<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.irs.gov/efile" returnVersion="2021v4.2">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2023-02-15T09:33:44-06:00</ReturnTs>
    <TaxPeriodEndDt>2022-03-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>381357951</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>PLANTE &amp; MORAN PLLC</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>600 E FRONT ST STE 300</AddressLine1Txt>
        <CityNm>TRAVERSE CITY</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>49686</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2021-04-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>382800065</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>HOLLAND COMMUNITY HOSPITAL</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>HOLL</BusinessNameControlTxt>
      <PhoneNum>6163925141</PhoneNum>
      <USAddress>
        <AddressLine1Txt>602 MICHIGAN AVENUE</AddressLine1Txt>
        <CityNm>HOLLAND</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>49423</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>DALE SOWDERS</PersonNm>
      <PersonTitleTxt>PRESIDENT &amp; CEO</PersonTitleTxt>
      <PhoneNum>6163925141</PhoneNum>
      <SignatureDt>2023-02-13</SignatureDt>
      <DiscussWithPaidPreparerInd>1</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <SigningOfficerGrp>
      <PersonFullName>
        <PersonFirstNm>DALE</PersonFirstNm>
        <PersonLastNm>SOWDERS</PersonLastNm>
      </PersonFullName>
      <SSN>999009999</SSN>
    </SigningOfficerGrp>
    <PreparerPersonGrp>
      <PreparerPersonNm>OLIVER JURKOVIC</PreparerPersonNm>
      <PTIN>P00433694</PTIN>
      <PhoneNum>2319477800</PhoneNum>
      <PreparationDt>2023-02-13</PreparationDt>
    </PreparerPersonGrp>
    <AdditionalFilerInformation>
      <TrustedCustomerGrp>
        <TrustedCustomerCd>3</TrustedCustomerCd>
        <AuthenticationAssuranceLevelCd>AAL1</AuthenticationAssuranceLevelCd>
        <IdentityAssuranceLevelCd>IAL1</IdentityAssuranceLevelCd>
      </TrustedCustomerGrp>
    </AdditionalFilerInformation>
    <TaxYr>2021</TaxYr>
    <BuildTS>2023-03-07 01:45:13Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="12">
    <IRS990 documentId="RetDoc1038000001" referenceDocumentId="RetDoc1044400001">
      <DoingBusinessAsName>
        <BusinessNameLine1Txt>HOLLAND HOSPITAL</BusinessNameLine1Txt>
      </DoingBusinessAsName>
      <PrincipalOfficerNm>DALE SOWDERS</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>602 MICHIGAN AVENUE</AddressLine1Txt>
        <CityNm>HOLLAND</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>49423</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>451958514</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>0</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>WWW.HOLLANDHOSPITAL.ORG</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1985</FormationYr>
      <LegalDomicileStateCd>MI</LegalDomicileStateCd>
      <ActivityOrMissionDesc>TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, COMPASSION, RESPECT AND DIGNITY.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>14</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>12</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>2577</TotalEmployeeCnt>
      <TotalVolunteersCnt>200</TotalVolunteersCnt>
      <TotalGrossUBIAmt>1299675</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>18483557</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>4351677</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>258449896</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>296613281</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>8879252</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>23346030</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>726328</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>344425</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>286539033</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>324655413</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>909988</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>749990</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>148867082</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>165255541</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>122854366</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>132584667</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>272631436</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>298590198</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>13907597</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>26065215</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>577046550</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>587178099</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>161273242</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>152813279</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>415773308</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>434364820</NetAssetsOrFundBalancesEOYAmt>
      <InfoInScheduleOPartIIIInd>X</InfoInScheduleOPartIIIInd>
      <MissionDesc>TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, COMPASSION, RESPECT AND DIGNITY.</MissionDesc>
      <SignificantNewProgramSrvcInd>0</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>0</SignificantChangeInd>
      <ExpenseAmt>273872349</ExpenseAmt>
      <GrantAmt>749990</GrantAmt>
      <RevenueAmt>295654308</RevenueAmt>
      <Desc>HOLLAND HOSPITAL, LOCATED IN HOLLAND, MI, IS A NATIONALLY RECOGNIZED LEADER IN QUALITY, VALUE AND HIGH PATIENT SATISFACTION. IN 2022, IT WAS THE ONLY HOSPITAL IN THE WEST MICHIGAN REGION TO EARN THE TOP 5-STAR RATING FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. THE HOSPITAL OFFERS A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES, MULTIPLE CONVENIENT LOCATIONS AND READY ACCESS TO A VARIETY OF PRIMARY CARE PROVIDERS AND EXPERIENCED SPECIALISTS.FOR 105 YEARS, HOLLAND HOSPITAL'S MISSION HAS BEEN TO CONTINUALLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, COMPASSION, RESPECT AND DIGNITY. WE MEASURE OUR ACHIEVEMENTS ON FIVE STRATEGIC ESSENTIALS: FINANCIAL STRENGTH, GROWTH, QUALITY, SUPERIOR SERVICE AND SUPERIOR WORKFORCE.QUALITY, VALUE AND PATIENT EXPERIENCETHE CENTERS FOR MEDICARE &amp; MEDICAID SERVICES (CMS) USES THE OVERALL HOSPITAL QUALITY STAR RATINGS SYSTEM TO EVALUATE AND COMPARE HOSPITALS NATIONWIDE. THE SYSTEM SUMMARIZES NUMEROUS QUALITY MEASURES INTO A UNIFIED RATING OF ONE TO FIVE STARS. HOLLAND HOSPITAL IS THE ONLY 5-STAR RATED HOSPITAL IN THE WEST MICHIGAN REGION AND AMONG JUST 14% OF HOSPITALS IN THE NATION TO EARN THE TOP RATING. IN ADDITION, THE HOSPITAL IS ONE OF THE FEW TO CONSISTENTLY ACHIEVE THE 5-STAR RATING SINCE IT WAS INTRODUCED. HOLLAND HOSPITAL IS ALSO AMONG THE REGION'S LOWEST COST PROVIDERS, DELIVERING EXCEPTIONAL VALUE AND AN OUTSTANDING PATIENT EXPERIENCE.IN 2022, HOLLAND HOSPITAL ALSO EARNED TOP AWARDS FROM HEALTHGRADES, THE LEADING SOURCE OF CONSUMER INFORMATION ON HOSPITAL PERFORMANCE. HEALTHGRADES EVALUATES ALL THE NATION'S ACUTE CARE HOSPITALS (OVER 4,500) BASED ON CLINICAL OUTCOMES DATA. HOLLAND HOSPITAL IS RATED AS ONE OF AMERICA'S 50 BEST HOSPITALS FOR SURGICAL CARE AND IS THE ONLY HOSPITAL IN MICHIGAN TO EARN THAT RECOGNITION. IT IS ALSO RANKED #1 IN JOINT REPLACEMENT IN MICHIGAN AND 5-STAR RATED IN CLINICAL CARE SERVICES, AMONG MANY OTHER AWARDS.THE ORGANIZATION IS ONE OF A SELECT GROUP OF HOSPITALS TO ACHIEVE AND MAINTAIN THE INTERNATIONAL STANDARD FOR QUALITY - ISO 9001:2008 CERTIFICATION. THIS UNIVERSAL BENCHMARK DEMONSTRATES OUR COMMITMENT TO ORGANIZATIONAL EXCELLENCE. OUR DEDICATION TO SYSTEMATICALLY IMPROVE QUALITY IS THE FOUNDATION OF SUPERIOR OUTCOMES AND HIGHER PATIENT SATISFACTION. THIS HAS EARNED NATIONAL RECOGNITION OVER MULTIPLE YEARS FROM THE LEADING RATING AGENCIES FOR THE TOTAL HOSPITAL AND IN ORTHOPEDICS, JOINT REPLACEMENT, CARDIOLOGY, SURGERY AND MANY OTHER AREAS.PROGRAMS / SERVICESHIGHLIGHTS OF PROGRAMS AND SERVICES THAT PROVIDE ACCESS TO QUALITY CARE INCLUDE:BOVEN BIRTH CENTERHOLLAND HOSPITAL'S BIRTH CENTER FEATURES THE LATEST TECHNOLOGY AND ENHANCEMENTS, INCLUDING 21 PRIVATE BIRTHING SUITES WITH HOME-LIKE AMENITIES, EIGHT LABOR-DELIVERY ROOMS, WELL-BABY NURSERY, STATE-OF-THE-ART OPERATING ROOMS, AND MORE. AN EIGHT-BED SPECIAL CARE NURSERY PROVIDES PRE-TERM AND TERM BABIES WHO NEED SPECIALIZED ATTENTION, EXTRA MONITORING AND CARE BEFORE GOING HOME. OUR BIRTH CENTER TEAM RECENTLY RECEIVED THE PLATINUM DESIGNATION FOR MATERNAL CARE FROM THE MICHIGAN ALLIANCE FOR INNOVATION ON MATERNAL HEALTH (MI AIM). CARDIAC CATHETERIZATION LABHOLLAND HOSPITAL'S CATH LAB DEPARTMENT HAS STATE-OF-THE-ART PROCEDURE ROOMS WITH THE LATEST TECHNOLOGY, IMAGING EQUIPMENT WITH THE HIGHEST RESOLUTION AND LOWEST RADIATION AVAILABLE FOR CARDIAC INTERVENTIONS AND A SPECIAL PROCEDURES ROOM FOR PERIPHERAL VASCULAR CARE AND PACEMAKER IMPLANTS. AS A PARTICIPATING HOSPITAL IN THE STATE-WIDE BMC2 CARDIOVASCULAR CONSORTIUM, HOLLAND HOSPITAL CONTINUOUSLY WORKS TO IMPROVE THE QUALITY OF CARDIOVASCULAR PROCEDURES AND PATIENT OUTCOMES. FOR EXAMPLE, HOLLAND HOSPITAL EXCEEDS THE STATE'S AGGREGATE DATA WITH 38% LESS RADIATION AND 53% HIGHER PCI ENROLLMENT IN CARDIAC REHAB, KEY ASPECTS THAT CONTRIBUTE TO SUCCESSFUL OUTCOMES. STROKE CARE / NEUROTHROMBECTOMY HOLLAND HOSPITAL ACTIVELY WORKS TO COMMUNICATE STROKE SIGNS AND SYMPTOMS WITHIN OUR SERVICE AREA AND ENCOURAGE RESIDENTS WHO MAY BE HAVING A STROKE TO CALL 911 IMMEDIATELY FOR TRANSPORT TO THE ER, WHERE OUR EXPERIENCED STROKE TEAM IS READY TO DELIVER APPROPRIATE CARE. NEUROTHROMBECTOMY PROCEDURES WERE RECENTLY ADDED TO OUR ADVANCED CARE FOR STROKE PATIENTS. THIS PROCEDURE INVOLVES SURGICAL REMOVAL OR A BLOOD CLOT IN THE BRAIN AND PROVIDES RAPID, LOCAL ACCESS TO LIFESAVING CARE FOR STROKE PATIENTS IN CERTAIN SITUATIONS. THE NEW PROGRAM WAS DEVELOPED AND IMPLEMENTED IN COOPERATION WITH EXPERTS FROM UNIVERSITY OF MICHIGAN HEALTH-WEST AND IS ANOTHER EXAMPLE OF OUR COLLABORATIVE APPROACH TO INITIATIVES THAT CAN BEST SERVE OUR COMMUNITY. ORTHOPEDICS / JOINT REPLACEMENTHOLLAND HOSPITAL HAS CONSISTENTLY EARNED THE ORTHOPEDIC EXCELLENCE AWARD FROM HEALTHGRADES AND IS AMONG AMERICA'S 100 BEST HOSPITALS FOR JOINT REPLACEMENT BEING RANKED #1 IN MICHIGAN FOR HIGH QUALITY JOINT REPLACEMENT. OUR HOSPITAL UTILIZES THE MOST RECENT TECHNOLOGY ADVANCEMENTS INCLUDING MAKO ROBOTIC-ASSISTED TECHNOLOGY FOR KNEE REPLACEMENT AND ANTERIOR HIP REPLACEMENT FOR FAST RECOVERY AND EXCEPTIONAL OUTCOMES. OUR SPINE &amp; ORTHOPEDICS UNIT FEATURES SUPERIOR DESIGN AND FUNCTION FOR AN EXCELLENT PATIENT EXPERIENCE. SURGICAL SERVICESAS MENTIONED, HOLLAND HOSPITAL IS RATED AS ONE OF AMERICA'S 50 BEST HOSPITALS FOR SURGICAL CARE AND IS THE ONLY HOSPITAL IN MICHIGAN TO EARN THAT RECOGNITION. THIS RECOGNITION INCLUDES A WIDE RANGE OF SURGICAL PROCEDURES IN UROLOGY, DIGESTIVE HEALTH, CARDIOVASCULAR CARE AND ORTHOPEDICS. HOLLAND HOSPITAL IS ONE OF AN EXCLUSIVE NUMBER OF HOSPITALS IN MICHIGAN USING THE NEW DA VINCI XI SURGICAL SYSTEM WHICH ENABLES SURGEONS TO PERFORM CERTAIN SURGERIES THROUGH TINY, ONE TO TWO CENTIMETER INCISIONS, OR IN SOME CASES, A SINGLE INCISION FOR FASTER RECOVERY AND LESS PAIN. THE HOSPITAL ALSO OFFERS THE MAZOR X SYSTEM FOR MINIMALLY INVASIVE SURGERY WHICH PROVIDES SAFER, MORE EFFICIENT SPINAL FUSION SURGERIES. IN ADDITION, HOLLAND HOSPITAL IS THE FIRST AREA HOSPITAL TO OFFER THE OLYMPUS SOLTIVE, A NEW LASER TECHNOLOGY THAT ENABLES QUICKER AND MORE EFFECTIVE KIDNEY STONE REMOVAL.BARIATRIC SERVICESBARIATRIC SERVICES ARE OFFERED AT HOLLAND HOSPITAL TO MEET THE GROWING NEED FOR THIS LIFE-CHANGING WEIGHT LOSS SURGERY IN OUR COMMUNITY. IN PARTNERSHIP WITH GRAND HEALTH PARTNERS, AN EXPERIENCED SURGICAL TEAM IN WEST MICHIGAN, HOLLAND HOSPITAL BARIATRIC SERVICES PROVIDES A MULTIDISCIPLINARY, TAILORED