2021-05-17T09:17:31-05:00 2020-06-30 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2019-07-01 383330803 NORTH OTTAWA COMMUNITY HOSPITAL NORT 6168423600 1309 SHELDON ROAD GRAND HAVEN MI 49417 SHELLEYE YAKLIN PRESIDENT/CEO 6168423600 2021-05-14 1 DARRYN MCGARVEY P00958683 6123764500 2019 2022-09-23 18:48:47Z SHELLEYE YAKLIN 1309 SHELDON ROAD GRAND HAVEN MI 49417 52514654 0 X WWW.NOCH.ORG X 1996 MI PROVIDE A NETWORK OF COMMUNITY HEALTHCARE, DELIVERING SERVICE WITH COMPASSION AND RESPECT. 10 10 641 180 2564119 0 66164 221205 52611849 48575008 3005705 303489 3967391 3030237 59651109 52129939 0 0 0 0 24776507 21259290 0 0 0 34593715 31633279 59370222 52892569 280887 -762630 32928570 43092061 51565757 68255689 -18637187 -25163628 THE MISSION OF NORTH OTTAWA COMMUNITY HOSPITAL IS TO ACHIEVE COMMUNITY WELLNESS THROUGH RELATIONSHIPS, RESOURCES AND PERSONALIZED SERVICE. WE WILL PROVIDE PERSONAL, TRUSTED, LIFE-LONG MEDICAL CARE AND GUIDANCE FOR OUR NEIGHBORS, FAMILY AND FRIENDS. 0 0 38237943 0 48575008 INPATIENT HEALTHCARE SERVICES WERE PROVIDED FOR 1,111 PATIENTS AND 164 NEWBORNS. SERVICE DAYS TOTALED 2,859 INCLUDING 2,564 ADULT/PEDIATRICDAYS AND 295 NURSERY DAYS.EMERGENCY SERVICES WERE PROVIDED TO 13,923 PATIENTS. IN ADDITION, 2,879 SURGERIES WERE PERFORMED AND 1,284 ENDOSCOPIC PROCEDURES WERE PERFORMED.DIAGNOSTIC TESTING, IMAGING, LABORATORY, ELECTRODIAGNOSTICS, AND SLEEP LAB SERVICES WERE PROVIDED TO 89,111 PATIENTS. 38237943 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 125 0 641 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 X SHELLEYE YAKLIN 6168423600 1309 SHELDON ROAD GRAND HAVEN MI 49417 KARL LAUTERBACH MD PHYSICIAN 40.00 X 307328 0 21147 ANDA SCORZA DO PHYSICIAN 40.00 X 299342 0 14468 SHELLEYE YAKLIN PRESIDENT / CEO 24.00 16.00 X 259362 0 16639 HANEY ASSAAD MD PHYSICIAN 40.00 X 256734 0 4115 STUART VANDERHEIDE MD PHYSICIAN 40.00 X 224082 0 18563 LISA HOEKSTRA JANSEN MD PHYSICIAN 40.00 X 191412 0 18193 RON RYBAR INTERIM CFO 24.00 16.00 X 0 0 0 JOY GAASCH CHAIR 0.30 0.70 X X 0 0 0 TIM PARKER VICE CHAIR 0.30 0.70 X X 0 0 0 JUDITH HOOYENGA SECRETARY 0.30 0.70 X X 0 0 0 DARREN RIOPELLE THROUGH JAN 2020 TREASURER 0.30 0.70 X X 0 0 0 TIM BARRON MD TRUSTEE 0.30 0.70 X 0 0 0 JEFF BESWICK TRUSTEE 0.30 0.70 X 0 0 0 HARRY DYCK JR TRUSTEE 0.30 0.70 X 0 0 0 TOM GODFREY TRUSTEE 0.30 0.70 X 0 0 0 TAMI HARVEY TRUSTEE 0.30 0.70 X 0 0 0 ERIC HAYWARD TRUSTEE 0.30 0.70 X 0 0 0 CLAIRE SHERIDAN TRUSTEE 0.30 0.70 X 0 0 0 1538260 0 93125 6 0 1 0 STATE OF MICHIGAN PO BOX 30437 LANSING MI 48909 MEDICAL SERVICES 2395477 IVY REHAB 1311 MAMARONECK AVE SUITE 140 WHITE PLAINS NY 10605 THERAPY SERVICES 1434442 COMPREHENSIVE PHARMACY SYSTEMS 5050 BRADENTON AVE