2021-03-30T12:43:29-07:00 2020-12-31 990 2020-01-01 381366927 Holland Home HOLL 6162355015 2100 Raybrook St SE Ste 300 Grand Rapids MI 49546 Hermina Breuker CEO 6162355005 2021-04-02 1 11 AAL2 2020 2022-09-23 18:48:47Z Hermina Breuker 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 70610582 0 X www.hollandhome.org X 1892 MI Provide nursing, therapy, and benevolent services for aged residents in skilled nursing, memory care, assisted living and independent living centers. 11 10 1160 435 23348 0 2300777 6204960 60354255 58700413 902960 918269 -52150 0 63505842 65823642 0 0 0 0 34874965 37329348 17723 8070 475696 28967455 28577478 63860143 65914896 -354301 -91254 237895859 244548467 226447091 228588597 11448768 15959870 In fulfilling God's calling to serve others, the organization will service aged persons (1) with love and compassion, (2) with a commitment to excellence, and (3) follow Christ's teachings and example in all that the organization does. 0 0 59819679 0 58677065 Provide nursing and residential care at three facilities located in Grand Rapids, Michigan to an average of approximately 1,420 residents each day in skilled nursing (approximately 125 per day), assisted living (approximately 245 per day) and independent living (approximately 1,050 per day). Of the approximately 245 residents in assisted living, the organization provides financial assistance to approximately 20% or 50 residents on average which amounts to $2.0 million in benevolence. In skilled nursing, the organization serves an average of 84 residents (67%) on Medicaid and 8 residents (6%) on Medicare. These contractual allowances cost the organization $2.7 million in 2020. The organization provides uncompensated cost of private rooms to most of the 84 residents on Medicaid. 0 0 0 59819679 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 37 0 1 1160 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MI X David Tiesenga 6162355035 2100 Raybrook St SE Ste 300 Grand Rapids MI 49546 Hermina Breuker President/CEO, Director 50 0 X X 411239 25752 0 Dr John Mulder Chief Medical Consultant 50 0 X 352491 0 0 David Tiesenga Chief Financial Officer 50 0 X 316459 24769 0 James Chiavaras Physician, Care Resources 50.00 0 X 258651 0 0 Tracey McKnight CEO, Care Resources 50 0 X 207075 924 0 Carolyn Flietstra Executive VP, Home and Community Services 50 0 X 201677 0 0 H David Claus Former President Emeritus 0 0 X 0 0 194667 Troy Vugteveen Executive VP, Operations 50 0 X 183738 0 0 Susan Vogel-Vanderson Chairperson, Director 2 0 X X 0 0 0 Mary Ursul Vice-Chairperson, Director 2 0 X X 0 0 0 Gary Malburg Treasurer, Director 2 0 X X 0 0 0 Nelson Sanchez Secretary, Director 2 0 X X 0 0 0 Jean Nagelkirk Director 2 0 X 0 0 0 Sam Watson Director 2 0 X 0 0 0 Carl VerBeek Director 2 0 X 0 0 0 David Knibbe Director 2 0 X 0 0 0 Nick Thole Director 2 0 X 0 0 0 Paul Farr Director 2 0 X 0 0 0 1931330 51445 194667 23 1 1 0 Erhardt Construction Co 6060 Fulton St E Ada MI 49301 construction services 4715949 Gordon Food Service PO Box 88029 Chicago IL 60680 food services 1533979 McKesson Medical-Surgical PO Box 630693 Cincinnati OH 45263 medical supply 655558 RehabCare Group PO Box 503534 St Louis MO 63150 rehabilitation services 534566 Spectrum Health Medical Group PO Box 2048 Grand Rapids MI 49501 employee COVID testing 503886 28 0 0 0 0 3434886 2770074 0 6204960 HFA, AFC and Independent Living 623311 18899138 18899138 0 0 Medicare/Medicaid 623000 7841574 7841574 0 0 Skilled Nursing 623000 6372424 6372424 0 0 Amortization of Endowments 623311 7035639 7035639 0 0 Ancillary Revenue 623311 601237 601237 0 0 17950401 17927053 23348 0 58700413 631836 0 0 631836 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5073373 0 4769574 17366 303799 -17366 286433 0 0 286433 0 0 65823642 58677065 23348 918269 0 0 0 0 0 0 0 0 922365 0 922365 0 0 0 0 0 30396754 27868449 2187341 340964 443547 394678 44040 4829 3251514 2893270 322846 35398 2315168 2060088 229875 25205 196413 182005 14408 0 44803 0 44803 0 116169 0 116169 0 0 0 0 0 8070 8070 22365 0 22365 0 0 0 0 0 638900 616220 22680 0 2487968 2326861 132285 28822 728144 76083 652061 0 0 0 0 0 3903796 3586326 317470 0 155601 142740 10484 2377 0 0 0 0 16150 11544 3911 695 6076276 6076276 0 0 0 0 0 0 8725687 8296282 429405 0 536766 498525 38241 0 Purchased Services 986068 950417 10200 25451 Medical Quality Assurance Fees 1298841 1298841 