APPROACH TO WEIGHT LOSS, INCLUDING SURGICAL AND NONSURGICAL INTERVENTIONS.DIGESTIVE HEALTHHOLLAND HOSPITAL SPECIALISTS HAVE EXTENSIVE EXPERIENCE TREATING HEARTBURN AND GERD WITH THE LATEST CARE OPTIONS. THE HOLLAND HOSPITAL ENDOSCOPY CENTER PERFORMS ADVANCED DIAGNOSTIC PROCEDURES AND TREATMENTS IN A COMFORTABLE SETTING WHILE OUR REFLUX CENTER PROVIDES CLOSE-TO-HOME ACCESS TO PROCEDURES SUCH AS LAPAROSCOPIC NISSEN FUNDOPLICATION (LNF) AND THE LINX REFLUX PROCEDURE.BREAST CAREHOLLAND HOSPITAL IS NATIONALLY RECOGNIZED AS A BREAST IMAGING CENTER OF EXCELLENCE, AS WELL AS ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY. OUR BREAST CARE PROGRAM PROVIDES EXPERT, COORDINATED CARE DELIVERED BY AN EXPERIENCED MULTIDISCIPLINARY TEAM. OUR MAMMOGRAPHY AND BREAST IMAGING SERVICES MEET THE HIGHEST STANDARDS FOR IMAGE QUALITY AND PATIENT SAFETY. WE OFFER THE NEW SMARTCURVE BREAST STABILIZATION SYSTEM WHICH IMPROVES COMFORT WHILE MAINTAINING EXCEPTIONAL IMAGE QUALITY. OUR BREAST CARE INCLUDES A HIGH-RISK BREAST CLINIC AND BREAST CANCER TREATMENT IS PROVIDED BY A TEAM OF RADIOLOGISTS, PATHOLOGISTS, SURGEONS, MEDICAL ONCOLOGISTS, RADIATION ONCOLOGISTS, PHYSICAL AND OCCUPATIONAL THERAPISTS, AND A NURSE NAVIGATOR WHO SERVES AS THE PATIENT'S GUIDE AND ADVOCATE.WOMEN'S SPECIALTY CAREOUR WOMEN'S SPECIALTY CARE OFFERS A RANGE OF SERVICES FOR WOMEN'S HEALTH NEEDS AT EVERY LIFE STAGE. THE PRACTICE PROVIDES ACCESS TO PERSONALIZED CARE, SPECIALIZED SUPPORT AND ADVANCED TECHNOLOGY IN A COMFORTABLE SETTING. PROVIDERS ARE CERTIFIED IN MENOPAUSAL CARE AND TREAT A BROAD SCOPE OF HEALTH CONCERNS.BEHAVIORAL HEALTHHOLLAND HOSPITAL OFFERS INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES TO ADDRESS SPECIFIC NEEDS. TREATING THE WHOLE PERSONMIND, BODY AND SPIRITIN A CONFIDENTIAL SETTING, OUR BEHAVIORAL HEALTH SPECIALISTS ARE DEDICATED TO DELIVERING PERSONALIZED CARE AND ATTENTION. IN ADDITION TO BOTH INPATIENT AND OUTPATIENT CARE, WE OFFER PARTIAL HOSPITALIZATION AND INTENSIVE OUTPATIENT PROGRAMS WHICH ARE SHORT-TERM, INNOVATIVE TREATMENT OPTIONS FOR ADULTS WHO REQUIRE MORE SUPPORT THAN TRADITIONAL OUTPATIENT TREATMENT. THESE POPULAR PROGRAMS ALONG WITH OUR OTHER MENTAL HEALTH OFFERINGS HAVE EXPERIENCED A SIGNIFICANT INCREASE IN DEMAND AND WE CONTINUE TO EXPAND OUR SERVICES TO THE AREA.</Desc>
      <ProgSrvcAccomActyOtherGrp>
        <Desc>CONTINUATION OF LINE 4A:VIRTUAL VISITS AND TELEHEALTHFOR CONVENIENT ACCESS TO CARE, WE HAVE VIRTUAL VISITS (ONLINE PROVIDER APPOINTMENTS) WHICH CONTINUE TO EXPAND. WE ALSO OFFER TELEHEALTH MONITORING TO ENSURE EXCELLENT OUTCOMES AND REDUCE RE-HOSPITALIZATIONS. THE TELEHEALTH CAPABILITIES OFFER A SIMPLE-TO-USE IN-HOME ELECTRONIC DEVICE THAT COLLECTS VITAL SIGNS AND TRANSMITS DATA TO MONITOR PATIENT CONDITIONS AND HELP GUIDE APPROPRIATE ACTION.CONVENIENT PRIMARY AND SPECIALTY CARETO BEST SERVE THE LAKESHORE AREA, HOLLAND HOSPITAL OFFERS A COMPREHENSIVE HEALTH CARE NETWORK FEATURING AN EXPANSIVE MEDICAL GROUP THAT INCLUDE FAMILY MEDICINE, INTERNAL MEDICINE, INTERNAL MEDICINE &amp; PEDIATRICS, AND A BROAD RANGE OF SPECIALTY CARE PRACTICES. IN RECENT YEARS, WE HAVE ADDED MANY NEW PRIMARY CARE PROVIDERS AND SPECIALIST TO EXPAND ACCESS TO CARE AND PREPARE TO MEET THE GROWING NEED FOR HEALTH CARE WITHIN THE COMMUNITY. ALL HOLLAND HOSPITAL MEDICAL PRACTICES ALSO OFFER VIRTUAL VISITS - ONLINE APPOINTMENTS FROM THE COMFORT OF HOME. IMMEDIATE CARE OPTIONS INCLUDE OUR WALK-IN CARE AND URGENT CARE. FOR LIFE-THREATENING CONCERNS, EMERGENCY SERVICES ARE OPEN 24/7.WORKPLACE EXCELLENCEFOR THE 20TH YEAR IN A ROW, HOLLAND HOSPITAL HAS BEEN SELECTED AS A WINNER IN WEST MICHIGAN'S BEST AND BRIGHTEST COMPANIES TO WORK FOR COMPETITION - MAKING IT THE ONLY HEALTH CARE ORGANIZATION TO ACHIEVE THIS MILESTONE. THE MUCH SOUGHT-AFTER RECOGNITION IDENTIFIES ORGANIZATIONS THAT ARE COMMITTED TO EXCELLENCE IN THEIR HUMAN RESOURCE PRACTICES AND EMPLOYEE ENRICHMENT. EACH ORGANIZATION IS ASSESSED BY ITS OWN EMPLOYEES IN THE AREAS OF COMMUNICATION, WORK-LIFE BALANCE, EMPLOYEE EDUCATION, DIVERSITY, RECOGNITION, RETENTION AND MORE.COMMUNITY OUTREACH PROGRAMSHOLLAND HOSPITAL SERVES THE GREATER COMMUNITY IN MANY WAYS BEYOND OUR INPATIENT AND OUTPATIENT CARE SERVICES. IN ADDITION TO THE CONTRIBUTIONS RECEIVED FROM THROUGHOUT THE COMMUNITY, THIS YEAR MARKS THE 23RD EMPLOYEE CAMPAIGN. THANKS TO THE STEADFAST COMMITMENT AND GENEROSITY OF MANY EMPLOYEES AND VOLUNTEERS, OUR STAFF HAS RAISED OVER $1 MILLION IN SUPPORT OF OUR OUTREACH PROGRAMS SINCE 1999. OUR COMMUNITY OUTREACH PROGRAMS INCLUDE:HOLLAND COMMUNITY HEALTH CENTER (CHC) THE CHC IS SERVICE OF HOLLAND HOSPITAL WHICH PROVIDES AFFORDABLE, PRIMARY CARE SERVICES IN A DOCTOR'S OFFICE SETTING. THE MAJORITY OF PATIENTS LACK ADEQUATE HEALTH INSURANCE. NEARLY HALF OF THE PATIENTS ARE CHILDREN. CHC ALSO ACQUIRES AND DISTRIBUTES FREE MEDICATIONS FOR THOSE WHO CANNOT AFFORD THEM. THIS ESSENTIAL CARE MAKES A SIGNIFICANT DIFFERENCE IN THE HEALTH OF OUR COMMUNITY.SCHOOL NURSING PROGRAMHOLLAND HOSPITAL'S SCHOOL NURSES ADDRESS THE HEALTH NEEDS OF OVER 12,000 CHILDREN IN 26 SCHOOLS IN FIVE LOCAL SCHOOL DISTRICTS. MANY OF THE STUDENTS LIVE AT OR BELOW THE POVERTY LEVEL AND DO NOT RECEIVE REGULAR MEDICAL CARE OUTSIDE OF SCHOOL. SCHOOL MENTAL HEALTH PROGRAM THIS NEW PROGRAM HAS PROVEN EFFECTIVE IN IMPROVING THE MENTAL HEALTH AND WELLNESS OF STUDENTS THROUGH EARLY INTERVENTION WHEN STUDENT MENTAL HEALTH CONCERNS ARE IDENTIFIED, AND BY COORDINATING CARE BETWEEN THE SCHOOL, FAMILY, CAREGIVERS, PHYSICIANS AND/OR HOSPITAL FOR THE MOST AT-RISK STUDENTS.BREAST CARE FUNDTHE BREAST CARE FUND COVERS THE COST OF SCREENING AND DIAGNOSTIC MAMMOGRAMS, ULTRASOUNDS AND BIOPSIES FOR HUNDREDS OF WOMEN IN OUR COMMUNITY WHO DO NOT HAVE INSURANCE COVERAGE FOR THESE LIFESAVING TESTS.COMMUNITY HEALTH AND WELLNESS OUR HEALTHY LIFE PROGRAMS OFFER A VARIETY OF CLASSES AND INDIVIDUAL EDUCATION OPPORTUNITIES TO SERVE THE COMMUNITY. THE HEALTHY LIFE PROGRAMS OFFICE ALSO WORKS WITH AREA BUSINESSES TO PROVIDE CHRONIC DISEASE MANAGEMENT AND BEHAVIOR CHANGE PROGRAMS DIRECTLY TO EMPLOYEES.COMMUNITY HEALTH NEEDS ASSESSMENTHOLLAND HOSPITAL PARTICIPATES IN THE OTTAWA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT TO ASSESS THE GENERAL HEALTH OF AREA RESIDENTS AND IDENTIFY NEEDS AND OPPORTUNITIES FOR IMPROVEMENT. AS A SPONSOR AND PARTICIPANT IN THE PROCESS, HOLLAND HOSPITAL USES THE FINDINGS AS INPUT TO HELP GUIDE PRIORITIES AND PROGRAM DEVELOPMENT.SUMMARY DURING FISCAL YEAR 2022, HOLLAND HOSPITAL PROVIDED: BEDS 189ADMISSIONS 7,000PATIENT DAYS 29,800DISCHARGES 6,800BIRTHS 1,400SURGERIES 16,000OUTPATIENT VISITS 451,800EMERGENCY ROOM VISITS 35,400URGENT CARE VISITS 30,900HOME HEALTH VISITS 27,400LAB TESTS 728,800RADIOLOGY PROCEDURES 130,100VIRTUAL VISITS 30,000UNCOMPENSATED MEDICAL COSTS HOLLAND HOSPITAL REMAINS COMMITTED TO CARING FOR MEMBERS OF OUR COMMUNITY WHO ARE UNINSURED OR UNDER-INSURED. IN FY 2022, HOLLAND HOSPITAL PROVIDED UN-REIMBURSED CARE TO OUR PATIENTS AT A COST OF $50 MILLION, DURING ANOTHER PARTICULARLY DIFFICULT YEAR.2022 COMMUNITY BENEFIT SUMMARY $50 MILLION TOTAL COMMUNITY BENEFITUNPAID COST OF MEDICAID $13,055,000UNPAID COST OF MEDICARE $21,215,000CHARITY CARE $1,508,000 BAD DEBT $9,053,000OTHER COMMUNITY BENEFITS (NOTE A) $4,813,000FINANCE COMMENT: CHARITY IS NOW BEING REPORTED AT COST, IN THE PAST IT HAD BEEN REPORTED AT WHAT GROSS CHARGES WOULD HAVE BEEN. NOTE A - OTHER COMMUNITY BENEFITS INCLUDE: COMMUNITY EDUCATION &amp; OUTREACH PROGRAMS CASH, IN-KIND DONATIONS &amp; CONTRIBUTIONS HOLLAND COMMUNITY HEALTH CENTER STUDENT NURSING PROGRAM HEALTH PROFESSIONAL EDUCATION &amp; RESEARCH HOLLAND HOSPITAL SUBSIDIZED SERVICES</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <TotalProgramServiceExpensesAmt>273872349</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc1039100001">1</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="RetDoc1234500001">1</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd referenceDocumentId="RetDoc1039700001">0</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd referenceDocumentId="RetDoc1039700001">1</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd referenceDocumentId="RetDoc1039700001">0</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc1040000001">0</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc1040000001">0</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc1040000001">0</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc1040000001">0</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd>1</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc1040000001">1</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc1040000001">1</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc1040000001">0</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc1040000001">0</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc1040000001">1</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc1040000001">0</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">1</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">0</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>0</SchoolOperatingInd>
      <ForeignOfficeInd>0</ForeignOfficeInd>
      <ForeignActivitiesInd>0</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>0</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>0</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd referenceDocumentId="RetDoc1041300001">0</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd referenceDocumentId="RetDoc1041300001">1</FundraisingActivitiesInd>
      <GamingActivitiesInd referenceDocumentId="RetDoc1041300001">1</GamingActivitiesInd>
      <OperateHospitalInd referenceDocumentId="RetDoc1041500001">1</OperateHospitalInd>
      <AuditedFinancialStmtAttInd referenceDocumentId="RetDoc2317200001">1</AuditedFinancialStmtAttInd>
      <GrantsToOrganizationsInd referenceDocumentId="RetDoc1041900001">1</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd referenceDocumentId="RetDoc1041900001">0</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="RetDoc1042400001">1</ScheduleJRequiredInd>
      <TaxExemptBondsInd referenceDocumentId="RetDoc1053100001">1</TaxExemptBondsInd>
      <InvestTaxExemptBondsInd>0</InvestTaxExemptBondsInd>
      <EscrowAccountInd>0</EscrowAccountInd>
      <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
      <EngagedInExcessBenefitTransInd>0</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>0</PYExcessBenefitTransInd>
      <LoanOutstandingInd>0</LoanOutstandingInd>
      <GrantToRelatedPersonInd>0</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>0</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>0</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>0</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>0</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>0</DeductibleArtContributionInd>
      <TerminateOperationsInd>0</TerminateOperationsInd>
      <PartialLiquidationInd>0</PartialLiquidationInd>
      <DisregardedEntityInd referenceDocumentId="RetDoc1043400001">1</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentId="RetDoc1043400001">1</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>1</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd referenceDocumentId="RetDoc1043400001">0</TransactionWithControlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd referenceDocumentId="RetDoc1043400001">0</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd referenceDocumentId="RetDoc1043400001">0</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>1</ScheduleORequiredInd>
      <IRPDocumentCnt>138</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>1</BackupWthldComplianceInd>
      <EmployeeCnt>2577</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>1</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>1</UnrelatedBusIncmOverLimitInd>