DUBLIN OH 43017 PHARMACY SERVICES 1295777 CARDINAL HEALTH PO BOX 70539 CHICAGO IL 60673 MEDICAL PRODUCTS 1280353 GRAND HEALTH PARTNERS 2060 EAST PARIS AVE SE SUITE 100 GRAND RAPIDS MI 49546 MEDICAL SERVICES 1062373 48 221205 221205 PATIENT REVENUE 621110 43130704 43130704 OTHER PATIENT REVENUE 621110 5444304 5444304 48575008 303489 303489 682746 382107 300639 300639 300639 1010 2608 -1598 -1598 DUNEWOOD PHARMACY 446110 2564119 2564119 FOOD SERVICES 722210 167077 167077 2731196 52129939 48575008 2564119 769607 X 276000 276000 17425125 12798055 4627070 489397 352366 137031 1790228 1288964 501264 1278540 923977 354563 49171 49171 176468 176468 8849846 7171386 1678460 142212 50341 91871 727432 523751 203681 1673556 1204960 468596 16244 7147 9097 398938 398938 1777362 1415929 361433 769317 769317 MEDICAL SUPPLIES 6986383 6986383 DRUGS 3022727 3022727 PROVISION FOR BAD DEBTS 2903160 2903160 MMQAA BED TAX 1513166 1513166 2627297 2491957 135340 52892569 38237943 14654626 0 4322 4322 866540 13655680 10750 6651609 5786161 1609098 1671176 588784 504352 87268874 68932324 19877788 18336550 1374497 1429134 112052 109720 102120 102120 1731010 1492846 32928570 43092061 16190586 17282829 9454 3094595 5032890 4948064 12515 12515 208303 2263720 2149121 5238900 28056592 35321362 51565757 68255689 X -19054902 -25633231 417715 469603 -18637187 -25163628 32928570 43092061 X -762630 3490 -5767301 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 PART II-B, LINE 1: A PORTION OF THE DUES NORTH OTTAWA PAYS THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION IS FOR LOBBYING. 0 1 X 85000 85000 85000 85000 79390 5610 85000 69910 10209 729 79390 76266 10 5648 718 69910 1 0 4753699 4753699 40843421 29256388 11587033 494090 494090 0 38934818 36939000 1995818 2242846 2242846 0 18336550 EMPLOYEE BENEFIT OBLIGATION 30623106 DUE TO/FROM RELATED PARTY 4698256 35321362 X PART IV, LINE 2B: THE AMOUNT INCLUDED ON PART X, LINE 21 REPRESENTS TENANT SECURITY DEPOSITS COLLECTED AT THE COMMENCEMENT OF TENTANT'S RENTAL CONTRACT WITH NOCH, ONCE THE CONTRACT IS TERMINATED THE SECURITY DEPOSITS ARE DUE BACK TO THE TENANT. PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY THE GRAND HAVEN AREA COMMUNITY FOUNDATION AND THE HOSPITAL USES THE INCOME FOR NURSING EDUCATION. PART X, LINE 2: INCOME TAXES THE SYSTEM, EXCEPT FOR SYNANON, INC., IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE. NO ENTITIES WITHIN THE SYSTEM ARE CONSIDERED TO BE A PRIVATE FOUNDATION. THE SYSTEM IS ALSO EXEMPT FROM STATE INCOME TAXES. THE SYSTEM'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE SYSTEM IS NOT AWARE OF ANY ADDITIONAL ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES THAN ARE CURRENTLY