiction treatment services program had 23,091 patient days of care in fiscal year 2017. 3541555 0 3662828 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 23,438 patient days of care in fiscal year 2017. 1065581 0 876302 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. In addition, a new residency program for medical school graduates has been initiated. 4135472 0 5576921 Pine Rest has operated a psychiatry residency program since July 2014, successfully beginning the third year of the program on July 1, 2016. There are currently 25 residents that spend 1 - 2 half days in lectures and individual supervision. The remaining time is spent on their rotations, working under the supervision of a psychiatrist to provide care to patients. Rotations include addictions, Network 180 (emergency psychiatry), child and adolescent, adult inpatient, older adult inpatient, primary care (OP family practice locations), neurology (Spectrum Health and Mercy Health) and outpatient clinic services. And, the Pine Rest OP Residency Clinic opened in October 2015 and is currently providing services to numerous community members. Applications for the next year's residency program are received in the fall. One hundred thirty interviews are already scheduled. Interviews occur on Mondays and Fridays from mid-October to mid-January. Up to 10 candidates are interviewed each day. Pine Rest is pleased that our residents come from a variety of excellent medical schools located throughout the country. The candidates are ranked based on their past record in medical school, test scores and performance on their interviews with faculty. The Graduate Medical Education match system then assigns the residents to Pine Rest. The Pine Rest Psychiatry Residency Program is currently accredited by the ACGME through 2025. A fellowship to train Child and Adolescent psychiatrists will begin in July 2017, where 2-3 fellows will be trained. This two year training program involves rotations in the child and adolescent inpatient unit, residential program, partial hospital and outpatient services, as well as rotations at locations in the community such as community mental health and adolescent addiction programs. 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 West Michigan has a sufficient amount of psychiatry to serve our community. 302146 0 26796 The Pine Rest Ventures program includes the employee assistance program, Church assistance and school assistance programs. These services leverage behavioral health expertise to facilitate individual and organizational well-being to enable those served to productively thrive. PAX Crisis Response is a service line within these programs that provides immediate crisis consultation after tragedies. These programs align with the Pine Rest goal of serving our community. 23103255 0 23674970 109562567 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 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 128 0 1 2348 1 0 0 0 0 0 0 0 0 0 0 0 0 X 22 20 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IA MI X Paul H Karsten 6162816363 300 68th St SE Grand Rapids MI 495010165 Mark C Eastburg PhD President & CEO 58 2 X X 400102 0 18597 Alam M Armstrong MD Chief Medical Officer 40 0 X X 305805 0 17023 Timothy Todd MD President of Med Staff 40 0 X X 181499 0 3894 Jon Swets Chairperson 3 0 X X 0 0 0 John Lichtenberg Vice Chairperson 2 0 X X 0 0 0 Gary Werkman Treasurer 2 0 X X 0 0 0 Scott Bolinger Secretary 2 0 X X 0 0 0 Mary Ann Cartwright Board Member 1 0 X 0 0 0 Randall Christenson MD Board Member 1 0 X 0 0 0 Sylvia Daining 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 Ron Kool 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 Alvin Padilla Board Member 1 0 X 0 0 0 Jack Roeda Board Member 1 0 X 0 0 0 Susan Valcq Board Member 1 0 X 0 0 0 Jody Vanderwel Board Member 1 0 X 0 0 0 Kathleen Vogelsang Board Member 1 0 X 0 0 0 Paul H Karsten VP & CFO 58 2.0 X 259286 0 17456 Scott A Wagner VP BHS 60 0 X 152828 0 14240 Thomas Elzinga VP General Services 60 0 X 131114 0 14146 Robert L Nykamp VP & COO 60 0 X 296614 0 15594 Jack Mahdasian Medical Staff 55 0 X 521041 0 19125 Bibhas Singla Medical Staff 55 0 X 388855 0 14913 Valerie MathisAllen Medical Staff 55 0 X 373237 0 15162 William Sanders Medical Staff 55 0 X 372521 0 19571 Marwan Tabbara Medical Staff 55 0 X 350088 0 19343 Verle Bell Medical Staff 55 0 X 320659 0 8961 Danielle Schellenberg Medical Staff 55 0 X 327826 0 19023 4381475 0 217048 107 0 1 0 Elzinga & Volkers 86 East 6th Street Holland MI 494232912 Construction 7581918 Unidine Corporation PO Box 360639 Pittsburgh PA 152516639 Patient Dietary and Cafeteria Services 2188062 American Healthcare Services Assoc LLC PO Box 945 Traverse City MI 49685 Hospital Staffing Solutions 788602 Locumtenens PO Box 405547 Atlanta GA 30384 Physician Staffing Solutions 805722 Custer Office 217 Grandville Avenue SW Grand Rapids MI 49503 Office and Residential Furniture 533877 59 0 0 0 1181058 0 6092850 0 7273908 Inpatient Care 622000 36790208 36790208 0 0 Outpatient