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        <Identifier>Supplemental nonqualified retirement plan</Identifier>
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        <Explanation>JOHN MACKEIGAN, MD 80,048</Explanation>
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      <GeneralExplanation>
        <Identifier>NUMBER OF EMPLOYEES</Identifier>
        <ReturnReference>FORM 990, PART I, LINE 5 AND FORM 990, PART V, LINE 2A</ReturnReference>
        <Explanation>TAXPAYER MAY HAVE INDIRECT EMPLOYEES. COMPENSATION FOR THESE EMPLOYEES IS PAID BY A RELATED ORGANIZATION. AN ALLOCATION OF AMOUNTS PAID FOR INDIRECT EMPLOYEES IS PURSUANT TO A MANAGEMENT SERVICES CONTRACT AND IS INCLUDED ON LINES 5-10 OF PART IX.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Classes of members or stockholders</Identifier>
        <ReturnReference>Form 990, Part VI, Section A, Line 6</ReturnReference>
        <Explanation>THE TAXPAYER HAS TWO MEMBERS AS FOLLOWS: - SPECTRUM HEALTH HOSPITALS (EIN 38-1360529) (50%) - BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY (EIN 38-6005984) (50%)</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Members or stockholders electing members of governing body</Identifier>
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      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Decisions requiring approval by members or stockholders</Identifier>
        <ReturnReference>Form 990, Part VI, Section A, Line 7b</ReturnReference>
        <Explanation>UNLESS OTHERWISE NOTED BELOW, THE MEMBERS (SEE FORM 990, PART VI, LINE 6) OF THE TAXPAYER HAVE THE RESERVED POWERS SET FORTH BELOW, AND SHALL NOT BE DEEMED AUTHORIZED UNLESS AND UNTIL APPROVED BY THE MEMBERS: - ADMISSION OF NEW MEMBERS TO THE CORPORATION; - AMENDMENT, MODIFICATION OR REPEAL OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; - SALE, TRANSFER OR PLEDGE OF A MEMBER'S INTEREST IN THE CORPORATION; - INCURRENCE, ASSUMPTION OR GUARANTEE OF ANY INDEBTEDNESS OR OTHER BORROWINGS, EXCEPT THAT THE BOARD MAY AUTHORIZE DRAWS AGAINST LINES OF CREDIT ESTABLISHED BY MEMBER ACTION, CONSISTENT WITH THE CORPORATION'S POLICIES IN THAT REGARD AND THE PURPOSES OF SUCH CREDIT LINES, AND EXCEPT THAT THE BOARD MAY AUTHORIZE THE CORPORATION TO BORROW FROM ITS MEMBERS IN ACCORDANCE WITH THE UNANIMOUS AGREEMENT OF THE MEMBERS; - SALE, EXCHANGE, LEASE OR OTHER TRANSFER OF MORE THAN TEN PERCENT (10%) OF THE ASSETS OF THE CORPORATION; - MERGER OR CONSOLIDATION OF THE CORPORATION WITH ANOTHER ENTITY OR DISSOLUTION OF THE CORPORATION; - ESTABLISHMENT OF JOINT FELLOWSHIPS; AND - AUTHORIZATION FOR THE CORPORATION OR THE MEMBERS JOINTLY TO ENGAGE IN GRADUATE MEDICAL EDUCATION ACTIVITIES.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Review of form 990 by governing body</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Line 11a</ReturnReference>
        <Explanation>A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. THE REVIEW PROCESS FOR THIS FORM 990 IS AS FOLLOWS: 1. PREPARATION OF THE RETURN IS SUPERVISED AND REVIEWED BY A MEMBER ORGANIZATION'S CORPORATE TAX DEPARTMENT. 2. A SECOND REVIEW IS PERFORMED BY AN EXTERNAL CPA FIRM WITH EXPERTISE IN TAX-EXEMPT RETURN PREPARATION. 3. THE RETURN IS REVIEWED BY A MEMBER ORGANIZATION'S V.P. OF HOSPITAL FINANCE AND SHARED WITH THE MEMBERS OF THE BOARD OF DIRECTORS. 4. THE MEMBER ORGANIZATION'S V.P. OF HOSPITAL FINANCE REVIEWS COMMENTS OR QUESTIONS RECEIVED BY MEMBERS OF THE BOARD OF DIRECTORS, IF ANY, TO ADDRESS OR TO INCORPORATE, AS APPROPRIATE, INTO THE RETURN PRIOR TO FILING.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Conflict of interest policy</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Line 12c</ReturnReference>
        <Explanation>EXCERPT FROM THE CONFLICT OF INTEREST POLICY DUTY TO DISCLOSE CONFLICT PRIOR TO BOARD OR COMMITTEE CONSIDERATION: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST AND IN ADDITION TO THE ANNUAL STATEMENT DISCLOSURES SET FORTH IN ARTICLE VI BELOW, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS: AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST: - AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. - THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. - AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. - IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY: - IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. - IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. THE MINUTES OF THE GOVERNING BOARD AND ALL COMMITTEES WITH BOARD DELEGATED POWERS SHALL CONTAIN: - THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE GOVERNING BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. - THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THE PROCEEDINGS.</Explanation>
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        <Identifier>Public Disclosure</Identifier>
        <ReturnReference>Form 990, Part VI, Section C, Line 19</ReturnReference>
        <Explanation>THE ORGANIZATION'S ARTICLES OF INCORPORATION HAVE BEEN PROVIDED TO THE STATE OF MICHIGAN AND ARE AVAILABLE TO THE PUBLIC ON THE STATE'S WEBSITE. THE ORGANIZATION'S BYLAWS AND INTERNAL POLICIES ARE GENERALLY NOT MADE AVAILABLE TO THE PUBLIC.</Explanation>
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        <Identifier>Average hours worked per week for related organization</Identifier>
        <ReturnReference>Form 990, Part VII, Section A, Column B</ReturnReference>
        <Explanation>JEFFREY DWYER, PHD - 50 JOHN MACKEIGAN, MD - 50 MARSHA RAPPLEY, MD - 50 JAMES TUCCI, MD - 50 MATTHEW VAN VRANKEN - 50 KIM WILCOX, PHD - 50 DENISE HOLMES - 50</Explanation>
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        <ReturnReference>FORM 990, PART VII, LINE 1A</ReturnReference>
        <Explanation>THE COMPENSATION REPORTED FOR THESE INDIVIDUALS IS NOT FOR SERVICES IN THEIR CAPACITY AS MEMBERS OF THE BOARD OF DIRECTORS BUT FOR SERVICES AS EMPLOYEES OF A RELATED ORGANIZATION. THE COMPENSATION AND BENEFITS ARE REPORTED USING THE MOST RECENT CALENDAR YEAR COMPENSATION DATA. THE COMPENSATION FIGURES REPORTED IN THESE SECTIONS ARE FOR THE YEAR ENDED DECEMBER 31, 2010.</Explanation>
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      <GeneralExplanation>
        <Identifier>Other changes in net assets or fund balances</Identifier>
        <ReturnReference>Form 990, Part XI, Line 5</ReturnReference>
        <Explanation>MEMBER CAPITAL CONTRIBUTIONS - 794344;</Explanation>
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          <City>GRAND RAPIDS</City>
          <State>MI</State>
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          <City>EAST LANSING</City>
          <State>MI</State>
          <ZIPCode>48824</ZIPCode>
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