FILED IN THE TAX RETURN. THE SYSTEM HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE SYSTEM FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 1 0 1 1 78431 78431 0.00150 5066311 3699617 1366694 0.02580 5144742 3699617 1445125 0.02730 72579 72579 0.00140 5 5 0.00000 72584 72584 0.00140 5217326 3699617 1517709 0.02870 1 2903160 5503390 6494229 -990839 X 1 1 1 LAKESHORE HEALTHCARE LLC REAL ESTATE 0.50000 0.00000 0.50000 1 1 NORTH OTTAWA COMMUNITY HOSPITAL 1309 SHELDON ROAD GRAND HAVEN MI 49417 HTTP://WWW.NOCH.ORG/ 700010 X X X NORTH OTTAWA COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 17 1 1 1 1 X HTTP://WWW.NOCH.ORG/MAIN.ASPX?ID=2624 X 1 17 1 HTTP://WWW.NOCH.ORG/MAIN.ASPX?ID=2624 0 1 X 150.000000000000 250.000000000000 X X X X X X X 1 1 X X X X 1 X HTTP://WWW.NOCH.ORG/UPLOADEDFILES/PATIENTS_AND_VISITORS/DOC001.PDF X HTTP://WWW.NOCH.ORG/UPLOADEDFILES/PATIENTS_AND_VISITORS/DOC002.PDF X HTTP://WWW.NOCH.ORG/MAIN.ASPX?ID=4469 X X X 1 X 0 X X 1 X 0 1 NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: THE JUNE 30, 2018 COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED IN-DEPTH TELEPHONE INTERVIEWS WITH 10 KEY STAKEHOLDERS (HOSPITAL DIRECTORS, CLINIC EXECUTIVE DIRECTORS, ETC.), AN ONLINE SURVEY WITH 91 KEY INFORMANTS (PHYSICIANS, NURSES, DENTISTS, PHARMACISTS, SOCIAL WORKERS, ETC.), A SELF-ADMINISTERED PAPER SURVEY FROM 489 VULNERABLE AND UNDERSERVED COMMUNITY MEMBERS, AND A TELEPHONE SURVEY FROM 1,318 ADULT COMMUNITY MEMBERS. NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: HOLLAND HOSPITAL AND SPECTRUM HEALTH-ZEELAND COMMUNITY HOSPITAL NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: OTTAWA DEPARTMENT OF PUBLIC HEALTH, COMMUNITY MENTAL HEALTH OTTAWA COUNTY, AND GREATER OTTAWA COUNTY UNITED WAY NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE HEALTH NEEDS IDENTIFIED IN THE MOST RECENT CHNA WERE: ACCESS TO CARE, MENTAL HEALTH, AND HEALTHY BEHAVIORS. SINCE THESE NEEDS WERE IDENTIFIED NOCH TOOK SPECIFIC ACTIONS, WHICH INCLUDED THE FOLLOWING FOR EACH IDENTIFIED NEED. ACCESS TO CARESTRATEGY 1: EXPANSION OF OTTAWA COUNTY PATHWAYS TO BETTER HEALTH (OPBH) TO ALLOW SERVING A GREATER NUMBER OF PEOPLE- SUPPORT WWW.MIOTTAWA.ORG/OPBH- PATHWAYS TO BETTER HEALTH PARTICIPATION- OAISD SCHOOL NURSE INITIATIVE PARTICIPATION- PCP OFFICE CARE COORDINATORS -INTEGRATE WITH ERSTRATEGY 2: EXPAND CARE COORDINATION IN PRIMARY CARE OFFICES- HIRED SOCIAL WORKER FOR PHYSICIAN OFFICES- PATHWAYS TO BETTER HEALTH PARTICIPATION- PCP OFFICE CARE COORDINATORS -INTEGRATE WITH ER- SPECIALTY CLINICS -ORTHOPEDICS, BARIATRICS- EMR INTEGRATION (NOCH, NOMG); GREAT LAKES HEALTH CONNECT- INTEGRATED COMMUNITY LINKAGES AND LOCAL RESOURCES INTO