Clinics 621400 33573716 33573716 0 0 Inpatient Contracted Services 622000 29899880 29899880 0 0 Residential Care 623000 17348039 17348039 0 0 Partial Hospitalization 622000 2036725 2036725 0 0 0 0 0 0 119648568 551852 0 0 551852 0 0 0 0 0 0 0 0 112751 0 16461 0 96290 0 96290 0 0 96290 16303292 0 15422198 0 881094 0 881094 0 0 881094 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rustic Market 624000 428081 0 0 428081 Pastoral and Other Training 611710 28489 0 0 28489 1319026 0 0 1319026 1775596 130227308 119648568 0 3304832 0 0 0 0 0 0 0 0 1890991 541720 1349271 0 0 0 0 0 78180661 71685792 5988606 506263 802179 661306 135919 4954 8263910 7596287 604103 63520 5427046 4881338 508225 37483 0 0 0 0 294816 0 294816 0 84750 0 84750 0 75613 0 75613 0 0 0 219910 0 219910 0 2216857 2216857 0 0 279637 0 279637 0 5206377 3278266 1872656 55455 3258439 2686215 552101 20123 0 0 0 0 3456062 3096663 356323 3076 337670 266766 69011 1893 0 0 0 0 399352 342369 51486 5497 154745 0 154745 0 0 0 0 0 4820437 4518454 299398 2585 659293 0 659293 0 Bad Debt Expense 1676854 1676854 0 0 Patient Assistance Fund 1595705 1595705 0 0 5480405 4517975 928584 33846 124781709 109562567 14484447 734695 3733024 243147 0 0 2870528 2870528 8046120 12213294 0 0 0 0 0 0 98904 98904 1172248 1172248 110430682 59519555 42782737 50911127 30665638 34530210 0 0 0 0 0 0 1173829 2073968 90543028 104113426 8324750 8184255 0 0 0 0 10330000 10330000 0 0 0 0 0 0 0 0 4002890 9976487 22657640 28490742 X 66257395 74130015 1627993 1492669 0 0 67885388 75622684 90543028 104113426 5445599 2291697 0 0 0 0 X 0 1 X 1 0 X 0 0 0 0 0 0 1 75613 0 0 75613 0 Schedule C, Part II-B, Line 1 Government relations strategies designed to assist Pine Rest in accomplishing its Federal Funding Objectives. 23301864 790005 1954474 1534202 334823 0 24177318 24825767 251951 -189133 1513848 72873 0 23301864 24711782 1247071 608038 1555088 186036 0 24825767 21949724 298596 3462014 960000 38552 0 24711782 20242440 178065 2463364 893150 40995 0 21949724 0.85 0.15 0 0 1 1 0 107148 107148 0 75514363 36822382 38691981 0 300093 0 300093 0 28302675 20128179 8174496 0 6206403 2568994 3637409 50911127 0 MSHDA Obligation 94326 Adv. OSAS 17273 Swap Liab. 251536 Def 457/ETO 2058310 Malpractice 90042 Notes Payable 500000 Lines of Credit 6965000 9976487 X 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 operating 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 earning on permanently restricted endowment funds in accordance with donor wishes. Schedule D, Part X, Line 2 The Corporation 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, 2017. 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 2014. 1 1 X 1 X 2.5 1 X 1 1 0 0 1918064 0 1918064 0.0155 24042535 25723221 -1680686 0 0 0 0 0 0 0 25960599 25723221 237378 0.0155 142867 0 142867 0.0012 0 0 0 0 74383871 62054033 12329838 0.0998 0 0 0 0 585000 0 585000 0.0047 0 0 75111738 62054033 13057705 0.1057 0 0 101072337 87777254 13295083 0.1212 0 1676854 1246150 7233377 310294 6923083 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 15 1 1 1 1 X https://www.pinerest.org/about-us/#KCCNA X http://www.kentcountychna.org/workgroups.html 1 16 1 https://www.pinerest.org/media/Pine-Rest-Strategy-for-Community-Needs-Assessment-Report.pdf 0 0 1 X 250 250 X X 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 0 0 Schedule H, Part V, Section B, Line 5-Pine Rest Christian Mental Health Services See Kent County Community Needs Assessment for details on methods employed, data collection, sources of input and key findings. Pine Rest collaborates in the development and utilizes these findings to establish strategic initiatives that support the community needs identified and correlate with the services provided and capabilities of Pine Rest. See https://www.pinerest.org/about-us/#KCCNA Schedule H, Part V, Section B, Line 6a-Pine Rest Christian Mental Health Services Mercy Healthcare, Spectrum Health, Metro Health and Mary Free Bed. Schedule H, Part V, Section B, Line 6b-Pine Rest Christian Mental Health Services See www.kentcountychna.org for a complete list of participants. Schedule H, Part V, Section B, Line 11-Pine Rest Christian Mental Health Services Each year, Pine Rest assesses and updates a response to the most recent CHNA. Consequently, Pine Rest has selected issues from the CHNA that can and should be addressed by Pine Rest. Schedule H, Part V, Section B, Line 13h-Pine Rest Christian Mental Health Services In determining financial assistance eligibility, Pine Rest will evaluate the patient/guarantor's ability to reimburse Pine Rest for the services being requested or previously rendered. Pine Rest will evaluate information such as the following: 1. Income Levels 2. Net worth 3. Employment status 4. Other financial obligations 5. Amount and frequency of healthcare bills Schedule H, Part V, Section B, Line 21d-Pine Rest Christian Mental Health Services Pine Rest is a psychiatric facility. We do not provide emergency medical care and do not fall under EMTALA. 