      <Form990TFiledInd>1</Form990TFiledInd>
      <ForeignFinancialAccountInd>0</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>0</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>0</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>0</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>1</QuidProQuoContributionsInd>
      <QuidProQuoContriDisclInd>1</QuidProQuoContriDisclInd>
      <Form8282PropertyDisposedOfInd>0</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>0</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>0</PayPremiumsPrsnlBnftCntrctInd>
      <DAFExcessBusinessHoldingsInd>0</DAFExcessBusinessHoldingsInd>
      <TaxableDistributionsInd>0</TaxableDistributionsInd>
      <DistributionToDonorInd>0</DistributionToDonorInd>
      <IndoorTanningServicesInd>0</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>0</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>0</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>14</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>12</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>0</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>0</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>0</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>0</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>0</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>0</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>0</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>1</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>1</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>0</OfficerMailingAddressInd>
      <LocalChaptersInd>0</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>0</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>1</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>1</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>1</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>1</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>1</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>1</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>1</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>1</InvestmentInJointVentureInd>
      <WrittenPolicyOrProcedureInd>1</WrittenPolicyOrProcedureInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>ALEXANDER ROEHLING</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>6163943456</PhoneNum>
        <USAddress>
          <AddressLine1Txt>602 MICHIGAN AVE</AddressLine1Txt>
          <CityNm>HOLLAND</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>49423</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>DALE M SOWDERS</PersonNm>
        <TitleTxt>PRESIDENT-CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>791145</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>21869</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVE MASON</PersonNm>
        <TitleTxt>CHAIR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SHELLY MACIEJEWSKI</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KRIS DEPREE MD</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JUANITA BOCANEGRA</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHAEL HILL</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>BILL VANDER VLIET MD</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TONY YASICK MD</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>14500</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>STEPHEN MAUGER</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GWEN AUWERDA</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LESLIE BROWN</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KEN FILIPPINI</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GREG CHRISTIE</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DOUG HOEY</PersonNm>
        <TitleTxt>TRUSTEE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARK L PAWLAK</PersonNm>
        <TitleTxt>SVP, QUALITY, IS &amp; HOSP OPS</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>506747</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>15182</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PATTI VANDORT</PersonNm>
        <TitleTxt>SVP, CNO, REHAB SERV, MARKETING, HOPS</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>514051</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>16358</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ALEX ROEHLING</PersonNm>
        <TitleTxt>VP, FINANCE &amp; CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>234679</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>10964</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARK A STID</PersonNm>
        <TitleTxt>PHYSICIAN/MANAGING PARTNER</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>275318</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20550</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TERRY L STEELE</PersonNm>
        <TitleTxt>SVP, FINANCE &amp; CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>393709</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>21937</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DERICK M JOHNSON</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>897061</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>26657</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>STEPHEN J MAUGER</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>677132</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>23249</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHAEL A TRAVER</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>677769</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>26471</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JOHN K LUDLOW</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>675825</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>17042</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TOBY F LEES</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>633291</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>26603</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>6291227</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>226882</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>166</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>CERNER</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 165750</AddressLine1Txt>
            <CityNm>KANSAS CITY</CityNm>
            <StateAbbreviationCd>MO</StateAbbreviationCd>
            <ZIPCd>64116</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SOFTWARE - PURCHASED MAINTENANCE</ServicesDesc>
        <CompensationAmt>4150428</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>TRIMEDX</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>5451 LAKEVIEW PKWY S DR</AddressLine1Txt>
            <CityNm>INDIANAPOLIS</CityNm>
            <StateAbbreviationCd>IN</StateAbbreviationCd>
            <ZIPCd>46268</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>HOUSEKEEPING</ServicesDesc>
        <CompensationAmt>3515683</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ARAMARK CORPORATION</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>12483 COLLECTIONS CENTER DR</AddressLine1Txt>
            <CityNm>CHICAGO</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>60693</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>HOUSEKEEPING</ServicesDesc>
        <CompensationAmt>2022650</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ELZINGA AND VOLKERS INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>86 E 6TH ST</AddressLine1Txt>
            <CityNm>HOLLAND</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49423</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION</ServicesDesc>
        <CompensationAmt>1773573</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>COLLABORATIVE SOLUTIONS LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>11190 SUNRISE VALLEY DR STE 110</AddressLine1Txt>
            <CityNm>RESTON</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>20191</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>OUTSIDE SERVICES</ServicesDesc>
        <CompensationAmt>1745494</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>63</CntrctRcvdGreaterThan100KCnt>
      <FundraisingAmt>90848</FundraisingAmt>
      <GovernmentGrantsAmt>3827912</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>432917</AllOtherContributionsAmt>
      <TotalContributionsAmt>4351677</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NET PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>267080027</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>267080027</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PHARMACY SALES UNDER SEC. 340B</Desc>
        <BusinessCd>446110</BusinessCd>
        <TotalRevenueColumnAmt>12660651</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12660651</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER RELATED REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>8300631</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>8300631</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>QUALITY INCENTIVE PAYMENTS</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>7272297</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>7272297</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>LAB ACTIVITY</Desc>
        <BusinessCd>621500</BusinessCd>
        <TotalRevenueColumnAmt>1299675</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>1299675</UnrelatedBusinessRevenueAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>296613281</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>4150164</TotalRevenueColumnAmt>
        <ExclusionAmt>4150164</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>686008</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>345306</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>340702</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>340702</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>340702</RelatedOrExemptFuncIncomeAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>145500197</SecuritiesAmt>
        <OtherAmt>633850</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>125927683</SecuritiesAmt>
        <OtherAmt>1010498</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>19572514</SecuritiesAmt>
        <OtherAmt>-376648</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>19195866</TotalRevenueColumnAmt>
        <ExclusionAmt>19195866</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>4802</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>90848</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>4802</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>18535</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>14812</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>3723</TotalRevenueColumnAmt>
        <ExclusionAmt>3723</ExclusionAmt>
      </NetIncomeFromGamingGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>324655413</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>295654308</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>1299675</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>23349753</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>749990</TotalAmt>
        <ProgramServicesAmt>749990</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>2965330</TotalAmt>
        <ProgramServicesAmt>664081</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2301249</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>122504079</TotalAmt>
        <ProgramServicesAmt>113052309</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9451770</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>31225526</TotalAmt>
        <ProgramServicesAmt>26629478</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4596048</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>8560606</TotalAmt>