ROUTINE CARE MANAGEMENT MEETINGS- EMBEDDED PHARMACISTS INTO PCP OFFICES TO ASSIST WITH REAL-TIME MEDICATION MANAGEMENTMENTAL HEALTHSTRATEGY 1: INCREASE PUBLIC AWARENESS OF EXISTING MENTAL HEALTH TREATMENT MODELS AND SERVICES- PARTNERED WITH MOSIAC COUNSELING FOR SUICIDE SAFETY RESPONSE TRAINING FOR STAFF AND COMMUNITY- PARTNERED WITH PINE REST AND OTTAWA COUNTRY DEPARTMENT OF PUBLIC HEALTH FOR CONTINUING MEDICAL EDUCATION WORK FOR PROVIDERS ON SUICIDE PREVENTION- MENTAL ILLNESS TASK FORCE (NORTHERN OTTAWA COUNTY) AND SUICIDE PREVENTION COALITION COLLABORATION- IMPLEMENTED EVIDENCE-BASED SUICIDE SAFETY PROTOCOL AND SCREENING TO PHYSICIAN OFFICES- INTEGRATED INFORMATION ON LOCAL MENTAL HEALTH RESOURCES INTO ER RISK AND CARE MANAGEMENT WITHIN PHYSICIAN PRACTICESSTRATEGY 2: INCREASE COMMUNITY CONVERSATION ABOUT MENTAL HEALTH- LOCAL TOWN HALL SERVICES ON MENTAL ILLNESS- PLANNING COMMITTEE INVOLVEMENTSTRATEGY 3: EDUCATE COMMUNITY ON ADVERSE CHILDHOOD EXPERIENCES (ACES)- THRIVE OTTAWA COUNTY COLLABORATIVE TASK FORCE TO ADDRESS ACES- CREATE PUBLIC AWARENESS CAMPAIGN- MDHHS TRAINED OVER 100 OTTAWA COUNTY COMMUNITY MEMBERS TO BE MASTER ACES COMMUNITY CHAMPIONSHEALTHY BEHAVIORSSTRATEGY 1: INCREASE AWARENESS OF LOW-COST AND FREE OPPORTUNITIES FOR PHYSICAL ACTIVITY IN OTTAWA COUNTY- FITNESS SAMPLER: PARTNERED WITH YMCA, FOUR POINTES, AND CITY OF GRAND HAVEN TO OFFER A VARIETY OF FREE PHYSICAL ACTIVITY CLASSES AT WATERFRONT STADIUM- PARTNERED WITH OTTAWA COUNTY DEPARTMENT OF PUBLIC HEALTH TO OFFER STEP IT UP! PROGRAMSTRATEGY 2: SUPPORT OTTAWA FOOD POLICY COUNCIL EFFORTS- INCORPORATED NUTRITION EDUCATION AND RESOURCE GUIDES FOR LOCAL HEALTH FOOD OPTIONS INTO PHYSICIAN PRACTICES, SERVICE LINES AT NOCHS, FOOD SERVICES, AND COMMUNITY OUTREACH ACTIVITIES- IMPLEMENT AN EDUCATIONAL CAMPAIGN ON IMPORTANCE OF FAMILY MEALS- ASSIST HEALTHCARE PROFESSIONALS IN REDUCING BARRIERS THAT PREVENT THEM FROM PROVIDING WEIGHT-RELATED ADVICE TO OVERWEIGHT AND OBESE PATIENTS. NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 13H: A PATIENT WHO IS IDENTIFIED AS "DECEASED WITH NO ESTATE" WILL QUALIFY FOR A 100% FINANCIAL ASSISTANCE DISCOUNT. NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 24: NON-MEDICALLY NECESSARY OR RETAIL/COSMETIC PROCEDURES WOULD NOT QUALITY FOR A DISCOUNT UNDER THE FAP. 4 1 - DUNEWOOD PHARMACY 1445 SHELDON ROAD GRAND HAVEN MI 49417 RETAIL AND INFUSION PHARMACY 2 - NORTH OTTAWA BARIATRIC CLINIC 1445 SHELDON ROAD GRAND HAVEN MI 49417 PHYSICIAN SERVICES 3 - NORTH OTTAWA PEDIATRICS 1445 SHELDON ROAD GRAND HAVEN MI 49417 PHYSICIAN SERVICES 4 - NORTH OTTAWA GENERAL SURGERY 1310 WISCONSIN AVENUE GRAND HAVEN MI 49417 PHYSICIAN SERVICES PART I, LINE 3C: FIRST WE DETERMINE ELIGIBILITY BASED ON INCOME UP TO 250% OF THE FPG. THEN WE CONSIDER ASSETS. THE INCOME LEVEL WRITE-OFF RATE IS ADJUSTED BY THE ASSET LEVEL WRITE-OFF RATE TO DETERMINE THE TOTAL WRITE OFF RATE. FOR EXAMPLE, FOR INCOME 150-200% OF POVERTY LEVEL, WE WRITE OFF 75%. THIS IS THEN ADJUSTED BY THE ASSET RATE. IF THE PATIENT HAS ASSETS >$35,000, THEN THE ADJUSTMENT PERCENT IS 0%. 