OMB No . 1545

2002 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung

benefit trust or private foundation) 1 The organization may have to use a coov of this return to satisfy state reoortinq requirements .

Department of the ?Feasury Internal Revenue Service

A For the 2002 calendar ye; D Employer ID number 38-2454555

E Telephone number Room/suite 616-774-7748

F Accounting method : u Cash Accrual 0 Other (specify)

1 00-

B Check if applicable: Please C Name of organization use iR Spectrum Health Urgent Care Centers Address change label or Name change print or f/k/a Spectrum Health Group Initial return type . Number and street (or P O box if mall is not delivered to street address)

Final return See 1840 Wealthy St SE Amended return

Specific Instruc-

City or town . state or country, and ZIP + 4 -

Application A Grand Rapids MI 49506 Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable H and I are not applicable to section 527 organizations .

trusts must attach a completed Schedule A (Form 990 or 990-EZ) . H(d) Is this a group return for affiliates? 0 Yes No

H(b) If "Yes," enter no . of affiliates 1 Web site : 1 Organization type check onl one 1 501(c)( 3 c insert no . 4947(a)( 1 ) or

Check here 1 if the organization's gross receipts are normally not more than

$25,000 . The organization need not file a return with the IRS; but if the organization

received a Form 990 Package in the mail, it should file a return without financial data .

Some states reauire a comolate return .

. . . . . . H(C) Are all affiliates included? Q Yes Q No

527 (If "No," att . a list . See instr .)

H(d) Is this a separate return filed by an

organization covered b a group ruling? Yes No

I Enter 4-di git GEN 1

K

M Check 1 Pg if the organization is not required to attach Sch . B (Form 990, 990-EZ, or 990-PF) . L Gross receipts : Add lines 6b, 8b, 9b, and 10b to line 12 1 11,391,43

Revenue, Expenses, and Changes in Net Assets or Fund Balances (See page 17 of the instructions . Contributions, gifts, grants, and similar amounts received : Direct public support 1a 1 . . . . . . Indirect public support 1b Government contributions (grants) 1c Total (add lines 1a through 1c) (cash $ 1 , 00 0 noncash $ ) 1d

Program service revenue including government fees and contracts (from Part VII, line 93) 2 Membership dues and assessments 3

Interest on savings and temporary cash investments 4 Dividends and interest from securities . . . . . . Gross rents 6a 688 , 942 less : rental expenses See Stmt 1 6b 630 , 162 Net rental income or r loss) (subtract line 6b from line 6a) 6e Other investment income (describe 1 . . . . . . . . . . . . . . . . . . . . . . . . , . . � _ � � , . � 7 Gross amount from s A Securities B Other

than inventory . REC.EIV.ED. . . . ea 244 , 963 Hess : cost or other basis tenses . N eb 149 , 605 Gain or (joss) (attach ̀ dine) ec 95 , 358 Net gain or (loss) (co ~ I' ur, ~f, s"~~C, d 0 . See S~t. . 2 . . 8d c~ . . . . . . . . . . . . . . . . . . . . . . tt[RI

1 .000 10,444,034

8 .7

9 Special events and aiviti Gross revenue {not in ~ludin~Q~DEN UT of contributions reported t:2~ 9a Less : direct expenses other than fundraising expenses . . . . . . , . . , . . . . . , . . . , . . 9b Net income or (loss) from special events (subtract line 9b from line 9a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gross sales of inventory, less returns and allowances 10a

Less : cost of goods sold 10b Gross profit or (loss) from sales of inventory (aft. sch.) (subtract line 10b from line 10a) Other revenue (from Part VII, line 103)

Total revenue (add lines 1 d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . , . . . . . , . Program services (from line 44, column (B)) Management and general (from line 44 . column (C)) Fundraising (from line 44, column (D))

Payments to affiliates (attach schedule)

b c

10a b

c

11

12 13 14 15 16

i

10c 11 8 , 194 12 10 , 611 , 669 13 11 , 037 , 207 14 730 , 879 15 16

E x p e n s e

r ~ , ..

Form 990 (2002)

4

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Form 990

G

J

O

W ZR z e Q Y

Ue n u e

1

a b

c

d

2

3

4

5

6a b

c

7

8a

b c d 9 a

4,303

A 18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 N S 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19

20 Other changes in net assets or fund balances (attach explanation) See Stmt 3 20 t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Net assets or fund balances at end of ear combine lines 18 19, and 20 . . . 21

For Paperwork Reduction Act Nonce, see the separate instructions . DAA

11,768,086 -1,156,417 8,247,825 -1 .372,019

Form sso (2002) Spectrum Health Urgent Care Centers 38-2454555 Page 2 : :P tu

x . . of All organizations must complete column (A) . Columns (B), (C), and (D) are required for section 501(c)(3) and (4) organizations

Functional Ex enses and section 4947 (a~( 1 ) nonexempt charitable trusts but optional for others . See page 21 of the instructions . Do not include amounts reported on line (s) Program (c) Management

6b 8b 9b 10b or 16 of Part I . (A) Total (D) Fundraising services I and general

22 Grants and allocations (attach schedule) non- . . . . . . . . . . . . . . . . . . . . . .

(cash $ cash $ ) 22

23 Specific assistance to individuals 23

24 Benefits paid to or for members 24

25 Compensation of officers, directors, . . . . . . . . . . . . . . . . . . . . . . . .

etc. 25

2s Other salaries and wages SEE STMT " " ~ " "' 2s 7 , 626 , 231 7 , 244 , 919 381 , 312 27 Pension plan contributions 27 28 Other employee benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 1 , 453 , 480 1 1 3-8-0- 1 8-0-6- 72 , 674 29 Payroll taxes 29 30 Professional fundraising fees 30 31 Accounting fees . . . . . . . . . . . . . ._ . . ., . . . . . . ., . . . . . . . ._ . . 31 32 Legal fees 32 691 691 33 supplies 33 565 , 808 459 289 106 , 519 34 Telephone 34 44 , 135 35 308 8 , 827 ss Postage and shipping 35 8 , 668 433 8 , 235 36 Occupancy 36 37 Equipment rental and maintenance 37 368 120 360 , 758 7 , 362 38 Printing and publications 38 39 Travel 39 99 , 261 4- 1 -96-3- 94 , 298 40 Conferences, conventions, and meetings 40 41 interest 41 89 , 960 89 960 42 Depreciation, depletion, etc. (attach schedule) . . . . . . . . . . . 42 197 , 720 187 , 834 9 , 886 43 Other expenses not covered above (itemize): a 43a

See Statement 4 43b 1 , 314 , 012 1 ,272 , 937 41 , 075 c 43c d 43d

e 43e

44 Total functional expenses (add lines 22 - 43) . Organizations

completing columns (B)-(D), car these totals to lines 13-15 44 11 , 768 , 08 6_ 11 037 207 730 , 879 Joint Costs. Check 1 U if you are following SOP 98-2 . Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services? If "Yes," enter (i) the aggregate amount of these joint costs $ ; (ii) the amount allocated to Program services $ (iii) the amount allocated to Management and general $ ; and (iv) the amount allocated to Fundraising $

10. 0 Yes R No

Accomplishments (See page 24 of the instructions .

a . . . Operation. centers which provide treatment to ., patients. . for . .injuries . .and illness that don' t warrant a. , trip . .to. . . the , emergency , room . .

