2017-01-24T13:50:06-07:00 2016-06-30 990 2015-07-01 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 2017-02-15 2015 2021-01-29 14:40:06Z Paul H Karsten 300 68th Street SE PO Box 165 Grand Rapids MI 49501 170482270 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 19 2287 150 0 0 3803883 3306011 103965840 104763143 1784779 -614282 2699820 6362683 112254322 113817555 0 0 0 0 85267363 88902765 0 0 713251 25751595 26589454 111018958 115492219 1235364 -1674664 115022115 113888471 22160199 22701219 92861916 91187252 X 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. 1 0 41583770 0 53789796 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 and had 6226 admissions during the year ended June 30, 2016 encompassing 61,032 days of patient care resulting in an average length of stay of 9.8 days. The partial hospitalization program had 1,687 admissions with 7,693 days of care. 29281141 336263 30052256 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. On an average day in FY2016, 1,095 patients were seen throughout the Clinic Network. In total, there were 280,354 outpatient visits in FY2016. 3294954 0 3403628 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. On average the Developmentally Disabled Homes cares for 63 patients a day resulting in 23,110 days of care in a year. 3408136 0 3298387 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. 3305518 4269 3181723 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. 4642201 0 5184985 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 Center for Psychiatric Residential Services served an average of 44 residents per day providing 16,142 patient days of care in 2016. 2362798 0 2105401 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). On average each day the Addiction Treatment Services cares for 70 patients resulting in 25,774 days of care in 2016. 3960432 0 4562863 Service offered to provide hospital management services to West Michigan psychiatric inpatient and clinic operations. Regional capacity to serve difficult inpatient psychiatric cases is very limited and has resulted in Pine Rest being viewed as the regional care center for these patients. Less difficult cases must still be served and Pine Rest is devoted to enhancing and maintaining the ability of community based inpatient psychiatric units to care for these patients near home and close to family. 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. 837907 127337 705993 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. 2533434 0 2593558 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. 21050426 131606 21632910 95210291 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 1 102 0 1 2287 1 0 0 0 0 0 0 X 22 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA MI X Paul H Karsten 6162816363 300 68th St SE Grand Rapids MI 495010165 Hon Joseph Scoville Chairperson 3.0 0 X X 0 0 0 Jon Swets Vice Chairperson and Treasurer 2.0 0 X X 0 0 0 Nicolas Kroeze Secretary 2.0 0 X X 0 0 0 Mark C Eastburg PhD President & CEO 60 0 X X 352767 0 26564 Alan M Armstrong MD Chief Medical Officer 40 0 X X 288746 0 24383 Gary Rich MD President of Medical Staff 60 0 X 186341 0 5754 Scott Bolinder Board Member 1.0 0 X 0 0 0 Randall Christenson MD Board Member 1.0 0 X 0 0 0 Sylvia Daining Board Member 1.0 0 X 0 0 0 Honorable Patricia Gardner Board Member 1.0 0 X 0 0 0 LaRissa Hollingsworth Board Member 1.0 0 X 0 0 0 Art Jongsma Board Member 1.0 0 X 0 0 0 Ron Kool Board Member 1.0 0 X 0 0 0 John Lichtenberg Board Member 1.0 0 X 0 0 0 Glenn Mitcham Board Member 1.0 0 X 0 0 0 Ginny VanderHart Board Member 1.0 0 X 0 0 0 Kathleen Vogelsang Board Member 1.0 0 X 0 0 0 Gary Werkman Board Member 1.0 0 X 0 0 0 Suzanne Keep Board Member 1.0 0 X 0 0 0 Joe Sweeney Board Member 1.0 0 X 0 0 0 Susan Valcq Board Member 1.0 0 X 0 0 0 Robert L Nykamp Vice President & COO 60 0 X 261298 0 20235 Paul H Karsten Vice President & CFO 60 0 X 249640 0 24644 Scott A Wagner Vice President Behavioral Health Solutions 60 0 X 156093 0 15099 Thomas Elzinga Vice President General Services 60 0 X 133501 0 16082 Jack A Mahdasian MD Medical Staff 55 0 X 503575 0 19663 William J Sanders DO Medical Staff 45 0 X 359871 0 31642 Bibhas Singla MD Medical Staff 45 0 X 348683 0 18344 Valerie Mathis-Allen MD Medical Staff 55 0 X 348806 0 18012 Verle L Bell MD Medical Staff 45 0 X 341656 0 20617 Gilbert A Masterson MD Medical Staff 45 0 X 271091 0 11328 3802068 0 252367 108 1 1 0 Unidine Corporation PO Box 360639 Pittsburgh PA 152516639 Patient Dietary and Cafeteria Services 2083001 Elzinga & Volkers 86 East 6th Street Holland MI 494232912 Construction 1708963 BWBR Architects Inc 380 Peter Street Suite 600 Saint Paul MN 55102 Architecture Services 882345 American Healthcare Services Assoc LLC PO Box 945 Traverse City MI 49685 Hospital Staffing Solutions 619442 Buiten & Associates LLC 5738 Foremost Drive SE Grand Rapids MI 49546 Insurance 565799 46 0 0 0 2092752 0 1213259 0 3306011 Outpatient Clinics 621400 28823621 28823621 0 0 Inpatient Contracted Services 622000 23462542 23462542 0 0 Inpatient Care 622000 33378094 33378094 0 0 Residential Care 623000 17093009 17093009 