40 Pine Rest - Cedar Units 300 68th Street SE Grand Rapids MI 49548 Child Caring Institution 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 - ECT TMS Clinic 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 - Sub-Acute Detox 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 - Addictions Medicine 300 68th Street SE Grand Rapids MI 49548 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Jellema Treatment Center 243 68th Street SE Grand Rapids MI 49548 Residential mental health and addiction treatment, screening, assessment 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 - Pella Clinic 2611 Washington Street Pella IA 50219 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Caledonia Clinic 9090 S Rogers Court SE Caledonia MI 49316 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Des Moines Clinic 6200 Aurora Ave Urbandale IA 50322 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - CenterPointe Recovery Center 1145 Oakland Drive Kalamazoo MI 49008 Adult Foster Care Pine Rest - Community Based Grant Program 320 Commerce Ave SW Grand Rapids MI 49503 Community Based Grants Coordination 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 - Maple 300 68th Street SE Grand Rapids MI 49548 Child Caring Institution Pine Rest - Community Support Coord 320 Commerce Ave SW Grand Rapids MI 49503 Community Support Coordination Pine Rest - Portage Clinic 1350 W Centre Avenue Portage MI 49024 Outpatient Clinic, screening, assessment, referral and follow up Pine Rest - Jellema House 523 Lyon Street NE Grand Rapids MI 49503 Residential mental health, addiction treatment, screening, assessment, referral and follow up Pine Rest - Streetreach 347 S Division SE Grand Rapids MI 49503 Education, awareness, access and non-traditional services to the community. 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 - Freedom House 300 68th Street SE Grand Rapids MI 49548 Residential mental health, addiction, case management, screening, assessment, referral, follow up Pine Rest - DeMey Clinic 620 Century SE Grand Rapids MI 49503 Outpatient Clinic, comm change alternative info training, screening, assessment, referal, follow up Pine Rest - Elder Case Management 320 Commerce Ave SW Grand Rapids MI 49503 Outpatient Clinic, comm change alternative information training, prevention and mental health Pine Rest - Supported Independent Living 300 68th Street SE Grand Rapids MI 49508 Residential supervised independent living Pine Rest - Integrated Med Clinic 300 68th St Grand Rapids MI 49503 Outpatient Clinic, screening, assessment, referral, follow up Pine Rest - Recovery Residence 47 Prospect Grand Rapids MI 49503 Residential addictions recovery home Schedule H, Part I, Line 7 Utilized prescribed worksheets 1 through 8 as defined by the IRS Schedule H, Part III, Section A, Line 4 The provision for bad debts 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 receivable are written off and charged to the provision for bad debts after collection efforts have been made in accordance with the Corporation policies. Recoveries are treated as a reduction to the provision for patient bad debts. Accounts receivable are reduced by an allowance for doubtful accounts. Periodically, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by major payer category. Schedule H, Part III, Section B, Line 8 Source 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 will notify the patient that they are eligible and let them know what amount they will receive through financial assistance and what reduced amount they would be responsible for, if any. The patient will be refunded any amount he or she paid for the care if that amount exceeds the amount he or she is determine to be responsible for paying under the Financial Assistance Program, unless such excess amount is less than $10.00. Pine Rest will take all reasonably available measures to reverse any extraordinary collection actions taken against the individual to obtain payment for care. Schedule H, Part VI, Line 2 Each year, Pine Rest assesses and updates a response to the CHNA. Pine Rest is a psychiatric hospital. Consequently Pine Rest is selecting the issues from the CHNA that can and should be addressed by Pine Rest. 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 patients 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. Schedule H, Part VI, Line 4 Pine Rest Christian Mental Health Services (Pine Rest) is a multi-service behavioral health organization serving a diverse group of people in multiple settings throughout West Michigan and with two locations in Iowa. Its network of inpatient, residential and outpatient services reaches people of all ages, from children to older adults. The majority of people served by Pine Rest are identified as being from counties within the state of Michigan, with 46.3% from Kent County. A small percentage (<5%) is from counties outside of Michigan. Pine Rest's main campus is located in Kent County with a population of 642,173 according to the last census. This ranks Kent County as one of the most populated counties in Michigan. The racial make up of Kent County per census data is: 74.3% White, 10.5% African American, 10.4% Latino, 2.9% Asian and 2.8% 2 or more races. In Kent County, 12.1% of the population are below the poverty level. 