11,037,207 b

(Grants and allocations $ d

e Other program services (attach schedule) (Grants and allocations $ ) f Total of Program Service Expenses (should equal line 44, column (B), Program services) . . , , . . . . . . . . . . . . . . . . . . , _ _ . . , . . , , 1 11 , 037,20 7

DAA Farm 990 120021

' SHURGC 06/06/2005 10 :24 AM

0

What is the organization's primary exempt purpose? Program Service t See Statement 5 Expenses

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Required for501(c)(3)8 All organisations must describe fheir~exempt purpose ~ach'ievements in a clear and concise manner. State the number (a) orgs., & a9a7(a)(t) of clients. served, publications issued, etc. Discuss achievements that are not measurable . (Section 501(c)(3) and (4) trusts ; but optional for

c

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Form sso (2002) Spectrum Health Urgent Care Centers 38-2454555 Page s

>Part IV Balance Sheets (See page 24 of the instructions .)

Note : Where required, attached schedules and amounts within the description (A) (B) column should be for end-of-year amounts onl y . Beginning of ear End of ear

45 Cash - non-interest-bearing 147 , 951 45 510 , 632 46 Savings and temporary cash investments 46

47a Accounts receivable 47a 2 , 790 , 339 b Less : allowance for doubtful accounts . . . . . . .' . . . . . . 47b 787 258 2 , 119 , 706 47c 2 003 , 081

48a Pledges receivable 48a b Less : allowance for doubtful accounts 48b 48c

49 Grants receivable . .~~~~ . . . . . . . . 49 50 Receivables from officers, directors, trustees, and key employees

A (attach schedule) 50 s 51a Other notes and loans receivable (attach s schedule) See Worksheet 51, e b Less : allowance for doubtful accounts 51b 6 ,277 51c t 52 Inventories for sale or use . . . . . . . . . . 52 s 53 Prepaid expenses and deferred charges . . . . . . . . . . . . . . . . . . . . . . . -204 , 352 53 3 , 177

54 Investments-securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 .Cost ~ . FMV 54 55a Investments-land, buildings, and

equipment: basis 55a b Less : accumulated depreciation (attach

schedule) See Stmt 6 55b 23 , 344 , 471 55c 56 Investments-other (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . .See. . Stmt . .7. . 3 , 827 , 710 56 3 , 842 , 392 57a Land, buildings, and equipment : basis 57a 4 008 259

b Less : accumulated depreciation (attach schedule) See Stmt 8 57b 1 , 705 , 373 1 , 416 , 041 57 c 2 , 302 , 886

58 Other assets (describe " See Stmt 9 ) 235 , 583 5s 48 , 808

59 Total assets add lines 45 through 58 must equal line 74 . . . . . . . . . . . . . . . . . . . . . . . . 30 , 893 , 387 59 8 , 710 , 976 60 Accounts payable and accrued expenses . , . , . 277 , 519 60 32 , 811 61 Grants payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

a 62 Deferred revenue 62 63 Loans from officers, directors, trustees, and key employees (attach

schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 i 64a Tax-exempt bond liabilities (attach schedule) See Worksheet 20 , 544 , 798 64a 2 , 088 , 853

b Mortgages and other notes payable (attach schedule) 64b 65 Other liabilities (describe 1 See Stmt 1~0 . ~ ~ ) ~ . . . . . . . ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1 , 823 , 245 65 869 , 923

s 66 Total liabilities add lines 60 throu gh 65 22 , 645 , 5621 66 2 , 991 , 587 Organizations that follow SFAS 117, check here 1 ~ and complete lines

67 through 69 and lines 73 and 74 . 67 unrestricted 8 , 247 , 825 67 5 , 719 , 389

e u 68 Temporarily restricted 68 t n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d 69 Permanently restricted . . . . . . . . . . . . . . . . . . . . . 69

q Organizations that do not follow SFAS 117, check here 1 Q and s B complete lines 70 through 74 . s a 70 Capital stock, trust principal, or current funds 70

I 71 Paid-in or capital surplus, or land, building, and equipment fund . . . . . . . . . . . . . . . . . . . . . . 71 t a . . . . . . . . . . . . . . . . . . . . . s n 72 Retained earnings, endowment, accumulated income, or other funds 72

73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72 ; column (A) must equal line 19 ; column (B) must equal line 21) 8 , 247 825 73 5 , 719 , 389

74 Total liabilities and net assets I fund balances add lines 66 and .73 ~ . . . . . 30 , 893 , 3871 74 8 , 710 , 976 Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a

particular organization . How the public perceives an organization in such cases may be determined by the information presented on its return . Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments . DAA

" SHURGC 06/06/2005 10 :24 AM

4 _Z404030 Pa

Reconciliation of Expenses per Audited Financial Statements with Expenses per

`''PatI:VA Reconciliation of Revenue per Audited Financial Statements with Revenue per Return See page 26 of the instructions .

a Total revenue gains , & other support a Total expenses and losses per e e per audited financial statements 1 a 10 611 669 audited financial statements 1 a

: b Amounts included on line a but not on b Amounts included on line a but not line 12, Form 990 : on line 17, Form 990 :

(1) Net unrealized gains on ' (1) Donated services and use < " ! . investments $ "' of facilities $

(2) Donated services and use ' (2) Prior year adjustments of facilities $ reported on line 20

(3) Recoveries of prior Form 990 $ year grants $ (3) Losses reported on line 20, xxx

(4) Other (specify) : Form 990 $ (4) Other (specify) :

Add amounts on lines (1) through (4) 1 b $ Add amounts on lines (1) through (4) 1 b

c Line a minus line b 1 c 10 611 669 c Line a minus line b 1 c d Amounts included on line 12 d Amounts included on line 17

Form 990 but not on line a : Form 990 but not on line a : (1) Investment expenses (1) Investment expenses

not included on line 6b, not included on line 6b, Form 990 $ Form 990 $

(2) Other (specify) : (2) Other (specify) : ;

. . . . . . . . . . . 3 ><.:::::: : Add amounts on lines (1) and (2) . . . . 1 d Add amounts on lines (1) and (2) . . _ 1 d

e Total revenue per line 12, Form 990 e Total expenses per line 17, Form 990

11,768,08

11 .768,086

DAA

(line c plus line d) . . . . . . . . . . . . . . . . . 1 1 e 1 10,611,669 1 (line c plus line d) . . . . . . . . . . . . . . . . . 1 1 e l 11,768,08 6 List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated ; see page 26 of . . . . . . . . . . . . . . . . . . . . . . the instructions .

(B) Title and average (C) Compensation (D) Contrib. to (E) Expense (A) Name and address hours per week devoted to (If not paid, enter plans &edefercedt account and other

position rampmsaiim allowances See Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0 0 0

75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations? . . . . , . . . . . . . . . . 1 ~ Yes Q No If "Yes," attach schedule-see page 26 of the instructions . See Stmt 11

Form 990 (2002)

DAA

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Form 99012002 Spectrum Health Urgent Care Centers 38-2454555 Pa e Pa~iV~ : : Other Information See page 27 of the instructions . Yes

76 Did the organization engage in any activity not previously reported to the IRS? If "Yes," attach a detailed description of each activity 76 X

77 Were any changes made in the organizing or governing documents but not reported to the IRS? 77 X If "Yes," attach a conformed copy of the changes .