0% ASSET RATE X 75% INCOME RATE = 0% WRITE-OFF. IF ASSETS ARE BETWEEN $20,000 - 35,000, THEN THE ADJUSTMENT FACTOR IS 75%, FOR EXAMPLE 75% INCOME RATE X 75% ASSET RATE = 56.25% WRITE-OFF. IF THE PATIENTS ASSETS TOTAL LESS THAN $20,000, THEN THE ASSET ADJUSTMENT RATE IS 100%. PART I, LINE 7: A COST TO CHARGE RATIO WAS USED. THIS RATIO WAS DERIVED FROM INPUTS FROM THE MHA COMMUNITY BENEFIT TRACKER SOFTWARE, WHICH FOLLOWS WORKSHEET 2 OF THE IRS INSTRUCTIONS TO SCHEDULE H. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL EMS DEPARTMENT IS PRESENT AT MANY COMMUNITY EVENTS AT NO CHARGE TO THE EVENT ORGANIZERS. THE EMS DEPARTMENT ATTENDS EVENTS SUCH AS LOCAL HIGH SCHOOL FOOTBALL GAMES, RUNNING EVENTS, PARADES, FIRE DEPARTMENT OPEN HOUSES, BEACH EVENTS, AND FESTIVALS. THEIR PRESENCE AT THESE EVENTS PROVIDES EDUCATION TO THE COMMUNITY, BUT MORE IMPORTANTLY AN IMMEDIATE INTERVENTION SHOULD A HEALTHCARE NEED ARISE. THE HOSPITAL ALSO PROVIDES FLU SHOT CLINICS TO AREA NURSING HOMES AND OTHER SUCH FACILITIES. PART III, LINE 2: THE HOSPITAL DIRECTLY WRITES OFF BAD DEBTS SUCH AS MEDICARE PRIMARY, MEDICAID SECONDARY ACCOUNT IN CASES WE KNOW THAT MEDICAID WILL NOT PAY THE SECONDARY AMOUNT. THE HOSPITAL ALSO CALCULATES A BAD DEBT ALLOWANCE ACCRUAL BASED ON SELF PAY BALANCE WITH THE COLLECTION AGENCIES BASED ON THEIR COLLECTION RATE. PART III, LINE 3: THE ORGANIZATION HAS NOT IDENTIFIED A METHOD TO REASONABLY CALCULATE THE PORTION OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE BUT FAILED TO COMPLETE AN APPLICATION. PART III, LINE 4: FOR A DESCRIPTION OF THE HOSPITAL'S BAD DEBT EXPENSE, SEE THE 'PATIENT AND RESIDENT ACCOUNTS RECEIVABLE' INFORMATION IN NOTE 1 ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE AMOUNTS INCLUDED IN PART III, LINES 5 AND 6 WERE GENERATED USING THE JUNE 30, 2020 FILED MEDICARE COST REPORT. THIS RESULTED IN A SHORTFALL OF APPROXIMATELY $990,839. SINCE OVER 40% OF OUR PAYORS ARE EITHER MEDICARE FFS OR MEDICARE ADVANTAGE PLANS, THIS IS A SIGNIFICANT SHORTFALL FOR A COMMUNITY HOSPITAL OF OUR SIZE, THEREFORE, WE FEEL THIS AMOUNT IS CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 9B: THE HOSPITAL WORKS VERY DILIGENTLY TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY OR UNDER-INSURED DISCOUNTS. ULTIMATELY IT IS UP TO THE PATIENT TO PROVIDE THE