        <ProgramServicesAmt>7882857</ProgramServicesAmt>
        <ManagementAndGeneralAmt>677749</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>68616</TotalAmt>
        <ManagementAndGeneralAmt>68616</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>842658</TotalAmt>
        <ManagementAndGeneralAmt>842658</ManagementAndGeneralAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>24654676</TotalAmt>
        <ProgramServicesAmt>21287890</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3366786</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>1162381</TotalAmt>
        <ProgramServicesAmt>1078282</ProgramServicesAmt>
        <ManagementAndGeneralAmt>84099</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>1195085</TotalAmt>
        <ProgramServicesAmt>1091026</ProgramServicesAmt>
        <ManagementAndGeneralAmt>104059</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>8933714</TotalAmt>
        <ProgramServicesAmt>8171442</ProgramServicesAmt>
        <ManagementAndGeneralAmt>762272</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>7575423</TotalAmt>
        <ProgramServicesAmt>7325204</ProgramServicesAmt>
        <ManagementAndGeneralAmt>250219</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>586375</TotalAmt>
        <ProgramServicesAmt>514526</ProgramServicesAmt>
        <ManagementAndGeneralAmt>71849</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>3257046</TotalAmt>
        <ProgramServicesAmt>2942714</ProgramServicesAmt>
        <ManagementAndGeneralAmt>314332</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>17168537</TotalAmt>
        <ProgramServicesAmt>16366721</ProgramServicesAmt>
        <ManagementAndGeneralAmt>801816</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>828353</TotalAmt>
        <ProgramServicesAmt>792951</ProgramServicesAmt>
        <ManagementAndGeneralAmt>35402</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES &amp; DRUG</Desc>
        <TotalAmt>50269116</TotalAmt>
        <ProgramServicesAmt>50256510</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12606</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PROVISION FOR BAD DEBTS</Desc>
        <TotalAmt>13544786</TotalAmt>
        <ProgramServicesAmt>13544786</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUES AND SUBSCRIPTIONS</Desc>
        <TotalAmt>784960</TotalAmt>
        <ProgramServicesAmt>784960</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>REPAIRS &amp; MAINTENANCE</Desc>
        <TotalAmt>76722</TotalAmt>
        <ProgramServicesAmt>76722</ProgramServicesAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>1636219</TotalAmt>
        <ProgramServicesAmt>659900</ProgramServicesAmt>
        <ManagementAndGeneralAmt>976319</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>298590198</TotalAmt>
        <ProgramServicesAmt>273872349</ProgramServicesAmt>
        <ManagementAndGeneralAmt>24717849</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>84843565</BOYAmt>
        <EOYAmt>43083801</EOYAmt>
      </CashNonInterestBearingGrp>
      <AccountsReceivableGrp>
        <BOYAmt>28253908</BOYAmt>
        <EOYAmt>30604315</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>7335683</BOYAmt>
        <EOYAmt>8283459</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>5599549</BOYAmt>
        <EOYAmt>5495938</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>326881288</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>187243062</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>146061845</BOYAmt>
        <EOYAmt>139638226</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>221156186</BOYAmt>
        <EOYAmt>247798640</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>64355124</BOYAmt>
        <EOYAmt>90162583</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>19440690</BOYAmt>
        <EOYAmt>22111137</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>577046550</BOYAmt>
        <EOYAmt>587178099</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>21807114</BOYAmt>
        <EOYAmt>24919319</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>1304046</BOYAmt>
        <EOYAmt>1531739</EOYAmt>
      </DeferredRevenueGrp>
      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>88469570</BOYAmt>
        <EOYAmt>86060924</EOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>49692512</BOYAmt>
        <EOYAmt>40301297</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>161273242</BOYAmt>
        <EOYAmt>152813279</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>414470176</BOYAmt>
        <EOYAmt>432997125</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>1303132</BOYAmt>
        <EOYAmt>1367695</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>415773308</BOYAmt>
        <EOYAmt>434364820</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>577046550</BOYAmt>
        <EOYAmt>587178099</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>26065215</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-8618344</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>1144641</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleC documentId="RetDoc1039700001">
      <VolunteersInd>0</VolunteersInd>
      <PaidStaffOrManagementInd>0</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>0</MediaAdvertisementsInd>
      <MailingsMembersInd>0</MailingsMembersInd>
      <PublicationsOrBroadcastInd>0</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>0</GrantsOtherOrganizationsInd>
      <DirectContactLegislatorsInd>0</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>0</RalliesDemonstrationsInd>
      <OtherActivitiesInd>1</OtherActivitiesInd>
      <OtherActivitiesAmt>18107</OtherActivitiesAmt>
      <TotalLobbyingExpendituresAmt>18107</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>0</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART II-B, LINE 1:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL PAYS DUES TO THE MICHIGAN HOSPITAL ASSOCIATION, AMERICAN HEALTH ASSOCIATION, AND AMERICAN MEDICAL GROUP ASSOCIATION, A PORTION OF WHICH GOES TOWARDS LOBBYING ACTIVITIES.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <CYEndwmtFundGrp>
        <BeginningYearBalanceAmt>585000</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>11187</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>11187</GrantsOrScholarshipsAmt>
        <EndYearBalanceAmt>585000</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>585000</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>12996</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>12996</GrantsOrScholarshipsAmt>
        <EndYearBalanceAmt>585000</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
      <CYMinus2YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>585000</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>12665</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>12665</GrantsOrScholarshipsAmt>
        <EndYearBalanceAmt>585000</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>585000</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>14900</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>14900</GrantsOrScholarshipsAmt>
        <EndYearBalanceAmt>585000</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>585000</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>20286</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>20286</GrantsOrScholarshipsAmt>
        <EndYearBalanceAmt>585000</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <BoardDesignatedBalanceEOYPct>0.00000</BoardDesignatedBalanceEOYPct>
      <PrmnntEndowmentBalanceEOYPct>1.00000</PrmnntEndowmentBalanceEOYPct>
      <TermEndowmentBalanceEOYPct>0.00000</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>0</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>0</EndowmentsHeldRelatedOrgInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>8535881</OtherCostOrOtherBasisAmt>
        <BookValueAmt>8535881</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>157053771</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>74129118</DepreciationAmt>
        <BookValueAmt>82924653</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>4948560</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>3995353</DepreciationAmt>
        <BookValueAmt>953207</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>146366692</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>109118591</DepreciationAmt>
        <BookValueAmt>37248101</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>9976384</OtherCostOrOtherBasisAmt>
        <BookValueAmt>9976384</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>139638226</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>INVESTMENTS IN AFFILIATED ENTITIES</Desc>
        <BookValueAmt>3663488</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <OtherSecuritiesGrp>
        <Desc>INVESTMENT IN OTHER VENTURE</Desc>
        <BookValueAmt>86499095</BookValueAmt>
        <MethodValuationCd>F</MethodValuationCd>
      </OtherSecuritiesGrp>
      <TotalBookValueSecuritiesAmt>90162583</TotalBookValueSecuritiesAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>PROFESSIONAL LIABILITY INSURANCE</Desc>
        <Amt>7646918</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>OTHER LONG-TERM LIABILITIES</Desc>
        <Amt>340000</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>EQUIPMENT CONTRACT LIABILITY</Desc>
        <Amt>243945</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>COST REPORT SETTLEMENT PAYABLE</Desc>
        <Amt>12239796</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>LEASE LIABILITY</Desc>
        <Amt>14729084</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>MEDICARE ADVANCE PAYMENT LIABILITY</Desc>
        <Amt>5101554</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>40301297</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>301689587</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>-8618344</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>736766</OtherRevenueAmt>
      <RevenueNotReportedAmt>-7881578</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>309571165</RevenueSubtotalAmt>
      <InvestmentExpensesNotIncldAmt>842658</InvestmentExpensesNotIncldAmt>
      <OtherRevenuesNotIncludedAmt>14241590</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>15084248</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>324655413</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>283098075</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>736766</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>736766</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>282361309</ExpensesSubtotalAmt>
      <InvestmentExpensesNotIncld2Amt>842658</InvestmentExpensesNotIncld2Amt>
      <OtherExpensesNotIncludedAmt>15386231</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>16228889</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>298590198</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART V, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>EARNINGS FROM THE PERMANENT ENDOWMENTS ARE INTENDED BY THE DONORS TO SUPPORT SCHOOL NURSING PROGRAMS AND TO HELP LOCAL INDIVIDUALS WHO ARE LACKING IN HEALTH INSURANCE/ FINANCIAL CAPACITY TO ACCESS HEALTH CARE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>RENTAL EXPENSE 345,306. NON CASH PRIZES 14,812. GAIN/LOSS ON SALE OF ASSETS 376,648.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 4B - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD DEBT EXPENSE 13,544,786. EXPENSES RECORDED AGAINST INCOME 1,841,445. LOSS ON EQUITY INVESTMENTS -1,144,641.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XII, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>LOSS ON SALE OF ASSETS 376,648. RENTAL EXPENSE 345,306. NON CASH PRIZES 14,812.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XII, LINE 4B - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD DEBT EXPENSE 13,544,786. EXPENSES RECORDED AGAINST INCOME 1,841,445.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="RetDoc1041300001">