0 0 Medical Supplies 505621 505621 0 0 COVID-19 Specific Expense (testing, PPE, etc) 1622087 1622087 0 0 515823 413366 98572 3885 65914896 59819679 5619521 475696 1742759 2690934 11746149 11096614 600875 583957 1498791 1264574 0 0 0 0 2299329 1537053 189107 635729 541712 324800 301354550 119460924 179407554 181893626 9543546 10832110 0 17139881 20526508 13186156 13162562 237895859 244548467 8020024 8809486 0 0 43966509 42687349 114289109 111904546 0 0 0 0 0 0 1274858 6565167 58896591 58622049 226447091 228588597 X 10169633 14046602 1279135 1913268 11448768 15959870 237895859 244548467 X -91254 809273 0 0 0 3793083 X 0 1 X 1 0 X 7046198 1602889 2817862 2248627 2697415 16412991 62310981 61969332 58543038 60318182 61162667 304304200 0 0 0 0 0 0 0 0 0 0 0 0 69357179 63572221 61360900 62566809 63860082 320717191 0 0 0 0 0 0 0 0 0 0 320717191 408371 659315 540457 571068 631836 2811047 0 0 0 0 408371 659315 540457 571068 631836 2811047 0 0 0 0 0 0 0 0 69765550 64231536 61901357 63137877 64491918 323528238 0.99131 0.99181 0.00869 0.00819 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 13985037 13985037 0 258188671 104344852 153843819 0 1026539 459415 567124 0 21703355 13372780 8330575 0 6450948 1283877 5167071 181893626 Interest in Net Assets of Charitable Foundation 20526508 F 20526508 Series 2016 Debt Service Reserve Funds 3656697 Series 2019 Debt Service Reserve Funds 3056066 Series 2012 Debt Service Reserve Funds 4906636 Investment in Tandem365 90000 Note Receivable from Care Resources 321352 Investment in Atrio Home Care 480000 457b Plan Assets 463968 Split Dollar Agreement Receivable 187843 13162562 0 Fair Value of Interest Rate Swap Agreements 3191748 Note Payable to Reliance CCP 2500000 Mortgage notes and Refundable Entrance Fees 52930301 58622049 64026641 0 0 0 0 0 64026641 22502 1774499 1797001 65823642 65849901 0 0 0 0 0 65849901 22502 42493 64995 65914896 Schedule D, Part XI, Line 4b Amount includes: $600,000 in contributed received from Holland Home Foundation; $1,294,137 in restricted contribution activity; $257,952 in reclassified State of Michigan reimbursement for direct care wages; as well as $138,314 in revenues related to discontinued operations. Schedule D, Part XII, Line 4b Amount includes: $300,445 in expenses related to discontinued operations and $257,952 in reclassified expenses related to State of Michigan wage reimbursement. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Hermina Breuker President/CEO, Director 382160 0 29079 0 0 0 19000 0 6752 0 436991 0 0 0 David Tiesenga Chief Financial Officer 294673 0 21785 0 0 0 19000 0 5769 0 341227 0 0 0 H David Claus Former President Emeritus 0 0 0 0 0 0 194667 0 0 0 194667 0 0 0 Dr John Mulder Chief Medical Consultant 334047 0 18444 0 0 0 0 0 0 0 352491 0 0 0 Carolyn Flietstra Executive VP, Home and Community Services 185898 0 15779 0 0 0 0 0 0 0 201677 0 0 0 Troy Vugteveen Executive VP, Operations 176287 0 7451 0 0 0 0 0 0 0 183738 0 0 0 James Chiavaras Physician, Care Resources 256151 0 2500 0 0 0 0 0 0 0 258651 0 0 0 Tracey McKnight CEO, Care Resources 203175 0 2500 0 0 0 0 0 0 0 205675 0 0 0 Schedule J, Part I, Line 1a The organization provides for the reimbursement of health club dies to the Chief Financial Officer. A Econ Dev Corp of the City of Kentwood 381844797 491740DF0 2012-06-29 50090801 See Part VI 0 0 0 B Econ Dev Corp of the City of Kentwood 381844797 491740EW2 2016-10-31 32187291 Refund prior issue (8/31/06) 0 0 0 C Michigan Strategic Fund 521417332 594698PM8 2016-10-31 9483642 Renovate Facility 0 0 0 D Michigan Strategic Fund 521417332 594698RM6 2019-09-06 27611429 See Part VI 0 0 0 A 13930000 0 50723207 4802749 0 0 1001816 0 0 0 45830922 0 2005 1 0 1 1 B 2135000 0 32322785 2715138 434 0 651160 0 0 0 28956053 0 2005 1 0 1 1 C 0 0 9512181 905039 0 0 182258 0 0 8424884 0 0 2019 0 0 1 1 D 1300000 0 27640844 1829253 0 0 550825 0 0 3857810 18178332 3224623 1 0 0 1 A 0 0 0 0 0 0 0 1 0 0 B 0 0 0 0 0 0 0 1 0 0 C 0 0 0 0 0 0 0 1 0 0 D 0 0 0 0 0 0 0 1 0 0 A 0 0 1 1 0 0 1 Wachovia 27.8000000 1 0 0 B 0 1 1 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 D 0 1 1 0 0 0 0 0 0 A 0 B 0 C 0 D 0 Schedule K, Part I-09/06/2019 27,611,429 Michigan Strategic Fund Construct and furnish facility and refund prior bonds (12/11/2014) Schedule K, Part I, Column f-06/29/2012 50,090,801 Econ Dev Corp of the City of Kentwood Refund prior bonds (8/2/2000, 