78a Did the organization have unrelated business gross inc . of $1,000 or more during the year covered by this return? 78a X b If "Yes," has it filed a tax return on Form 990-T for this year? N/A 78b

79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes," attach a statement 79 X

80a Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? 80a X

b If "Yes," enter the name of the organization t See Statement and check whether it is exempt or nonexempt . D

81a Enter direct or indirect political expenditures . See line 81 instr. N/A 81a ``_-` -` ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Did the organization file Form 1120-POL for this year? 81b X

82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? 82a X

b If "Yes," You may indicate the value of these items here . Do not include this amount as revenue in Part I or as an expense in P art II . (See instructions in Part III .) N/A 82b

83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a X b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? N/A 83b

84a Did the organization solicit any contributions or gifts that were not tax deductible? 84a X b If "Yes," did the organization include with every solicitation an express statement that such contributions

or gifts were not tax deductible? N/A 84b 85 501(c)(4), (5), or (6) organizations . a Were substantially all dues nondeductible by members? N/A 85a

b Did the organization make only in-house lobbying expenditures of $2,000 or less? . . . .

. . . . . . . .

. . . . . . . .

. . . . , , , . , . . . . . . , . . . . . . N/A 85b If "Yes" was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization . . received a waiver for proxy tax owed for the prior year.

c Dues, assessments, and similar amounts from members 85c N/A d Section 162(e) lobbying and political expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . 85d N/A e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e N/A f Taxable amount of lobbying and political expenditures (line 85d less 85e) . . . . . . . . . . . . . . . 85f N/A . . . . . . . . . . . . . . . . . . g Does the organization elect to pay the section 6033(e) tax on the amount in 85f? . . . . . . N/A h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount in 85f to its reasonable

estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? N/A 85h 86 501(c)(7) or9s . Enter : a Initiation fees and capital contributions included on line 12 86a N A

receipts, included b Gross on line 12 for public use of club facilities 86b N/A 87 501 (c)(12) or9s . Enter : a Gross income from members or shareholders 87a N/A

b Gross income from other sources . (Do not net amounts due or paid to other . . . . . .

sources against amounts due or received from them .) 87b N/A . . . . . . 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or

partnership, or an entity disregarded as separate from the organization under Regulations sections 301 .7701-2 and 301 .7701-3? If "Yes," complete Part IX 88 X

89a 501(c)(3) organizations . Enter : Amount of tax imposed on the organization during the year under. section 4911 1 n 1 1 0 ;section 4912 . 0 ' section 4955 0

b 501(c)(3) and 501(c)(4) orgs . Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year? If "Yes," attach a statement explaining each transaction 89b X

c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 1 0

d Enter: Amount of tax on line 89c, above, reimbursed by the organization 1 90a List the states with which a copy of this return is filed t None

b Number of employees employed in the pay period that includes March 12, 2002 (See instructions .) I 90b ~ 0 91 The books are in care of 1 Mr . Joseph. . Fifer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Telephone no . 1 616-39.1.-2754

Locatedat t 1840 WealthY . . St . SE . ., . . .Grand Ra ids, . .MI . . . . . . . . . . . . . ZIP-4 t 49506 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041- Check here

and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . . . . . . . . . . . . . . . . . . , , , . . . . 1 ~ 92 ~ . N~A Form 990 (2002)

' SHURGC 06/06/2005 10 :24 AM

Form sso (2002 Spectrum Health Urgent Care Centers 38-2454555 Page s Pat>ffll'' Analysis of Income-Producin Activities See page 31 of the instructions . Note : Enter gloss amounts unless otherwise Unrelated business income Excluded b sec . 512, 513, or 514 (E) indicated . (A) (B) (C) (p)

Related or Business code Amount Exclusion Amount exempt function

93 Program service revenue : code income a -Patient service revenue 10 , 444 , 034 b c d e f Medicare/Medicaid payments g Fees and contracts from government agencies

94 Membership dues and assessments 95 Interest on savings and temporary cash investments 14 4 303 . . . . . . . . 96 Dividends and interest from securities ; . : .

real estate ,. : .. ,:

97 Net rental income or loss from re ! ::::: :: : :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . ... . . . : : " :: : : :: :::' a debt-financed property b not debt-financed property 3 0 58 , 7 80

98 Net rental income or (loss) from personal property 99 Other investment income 100 Gain or (loss) from sales of assets other than inventory 18 95 , 358 101 Net income or (loss) from special events 102 Gross profit or (loss) from sales of inventory 103 Other revenue : a

a miscellaneous revenue 8 , 194 c d e

104 Subtotal add columns B), (D), and (E)) 0' ?>158 441 10,452,228 . . . . . . . . . . . . . . . . . . . 105 Total (add line 104, columns (B), (D), and (E)) 1 10 , 610 ,669 Note : Line 105 plus line 1d, Part I, should equal the amount on line 12, Part I . >`Part Vtt[. ;; Relationshi p of Activities to the Accomplishment of Exempt Purposes See page 32 of the instructions .

Line No . Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment " of the or anization's exempt purposes other than b providin g funds for such pur poses ) .

See Statement 12

~?~tt'IX Information Regarding Taxable Subsidiaries and Disregarded Entities See page 32 of the instructions . (A) (B) (C) (D) (E)

Name, address, and EIN of corporation, Percentage of Nature of activities Total income End-of-year partnership , or disre garded entity ownership interest assets

See Stmt 13 %

f P~ Information Re ardin Transfers Associated with Personal Benefit Contracts see page 33 of the instructions .

(0) Did the organization, during the year, receive any funds, directly or indirectly, to pa (b) Did the organization, during the year, pay premiums, directly or indirect Note : If "Yes" to b file Form 8870 and Form 4720 see instructions ) .

Under penalties of perjury, I declare that I hav xamined this return, inclu and belief, it i rrect nd complete c lion of preparer (other t

Please --' Sign Here ' Signature of officer

' f

T e or print name and title . Preparer's '

Paid signature Preparer's Firm's game (or yours ' Use Only if self-employed),

address, and ZIP + 4 DAA

Organization Exempt Under Section 501(c)(3) (Except Private Foundation) and Section 501(e), 5010, 501(k),

501(n), or Section 4947(a)(1) Nonexempt Charitable Trust Supplementary Information-(See separate instructions.)

1 MUST be completed by the above organizations and attached to their Form 990 or 990-EZ

OMB No . 1545-0047

2002 Department of the Treasury Internal Revenue Service

Name of the organization

Spectrum Health Urgent Care Centers Employer identification number

0

Total number of other employees paid over 10,000 . . 1 22 Paskll Compensation of the Five Highest Paid Independent Contractors for Professional Services

See page 2 of the instr . List each one whether individuals or firms . If there are none enter "None."

(a) Name and address of each independent contractor paid more than $ 50,000 (b) Type of service (c) Compensation

Michiqan .Medical PC Grand Rapids, Michigan Medical service 62,030

Schedule A (Form 990 or 990-EZ) 2002

DAA

SHURGC 06/06/2005 10 :24 AM

SCHEDULE A (Form 990 or 990-EZ)

Spectrum Health Group 1 38-2454555 Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees See page 1 of the instructions . List each one . If there are none enter "None ."