NECESSARY PAPERWORK TO QUALIFY THEM FOR CHARITY CARE OR UNDERINSURED DISCOUNTS. IN THE EVENT THAT THE PATIENT DOES NOT RESPOND TO REQUESTS FOR INFORMATION, THEY WILL BE SENT TO AN OUTSIDE COLLECTION AGENCY. OFTEN TIMES THE COLLECTION AGENCY HAS SUCCESS IN OBTAINING THE NECESSARY PAPERWORK TO DETERIMINE IF THE PATIENT FALLS WITHIN OUR CHARITY CARE GUIDELINES. IF THE PATIENT IS COMPLIANT IN FILLING OUT THE PAPERWORK AND FOUND TO BE ELIGIBLE FOR CHARITY CARE, WE MOVE THEM FROM BAD DEBT STATUS TO ACCOUNTS RECEIVABLE, AND THEN EVENTUAL ADJUSTMENT OF THEIR BILL TO THE APPROPRIATE ADJUSTMENT CODE. PART VI, LINE 2: NORTH OTTAWA COMMUNITY HOSPITAL HAS BEEN AN INTEGRAL PART OF THE OTTAWA COUNTY HEALTH ASSESSMENT COMMITTEE, WHICH IS LED BY THE OTTAWA COUNTY HEALTH DEPARTMENT. THE HOSPITAL MEETS FREQUENTLY WITH MUNICIPALITY REPRESENTATIVES TO EVALUATE HEALTH-RELATED SERVICES THAT CAN BE ENHANCED OR ADDED TO OUR FACILITY. WE CONDUCT SURVEYS, HOLD FOCUS GROUPS AND INVITE BUSINESS AND COMMUNITY GROUPS TO HELP US DETERMINE THE NEEDS OF THE COMMUNITY. WE HAVE RELATIONSHIPS WITH "SAFETY NET PROVIDERS" IN OUR LOCAL COMMUNITY THAT FURTHER ENHANCE OUR ABILITY TO PROVIDE CARE AND HEALTH RELATED PROGRAMS TAILORED TO OUR SERVICE AREA. WE ALSO USE COMMUNITY HEALTH STATUS INFORMATION (MORTALITY, MORBIDITY, DISEASE RATES, BIRTH RATES, IMMUNIZATION RATES, ETC) TO HELP US FOCUS ON LOCAL NEEDS. FINALLY, ON A REGIONAL COLLABORATIVE BASIS WE PARTICIPATE IN AH4Q-ALIGNING HEALTHCARE PROVIDERS FOR QUALITY, WHICH ASSESSES, EVALUATES AND PROMOTES BETTER CARE FOR WEST MICHIGAN CITIZENS. PART VI, LINE 3: AS SOON AS THE HOSPITAL BECOMES AWARE THAT A PATIENT DOES NOT HAVE INSURANCE COVERAGE, OR IS UNDER-INSURED, THAT PERSON IS CONTACTED EITHER BY PHONE, MAIL, OR IN PERSON BY OUR FINANCIAL COUNSELOR. WE HAVE A NUMBER OF PAMPHLETS THAT OUTLINE OUR CHARITY CARE POLICY, AS WELL AS HELP LOANS FOR WHICH THE HOSPITAL UNDERWRITES THE INTEREST PORTION OF THE LOAN. PART VI, LINE 4: THE HOSPITAL MAINLY SERVES THE CITIZENS OF THE ADJACENT COMMUNITIES OF GRAND HAVEN, GRAND HAVEN TOWNSHIP, FERRYSBURG, VILLAGE OF SPRING LAKE, SPRING LAKE TOWNSHIP, ROBINSON TOWNSHIP, WEST OLIVE TOWNSHIP AND CROCKERY TOWNSHIP. THE HOSPITAL SERVES PATIENTS OF ALL INCOME LEVELS. PART VI, LINE 5: IN CONJUNCTION WITH THE MICHIGAN HOSPITAL ASSOCIATION, A COMMUNITY BENEFIT SURVEY IS COMPLETED EACH YEAR. X X X X X 0 0 0 0 0 0 0 0 0 KARL LAUTERBACH MD PHYSICIAN 0 0 0 0 307328 0 0 0 21147 0 328475 0 0 0 ANDA SCORZA DO PHYSICIAN 0 0 0 0 299342 0 0 0 14468 0 313810 0 0 0 SHELLEYE YAKLIN PRESIDENT / CEO 0 0 0 0 259362 0 0 0 16639 0 276001 0 0 0 HANEY ASSAAD MD PHYSICIAN 0 0 0 0 256734 0 0 0 4115 0 260849 0 0 0 STUART VANDERHEIDE MD