8/31/2006, 10/3/2002) Schedule K, Part II, Line 3-06/29/2012 50,090,801 Econ Dev Corp of the City of Kentwood Total proceeds do not agree to the issue price in Part I, column E due to investment earnings / market value fluctuations. The total proceeds do not equal the summation of lines 4-12 due to transferred or replacement proceeds in line 4. Schedule K, Part IV, Line 2c-06/29/2012 50,090,801 Econ Dev Corp of the City of Kentwood Date the Rehab Computation was Performed: 5/31/2017 A Econ Dev Corp of the City of Kentwood 381844797 491740EY0 2019-10-17 13042526 Refund prior issue (6/29/12) 0 0 0 A 0 0 13040609 1137582 0 0 258990 0 0 0 11644036 0 2005 1 0 1 1 A 0 0 0 0 0 0 0 1 0 0 A 0 1 1 0 0 0 0 0 0 A 0 Form 990, Part VI, Section A, Line 6 Pursuant to its Articles of Incorporation, as amended, the organization is organized on a membership basis. Form 990, Part VI, Section A, Line 7b Pursuant to its Bylaws, as amended, the corporation is a subsidiary of Christian Living Services (CLS) and not withstanding any (CLS) and not withstanding any other provision in their Bylaws to the contrary, the approval of Christian Living Services as the member of this corporation is required to: (1) change the purpose, philosophy, core values or mission of the corporation, (2) amend the Articles of Incorporation or Bylaws of the corporation, (3) make any changes to the structure of operations of the corporation which would affect its status as a nonprofit entity, exempt from taxation under Section 501(c)(3) of the Internal Revenue Code, (4) dissolve or liquidate the corporation, (5) merge or consolidate with another entity, (6) remove a Director of the corporation, (7) create or acquire a new subsidiary entity or enter into a joint venture or partnership, (8) purchase, acquire, or lease any real property or sell, lease, exchange, give as security, mortgage, or dispose of any personal property owned, held or leased by the corporation, (9) purchase, lease (as lessor or lessee), sell or otherwise dispose of any personal property that would be a capital asset of the corporation under generally accepted accounting principles, (10) borrow or enter into a guarantee, (11) adopt a budget, schedule of fees, marketing plan or long-range plan for the corporation, (12) enter into a material contract such as an employee lease arrangement or a contract to subcontract the provision for food service, facilities, maintenance or janitorial services, or (13) change accountants or attorneys. Form 990, Part VI, Section B, Line 11b The Form and appropriate Schedules are prepared by the organization. A draft of the form is reported to the organization's Finance Committee, which is given opportunity to review the form, prior to its submission to the Internal Revenue Service. Upon confirmation of review, the form is subsequently submitted and filed with the Internal Revenue Service. Form 990, Part VI, Section B, Line 12c On an annual basis each director, principal officer, and member of a committee with board delegated powers must complete a statement that (1) they have received a copy of the Conflict of Interest Policy, (2) they have read and understood the policy, (3) they have agreed to comply with the policy , and (4) understands the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. Form 990, Part VI, Section B, Line 15 The organization purchases compensation surveys and establishes the executive compensation around the fiftieth percentile (with some flexibility) of prevailing market rates for similar positions, market trends, and the financial resources of the organization. The organization is committed to balancing fiscal stewardship with a desire to competitively compensate its personnel. Executive compensation is reviewed within the compensation committee of the Board of Directors. Form 990, Part VI, Section C, Line 19 The organization does not generally make its governing documents or Conflict of Interest Policy available to the public; however, such documents would be subject to public inspection if so requested. A summary of the annual audited financial statements is made available each year within a quarterly publication of Holland Home called "New Horizons." This publication is made available to residents and key stakeholders. Form 990, Part XI, Line 9 Other changes in net assets includes: unrealized gain of $3,514,713 on changes in net assets