      <FundraisingEventInformationGrp>
        <Event1Nm>CULINARY CABARET</Event1Nm>
        <GrossReceiptsEvent1Amt>95650</GrossReceiptsEvent1Amt>
        <CharitableContriEvent1Amt>90848</CharitableContriEvent1Amt>
        <GrossRevenueEvent1Amt>4802</GrossRevenueEvent1Amt>
        <OtherDirectExpensesEvent1Amt>4802</OtherDirectExpensesEvent1Amt>
        <GrossReceiptsTotalAmt>95650</GrossReceiptsTotalAmt>
        <CharitableContributionsTotAmt>90848</CharitableContributionsTotAmt>
        <GrossRevenueTotalEventsAmt>4802</GrossRevenueTotalEventsAmt>
        <OthDirectExpnssTotalEventsAmt>4802</OthDirectExpnssTotalEventsAmt>
        <DirectExpenseSummaryEventsAmt>4802</DirectExpenseSummaryEventsAmt>
        <NetIncomeSummaryAmt>0</NetIncomeSummaryAmt>
      </FundraisingEventInformationGrp>
      <GamingInformationGrp>
        <GrossRevenueOtherGamingAmt>18535</GrossRevenueOtherGamingAmt>
        <NonCashPrizesOtherGamingAmt>14812</NonCashPrizesOtherGamingAmt>
        <VolunteerLaborOtherGamingInd>1</VolunteerLaborOtherGamingInd>
        <VolunteerLaborOtherGamingPct>0.95000</VolunteerLaborOtherGamingPct>
        <GrossRevenueTotalGamingAmt>18535</GrossRevenueTotalGamingAmt>
        <NonCashPrizesTotalGamingAmt>14812</NonCashPrizesTotalGamingAmt>
        <DirectExpenseSummaryGamingAmt>14812</DirectExpenseSummaryGamingAmt>
        <NetGamingIncomeSummaryAmt>3723</NetGamingIncomeSummaryAmt>
      </GamingInformationGrp>
      <StatesWhereGamingConductedCd>MI</StatesWhereGamingConductedCd>
      <LicensedInd>1</LicensedInd>
      <LicenseSuspendedEtcInd>0</LicenseSuspendedEtcInd>
      <GamingWithNonmembersInd>1</GamingWithNonmembersInd>
      <MemberOfOtherEntityInd>0</MemberOfOtherEntityInd>
      <GamingOtherFacilityPct>1.00000</GamingOtherFacilityPct>
      <IndividualWithBooksNm>COLLEEN PERDOK</IndividualWithBooksNm>
      <PersonsWithBooksUSAddress>
        <AddressLine1Txt>602 MICHIGAN AVE</AddressLine1Txt>
        <CityNm>HOLLAND</CityNm>
        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>49423</ZIPCd>
      </PersonsWithBooksUSAddress>
      <CntrctWith3rdPrtyForGameRevInd>0</CntrctWith3rdPrtyForGameRevInd>
      <GamingManagerPersonNm>COLLEEN PERDOK</GamingManagerPersonNm>
      <GamingManagerCompensationAmt>0</GamingManagerCompensationAmt>
      <GamingManagerServicesProvTxt>FUND DEVELOPMENT COORDINATOR</GamingManagerServicesProvTxt>
      <GamingManagerIsEmployeeInd>X</GamingManagerIsEmployeeInd>
      <CharitableDistributionRqrInd>0</CharitableDistributionRqrInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE G, PART III, LINE 16:</FormAndLineReferenceDesc>
        <ExplanationTxt>INCLUDED IN COLLEEN PERDOK'S RESPONSIBILITIES IS THE ROLE OF GAMING MANAGER; HOWEVER, THE AMOUNT OF COMPENSATION ALLOCATED TO THIS ROLE IS MINIMAL.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleG>
    <IRS990ScheduleH documentId="RetDoc1041500001">
      <FinancialAssistancePolicyInd>1</FinancialAssistancePolicyInd>
      <WrittenPolicyInd>1</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>1</FPGReferenceFreeCareInd>
      <FreeCareOthPercentageGrp>
        <OtherInd>X</OtherInd>
        <FreeCareOtherPct>225.000000000000</FreeCareOtherPct>
      </FreeCareOthPercentageGrp>
      <FPGReferenceDiscountedCareInd>1</FPGReferenceDiscountedCareInd>
      <Percent300Ind>X</Percent300Ind>
      <FreeCareMedicallyIndigentInd>1</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>1</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>0</ExpensesExceedBudgetInd>
      <AnnualCommunityBnftReportInd>1</AnnualCommunityBnftReportInd>
      <ReportPublicallyAvailableInd>1</ReportPublicallyAvailableInd>
      <FinancialAssistanceAtCostTyp>
        <TotalCommunityBenefitExpnsAmt>1536818</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>1536818</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00530</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>34754351</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>27354672</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>7399679</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.02560</TotalExpensePct>
      </UnreimbursedMedicaidGrp>
      <TotalFinancialAssistanceTyp>
        <TotalCommunityBenefitExpnsAmt>36291169</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>27354672</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>8936497</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.03090</TotalExpensePct>
      </TotalFinancialAssistanceTyp>
      <CommunityHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>1569564</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>36477</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>1533087</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00530</TotalExpensePct>
      </CommunityHealthServicesGrp>
      <HealthProfessionsEducationGrp>
        <TotalCommunityBenefitExpnsAmt>219079</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>219079</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00080</TotalExpensePct>
      </HealthProfessionsEducationGrp>
      <CashAndInKindContributionsGrp>
        <TotalCommunityBenefitExpnsAmt>818814</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>818814</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00280</TotalExpensePct>
      </CashAndInKindContributionsGrp>
      <TotalOtherBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>2607457</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>36477</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>2570980</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00890</TotalExpensePct>
      </TotalOtherBenefitsGrp>
      <TotalCommunityBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>38898626</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>27391149</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>11507477</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.03980</TotalExpensePct>
      </TotalCommunityBenefitsGrp>
      <WorkforceDevelopmentGrp>
        <TotalCommunityBenefitExpnsAmt>717418</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>717418</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00250</TotalExpensePct>
      </WorkforceDevelopmentGrp>
      <TotalCommuntityBuildingActyGrp>
        <TotalCommunityBenefitExpnsAmt>717418</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>717418</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00250</TotalExpensePct>
      </TotalCommuntityBuildingActyGrp>
      <BadDebtExpenseReportedInd>0</BadDebtExpenseReportedInd>
      <BadDebtExpenseAmt>9052762</BadDebtExpenseAmt>
      <BadDebtExpenseAttributableAmt>0</BadDebtExpenseAttributableAmt>
      <ReimbursedByMedicareAmt>28583021</ReimbursedByMedicareAmt>
      <CostOfCareReimbursedByMedcrAmt>35597178</CostOfCareReimbursedByMedcrAmt>
      <MedicareSurplusOrShortfallAmt>-7014157</MedicareSurplusOrShortfallAmt>
      <CostingMethodologyUsedGrp>
        <CostToChargeRatioInd>X</CostToChargeRatioInd>
      </CostingMethodologyUsedGrp>
      <WrittenDebtCollectionPolicyInd>1</WrittenDebtCollectionPolicyInd>
      <FinancialAssistancePrvsnInd>1</FinancialAssistancePrvsnInd>
      <ManagementCoAndJntVenturesGrp>
        <EntityName>
          <BusinessNameLine1Txt>1 HOLLAND PHO</BusinessNameLine1Txt>
        </EntityName>
        <PrimaryActivitiesTxt>COORD. RESOURCES FOR ITS MEMBERS FOR THE DELIVERY OF QUALITY HEALTH CARE.</PrimaryActivitiesTxt>
        <OrgProfitOrOwnershipPct>0.50000</OrgProfitOrOwnershipPct>
        <OfcrEtcProfitOrOwnershipPct>0.00000</OfcrEtcProfitOrOwnershipPct>
        <PhysiciansProfitOrOwnershipPct>0.50000</PhysiciansProfitOrOwnershipPct>
      </ManagementCoAndJntVenturesGrp>
      <HospitalFacilitiesCnt>1</HospitalFacilitiesCnt>
      <HospitalFacilitiesGrp>
        <FacilityNum>1</FacilityNum>
        <BusinessName>
          <BusinessNameLine1Txt>HOLLAND COMMUNITY HOSPITAL</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>602 MICHIGAN AVE</AddressLine1Txt>
          <CityNm>HOLLAND</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>49423</ZIPCd>
        </USAddress>
        <WebsiteAddressTxt>WWW.HOLLANDHOSPITAL.ORG</WebsiteAddressTxt>
        <StateLicenseNum>1060000036</StateLicenseNum>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
      </HospitalFacilitiesGrp>
      <HospitalFcltyPoliciesPrctcGrp>
        <HospitalFacilityName>
          <BusinessNameLine1Txt>HOLLAND COMMUNITY HOSPITAL</BusinessNameLine1Txt>
        </HospitalFacilityName>
        <FacilityNum>1</FacilityNum>
        <FirstLicensedCYOrPYInd>0</FirstLicensedCYOrPYInd>
        <TaxExemptHospitalCYOrPYInd>0</TaxExemptHospitalCYOrPYInd>
        <CHNAConductedInd>1</CHNAConductedInd>
        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <OtherHealthIssuesInd>X</OtherHealthIssuesInd>
        <CommunityHlthNeedsIdProcessInd>X</CommunityHlthNeedsIdProcessInd>
        <ConsultingProcessInd>X</ConsultingProcessInd>
        <PriorCHNAImpactInd>X</PriorCHNAImpactInd>
        <OtherInd>X</OtherInd>
        <CHNAConductedYr>20</CHNAConductedYr>
        <TakeIntoAccountOthersInputInd>1</TakeIntoAccountOthersInputInd>
        <CHNAConductedWithOtherFcltsInd>1</CHNAConductedWithOtherFcltsInd>
        <CHNAConductedWithNonFcltsInd>1</CHNAConductedWithNonFcltsInd>
        <CHNAReportWidelyAvailableInd>1</CHNAReportWidelyAvailableInd>
        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>HTTPS://TINYURL.COM/YAG4VGPR</OwnWebsiteURLTxt>
        <OtherWebsiteInd>X</OtherWebsiteInd>
        <OtherWebsiteURLTxt>HTTPS://TINYURL.COM/YDUJWJR4</OtherWebsiteURLTxt>
        <PaperCopyPublicInspectionInd>X</PaperCopyPublicInspectionInd>
        <RptAvailableThruOtherMethodInd>X</RptAvailableThruOtherMethodInd>
        <ImplementationStrategyAdoptInd>1</ImplementationStrategyAdoptInd>
        <ImplementationStrategyAdptYr>20</ImplementationStrategyAdptYr>
        <StrategyPostedWebsiteInd>1</StrategyPostedWebsiteInd>
        <StrategyWebsiteURLTxt>HTTPS://TINYURL.COM/YAG4VGPR</StrategyWebsiteURLTxt>
        <OrganizationIncurExciseTaxInd>0</OrganizationIncurExciseTaxInd>
        <EligCriteriaExplainedInd>1</EligCriteriaExplainedInd>
        <FPGFamilyIncmLmtFreeDscntInd>X</FPGFamilyIncmLmtFreeDscntInd>
        <FPGFamilyIncmLmtFreeCarePct>225.000000000000</FPGFamilyIncmLmtFreeCarePct>
        <FPGFamilyIncmLmtDscntCarePct>300.000000000000</FPGFamilyIncmLmtDscntCarePct>
        <AssetLevelCriteriaInd>X</AssetLevelCriteriaInd>
        <MedicalIndigencyCriteriaInd>X</MedicalIndigencyCriteriaInd>
        <ExplainedBasisInd>1</ExplainedBasisInd>
        <AppFinancialAsstExplnInd>1</AppFinancialAsstExplnInd>
        <DescribedInfoInd>X</DescribedInfoInd>
        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <ProvidedNonprofitContactInd>X</ProvidedNonprofitContactInd>
        <IncludesPublicityMeasuresInd>1</IncludesPublicityMeasuresInd>
        <FAPAvailableOnWebsiteInd>X</FAPAvailableOnWebsiteInd>
        <FAPAvailableOnWebsiteURLTxt>TINYURL.COM/Y78LJRTZ</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>TINYURL.COM/Y78LJRTZ</FAPAppAvailableOnWebsiteURLTxt>
        <FAPSummaryOnWebsiteInd>X</FAPSummaryOnWebsiteInd>
        <FAPSummaryOnWebsiteURLTxt>TINYURL.COM/Y78LJRTZ</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
        <FAPSumAvlblOnRequestNoChrgInd>X</FAPSumAvlblOnRequestNoChrgInd>
        <NotifiedFAPCopyBillDisplayInd>X</NotifiedFAPCopyBillDisplayInd>
        <CommuntityNotifiedFAPInd>X</CommuntityNotifiedFAPInd>
        <FAPTranslatedInd>X</FAPTranslatedInd>
        <OtherPublicityInd>X</OtherPublicityInd>