0 0 Partial Hospitalization 622000 2005877 2005877 0 0 0 0 0 0 104763143 471047 471047 0 0 0 0 0 0 0 0 0 0 82068 0 7084 0 74984 0 74984 74984 0 0 55572302 0 56657631 0 -1085329 0 -1085329 0 0 -1085329 0 Rustic Market and Thrift Store 624000 784 784 0 0 Pastoral and Other Training 611710 63257 63257 0 0 6223658 6223658 0 0 6287699 113817555 111596873 0 -1085329 0 0 0 0 0 0 1761147 505223 1255924 0 0 0 0 0 72723530 66657224 5651046 415260 663942 594758 64937 4247 8661397 8026812 576900 57685 5092749 4582848 479140 30761 195152 0 195152 0 105597 0 105597 0 42670 0 42670 0 0 0 320765 0 320765 0 1991057 1991057 0 0 297278 0 297278 0 4989917 3226779 1730368 32770 2812751 2334123 459532 19096 0 0 0 0 3457646 3112767 341927 2952 367062 305312 56394 5356 0 0 0 0 411508 347498 60171 3839 462417 0 462417 0 0 0 0 0 4490443 4203129 284855 2459 657170 0 657170 0 Patient Assistance Fund 1409214 1409214 0 0 Other 4578807 -2086453 6526434 138826 115492219 95210291 19568677 713251 2855832 3905350 0 0 0 761616 14407682 10306455 60000 0 0 0 0 0 62046 80753 725118 971155 97793705 55010968 41330461 42782737 54318129 53901576 0 0 0 0 0 0 1262847 1178829 115022115 113888471 8728633 8368329 0 0 0 0 8025000 10330000 0 0 0 0 128872 0 1500000 0 3777694 4002890 22160199 22701219 X 87050802 85853386 2105241 1627993 3705873 3705873 92861916 91187252 115022115 113888471 -1674664 0 0 0 0 0 X 0 1 X 1 0 X 0 0 0 0 0 0 1 42670 0 0 42670 0 Schedule C, Part II-B, Line 1 Government relations strategies design to assist Pine Rest in accomplishing the organizations Federal Funding Objectives. Verbal and written communication with public officials regarding legislation and proposals affecting the delivery of health care in Michigan and nationally. 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 20338206 603298 152314 755689 95689 0 20242440 0.85 0.15 0 0 1 1 0 108148 108148 0 63018164 34731744 28286420 0 302560 0 302560 0 26924913 17903943 9020970 0 7439920 2375281 5064639 42782737 MSHDA Obligation 111599 Adv. OSAS 17273 Swap Liab 466415 Def 457/ETO 1623804 Malpractice 79570 Notes Payable 500000 Amount Payable to 3rd Pty 1204229 4002890 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 Pine Rest 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). Pine Rest must recognize the tax benefit from an uncertain tax position only if it is "more-likely-than-not" that the tax position will be sustained on examination by the applicable taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement. There were no uncertain tax benefits identified at June 30, 2016 and 2015. Pine Rest does not expect the total amount of unrecognized tax benefits to significantly change in the next twelve months. Pine Rest 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, 2016 and 2015. Pine Rest is no longer subject to examination by taxing authorities for years before 2014. 1 1 1 X 2.5 1 X 1 1 0 1 1 0 0 1409214 0 1409214 0.0122 0 0 24419278 25942163 -1522884 0 0 0 0 0 0 0 0 0 25828492 25942163 -113670 0.0122 0 0 150000 0 150000 0.0013 0 0 0 0 0 0 0 0 64221461 55672551 8548910 0.074 0 0 0 0 0 0 0 0 687323 0 687323 0.006 0 0 65058784 55672551 9386233 0.0813 0 0 90887276 81614714 9272563 0.0935 0 2319990 0 7576013 7406620 169393 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 www.pinerest.org 1 15 1 pinerest.org 0 0 1 X 250 250 X X X 1 1 X X X X 1 X www.pinerest.org X www.pinerest.org X X X X X 1 0 X X X X 1 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 http://www.kentcountychna.org 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 The Pine Rest Christian Mental Health Services Organization utilizes a patient assistance fund agreement and authorized form. 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 821 68th Street SE Grand Rapids MI 49508 Residential supervised independent living Pine Rest - Integrated Med Clinic 349 S Division 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 Allowance for Doubtful Accounts: 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 Corporation's 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 The collection policy states "Outstanding balances not covered by the Financial Assistance Program may be subject to collections activity. As a result, your account, if unpaid, may be referred to a collections agency. Subsequent actions may include litigation, garnishment of wages or credit bureau reporting". 