of Foundation and unrealized gain of $278,370 on changes in fair value of interest rate swap agreements. Christian Living Services 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 261126816 Admin Services MI 501(c)(3) 12b N/A 0 Faith Hospice 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 383062893 Hospice Care MI 501(c)(3) 12b Christian Living Services 0 Reliance Community Care Partners 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 382295909 Community Services ME 501(c)(3) 10 Christian Living Services 0 Helpers of Holland Home 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 271062997 In-Home services MI 501(c)(3) 12b Christian Living Services 0 Atrio Home Health 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 382660300 Home Health Care MI 501(c)(3) 12b Christian Living Services 0 Trillium Institute 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 471295260 Education Services MI 501(c)(3) 12b Christian Living Services 0 Rehab Dimensions 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 383337881 Rehabilitation Services MI 501(c)(3) 12b Christian Living Services 0 Atrio Home Health Lakeshore 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 814839696 Home Health Care MI 501(c)(3) 12b Atrio Home Care 0 Atrio Home Care 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 813166606 In-Home Services MI 501(c)(3) 10 CLS 0 Holland Home Foundation 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 382663466 Mission Fundraising MI 501(c)(3) 7 Holland Home 1 Care Resources 1471 Grace St SE Grand Rapids MI 49506 300166828 PACE Services MI 501(c)(3) 12b N/A 0 Raybrook Limited Partners 2100 Raybrook ST SE Grand Rapids MI 49534 property ownership MI Holland Home Related 0 0 1 Facility Management Services 2100 Raybrook St SE Grand Rapids MI 49534 grounds maintenance MI Holland Home Unrelated 0 0 1 EHCO Group LLC 2100 Raybrook St SE Grand Rapids MI 49534 health management MI N/A Related 0 0 0.2 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 1 1 Holland Home Foundation c 600000 cash transfer / grant Atrio Home Care l 134580 set fee based on services Atrio Home Health Lakeshore l 130061 set fee based on services Reliance Community Care Partners l 1046446 set fee based on services Care Resources l 782382 set fee based on services Faith Hospice l 3283304 set fee based on services Trillium Institute l 45000 set fee based on services Atrio Home Health l 327084 set fee based on services Reliance Community Care Partners n 238943 Rent Faith Hospice n 93802 rent Atrio Home Health n 57796 Rent Faith Hospice p 17087 reimbursement for expenses Atrio Home Health p 328 reimbursement for expenses Atrio Home Care q 213096 reimbursement for expenses Atrio Home Health Lakeshore q 186543 reimbursement for expenses Reliance Community Care Partners q 449283 reimbursement for expenses Care Resources q 6357554 reimbursement for expenses EHCO Group LLC q 3323926 reimbursement for expenses Faith Hospice q 850644 reimbursement for expenses Trillium Institute q 425651 reimbursement for expenses Atrio Home Health q 454262 reimbursement for expenses Reliance Community Care Partners r 75000 payment of interest on note payable Care Resources s 83013 payment of principal and interest EHCO Group LLC s 50000 distribution Faith Hospice s 1030147 payment of principal and interest Schedule R, Part I Facility Management Services of Holland Home, LLC is not an exempt organization; however, it is a wholly owned subsidiary of Holland Home, generating unrelated business income for the benefit of Holland Home. Holland Home files a Form 990-T on an annual basis, reporting any unrelated business income related to Facility Management Services of Holland Home. Holland Home is a wholly owned subsidiary of Christian Living Services. EHCO Group, LLC (dba Tandem 365) is not an exempt organization. Holland Home, a wholly owned subsidiary of Christian Living Services, maintains a 20% membership interest. The organization is a collaborative partnership between five organization focused on managing health care costs of a specific pool of individuals, based upon contracting with health insurers and health care providers. Raybrook Partners was dissolved in 2018 and previously held ownership of the 2100 Raybrook corporate office of Holland Home. The property was transferred to Holland Home in 2018 and the partnership subsequently dissolved