(a) Name and address of each employee paid more (b) Title and average hours I I (d) Contributions to I (e) Expense

than $50,000 per week devoted to position (c) Compensation employee ben . plans 8 account and other P P (IPPPl7P(V enmnoncafinn all-n...

JAMES R . POCHERT ~ PHYSICIAN GRAND~~RAPIDS MI~~4~9503~~~~~~~~~~~~~~~~~~ 50 I 189,3931 27,431

KEVIN VANALLEN PHYSICIAN ~GRAND~~RAP ID

. SMI

. . 4

. 9

. 503

. . . . . . . . . . . . . . . . . . ~ 50 187,0661 15 .420

.CHARLES . ANDERSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I PHYSICIAN RAPIDS, MI 49503 50

I 174 . 9641 38 . 697 GRAND

MICHAEL W . MOTT PHYSICIAN GRAND RAPIDS, MI 49503 I 50

. .6ARY. .H . . . BLISS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I PHYSICIAN 7

0

0

Total number of others receiving over $50,000 for professional services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ .

and state 1 10 ~ An organization operated for the benefit of a college or university owned or operated by a governmental unit . Section 170(b)(1)(A)(iv) .

(Also complete the Support Schedule in Part IV-A .) 11a ~ An organization that normally receives a substantial part of its support from a governmental unit or from the general public .

Section 170(b)(1)(A)(vi) . (Also complete the Support Schedule in Part IV-A .) 11b 8 A community trust. Section 170(b)(1)(A)(vi) . (Also complete the Support Schedule in Part IV-A .) 12 An organization that normally receives : (1) more than 33 113% of its support from contributions, membership fees, and gross

receipts from activities related to its charitable, etc ., functions-subject to certain exceptions, and (2) no more than 33 113% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975 . See section 509(a)(2). (Also complete the Support Schedule in Part IV-A .)

13 R An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in : (1) lines 5 through 12 above ; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) . (See

(b) Line number from above

(a) Name(s) of supported organization(s)

7 ctrum Health Hospitals

14 An organization organized and operated to test for public safety. Section 509(a)(4) . (See page 5 of the instructions .) DAA Schedule A (Form 990 or 990-EZ) 2002

SHURGC 06/06/2005 10:24 AM

Schedule A Form sso or 990-EZ 2002 Spectrum Health Urgent Care Centers 38-2454555 Pa e

. . . . . . Statements About Activities (See page 2 of the instructions .) Yes No

1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If "Yes," enter the total expenses paid 1 X or incurred in connection with the lobbying activities 1$ (Must equal amount on line 38, Part VI-A, or line i of Part VI-B .) Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A . Other organizations checking "Yes," must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities .

2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? (If the answer to any question is "Yes," attach a detailed statement explaining the transactions .)

a Sale, exchange, or leasing of property? 2a X

b Lending of money or other extension of credit? I 2b I ~ X

c Furnishing of goods, services, or facilities? . . . ., . . . . . . ., . . . . . . . . . ., . . . . . . . . ., . . . . .__ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 2c I I X

d Payment of compensation (or payment or reimbursement of exp. if more than $1,000)? SEE 990 . , . . PART V

e Transfer of any part of its income or assets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e X

3 Does the organization make grants for scholarships, fellowships, student loans, etc.? (See Note below .) 3 X 4 Do you have a section 403(b) annuity plan for your employees? 4 X Note : Attach a statement to explain how the organization determines that individuals or organizations receiving grants or loans from it in furtherance of its charitable p ro grams "q ualify" to receive payments .

. . . P~~'IV' Reason for Non-Private Foundation Status (See pages 3 through 5 of the instructions .)

The organization is not a private foundation because it is : (Please check only ONE applicable box .) 5 A church, convention of churches, or association of churches . Section 170(b)(1)(A)(i) . 6 A school . Section 170(b)(1)(A)(ii) . (Also complete Part V .) 7 A hospital or a cooperative hospital service organization . Section 170(b)(1)(A)(iii) . 8 A Federal, state, or local government or governmental unit . Section 170(b)(1)(A)(v) . 9 u A medical research organization operated in conjunction with a hospital . Section 170(b)(1)(A)(iii) . Enter the hospital's name, city,

d Add : Line 27a total and line 27b total " 27d e Public support (line 27c total minus line 27d total) 1 27e f Total support for section 509(a)(2) test : Enter amount on line 23 'Col u mn 1 (e 27f ) f g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 27 h Investment income percentage line 18 column e numerator divided b line 27f denominator 1 27h

28 Unusual Grants : For an organization described in line 10, 11, or 12 that received any unusual grants during 1998 through 2001, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant. Do not file this list with your return . Do not include these grants in line 15 .

DAA Schedule A (Form 990 or 990-EZ) 2002

SHURGC 06/06/2005 10 :24 AM

Schedule A (Form sso or 990-EZ) 2002 Spectrum Health Urgent Care Centers 38-2454555 Page s Pa : IVA Support Schedule (Complete only if you checked a box on line 10, 11, or 12 .) Use cash m ethod of accounting . _ . . . .�,;,~. : ::::::::::: : : :.

Note : You ma use the worksheet in the instructions for converting from the accrual to the cash method of accountin . Calendar ear or fiscal ear beginning in 1 a 2001 b 2000 C 1999 d 1998 e Total 15 Gifts, grants, and contributions

received . (Do not include unusual

rants. See line 28 .

16 Membership fees received

17 Gross receipts from admissions, merchandise

sold or services performed, or furnishing of

facilities in any activity that is related to the organization's charitable, etc., purpose

18 Gross inc . from int., dividends, amounts received from pymt . on securities loans (section 512(a)(5)), rents, royalties, 8 unrelated busn . taxable inc. (less sec. 511 taxes) from businesses acquired b the or ganization after June 30, 1975 . . . . ,

19 Net income from unrelated business

activities not included in line 18 . . . . . . .

20 Tax revn . levied for the organization's ben.

8 either aid to it or expended on its behalf 21 The value of serv . or facl . furnished to the

org. by a governmental unit without charge . Do not incl . the value of serv . or fac . gen- erally furnished to the public without charge

22 Other income . Attach a schedule . Do not include gain

or" oss)

from sale of ca . assets

23 Total of lines 15 through 22 . . . . . . . . . . .

24 Line 23 minus line 17 . . . , . . . . . . . . , , ,

25 Enter 1 /o ° of line 23

26 Organizations described on lines 10 or 11 : a Enter 2% of amount in column (e), line 24 1 26a

b Prepare a list for your records to show the name of and amount contributed by each person other than a

governmental unit or publicly supported organization) whose total gifts for 1998 through 2001 exceeded the amount shown in line 26a. Do not file this list with your return . Enter the total of all these excess amounts 1 26b

c Total support for section 509(a)(1) test: Enter line 24, column (e) . . .