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 composed of persons who reside in the organization's primary service area 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 by Pine Rest Christian Mental Health Services 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 has board designated funds that fund outreach services improving access to the community. Pine Rest also provides many educational opportunities to the community on various behavioral health topics. X 1 1 X 0 0 0 0 0 0 0 1 0 Jack Mahdasian Medical Staff 501061 0 1980 0 18000 0 4434 0 14691 0 540166 0 0 Bibhas Singla Medical Staff 274177 0 114255 0 423 0 4500 0 10413 0 403768 0 0 Valerie MathisAllen Medical Staff 240276 0 112765 0 20196 0 4491 0 10672 0 388400 0 0 William Sanders Medical Staff 267101 0 74552 0 30868 0 4500 0 15071 0 392092 0 0 Marwan Tabbara Medical Staff 300472 0 48400 0 1216 0 4852 0 14497 0 369437 0 0 0 Verle Bell Medical Staff 285264 0 29200 0 6195 0 2267 0 12323 0 335249 0 0 Danielle Schellenberg Medical Staff 259829 0 48755 0 19242 0 4516 0 14507 0 346849 0 0 0 Paul H Karsten VP & CFO 253039 0 0 0 6246 0 3844 0 13612 0 276741 0 0 Scott A Wagner VP BHS 151007 0 0 0 1822 0 2346 0 11894 0 167069 0 0 0 Thomas Elzinga VP General 129997 0 0 0 1117 0 1917 0 12229 0 145260 0 0 Mark C Eastburg PhD President & CEO 367439 0 0 0 32663 0 4479 0 14118 0 418699 0 0 Alam M Armstrong MD Chief Medical Officer 280947 0 0 0 24858 0 4367 0 12656 0 322828 0 0 Timothy Todd MD President of Med Staff 181002 0 0 0 497 0 2735 0 1159 0 185393 0 0 0 Robert L Nykamp VP & COO 290248 0 0 0 6366 0 2175 0 13418 0 312207 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 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 designated the Compensation Committee the responsibility for implementing and overseeing compensation issues with regular reporting to the board. The Compensation Committee consists of no fewer than three non-employee members of the Board, one of whom is a member of the Executive Committee. 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 for Physicians (both employed and independent contractors), the Compensation Committee relies on market data for similarly situated professionals serving comparable institutions. The organization regularly commissions studies by Integrated Healthcare Strategies to assure 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 adopted by the organization 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 insure 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 0 0 0 A 0 0 0 0 0 0 0 0 0 0 0 0 2023 1 0 1 1 A 0 0 0 0 0 0 0 1 0 1 A 1 1 1 Macatawa Bank 1.0 0 0 0 0 1 A 0 William Sanders Medical Staff Recruitment X 100000 25000 0 1 1 25000 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. Every three years, the external auditors are engaged to perform a quality review of the draft form 990 prior to Finance Committee approval. Recommended changes are made to the Form 990 and supporting schedules and the Finance Committee votes on a motion to approve the form as amended. The final filed Form 990 is made available to all Board members for their review and information. Form 990, Part VI, Section B, Line 12c Ongoing Board of Director and Board Committee discussions in concert with the annual audit and Corporate Integrity Office activities monitor and maintain an 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. The Compensation Committee consists of no fewer than three non-employee members of the Board, one of whom is a member of the Executive Committee. 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 for Physicians (both employed and independent contractors), the Compensation Committee relies on market data for similarly situated professionals serving comparable institutions. The corporation regularly commissions studies by Integrated Healthcare Strategies to assure 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 assure that all compensation packages are within the approval limits. Documentation and supporting detail are maintained for all compensation decisions. 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 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 1 0 0 Pine Rest Foundation c 1181058 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 health care and counseling programs. Pine Rest Foundation p 184670 Pine Rest Christian Mental Health Services Accounts Payable department processes all invoices for the Pine Rest Foundation. Pine Rest Foundation then reimburses Pine Rest Christian Mental Health Services an amount equal to the invoices that have been paid on their behalf. Pine Rest Foundation m 6986348 The Pine Rest Foundation, the related organization serves as the "single-portal" for all donations intended for the Pine Rest Foundation and Pine Rest Christian Mental Health Services.