PHYSICIAN 0 0 0 0 224082 0 0 0 18563 0 242645 0 0 0 LISA HOEKSTRA JANSEN MD PHYSICIAN 0 0 0 0 191412 0 0 0 18193 0 209605 0 0 0 A ECONOMIC DEVELOPMENT CORPORATION OF THE COUNTY OF OTTAWA 386004883 689238AC7 2015-12-18 5440000 EMERGENCY DEPARTMENT REMODEL 0 0 0 A 90000 5284781 378438 106344 4800000 2015 0 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 RON RYBAR RYBAR GROUP INTERIM CFO OUTSTANDING YEAR END PAYABLE BALANCE X 208303 208303 0 0 1 208303 RON RYBAR RYBAR GROUP INTERIM CFO 313708 INDEPENDENT CONTRACTOR 0 PART II AND PART IV RON RYBAR OF THE RYBAR GROUP (RGI) PROVIDES INTERIM CHIEF OFFICER SERVICES TO NOCHS AND PROVIDES OVERSIGHT OF THE FINANCIAL REPORTING AND DAY TO DAY FINANCIAL OPERATIONS OF THE ORGANIZATION. RGI ALSO PROVIDES AN INTERIM MANAGER OF REIMBURSEMENT WHO OVERSEES THE DAY TO DAY OPERATIONS OF THIS DEPARTMENT. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE BOARD OF TRUSTEES AND ONE LAY TRUSTEE WHO SHALL BE APPROVED BY THE BOARD OF TRUSTEES THROUGH THE GOVERNANCE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY TO EXERCISE ALL OF THE POWER OF THE BOARD OF TRUSTEES DURING INTERVALS WHEN THE FULL BOARD OF TRUSTEES IN UNABLE TO MEET. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE REPORTED TO THE FULL BOARD OF TRUSTEES AT ITS NEXT MEETING. FORM 990, PART VI, SECTION A, LINE 3 RON RYBAR OF THE RYBAR GROUP (RGI) PROVIDES INTERIM CHIEF OFFICER SERVICES TO NOCHS AND PROVIDES OVERSIGHT OF THE FINANCIAL REPORTING AND DAY TO DAY FINANCIAL OPERATIONS OF THE ORGANIZATION. RGI ALSO PROVIDES AN INTERIM MANAGER OF REIMBURSEMENT WHO OVERSEES THE DAY TO DAY OPERATIONS OF THIS DEPARTMENT. SEE SCHEDULE L FOR FURTHER DETAILS. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATION SHALL BE DIRECTED AND GOVERNED BY A BOARD CONSISTING OF APPOINTED TRUSTEES AND TRUSTEES AT LARGE. THE APPOINTED TRUSTEES SHALL BE APPOINTED BY THE RESPECTIVE LEGISLATIVE BODIES OF THE FOLLOWING MUNICIPALITIES: THE CITY OF GRAND HAVEN, THE TOWNSHIP OF GRAND HAVEN, THE TOWNSHIP OF SPRING LAKE, THE CITY OF FERRYSBURG, THE TOWNSHIP OF CROCKERY, AND THE TOWNSHIP OF ROBINSON. EACH MUNICIPALITY SHALL APPOINT ONE TRUSTEE. THERE SHALL BE FIVE (5) TRUSTEES AT LARGE, WHO SHALL BE SELECTED BY A MAJORITY VOTE OF THE APPOINTED TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B ANY CHANGE IN OWNERSHIP, INCLUDING FACILITY LEASE AGREEMENTS, REQUIRES MAJORITY APPROVAL BY THE VOTERS OF THE SIX MUNICIPALITIES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND RELATED SCHEDULES WILL UNDERGO A REVIEW BY FINANCIAL PERSONNEL. A SECOND REVIEW WILL BE PERFORMED BY THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. AFTER CHANGES ARE FINALIZED, AN ELECTRONIC