. . . . . 1 26c

d Add: Amounts from column (e) for lines: 18 1 9

22 Zsb t 26d . . . . . . e Public support (line 26c minus line 26d total) . . . . . . 1 26e . . . . f Public support percentage line 26e numerator divided b line 26c denominator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 26f

27 Organizations described on line 12 : a For amounts included in lines 15, 16, and 17 that were received from a "disqualified person," prepare a list for your records to show the name of, and total amounts received in each year from, each "disqualified person ." Do not file this list with your return . Enter the sum of such amounts for each year : N/A

(2001) . . . . . . . . . . . . . . . . . . . . . . . (2000) . . . . . . . . . . . . . . . . . . . . . . . . (1999) . . . . . . . . . . . . . . . . . . . . . . . (1998) . . . . . . . . . . . . . . . . . . . . . . . . b For any amount included in line 17 that was received from each person (other than "disqualified persons"), prepare a list for your records to

show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000 . (Include in the list organizations described in lines 5 through 11, as well as individuals .) Do not file this list with your return. After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year : N/A (2001) . . . . . . . . . . . . . . . . . . . . . . . (2000) . . . . . . . . . . . . . . . . . . . . . . . . (1999) . . . . . . . . . . . . . . . . . . . . . . . (1998) . . . . . . . . . . . . . . . . . . . . . . . .

c Add : Amounts from column (e) for lines : 15 16 17 20 21 11111- 1 27c . . . . . . . . . . . .

If you answered "No" to any of the above, please explain . (If you need more space, attach a separate statement.)

33 Does the organization discriminate by race in any way with respect to :

a Students' rights or privileges?

b Admissions policies?

c Employment of faculty or administrative staff?

d Scholarships or other financial assistance?

e Educational policies?

f Use of facilities?

g Athletic programs?

h Other extracurricular activities?

If you answered "Yes" to any of the above, please explain . (If you need more space, attach a separate statement .)

34a Does the organization receive any financial aid or assistance from a governmental agency?

b Has the organization's right to such aid ever been revoked or suspended? If you answered "Yes" to either 34a or b, please explain using an attached statement.

35 Does the organization certify that it has complied with the applicable requirements of sections 4 .01 through 4.05 of Rev. Proc . 75-50, 1975-2 C.B . 587, covering racial nondiscrimination? If "No ." attach an explanation

Schedule A (Form 990 or 900-EZ) 2002

DAA

' SHURGC 06/06/2005 10 :24 AM '

Schedule A (Form sso or 990-EZ) 2002 Spectrum Health Urgent Care Centers 38-2454555 Page a Pa1f Private School Questionnaire (See page 7 of the instructions.)

To be completed ONLY b schools that checked the box on line 6 in Part IV 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, N/A Yes No

other governing instrument, or in a resolution of its governing body? 29 30 Does the organization include a statement of its raciall y nondiscriminatory policy toward students in all its

brochures catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships? 30

1 H r 3 as the organization publicized its racially nondiscriminatory policy 9 nondiscriminato through newspaper or broadcast media during the period of solicitation for students or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? 31 If "Yes," Please describe ; if "No," Please explain . (if you need more space, attach a separate statement.)

32 Does the organization maintain the following : a Records indicating the racial composition of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory

basis? c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing

with student admissions, programs, and scholarships? d Copies of all material used by the organization or on its behalf to solicit contributions?

DAA

SHURGC 06/06/2005 1024 AM '

Schedule A (Form 990 or 990-EZ) 2002 Spectrum Health Urgent Care Centers 38-2454555 Page s . . . . . . . . . . . . . . . . . . ~: A Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions . )

To be completed ONLY b an eligible or anization that filed Form 5768 N/A Check 1 a if the organization belongs to an affiliated g roup . Check 1 b if you checked "a" and "limited control" provisions appl y.

Limits on Lobbying Expenditures Affiliated group totals To be completed for ALL electing

The term "ex p enditures" means amounts aid or incurred . organizations

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) . . . . . . , , , . . . . . , , , 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37 38 Total lobbying expenditures (add lines 36 and 37) 38 39 Other exempt purpose expenditures 39 40 Total exempt purpose expenditures (add lines 38 and 39) 40 41 Lobbying nontaxable amount. Enter the amount from the following table-

If the amount on line 40 is- The lobbying nontaxable amount is-Not over $500,000 20% of the amount on line 40 Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000 ' ' ` . . . Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 41

a Over $1,500,000 but not over $17,000,000 $225,000 plus 5 /o of the excess over $1,500,000 '''"' >" ;.. ; . . . . . . . . . . . . . . . . . ; : ; :;:; : ' . ::: . Over $17 , 000 , 000 $1 , 000 , 000 42 Grassroots nontaxable amount (enter 25% of line 41) 42 43 Subtract line 42 from line 36 . Enter -0- if line 42 is more than line 36 43 44 Subtract line 41 from line 38 . Enter -0- if line 41 is more than line 38 . . ' . . . . . . ' . . . . . . . . . . . ' 44

Caution: If there is an amount on either line 43 or line 44, You must file Form 4720 . ~-`?`~ 4-Year Averaging Period Under Section 501(h)

(Some organizations that made a section 501(h) election do not have to complete all of the flue columns below. See the instructions for lines 45 through 50 on page 11 of the instructions .)

Lobbying Expenditures During 4-Year Averaging Period

Calendar year (or I (a) I (b) I (c) (d) I (e) fiscal vear beainnina in) 1 2002 2001 2000 1999 Tots

46 Lobbying ceiling amount (150% of line 45(e)1

47 Total lobbvinp expenditures

49 Grassroots ceiling amount (150% of

`Part,Vl=B ;̀ Lobbying Activity by Nonelecting Public Charities For reporting only b organizations that did not complete Part VI-A) See a e 11 of the instr. N /A

During the year, did the organization attempt to influence national, state or local legislation, including any Yes No Amount

attempt to influence public opinion on a legislative matter or referendum, through the use of: a Volunteers b Paid staff or management (include compensation in expenses reported on lines c through h . ) c Media advertisements d Mailings to members, legislators, or the public e Publications, or published or broadcast statements f Grants to other organizations for lobbying purposes . ., . . . . ., . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . ., . . . . . . . . . . . . . . g Direct contact with legislators, their staffs, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means i Total lobbying expenditures (add lines c through h . )

If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities . Schedule A (Form 990 or 990-EZ) 2002

52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? . . . . . . . . . , , . . . . . . . . , . , , , . . . . . . . . . _ . . 1 ~ Yes 0 No

b If "Yes ." complete the following schedule :

of rf

(b)

of

PRIORITY HEALTH

Schedule A (Form 990 or 990-EZ) 2002 DAA

SHURGC 06/06/2005 10 :24 AM '

scneduieP~

A (Form sso or 990-EZ) 2002 Spectrum Health Urgent Care Centers 38-2454555 Pa4e s 1111 Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations (See page 12 of the instructions .) 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No

(i) Cash 51a i X (ii) Other assets a( ii ) X

b Other transactions : (i) Sales or exchanges of assets with a noncharitable exempt organization b( i) X (ii) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . , , , . . . . . . . . . . . . . . . . . . . . . . . . , , , . . . . . . b( ii ) X (iii) Rental of facilities, equipment, or other assets b( iii) X (iv) Reimbursement arrangements , . . . . . . . . . . . . _ . . . . . . . . . . . , , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , . , . . . . . . . . . . . . . . . . , b( Iv) X (v) Loans or loan guarantees b(v) X (vi) Performance of services or membership or fundraising solicitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b( vi ) X

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X d If the answer to any of the above is "Yes," complete the following schedule . Column (b) should always show the fair market value of the

goods, other assets, or services given by the reporting organization . If the organization received less than fair market value in any transaction or sharing arrangement. show in column (d) the value of the goods . other assets. or services received :

(a) I (b) I (c) I (d) ie no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions . and

N/A

(a)

GROUP

The form 990 is being amended due to an oversight in reporting accrued supplemental executive retirement plan payments and deferred pension estimates in Part V, Column D. Additionally, deferred pension estimates were not originally included in Schedule A, Part I, Column D. These amended returns are adjusted to correct this oversight .