        <FAPActionsOnNonpaymentInd>1</FAPActionsOnNonpaymentInd>
        <PermitNoActionsInd>X</PermitNoActionsInd>
        <CollectionActivitiesInd>0</CollectionActivitiesInd>
        <ProvidedWrittenNoticeInd>X</ProvidedWrittenNoticeInd>
        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
        <ProcessedFAPApplicationInd>X</ProcessedFAPApplicationInd>
        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <OtherActionsTakenInd>X</OtherActionsTakenInd>
        <NondisEmergencyCarePolicyInd>1</NondisEmergencyCarePolicyInd>
        <LookBackMedicarePrivateInd>X</LookBackMedicarePrivateInd>
        <AmountsGenerallyBilledInd>0</AmountsGenerallyBilledInd>
        <GrossChargesInd>0</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>HOLLAND COMMUNITY HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 3J: THE NEEDS ASSESSMENT DESCRIBED THE COMMUNITY'S STRENGTHS AND OPPORTUNITIES REGARDING QUALITY OF LIFE, OVERALL HEALTH, HEALTH BEHAVIORS, AND HEALTH CARE. THE TWO BROAD THEMES WHICH EMERGED FROM THE REPORT WERE THE DIRECT RELATIONSHIP BETWEEN HEALTH OUTCOMES AND INCOME/EDUCATION, AND THE EXISTANCE OF CHALLENGED SUBGOUPS WITHIN THE POPULATION. IDENTIFIED AREAS FOR OPPORTUNITIES INCLUDED ACCESS TO HEALTHCARE FOR THOSE WITH PUBLIC HEALTH INSURANCE AND IMPROVED CARE FOR THOSE WITH CHRONIC DISEASE ESPECIALLY DIABETES.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>HOLLAND COMMUNITY HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 5: DATA WAS OBTAINED FROM MULTIPLE SOURCES INCLUDING; KEY STAKEHOLDERS (EXECUTIVE DIRECTORS OF HOSPITALS, CLINICS AND PUBLIC HEALTH) VIA TELEPHONE INTERVIEWS, KEY INFORMANTS (PHYSICIANS, NURSES, DENTISTS, PHARMACISTS AND SOCIAL WORKERS) VIA ONLINE SURVEY, COMMUNITY RESIDENTS- ADULTS VIA A TELEPHONE SURVEY, AND VULNERABLE AND UNDERSERVED COMMUNITY RESIDENTS VIA A PAPER SURVEY.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>HOLLAND COMMUNITY HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 6A: NORTH OTTAWA COMMUNITY HEALTH SYSTEM &amp; SPECTRUM HEALTH ZEELAND COMMUNITY HOSPITAL</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>HOLLAND COMMUNITY HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 6B: GREATER OTTAWA COUNTY UNITED WAY, OTTAWA COUNTY DEPARTMENT OF PUBLIC HEALTH AND OTTAWA COUNTY COMMUNITY MENTAL HEALTH</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>HOLLAND COMMUNITY HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 7D: AVAILABLE UPON REQUEST FROM THE HOSPITAL FACILITY. PRINT COPIES WERE MADE AVAILABLE TO VARIOUS LOCATIONS AND INDIVIDUALS INCLUDING THE COMMUNITY OUTREACH COMMITTEE OF THE HOLLAND HOSPITAL BOARD. THE REPORT WAS ALSO POSTED ON THE HOSPITAL WEBSITE.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>HOLLAND COMMUNITY HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 11: OTTAWA COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN WAS INITIATED BY THE PARTNERS OF THE CHNA AND COMMUNITY MEMBERS. THE CHIP IDENTIFIES 3 HEALTH PRIORITY AREAS INCLUDING; ACCESS TO HEALTH CARE, MENTAL HEALTH, AND HEALTHY BEHAVIORS. HOLLAND HOSPITAL IS AN ACTIVE PARTNER SERVING ON THE COMMUNITY HEALTH IMPROVEMENT STEERING COMMITTEE. THE HOSPITAL DID NOT ADDRESS ALL NEEDS IDENTIFIED IN THE CHNA DUE TO LIMITED RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO THE THREE PRIORITY NEEDS IDENTIFIED ABOVE.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>HOLLAND COMMUNITY HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY IS POSTED ON THE HOSPITAL'S WEBSITE (ENGLISH AND SPANISH). PATIENTS MAY ALSO OBTAIN A FINANCIAL ASSISTANCE APPLICATION BY CALLING THE CUSTOMER SERVICE LINE. INFORMATION ON HOW TO OBTAIN AN APPLICATION IS ALSO AVAILABLE ON OUR BILLING STATEMENTS, POSTED IN THE FACILITY'S WAITING ROOMS, AS WELL AS OUTLINED ON A BUSINESS CARD AND PLAIN LANGUAGE SUMMARY WHICH IS OFFERED TO ALL PATIENTS AT REGISTRATION, ADMISSION AND AVAILABLE AT DISCHARGE.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>HOLLAND COMMUNITY HOSPITAL</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 20E: FINANCIAL ASSISTANCE IS DISCUSSED AND OFFERED TO PATIENTS VIA OUR PATIENT FINANCIAL SERVICE CUSTOMER SERVICE REPRESENTATIVES, PATIENT ADVOCATES, IN-HOUSE MEDICAID VENDOR, PRE-COLLECT AND COLLECTION AGENCIES.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>5</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>1 - LAKESHORE AREA RADIATION ONCOLOGY CENTER</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>12642 RILEY STREET</AddressLine1Txt>
            <CityNm>HOLLAND</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49424</ZIPCd>
          </USAddress>
          <FacilityTxt>COMPREHENSIVE OUTPATIENT RADIATION TREATMENT CENTER</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>2 - HOLLAND HOSPITAL MEDICAL GROUP</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>602 MICHIGAN AVE</AddressLine1Txt>
            <CityNm>HOLLAND</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49423</ZIPCd>
          </USAddress>
          <FacilityTxt>PHYSICIAN OFFICE</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>3 - WEST MICHIGAN UROLOGICAL ASSOCIATES</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>602 MICHIGAN AVE</AddressLine1Txt>
            <CityNm>HOLLAND</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49423</ZIPCd>
          </USAddress>
          <FacilityTxt>PHYSICIAN OFFICE</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>4 - HHMG - INTERNAL FAMILY MEDICINE</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>602 MICHIGAN AVE</AddressLine1Txt>
            <CityNm>HOLLAND</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49423</ZIPCd>
          </USAddress>
          <FacilityTxt>PHYSICIAN OFFICE</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>5 - THE BONE AND JOINT CENTER OF HOLLAND</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>602 MICHIGAN AVE</AddressLine1Txt>
            <CityNm>HOLLAND</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49423</ZIPCd>
          </USAddress>
          <FacilityTxt>PHYSICIAN OFFICE</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 3C:</FormAndLineReferenceDesc>
        <ExplanationTxt>FAMILY INCOME 225 TO 300 PERCENT OF THE FEDERAL POVERTY GUIDELINES QUALIFY FOR DISCOUNTED CARE ON A RATED SCALE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 7:</FormAndLineReferenceDesc>
        <ExplanationTxt>A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THE SCHEDULE.THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E), HEALTH PROFESSIONS EDUCATION (LINE 7F), AND CASH AND IN-KIND CONTRIBUTIONS (LINE 7I).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 7, COLUMN (F):</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 9,052,762.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART II, COMMUNITY BUILDING ACTIVITIES:</FormAndLineReferenceDesc>
        <ExplanationTxt>HOLLAND HOSPITAL PROVIDES A BROAD RANGE OF HEALTH CARE SERVICES FOR RESIDENTS OF OTTAWA COUNTY AND ALLEGAN COUNTY, AS WELL AS OTHER AREAS OF MICHIGAN AND BEYOND. THESE SERVICES REACH PATIENT POPULATIONS THAT ARE DEMOGRAPHICALLY AND SOCIO-ECONOMICALLY DIVERSE. IN ADDITION TO MEDICAL AND SURGICAL CARE, THE HOSPITAL PROVIDES PHYSICAL THERAPY AND REHABILITATION, MENTAL HEALTH SERVICES, HOME HEALTH CARE, DIAGNOSTIC TESTING, SCREENINGS, COMMUNITY OUTREACH, EDUCATION AND SUPPORT PROGRAMS. AMONG MANY INITIATIVES, THE HOSPITAL HAS TAKEN ADDED STEPS TO ADDRESS THE GROWING NEED FOR MENTAL HEALTH CARE IN THE AREA - A CONCERN THAT WAS HIGHLIGHTED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. THESE STEPS INCLUDED EXPANDING BEHAVIORAL HEALTH SERVICES WITH ADDITIONAL OUTPATIENT THERAPY ROOMS AND OFFICE SPACE TO SERVE PATIENT FOR MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT. WE ALSO EXPANDED OUR PARTIAL HOSPITALIZATION PROGRAM (PHP) WHICH IS A SHORT-TERM PROGRAM DESIGNED TO BRIDGE THE GAP BETWEEN INPATIENT AND OUTPATIENT CARE. TO ADDRESS MULTIPLE POINTS OF CARE, WE HAVE SPECIAL EMERGENCY DEPARTMENT ROOMS THAT ARE DEDICATED TO MENTAL HEALTH TREATMENT AND INTRODUCED TARGETED SUPPORT PROGRAMS TO ADDRESS THE NEEDS OF OUR STAFF MEMBERS.HOLLAND HOSPITAL'S COMMUNITY OUTREACH PROGRAMS HELP PROVIDE SECURITY AND STABILITY THOSE IN NEED. OUTREACH EFFORTS FOCUS ON THE FOLLOWING KEY AREAS:(1) HOLLAND COMMUNITY HEALTH CENTER: THE HOLLAND COMMUNITY HEALTH CENTER (HCHC) IS AN OUTREACH SERVICE OF HOLLAND HOSPITAL, PROVIDING HEALTH CARE SERVICES FOR ALL REGARDLESS OF AGE, LANGUAGE, CULTURAL BARRIERS, HEALTH INSURANCE OR ABILITY TO PAY. THE HCHC PROVIDES PRIMARY CARE SERVICES, REFERRALS AND OTHER HEALTH CARE SUPPORT FOR ADULTS AND CHILDREN IN AN OFFICE SETTING IN ITS HOLLAND FACILITY. THE MAJORITY OF HCHC PATIENTS LACK ADEQUATE HEALTH INSURANCE. THE HCHC ALSO ACQUIRES AND DISTRIBUTES FREE MEDICATIONS FOR PATIENTS WHO CANNOT AFFORD THEM, FILLING A VITAL NEED IN THE COMMUNITY.(2) SCHOOL MENTAL HEALTH PROGRAM: THIS PROGRAM HAS PROVEN EFFECTIVE IN IMPROVING THE MENTAL HEALTH AND WELLNESS OF STUDENTS THROUGH EARLY INTERVENTION WHEN STUDENT MENTAL HEALTH CONCERNS ARE IDENTIFIED, AND BY COORDINATING CARE BETWEEN THE SCHOOL, FAMILY, CAREGIVERS, PHYSICIANS AND/OR HOSPITAL FOR THE MOST AT-RISK STUDENTS.(3) SCHOOL NURSE PROGRAM: BETTER HEALTH MEANS BETTER LEARNING AND A HEALTHIER OUTLOOK FOR OUR CHILDREN AND COMMUNITY. HOLLAND HOSPITAL'S SCHOOL NURSE PROGRAM PROVIDES ONSITE DIRECT MEDICAL SUPPORT, PREVENTION, CHRONIC DISEASE MANAGEMENT AND REFERRALS FOR MORE THAN 12,000 STUDENTS IN 26 SCHOOLS WITHIN THE DISTRICTS OF HOLLAND PUBLIC, WEST OTTAWA, HAMILTON, HOLLAND CHRISTIAN, AND FENNVILLE. MANY OF THE STUDENTS LIVE AT OR BELOW THE POVERTY LEVEL AND DO NOT RECEIVE REGULAR MEDICAL CARE OUTSIDE OF SCHOOL.(4) BREAST CARE FUND: EARLY DETECTION PROVIDES THE BEST OPPORTUNITY TO TREAT BREAST CANCER AND REDUCE THE RISK OF RECURRENCE. THE BREAST CARE FUND PROVIDES FINANCIAL SUPPORT FOR MAMMOGRAMS AND OTHER BREAST HEALTH SERVICES FOR WOMEN AT RISK IN OUR COMMUNITY. THE BREAST CARE FUND COVERS THE COST OF SCREENING AND DIAGNOSTIC MAMMOGRAMS, ULTRASOUNDS AND BIOPSIES FOR HUNDREDS OF WOMEN IN OUR COMMUNITY. (5) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS A PERIODIC STUDY (APPROXIMATELY EVERY 3 YEARS) THAT LOOKS AT THE HEALTH OF PEOPLE IN OTTAWA COUNTY AND SERVES AS A TOOL TO HELP ADDRESS HEALTH NEEDS THROUGH COMMUNITY ENGAGEMENT AND COLLABORATION. HOLLAND HOSPITAL IS PART OF THE ADVISORY COUNCIL OF OTTAWA COUNTY AREA PUBLIC HEALTH PARTNERS, INCLUDING HEALTH AGENCIES AND OTHER HOSPITALS, WHICH COLLECTS AND ORGANIZES DATA FOR THE CHNA. THIS INFORMATION IS USED TO HELP GUIDE OUR PLANS AND PROGRAMS THAT CAN CONTINUE TO IMPROVE THE HEALTH OF OUR COMMUNITY. DETAILS OF THE 2020 CHNA ARE PROVIDED IN SECTIONS BELOW.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THIS IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO QUALIFYING INDIVIDUALS AS PART OF OUR FINANCIAL ASSISTANCE POLICY, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO SELF-PAY PATIENTS. ESTIMATES FOR EXPLICIT PRICE CONCESSIONS ARE BASED ON PROVIDER CONTRACTS, PAYMENT TERMS FOR RELEVANT PROSPECTIVE PAYMENT SYSTEMS, AND HISTORICAL EXPERIENCE ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS SIGNIFICANT IMPLICIT PRICE CONCESSIONS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE."</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>COSTING METHODOLOGY IS A COST TO CHARGE RATIO AS DEFINED BY THE IRS 990 INSTRUCTIONS. THE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT DUE TO ITS REPRESENTATION OF COST OF A PORTION OF SERVICES PROVIDED TO THE COMMUNITY WITHOUT PAYMENT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 9B:</FormAndLineReferenceDesc>