COPY OF THE RETURN WILL BE SENT TO THE FULL BOARD TO REVIEW THE FORM 990 AND RELATED SCHEDULES PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND KEY EMPLOYEES ARE REQURED TO DISCLOSE ON AN ANNUAL BASIS AND TRUSTEES ARE REQUIRED TO DISCLOSE ON A BIANNUAL BASIS ANY CONFLICTS OF INTEREST THROUGH COMPLETION OF A QUESTIONNAIRE. THE QUESTIONNAIRES ARE REVIEWED BY THE BOARD OF TRUSTEES. WHEN A CONFLICT IS DISCLOSED, THE BOARD SHALL DETERMINE IF A MORE BENEFICIAL TRANSACTION OR ARRANGEMENT IS WITHIN REASONABLE EFFORTS OF THE ORGANIZATION. IF A MORE BENEFICIAL ARRANGEMENT IS NOT REASONABLY ATTAINABLE THE BOARD SHALL DETERMINE BY A MAJORITY VOTE WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF THE ORGANIZATION AND IS FAIR AND REASONABLE. THE CONFLICTED PERSON IS ASKED TO LEAVE THE ROOM WHILE THE TRANSACTION IS BEING DISCUSSED AND VOTED ON. FORM 990, PART VI, SECTION B, LINE 15A AN INDEPENDENT COMPENSATION CONSULTANT IS HIRED TO HELP SET COMPENSATION FOR THE CEO. THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS INFORMATION, INCLUDING A COMPENSATION SURVEY, SUPPLIED BY THE CONSULTANT. A WRITTEN EMPLOYMENT CONTRACT DETAILS THE COMPENSATION OF THE CEO AND IS REVIEWED BY THE BOARD. COMPENSATION IS ADJUSTED ACCORDINGLY BEFORE THE BOARD APPROVES THE CONTRACT. FOR OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE SAME PROCESS IS PERFORMED BY THE CEO. THE MOST RECENT REVIEW TOOK PLACE IN 2017. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 6,130,418. MANAGEMENT AND GENERAL EXPENSES 1,678,460. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,808,878. PROFESSIONAL THERAPY FEES: PROGRAM SERVICE EXPENSES 1,040,968. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,040,968. FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS WITH DONOR RESTRICTIONS -50,648. CHANGE IN PENSION PLAN ACCOUNT -7,334,797. CHANGE IN DEFINED BENEFIT PENSION PLAN 1,618,144. 1101 SOUTH BEACON BOULEVARD LLC 1101 SOUTH BEACON BOULEVARD GRAND HAVEN MI 49417 383330803 RENTAL MI 0 0 NORTH OTTAWA COMMUNITY HOSPITAL NORTH OTTAWA CARE CENTER 18525 WOODLAND RIDGE DRIVE SPRING LAKE MI 49456 382602971 NURSING SERVICES MI 501(C)(3) LINE 10 NORTH OTTAWA COMMUNITY HOSPITAL 1 HOSPICE OF NORTH OTTAWA COMMUNITY INC 1061 SOUTH BEACON BLVD GRAND HAVEN MI 49417 382370192 HOSPICE SERVICES MI 501(C)(3) LINE 7 NORTH OTTAWA COMMUNITY HOSPITAL 1 NORTH OTTAWA HOSPITAL AUXILIARY INC 1309 SHELDON ROAD GRAND HAVEN MI 49417 386088836 FUNDRAISING MI 501(C)(3) LINE 12D, III-O N/A 0 SYNANON INC 1309 SHELDON ROAD GRAND HAVEN MI 49417 382715568 URGENT CARE MI NORTH OTTAWA COMMUNITY HOSPITAL C 408601 260790 1.00000 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 SYNANON INC A 42257 CASH