IMI LIM Spectrum Health

Blodgett Campus 1840 WEALTHY SE GRAND RAPIDS MI 9546-2968

616 774-7444 www . spectrum-health. org

Spectrum Health Urgent Care Centers EiN : 38-2454555 Year ending June 30`h, 2003

SHURGC 06/06/2005 10:24 AM '

Form Other Notes and Loans Receivable 990/990-PF

For calendar ear 2002, or tax ear beg inning 7 / 01 / 02 , and Name Spectrum Health Urgent Care Centers f/k/a Spectrum Health Grouv

6/30 /03 202

Employer Identification Number

38-2454555

Name of borrower

West River Land Devel

Interest rate Date of loan

1/01/93

io

Purpose of loan Purchase of land to build on

Balance due at I Fair market value end of year (sso-PF only) Consideration furnished by lender

277

i

Original amount borrowed

85,000

Security provided by borrower

- Additional Information

Relationship to disqualified person

t N/A

Maturity date I Repayment terms

10/01/02 $3,245 auarterlv

Balance due at beginning of year

6,277

SHURGC 06/06/2005 10 :24 AM

Tax-Exempt Bond Liabilities Form 990 2002

For calendar ear 2002, or tax ear beginning 7 /01/02 , and endin 6/30 /03 1 Name Employer Identification Number Spectrum Health Urgent Care Centers f k a Spectrum Health Group 38-2454555

Form 990 Part IV Line 64a - Additional Information

Name of lender Purpose of issue

Tax-exempt issue - 1998 Construction - refunding bond 2 (SEE SUPPLEMENTAL STATEMENT) 3 4 5 6 7 8 .9

'10

Original amount Form 8038 filed : Completion date Unexpended Issue date of issue Y/N Date filed Date retired of project bond proceeds

(i 8/14 / 98 23 , 384 , 896 Y 8/14 /98 "2 '3 '4 '5 '6

,8 .9

10)

Third party Maturity Interest use percent date Repayment terms rate

1 2 3 4 5 6

8 9 10

provided by borrower Amount outstanding Amount outstanding

Security at beginning of year at end of year

i~ Admit privileges to physicians 20,544,798 2,088,853

20,544,798 1 2,088,853 T

SHURGC Spectrum Health Urgent Care Centers 38-2454555 Federal Statements FYE : 6/30/2003

6/6/2005 10 :24 AM

Spectrum Health Urgent Care Centers treat patients with injuries and illnesses that don't warrant a trip to the emergency department and who can't wait to see their physician during regular office hours, with access to five convenient locations throughout the greater Grand Rapids, Michigan, area, of which two locations are open 24 hours/day, 7 days/week .

4-5

Statement 4 - Form 990 . Part II, Line 43 - Other Functional Expenses

Total Program Mgt & Description Expenses Service General

S S S Expenses

Physician & other fees 239,399 239,399 Bad debt expense 750,052 750,052 Utilities 59,538 56,561 2,977 Taxes 68,203 64,793 3,410 Liability insurance 2,100 2,100 Software & equipment 95,627 95,627 Bank charges 17,857 17,857 Uniforms 13,910 13,910 Miscellaneous 67,326 50,495 16,831

Total $ 1,314,012 $ 1,272,937 $ 41,075

Statement 5 - Form 990, Part III - Organization's Primary Exempt Purpose

Fund-Raising

S

$ 0

6-9

SHURGC Spectrum Health Urgent Care Centers 6/6/2005 10 :24 AM 38-2454555 Federal Statements FYE: 6/30/2003

Statement 6 - Form 990, Part IV, Line 55 - Investments in Land, Buildings, and Equipment

Description Beginning Accum End of Accum of Year Deprec Year Deprec

Land & land improvements $ 286, 173 $ $ $

Buildings 28,628,117 5,573,885

Equipment 12,568 8,502

Total $ 28,926,858 $ 5,582,387 $ 0 $ 0

Statement 7 - Form 990, Part IV, Line 56 - Other Investments

Beginning End of Basis of Description of Year Year Valuation

Spectrum Health Occupational Health $ 3,662,716 $ 3,662,716 Cost DeVos Women's and Children's Bldg 150,798 173,851 Cost The Wellness Center 14,196 5,825 Cost

Total $ 3,827,710 $ 3,842,392

Statement 8 - Form 990, Part IV, Line 57 - Land, Buildings, and Equipment

Description Beginning Accum End of Accum of Year Deprec Year Deprec

Land & land improvements $ 350,000 $ $ 515,000 $

Buildings 1,528,068 767,983 2,543,984 1,213,177

Equipment 545,956 285,906 666,602 443,400

Leasehold improvements 85,788 39,882 282,673 48,796

Total $ 2,509,812 $ 1,093,771 $ 4,008,259 $ 1,705,373

Statement 9 - Form 990. Part IV, Line 58 - Other Assets

Beginning End of Description of Year Year

Due from affiliates $ 37,996 $ 29,556 Amortized bond costs 197,587 19,252

Total $ 235,583 $ 48,808

Spectrum Health Urgent Care Centers (f/k/a Spectrum Health Group) Form 990(2002)

' FY Ended June 30, 2003

38-2454555

" Details of Compensation for the year ended December 31, 2002 are as follows :

Joseph Fife Annual base salary Short-term incentive bonus

$ 218,694 37,097

$ 255,791

Lois Temple Annual base salary $ 88,464 Short-term incentive bonus 11,566

$ 100,030

"' Spectrum Health has a long-term incentive bonus plan in place for certain key executives with a measurement date of June 30, 2003 which assesses performance to targets established for the combination of the 2001, 2002 and 2003 fiscal years . No amounts were accrued or paid under this plan for the calendar year 2002 .

Part V . List of Officers, Directors, Trustees, and Key Employees

Spectrum Health Urgent Care Centers Officers & Board of Directors

Column A Column B Column C Column D Column E Contributions to Expense Employee Benefit Account and

Average Plans & Deferred Other Officers & Key Employees Address Hrs/Week Compensation" Compensation' Allowances"

Joseph Fifer, Treasurer Grand Rapids, MI 49503 4 $0 $0 $0 Lois Temple, Secretary Grand Rapids, MI 49503 4 $0 $0 $0

Part V, Line 75 - Information on Compensation Exceeding $100,000

Contributions to Expense Employee Benefit Account and Plans & Deferred Other

Name Related Organization Compensation* Compensation` Allowances'

Joseph Fifer Spectrum Health Hospitals $ 255,791 *' $ 49,333 $0 Lois Temple Spectrum Health Hospitals $ 100,030 "* $ 13,390 $0

" Consistent with prior years, compensation and benefits are reported using the most recent calendar year compensation data . Information above is for the year ended December 31, 2002 .