        <ExplanationTxt>ANY BALANCE DEEMED PATIENT RESPONSIBILITY (AFTER INSURANCE PAYMENT/DETERMINATION AND AFTER ANY APPLICABLE DISCOUNT OR CHARITY), IF NOT PAID, WILL RECEIVE A MINIMUM OF FOUR STATEMENTS. THE ACCOUNT WILL BE HELD ON HOLLAND HOSPITAL'S "BOOKS" UNTIL IT HAS AGED TO A MINIMUM OF 120 DAYS FROM THE DATE OF THE FIRST STATEMENT. AT THIS TIME THE ACCOUNT IS ELIGIBLE AND WILL BE REVIEWED TO BE SENT TO A COLLECTION AGENCY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>IN COLLABORATION WITH THE OTTAWA COUNTY HEALTH DEPARTMENT, THE UNITED WAY, AND SEVERAL OTHER LOCAL ENTITIES A COMMUNITY ASSESSMENT IS PERFORMED. THE UNITED WAY PUBLISHES THEIR ASSESSMENT EVERY 5 YEARS (LAST ONE IN 2017) AND THE OTTAWA COUNTY HEALTH DEPARTMENT PUBLISHES THEIR YOUTH ASSESSMENT (LAST ONE IN 2019) AND ADULT ASSESSMENT (LAST ONE IN 2020). THE CHNA COLLABORATIVE CONSISTED OF HOLLAND HOSPITAL, NORTH OTTAWA, SPECTRUM ZEELAND HOSPITALS AND THE OTTAWA COUNTY HEALTH DEPARTMENT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>OUR FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR WEBSITE. REFERENCED ON OUR BILLING STATEMENTS, POSTED IN OUR EMERGENCY WAITING ROOM AND ADMISSION OFFICES. THIS INCLUDES INSTRUCTION OF HOW TO REQUEST A COPY OF THE POLICY. IT IS ALSO AVAILABLE AT THE TIME OF REGISTRATION AND/OR WHEN THERE IS A PATIENT REQUEST. FINANCIAL ASSISTANCE IS ALSO REFERENCED IN BROCHURES AND OTHER COMMUNICATIONS WITH OUR PATIENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>HOLLAND HOSPITAL'S PRIMARY SERVICE AREA (PSA) CONSISTS OF NINE ZIP CODES THAT FALL WITHIN ALLEGAN AND OTTAWA COUNTIES OF WEST MICHIGAN. TOTAL POPULATION OF THE PSA IS ESTIMATED AT 164,902 (2022) WITH RAPID GROWTH OVER THE PAST 10 YEARS (+9.3%) THAT HAS OUTPACED THE STATE OF MICHIGAN. WHILE MICHIGAN'S TOTAL POPULATION HAS BEGUN TRENDING DOWNWARD, CONTINUED GROWTH IS FORECAST FOR OUR PSA THROUGH 2030 (+10.0% PROJECTED). THE MOST RECENT US CENSUS BUREAU ESTIMATES (2021) SHOW THE TOTAL POPULATION FOR OTTAWA COUNTY IS 299,157 AND THE TOTAL POPULATION OF ALLEGAN COUNTY IS 120,950. OTTAWA COUNTY IS THE FASTEST GROWING COUNTY IN MICHIGAN AND ALLEGAN COUNTY RANKS AS THE FOURTH FASTEST GROWING COUNTY. THE MOST RECENT CATEGORIZATION OF DATA FROM THE CENSUS BUREAU COMES FROM THE AMERICAN COMMUNITY SURVEY WHICH SHOWS THE FOLLOWING POPULATION DEMOGRAPHICS FOR OTTAWA AND ALLEGAN COUNTIES: OTTAWA COUNTY: RACE/ETHNICITY: BLACK OR AFRICAN AMERICAN (1.9%), AMERICAN INDIAN AND ALASKA NATIVE (0.6%), ASIAN (3.0%), NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER (0.1%), HISPANIC OR LATINO (10.2%), WHITE, NOT HISPANIC OR LATINO (83.4%), TWO OR MORE RACES (2.0%); INCOME &amp; POVERTY: MEDIAN HOUSEHOLD INCOME = $72,418, PERSONS IN POVERTY (6.7%).ALLEGAN COUNTY: RACE/ETHNICITY: BLACK OR AFRICAN AMERICAN (1.6%), AMERICAN INDIAN AND ALASKA NATIVE (0.7%), ASIAN (0.9%), NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER (0.0%), HISPANIC OR LATINO (7.5%), WHITE, NOT HISPANIC OR LATINO (88.1%), TWO OR MORE RACES (1.9%); INCOME &amp; POVERTY: MEDIAN HOUSEHOLD INCOME = $65,071, PERSONS IN POVERTY (7.3%).THE MOST RECENT IN-DEPTH EXAMINATION OF OUR AREA'S HEALTH CAN BE FOUND IN THE 2020 OTTAWA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). KEY HIGHLIGHTS INCLUDE THE FOLLOWING:IN 2020, THE SOCIAL, ECONOMIC, AND POLITICAL IMPACT OF THE CORONAVIRUS (COVID-19) PANDEMIC HAS BEEN SYSTEMIC WORLDWIDE. INDIVIDUALLY THERE WAS, AND CONTINUES TO BE, AN IMPACT ON PHYSICAL AND MENTAL HEALTH. BECAUSE THIS WAS SUCH A UNIQUE YEAR, THE APPROACH TO PRESENTING RESEARCH FINDINGS IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT (2020) REPORT IS SLIGHTLY DIFFERENT THAN IN PREVIOUS REPORTS. THAT SAID, ON MANY LEVELS THE FINDINGS FROM THE 2020 CHNA INDICATE THAT OTTAWA COUNTY IS ONE OF THE HEALTHIEST COUNTIES IN MICHIGAN, ACCORDING TO THE COUNTY HEALTH RANKINGS. OTTAWA COUNTY RESIDENTS ALSO REPORT GOOD OR BETTER HEALTH AND RELATIVELY LOW LEVELS OF PSYCHOLOGICAL DISTRESS. THEY ENJOY LONGER LIFE EXPECTANCY AND LOWER ADULT AND INFANT MORTALITY RATES THAN RESIDENTS ACROSS MICHIGAN OR THE U.S. THE PREVALENCE OF CHRONIC CONDITIONS TENDS TO BE LOW RELATIVE TO THE STATE AND THE NATION; HOWEVER, THE PREVALENCE OF SOME CHRONIC CONDITIONS, INCLUDING DIABETES, IS UP NOTABLY FROM PREVIOUS CHNA ITERATIONS. THIS COULD BE DIRECTLY, OR INDIRECTLY, RELATED TO THE COVID-19 PANDEMIC. OTTAWA COUNTY PERFORMS WELL WHEN IT COMES TO CLINICAL PREVENTIVE PRACTICES. A SIZEABLE MAJORITY OF ADULTS AGE 65 OR OLDER HAVE RECEIVED FLU VACCINES. THE VAST MAJORITY OF CHILDREN AGE 19-35 MONTHS ARE FULLY IMMUNIZED AND ALMOST ALL CHILDREN 0-17 HAVE HAD A ROUTINE PHYSICAL EXAM IN THE PAST YEAR. THE VAST MAJORITY OF PREGNANT WOMEN BEGIN PRENATAL CARE IN THE FIRST TRIMESTER. THE PREVALENCE OF RISK BEHAVIORS IS ALSO, TYPICALLY, RELATIVELY LOW COMPARED TO THE STATE OR NATION. THE PREVALENCE OF CIGARETTE SMOKING IS DOWN IN 2020, WHILE HEAVY DRINKING AND BINGE DRINKING ARE HIGHER THIS YEAR THAN IN THE PREVIOUS CHNA (2017). THIS COULD ALSO BE CONNECTED TO THE COVID-19 PANDEMIC. WHILE OTTAWA COUNTY POSSESSES THE SOCIAL AND COMMUNITY CHARACTERISTICS THAT TEND TO DISTINGUISH A COMMUNITY AS HEALTHY, DISPARITIES IN HEALTH CARE DISTRIBUTION AND ACCESS CONTINUE TO EXIST WITH POCKETS OF POVERTY IN THE AREA; 8.2% OF ALL ADULTS AGE 1864 HAVE NO HEALTH INSURANCE AND 11.9% HAVE NO PERSONAL HEALTH CARE PROVIDER. AREAS OF HEALTH CONCERN CONTINUE TO INCLUDE MENTAL HEALTH, SUBSTANCE ABUSE, OBESITY AND CHRONIC DISEASES, AS WELL AS CERTAIN SOCIAL DETERMINANTS OF HEALTH SUCH AS AVAILABILITY OF AFFORDABLE HOUSING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>HOLLAND HOSPITAL HAS RECEIVED STATE-WIDE RECOGNITION FOR ITS COMMUNITY HEALTH PROMOTION REFLECTING OUR ORGANIZATION-WIDE COMMITMENT TO STRONG COMMUNITY HEALTH MESSAGING REGARDING THE COVID PANDEMIC AND OUR ONGOING HEALTH PROMOTION. DURING THE COVID SURGE, HOLLAND HOSPITAL WAS ABLE TO AVOID CLOSING SERVICES OR REDUCING ACCESS TO OUR CARE OVER THE PAST TWO YEARS, IN LARGE PART DUE TO THE EXCEPTIONAL WORK AND COMMITMENT OF OUR EMPLOYEES, MEDICAL STAFF AND VOLUNTEERS.THIS HAS ALLOWED US TO CONTINUE TO COMMUNICATE IMPORTANT INFORMATION TO HELP OUR COMMUNITY RESIDENT MAINTAIN THEIR HEALTH AND ENCOURAGE THEM TO SEEK HELP WHEN NEEDED, RATHER THAN DELAYING CARE AND RISKING MORE SERIOUS ILLNESS.OVERALL, OUR PROMOTION OF COMMUNITY HEALTH IS EVIDENCED BY PRESENTATIONS AND SPONSORSHIP SUPPORT OF COMMUNITY-WIDE EVENTS, EDUCATIONAL LECTURES, AND EXTENSIVE HEALTH INFORMATION PROVIDED THROUGH BOTH DIGITAL AND TRADITIONAL MEDIA. THE HOSPITAL WEBSITE IS A RICH RESOURCE OF INFORMATION ON HEALTH CONCERNS AND CONSUMER GUIDANCE FOR HEALTH CARE DECISIONS AND ACCESS TO SERVICES. ON A REGULAR BASIS, HOSPITAL PHYSICIANS AND CLINICIANS SHARE ADVICE WITH THE GENERAL PUBLIC THROUGH WEBSITE ARTICLES, VIDEOS, HEALTH BLOGS, TV/RADIO AND PRINT INTERVIEWS. DURING EACH OF THE PAST SEVERAL YEARS, WE HAVE PROMOTED MEN'S AND WOMEN'S HEALTH WITH MAJOR EDUCATIONAL EVENTS PRESENTED IN-PERSON AND VIRTUALLY ON THE WEB. THESE EVENTS HAVE RECEIVED TOP AWARDS IN MICHIGAN AND ATTRACTED EXTENSIVE VIEWS ON OUR WEBSITE AND SOCIAL MEDIA. ON AN ONGOING BASIS, MEMBERS OF THE HOSPITAL'S STAFF ALSO SERVE ON COMMUNITY EVENT STEERING COMMITTEES. THE HOSPITAL WELCOMES INTERNS AND OFFERS TOURS FOR HIGH SCHOOL AND COLLEGE STUDENTS INTERESTED IN PURSUING HEALTHCARE DEGREES. OUR INFLUENCE ON HEALTHY BEHAVIORS IS ALSO EVIDENCED BY OUR COMMUNITY OUTREACH PROGRAMS (DESCRIBED ABOVE) THAT INCLUDE THE HOLLAND COMMUNITY HEALTH CENTER, WHICH PROVIDE AFFORDABLE CARE FOR THOSE WHO LACK HEALTH INSURANCE; THE SCHOOL NURSE PROGRAM WHICH ADDRESSES THE HEALTH NEEDS OF STUDENTS AND SUPPORT FOR THEIR FAMILIES; AND THE BREAST CARE FUND THAT COVERS THE COST OF SCREENING AND DIAGNOSTIC MAMMOGRAMS AND OTHER BREAST CARE DIAGNOSTICS FOR HUNDREDS OF AREA WOMEN EACH YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 6:</FormAndLineReferenceDesc>
        <ExplanationTxt>NOT AFFILIATED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 7, REPORTS FILED WITH STATES</FormAndLineReferenceDesc>
        <ExplanationTxt>MI</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleH>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <GrantRecordsMaintainedInd>1</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>COMMUNITY HEALTH CENTER</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>602 MICHIGAN AVENUE</AddressLine1Txt>
          <CityNm>HOLLAND</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>49423</ZIPCd>
        </USAddress>
        <RecipientEIN>200602574</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>749990</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>N/A</ValuationMethodUsedDesc>
        <NonCashAssistanceDesc>N/A</NonCashAssistanceDesc>
        <PurposeOfGrantTxt>OPERATIONAL CASH FLOW TO BREAK-EVEN</PurposeOfGrantTxt>
      </RecipientTable>
      <Total501c3OrgCnt>1</Total501c3OrgCnt>
      <TotalOtherOrgCnt>0</TotalOtherOrgCnt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL RECEIVES THEIR MONTHLY INTERNAL FINANCIALS AND A COPY OF THE AUDITED STATEMENTS ANNUALLY. HOLLAND HOSPITAL IS FUNDING, IN PART, THE OPERATIONS OF THE ABOVE MENTIONED CLINIC, WHICH IS A SIGNIFICANT COMMUNITY BENEFIT</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>1</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>1</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DERICK M JOHNSON</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>855678</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>41383</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>8700</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>17957</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>923718</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DALE M SOWDERS</PersonNm>
        <TitleTxt>PRESIDENT-CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>679353</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>111792</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>8700</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>13169</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>813014</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHAEL A TRAVER</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>465741</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>196078</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>15950</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>8700</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>17771</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>704240</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>STEPHEN J MAUGER</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>285002</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>320988</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>71142</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5354</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>17895</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>700381</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JOHN K LUDLOW</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>465741</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>196078</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>14006</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4148</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>12894</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>692867</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TOBY F LEES</PersonNm>
        <TitleTxt>PHYSICIAN</TitleTxt>
        <BaseCompensationFilingOrgAmt>466554</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>158467</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>8270</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>8700</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>17903</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>659894</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>PATTI VANDORT</PersonNm>
        <TitleTxt>SVP, CNO, REHAB SERV, MARKETING, HOP</TitleTxt>