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 patient responsibility is established, the patient's status relative to charity care is reviewed and a decision is made about the availability of patient assistance funds. Schedule H, Part VI, Line 4 Pine Rest Christian Mental Health Services (Pine Rest) is a multi-service behavioral health organization serving a diverse range of people in multiple settings throughout West Michigan and with two locations in Iowa. Its network of inpatient, residential and outpatient services reach people of all ages, from children to older adults. The majority of people served by Pine Rest were identified as being from counties within the state of Michigan, with 46% from Kent County. A small percentage (<5%) are from counties outside of Michigan. Pine Rest's main campus is located in Kent County with a population of 636,369 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: 74.6% White, 10.5% African American, 10.3% Latino, 2.9% Asian and 2.8% 2 or more races. In Kent County, 15.3% 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 comprised 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. An open medical staff broadens the availability of care to the community served by Pine Rest Christian Mental Health Services through the availability of medical staff to all patients in the service area. Since 1908, the organization has consistently applied surplus funds to the 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 provide outreach to the community to engage them in services. Pine Rest also provides many educational opportunities to the community on various behavioral health topics. X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 Jack A Mahdasian MD Medical Staff 493575 0 10000 0 0 0 42000 0 19638 0 565213 0 0 0 William J Sanders DO Medical Staff 305306 0 54565 0 0 0 4312 0 18361 0 382544 0 0 0 Bibhas Singla MD Medical Staff 263019 0 85664 0 0 0 16061 0 17937 0 382681 0 0 0 Valerie Mathis-Allen MD Medical Staff 261356 0 87450 0 0 0 37124 0 15837 0 401767 0 0 0 Mark C Eastburg PhD President & CEO 328367 0 24400 0 0 0 38667 0 18959 0 410393 0 0 0 Verle L Bell MD Medical Staff 311956 0 29700 0 0 0 9200 0 14161 0 365017 0 0 0 Alan M Armstrong MD Chief Medical Officer 275245 0 13500 0 0 0 36914 0 17500 0 343159 0 0 0 Gilbert A Masterson MD Medical Staff 211071 0 10020 0 50000 0 15628 0 11328 0 298047 0 0 0 Robert L Nykamp Vice President & COO 243906 0 17392 0 0 0 0 0 13933 0 275231 0 0 0 Paul H Karsten Vice President & CFO 232728 0 16912 0 0 0 15940 0 17315 0 282895 0 0 0 Gary Rich MD President of Medical Staff 186341 0 0 0 0 0 39244 0 3757 0 229342 0 0 0 Scott A Wagner Vice President Behavioral Health Solutions 128628 0 27465 0 0 0 13130 0 13263 0 182486 0 0 0 Thomas Elzinga Vice President General Services 133501 0 0 0 0 0 24000 0 14971 0 172472 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. Mark Eastburg, Paul Karsten and Bob Nykamp. Schedule J, Part I, Line 3 The Board of Directors has adopted a written Executive Compensation plan and has designated the responsibility for implementing and overseeing compensation issues to the Compensation Committee, with regular reporting to the Board. The seven member Compensation Committee consists of four non-employee members, three of whom are also members 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 as well as determining compensation for physicians (both employed and independent contractors). 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 the 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. Schedule J, Part I, Line 7 Employment contracts with officers of the organization allow for performance based incentives. Each year the Board of Directors articulate and approve specific measurable performance criteria. If performance criteria are met, then performance based incentives are paid. A Kent Hospital Finance Authority 381603110 490576AC9 2006-09-26 10030000 Capital Expansion - various projects 0 0 0 B Kent Hospital Finance Authority 381603110 490576AC9 2015-10-01 10330000 Refinancing of original debt 0 0 0 A 10030000 0 10030000 0 0 0 218893 0 0 10030000 0 0 2008 0 0 1 1 B 0 0 10330000 0 0 0 58659 0 0 10330000 0 0 2008 0 0 1 1 A 0 0 0 0 0 0 0 1 0 1 B 0 0 0 0 0 0 0 1 0 1 A 1 1 1 Fifth Third Bank 1.0 0 0 0 0 1 B 1 1 1 Macatawa Bank 1.0 0 0 0 0 1 A 0 B 0 William Sanders Medical Staff Recruitment/Enhancement X 100000 35000 0 1 1 Kelly Demagala Medical Staff Recruitment X 85000 31000 0 1 1 Jonathan Dargo Medical Staff Recruitment X 100000 25000 0 1 1 Vegas Coleman Medical Staff Recruitment X 40000 35833 0 1 1 Kelly Blankenship Medical Staff Recruitment X 30000 27000 0 1 1 153833 Form 990, Part III, Line 2 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. 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 990 and supporting schedules 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 on 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 responsibility for implementing and overseeing compensation issues to the Compensation Committee, with regular reporting to the Board. The seven member Compensation Committee consists of four non-employee members, three of whom are also members 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 as well as determining compensation for physicians (both employed and independent contractors). 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 the 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 Pine Rest Christian Community & Residential Services 300 68th Street SE PO Box 165 Grand Rapids MI 495010165 Community Residential MI 501(c)(3) III Pine Rest Christian Mental Health Services 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 Pine Rest Foundation c 2781172 Pine Rest Foundation p 6700 Pine Rest Christian Mental Health Services received approval of Form 8868 extending the due date to February 15, 2017.