During the year ended June 30, 2003, Spectrum Health Urgent Care Centers ("Urgent Care') transferred land and buildings, the related liability for tax-exempt bonds issued in 1998, and the net asset balance to Spectrum Health Hospitals ("Hospital' . The transfer was done as part of an overall restructuring within the Spectrum Health group of entities and more appropriately reflects the land and buildings and related debt as part of the Hospital's operations. The transfer is not considered a substantial contraction on the part of Urgent Care Centers and the operations and overall exempt-purpose of Urgent Care has not changes as a result of the transfer.

Spectrum Health Urgent Care Centers 38-2454555 Supplemental Statement to Form 990 Year Ended June 30, 2003

Part I, Line 20 - Other changes in net assets or fund balances Part N, Line 55 - Investments in land and buildings, and Line 64 - Tax-exempt bond

liabilities

38-2454559

Part 11, Lines 28 and 26

Certain employees with salaries and wages indicated above are eligible to participate in Spectrum Health Hospitals' 403(b) plan .

Spectrum Health Urgent Care Centers Form 990 (2002) For the year ended June 30, 2003

Amounts reported by Spectrum Heals Urgent Care Centers for salaries and wages on Form 990, Part II, lines 25 and 26 represent an allocation of salaries and wages paid by Spectrum Health Hospitals (an affiliate) due to centralized payroll processing . The Form 941's reporting these salaries and wages were filed under the Spectrum Health Hospitals' federal employment identification number (38-1360529) .

Schedule A, Part Ill, Line 4

Accum Deer Land 162000 (6,676,158 .45) (797,728.97) 31,807.59 7,442,079.83 0.00 Accum Depr Misc 162500 0.00 0.00 0.00 0.00 0.00 Accum Deer Land Impr 162200 0.00 0.00 0.00 0.00 0.00 Accum Deer Bldg 162300 0.00 (4,408 .24) 0.00 (257,077.42) (261,485 .66) Accum Deer Bldg Impr 162310 0.00 (18,534.67) 0.00 (933,156.38) (951,691 .05) Accum Depr Cap Lease 162320 0.00 0.00 0.00 0.00 0.00 Accum Depr Lease 162400 0.00 (1,891 .51) 0.00 (46,904.62) (48,796.13) Accum Depr Purn/Equip 162510 0.00 (3,654 .55) 0.00 (370,812.29) (374,466.84) Accum Depr Helicopter 162510 0.00 0.00 0.00 0.00 0.00 Accum Deer Hardware 162600 0.00 (1,125 .90) 0.00 (63,279.59) (64,405.49) Accum Depr Software 162610 0.00 (538.43) 0.00 (3,990 .00) (4,528.43) Accum Depr Auto 162630 0.00 0.00 0.00 0.00 0.00

TOTAL DEPRECIATION (6,676,158.45) (827,882.27) 31,807.59 5,766,859.53 (1,705,373.60)

TOTAL NBV 24,760,512 .80 # (455,61938) (149,604.41) (21,852,403.34) 2,302,885.67

Spectrum Health Urgent Care Centers 38-2454555 Form 990 - Fixed Asset Summary

ne 30, 2003

6/30/02 For Twelve Months Ending 6/30/2003 Balance Balance

Page 3, Pert IV, Line 57 per G/L Additions Disposals Transfers per G/L

Land 160100 636,173 .00 0.00 (121.173.00) 0.00 515,000.00 Land Improvements 160200 0.00 76,343.28 0.00 (76,343.28) 0.60 Buildings 160300 28,231,609 .42 0.00 (40,501 .00) (27,462,608.42) 728,500.00 Bldg Imptov & Reno 160310 1,924,576.15 9,632.18 (19,738.00) (98,986.01) 1,815,484.32 Capital Leases-Bldg 160320 0.00 0.00 0.00 0.00 0.00 Capital Interest 160325 0.00 0.00 0.00 0.00 0.00 Fixed Equip 160500 0.00 0.00 0.00 0.00 0.00 Furniture 8c Equipment 160510 557,524.68 90,402.35 0.00 (72.976.02) 574,951 .01 Computer Hardware 160600 0.00 0.00 0.00 78,479.18 78,479.18 Computer Software 160610 0.00 0.00 0.00 13,171 .68 13,171 .68 Automobiles 160630 0.00 0.00 0.00 0.00 0.00 Capital Leases 160520 0.00 0.00 0.00 0.00 0.00 Leasehold Improvements 160400 85,788.00 196,885.08 0.00 0.00 282,673.08

Construction In Progress 161000 1,000.00 (1,000 .00) 0.00 Asset Clearing 163000 0.00 0.00 0.00 CIP Temporary 163200 0.00 0.00 Proceeds Clearing 163300 0.00 0.00 "sset Clearing 163500 0.00 6.00 .TM Special Projects 164500 0.00 0.00

-finical Informatics Proj 165000 0.00 0.00 Reserve fot Gain/(Loss) 160150 0.00 0.00

TOTAL COST 31,436,671.25 372,262.89 (181,412 .00) (27,619,262.87) 4,008,259.27

!^

Federal Tax Nonexempt ID Number

Spectrum Health Hospitals X Spectrum Health Primary Care Partners X Blodgett Mobile Cardiac Catheterization X Spectrum Health X Spectrum Health Urgent Care Centers X Butterworth Occupational Health Villa Elizabeth - Buttervvorth Inc . X Aeromed at Spectrum Health X Partnership for Children's Health Butterworth Self-Insurance Trust of 1977 X Spectrum Heath Kent Community Campus X Reed City Hospital Corporation X Blodgett/Butterworth Health Care Foundation X Spectrum Health Continuing Care X Blodgett Emergency Services Corporation X Spectrum Health Worth Home Care X Spectrum Health Worth Residential Services X Spectrum Health Continuing Care Center X Visiting Nurse Association of Western Michigan X Visiting Nurse Services of Western Michigan X Visiting Nurse Extracare of Western Michigan X Blodgett Assurance Co. N/A Priority Health X Priority Health Managed Benefits Priority Health Governmental Programs X Hackley Health Systems, Inc . X Hackley Hospital X Child & Family Services of Muskegon X Lakeshore Community Hospital X Visiting Nurse Home Care X Lakeshore Health Ventures aka Hackley Health Ventures Metropolitan Butterworth Health Services MRI Mobile Services of West Michigan X MR! Mobile Services II of West Michigan X MRI Services of West Michigan X

38-2715520 38-3085182 32-0016523 38-2589966 38-1358196 38-1386362 38-2549295 38-2620872 38-2589959 3$-2760259 38-3073745 38-3293642 3$-2903473

X X

Spectrum Health Urgent Care Centers Form 990(2002) Year ended June 30, 2003

Page 5. Part VI, Other Information, Line 80b

Name of Organization Exempt

38-2454555

X

X

N/A

X

38-1360529 38-1358164 38-2950361 38-3382353 38-2454555 36-2563928 38-3245644 38-2688381 38-3364876 38-6378787 38-3472677 38-2770076 38-2752328 38-3242232 38-1642407 38-2620872 38-2786617 38-2415333 38-2613527 38-1359195 38-2613525

Fvrm 8868 ;December 2000) 3epaRrrNnt of IM Treasury

Application for Extension of Time To File an Exempt Organization Return OMB No . 1546-1709