        <BaseCompensationFilingOrgAmt>360537</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>153514</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>8700</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>7658</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>530409</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARK L PAWLAK</PersonNm>
        <TitleTxt>SVP, QUALITY, IS &amp; HOSP OPS</TitleTxt>
        <BaseCompensationFilingOrgAmt>360537</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>146210</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>8700</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>6482</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>521929</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>TERRY L STEELE</PersonNm>
        <TitleTxt>SVP, FINANCE &amp; CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>331120</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>62589</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>8700</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>13237</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>415646</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MARK A STID</PersonNm>
        <TitleTxt>PHYSICIAN/MANAGING PARTNER</TitleTxt>
        <BaseCompensationFilingOrgAmt>234868</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>34541</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>5909</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>2106</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>18444</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>295868</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ALEX ROEHLING</PersonNm>
        <TitleTxt>VP, FINANCE &amp; CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>200038</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>34641</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5476</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>5488</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>245643</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>DALE SOWDERS PARTICIPATED IN A 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THE SERP IS DESIGNED TO PROVIDE THE PARTICIPANT WITH A TARGET BENEFIT FOR LIFE BEGINNING AT THE PARTICIPANTS ATTAINMENT OF AGE 65 EQUAL TO 60 PERCENT OF THE PARTICIPANTS FINAL AVERAGE COMPENSATION, OFFSET BY THE PARTICIPANTS SOCIAL SECURITY BENEFIT AND 401(K) SAVINGS PLAN EMPLOYER CONTRIBUTION EQUIVALENT. CONTRIBUTIONS MADE TO THE SERP ARE INCLUDED IN PART II, COLUMN (C). NO PAYMENTS WERE MADE IN 2021.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 7</FormAndLineReferenceDesc>
        <ExplanationTxt>MANAGEMENT BONUSES ARE DISCRETIONARY AND DETERMINED BY THE BOARD.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="RetDoc1053100001">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>MICHIGAN STATE HOSPITAL FINANCE AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>800596186</BondIssuerEIN>
        <CUSIPNum>59447TNK5</CUSIPNum>
        <BondIssuedDt>2016-10-06</BondIssuedDt>
        <IssuePriceAmt>41320000</IssuePriceAmt>
        <PurposeDesc>CONSTRUCTION OF NEW BUILDING AND DEFEASANCE OF 2004B BONDS</PurposeDesc>
        <DefeasedInd>0</DefeasedInd>
        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>JP MORGAN CHASE</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>134994650</BondIssuerEIN>
        <CUSIPNum>NONEAVAIL</CUSIPNum>
        <BondIssuedDt>2020-08-03</BondIssuedDt>
        <IssuePriceAmt>10445481</IssuePriceAmt>
        <PurposeDesc>CONSTRUCTION OF NEW BUILDING AND DEFEASANCE OF 2010 BONDS</PurposeDesc>
        <DefeasedInd>0</DefeasedInd>
        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>MICHIGAN STATE HOSPITAL FINANCE AUTHORITY</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>800596186</BondIssuerEIN>
        <CUSIPNum>59447PTK7</CUSIPNum>
        <BondIssuedDt>2013-02-20</BondIssuedDt>
        <IssuePriceAmt>39641117</IssuePriceAmt>
        <PurposeDesc>CONSTRUCTION OF NEW BUILDING AND DEFEASANCE OF 2004A BONDS</PurposeDesc>
        <DefeasedInd>0</DefeasedInd>
        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>5085000</RetiredAmt>
        <TotalProceedsAmt>44193387</TotalProceedsAmt>
        <IssuanceCostsFromProceedsAmt>573771</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>21796000</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>21823616</OtherSpentProceedsAmt>
        <SubstantialCompletionYr>2016</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>0</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>1</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>1</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>1</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <RetiredAmt>1305556</RetiredAmt>
        <TotalProceedsAmt>10445481</TotalProceedsAmt>
        <IssuanceCostsFromProceedsAmt>167638</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>4111137</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>6166706</OtherSpentProceedsAmt>
        <SubstantialCompletionYr>2020</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>1</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>0</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>1</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>1</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <RetiredAmt>2950000</RetiredAmt>
        <TotalProceedsAmt>39641117</TotalProceedsAmt>
        <IssuanceCostsFromProceedsAmt>512903</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>20471662</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>18656552</OtherSpentProceedsAmt>
        <SubstantialCompletionYr>2015</SubstantialCompletionYr>
        <RefundingTaxExemptBondsInd>0</RefundingTaxExemptBondsInd>
        <RefundingTaxableBondsInd>1</RefundingTaxableBondsInd>
        <FinalAllocationMadeInd>1</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>1</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>0</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <PrivateBusUseByOthersPct>0.00000</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.00000</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.00000</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>0</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>0</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <PrivateBusUseByOthersPct>0.00000</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.00000</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.00000</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>0</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>0</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <PrivateBusUseByOthersPct>0.00000</PrivateBusUseByOthersPct>
        <PrivateBusConcerningUBIPct>0.00000</PrivateBusConcerningUBIPct>
        <TotalPrivateBusinessUsePct>0.00000</TotalPrivateBusinessUsePct>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>0</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>1</RebateNotDueYetInd>
        <ExceptionToRebateInd>0</ExceptionToRebateInd>
        <NoRebateDueInd>0</NoRebateDueInd>
        <VariableRateIssueInd>0</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>0</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>0</RebateNotDueYetInd>
        <ExceptionToRebateInd>1</ExceptionToRebateInd>
        <NoRebateDueInd>0</NoRebateDueInd>
        <VariableRateIssueInd>0</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>0</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>1</RebateNotDueYetInd>
        <ExceptionToRebateInd>0</ExceptionToRebateInd>
        <NoRebateDueInd>0</NoRebateDueInd>
        <VariableRateIssueInd>0</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>0</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>0</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>0</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>B</BondReferenceCd>
        <ProceduresCorrectiveActionInd>0</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>C</BondReferenceCd>
        <ProceduresCorrectiveActionInd>0</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE K, PART I, ISSUER NAME:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE MICHIGAN FINANCE AUTHORITY IS THE SUCCESSOR IN INTEREST TO THE MICHIGAN STATE HOSPITAL FINANCE AUTHORITY (EIN: 38-2889417), PURSUANT TO MICHIGAN EXECUTIVE ORDER 2010-2. EFFECTIVE MAY 30, 2010, ALL THE POWERS, RIGHTS, RESPONSIBILITIES AND DUTIES OF THE MICHIGAN STATE HOSPITAL FINANCE AUTHORITY WERE TRANSFERRED TO THE MICHIGAN FINANCE AUTHORITY PURSUANT TO MICHIGAN EXECUTIVE ORDER 2010-2.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART I, ITEM C</FormAndLineReferenceDesc>
        <ExplanationTxt>DBA: WESTERN MICHIGAN UROLOGICAL ASSOCIATES DBA: THE BONE AND JOINT CENTER OF HOLLAND DBA: SURGERY CENTER OF WESTERN MICHIGAN DBA: HOLLAND HOSPITAL HOME HEALTH SERVICES DBA: HOLLAND HOSPITAL MEDICAL GROUP</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>HOLLAND COMMUNITY HOSPITAL'S CEO AND CFO REVIEW THE FORM 990 PRIOR TO FILING. THE CEO THEN SIGNS AND FILES THE FORM 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD OF DIRECTORS, ADMINISTRATION, DIRECTORS AND MANAGERS FILL OUT A CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. THESE FORMS ARE COLLECTED BY THE COMPLIANCE OFFICE, INVESTIGATED AND THEN MAINTAINED BY HUMAN RESOURCES. THE BYLAWS SPECIFICALLY STATE THAT A BOARD MEMBER WHO HAS A CONFLICT OF INTEREST AS TO A MATTER BEFORE THE BOARD SHOULD NOT VOTE OR USE PERSONAL INFLUENCE WITH OTHER BOARD MEMBERS. THE MINUTES OF THE BOARD MEETING SHALL DISCLOSE THE MEMBER'S ABSTINENCE FROM VOTING ON THE MATTER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION USES CONSULTANTS TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND RECOMMEND UPDATES/INCREASES AS DICTATED BY THE MARKET. THIS PROCESS OCCURS EVERY THREE YEARS OR AS DIRECTED BY THE BOARD. COMPENSATION IS SET FOR EACH POSITION WITH ESTABLISHED TARGETS USING NATIONAL AND REGIONAL DATA FOR SIMILAR HOSPITALS. THIS POLICY IS BOARD APPROVED AND HAS AN ONGOING REVIEW PROCESS WHICH IS COMPARATIVE AND DATA-DRIVEN. THIS PROCESS OCCURRED MOST RECENTLY IN 2021.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>DOCUMENTS ARE AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>REALIZED AND UNREALIZED LOSS IN AFFILIATES 1,144,641.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdDisregardedEntitiesGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>HOLLAND HOSPITAL PHYSICIAN CLINIC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>602 MICHIGAN AVENUE</AddressLine1Txt>
          <CityNm>HOLLAND</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>49423</ZIPCd>
        </USAddress>
        <EIN>263479537</EIN>
        <PrimaryActivitiesTxt>NOT ACTIVE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MI</LegalDomicileStateCd>
        <TotalIncomeAmt>0</TotalIncomeAmt>
        <EndOfYearAssetsAmt>0</EndOfYearAssetsAmt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>HOLLAND COMMUNITY HOSPITAL</BusinessNameLine1Txt>
        </DirectControllingEntityName>
      </IdDisregardedEntitiesGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>HOLLAND COMMUNITY HOSPITAL AUTHORITY SELF-INSURANCE TRUST FUND</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>602 MICHIGAN AVENUE</AddressLine1Txt>
          <CityNm>HOLLAND</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>49423</ZIPCd>
        </USAddress>
        <EIN>386389385</EIN>
        <PrimaryActivitiesTxt>SUPPORTING ORGANIZATION</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MI</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 12A, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>HOLLAND COMMUNITY HOSPITAL</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