Z Ii this fax year is for less than 12 months, check reason : 0 Initial return 0 Final return a Change in accounting period

3a Ii this application is for Form 990-BL, 990-PF, 990-T, 4720, a 6069, enter the tentative tax, less any ' nonrefundable credits . See Instructions $

b If this application la for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Balance Dug. Subtract line 3b from One 3a . Include your payment with this form, a, H required, deposit with FTD coupon a, K required, by using EFTPS (Electronic Federal Tax Payment System). See Instructions . . . . . . . -- ---------------------------------- ----- t

Signature and Verification lnder penalties of penury, I declare that I have examined this farm, Including accompanying schedules and statements, and to the best of my nowledpe and belief, it Is true, correct, and complete, and that I am authorized to prepare this form .

ignawro t LJIJ'w4 tmltJ TM. 1 'or Paperwork Reduction Act Notice, see Instruction Form 8888 (12-2000)

41 M

If you are filing for an Automatic 3-Month Extension, complete only Pert I and check this box , , , , , , , , , , , ,f thl

. , , , , , , , , , . . , , . , . , . . , , . . . , . . . , 10, u are filing for an Additional (not automaUc) 3-Month Extension, complete only Part II (on papa2 os toms).

Vot.. to not complete Pert 11 unless you have already bye granted an automatic 3-month extension on a previously filed :arm 8884.

Automatic 3 -Month Extension of Time- Only submit original (no copies needed) '. ri. . . ... n ,

4ots : Form 990-T corporations requesting an automatic 8-month extension-check his box and complete Part I only . . . , . . . . . . . . . , . . . . . . . . , . . . . . . , 1 0 i!1 other corporations (including Form 990-0 fliers) must use Form 7004 to request an extension of time to file Income tax

I, fyps or Name of Exempt Organization Employer Identification numbet jrInt SPECTRUM HEALTH URGENT GARB CENTERS lie bya,. F K A SPECTRUM HEALTH GROUP 38-2454555 ' ius data for Number, street, and room or suite no. If a P.O . box, see Instructions . ding °"` 1840 HEALTHY ST SE atom. See iawcuons. City, town or post office, state, and ZIP code. For a foreign address, see Instructions .

GRAND RAPIDS MI 49506 :hick type of return to be filed (file a separate application for each realm):

Form 990 Forth 990-T (corporation) Forth 4720 Forth 990-BL Forth 990-T (sec. 401(a) or 408(a) trust) , Forth 5227 Form 990-EZ Forth 990-T (trust other than above) Forth 8069 Form 990-PF I I Forth 1041-A n Form 8870

Ii the organization does not have an office a place of business In the United States, check this box , . , . . . , . , , , . . . . . . . , , . . . . . . . . . , . , If this Is for a Group Return, enter the organization's four digit Group Exemption Number (GEN . It this Is

or ~e whole group, check this box 1 0 . If It is for pan of the group, check this box 1 and attach a list with the games and EINs of all members the extension will cover. 1 I request an automatic 3-month (8-month, for 990-T corporation) extension of time until _ 2 / 1610 4 ,

to file the exempt organization return for the organization named above. The extension Is for the organization's return for. calendar year or

" ~ tax year beginning _ 1j0110 2 , and ending - §J3 Ol0 3 .

It you are filing fog an Additional (not automatic) 3-Month Extension, complete only Part II and check this box 1 . . . . . . . . . . . . . . . . . . . .3. . � iota: complete Part II it you have speedy bean granted an automatic 3-month extension on a previously filed` Form8888. ~ you aye filing for an Automatic 3-Month Extension, complete only Part I (on page 1) .

1!_Uww" 16 Cv"ewaiww wf T{.r~w_wA~~ef Cllw

=ile by the t< A I°! zt' 151:-1 A V i% racasar a n %sa%v v r

Wended Number, street, and room or suite no . If a P.O . box, see instructions. sue dace for utno use 1840 WEALTHY ST SE etum . See City, town or post office, state, and ZIP code . For a foreign address, see instr. nswctions. GRAND RAPIDS MI 49506 :heck type of return to be filed (File a separate application for each return): !1C Form 990 R Form 990-EZ R Form 990-7 (sec. 401(a) or 408(a) trust) 1 Form s90-BL Form 990-PF Form 990-7 (trust other than above)

Form 1041-A R Form 5227 0 Form 8870 Form 4720 Form 6089

STOP : Do not complete Part II Ii you wens not already granted an automatic 3-month extension on a previously filed Form 8888.

If the organization does not have an office or place of business In the United States, check this box , . . . , . , . , . . . . . . , If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) , It this is

for the whole group, check this box 1 a . If It Is for part of the group, check this box 1 0 and attach a list with the lames and EINs of all members the extension is for. 4 1 request an additional 3-month extension of time until 1jeP 5 For calendar year , or other tax year beginning V.91 TO 2 and ending - 6 /3 OLO 3 8 If this tax year is for less than 12 months, check reason : [TInidal return ~ Final return [] Change in accounting period 7 State in detail why you need the extension _ -

ADDITIONAL TIME NEEDED TO ACCUMULATE INFORMATION NEEDED TO ACCURATELY PREPARE A COMPL]i-TE RETURN _

Sa If this application Is for Form 990-BL, 990-PF, 990-7, 4720, or 6069, enter we tentative tax, less any nonrefundable credits . See Instructions ' this application is for Form 990-PF, 990-T,4720, or 6069, enter any refundable credits and estimated . ~ . ~ . . ~ ~ : ~ 1~ ~ x payments made . Include any prior year overpayment allowed as a credit and any amount paid

previously with Form 8868 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ i ~~ ._ .'. I

c Balance Due. Subtract Ilne 8b from Iine 8a . Indude your payment with this form, or, it required, deposit "------ - - � _ with FTD coupon a, If required, by using EFTPS (Electronic Federal Tax Payment System). See --~ ~ . Instructions ., . . . . . -"-

Signature and Verification Under penalties of perjury, I declare that I have examined this forth, Including accompanying schedules and statement, and to the best of my knowledge and belief, It is true, collect, and complete, and that t am authorized to prepare this form .

-3I«IAd _ ..r. Si9naare Notice to AEplicant-To Be Completed by the IRS

We have approved this application . Please attach this forth to the organization's return . r~INe haw not approved this appllcaUon. However, we have granted a 10-day grace period from the later of the

due date of the organization's return pnduding any prior extensions) . This grace period is considered m be a v elections otherwise required to be made an a timely return . Please attach this form to the organization's return,

a We haw not approved this application . After considering the reasons stated in Item 7, we cannot grant your n to file . We are not granting a 10-day grace period . We cannot consider this application because it was filed after the due date of the return for which an extenaiam 8Other

"- BY

Name

City or town, province or stab, and country (Including postal or ZIP cods)

Form 8868 (12-20001 i )An

I'A Name of Exempt Organization )rIne I SPECTRUM HEALTH URGENT CARL CENTERS

Employer Identification number

.78-L "!36l7 : For IRS use only

EXTEMSION APPROVED

MAR Q 12004

3rectot I Alternate Mailing Address " Enter the address If you want the copy of this application for an additional 3-morNh e~densfon .

Type or print

Number and street (Include suite, room, or apt no .) Or a P.O. box number