2021-03-30T12:26:39-07:00 2020-12-31 990 2020-01-01 383062893 Faith Hospice FAIT 6162355015 2100 Raybrook St SE Grand Rapids MI 49546 Hermina Breuker President & Chief Executive Officer 6162355005 2021-04-02 1 11 AAL2 2020 2022-09-23 18:48:47Z Hermina Breuker 2100 Raybrook st se Grand Rapids MI 49546 25642749 0 X www.faithhospicecare.org X 1992 MI To provide hospice services in a 20 bed facility and to provide in-home services to residents of the greater Grand Rapids and Western Michigan communities. 11 10 232 150 0 0 1088441 1120302 22930292 23718232 101872 84119 82250 38317 24202855 24960970 0 0 0 0 9552079 10608800 0 0 0 11449575 11221577 21001654 21830377 3201201 3130593 16329744 19085764 3234625 2715214 13095119 16370550 In fulfilling God's calling to serve others, we will serve each hospice patient, whether residing in our facility or in their homes, (1) with love and compassion, (2) with a commitment to excellence and (3) to follow Christ's teachings and example in all we do. 0 0 15017770 19634255 Provision of hospice services throughout the Western Michigan community to more than 2,000 patients, most of whom were Medicare or Medicaid recipients. The organization provides benevolence where needed, for patients who do not qualify for Medicare or Medicaid and can not afford the full cost of the services provided. 3881899 0 3803621 Provision of hospice services in a 20 bed hospice facility (Trillium Woods). Services were provided in the 20 bed hospice facility at an uncompensated loss of $57,463, of which amounts were received via public donations to cover a portion of the uncompensated loss. 503976 0 280356 Provision of palliative care services through physician/nurse practitioner teams and home health teams, available 24/7 to focus on physical, emotional and psychological needs of the patient and their family. Palliative care services were provided at an uncompensated loss of $211,523. 0 0 0 19403645 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 11 0 232 1 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 MI X David Tiesenga 6162355035 2100 Raybrook St SE Grand Rapids MI 49546 Hermina Breuker President/CEO, Director 0 50 X X 0 411239 25752 David Tiesenga Chief Financial Officer 0 50 X 0 316459 24769 Therese Rouse Physician 50 0 X 231214 342 0 Rene Wheaton Administrator 50 0 X 146279 0 0 Lisa Orcasitas RN, Case Manager 50 0 X 129306 5048 0 Andrea Lim RN, Case Manager 50 0 X 130423 0 0 Amy Schmidbaur RN, Case Manager 50 0 X 109271 2240 0 Susan Vogel-Vanderson Chairperson, Director 0 2 X X 0 0 0 Mary Ursul Vice-Chairperson, Director 0 2 X X 0 0 0 Gary Malburg Treasurer, Director 0 2 X X 0 0 0 Nelson Sanchez Secretary, Director 0 2 X X 0 0 0 Jean Nagelkirk Director 0 2 X 0 0 0 Sam Watson Director 0 2 X 0 0 0 Carl VerBeek Director 0 2 X 0 0 0 David Knibbe Director 0 2 X 0 0 0 Nick Thole Director 0 2 X 0 0 0 Paul Farr Director 0 2 X 0 0 0 746493 735328 50521 9 0 1 1 Holland Home 2100 Raybrook St SE Grand Rapids MI 49546 board & care, mgmt svcs 5537248 Enclara Pharmaceuticals PO Box 95000 Philadelphia PA 19195 pharmacy & related svcs 822773 Samaritas Senior Living 1950 32nd St SE Grand Rapids MI 49508 board & care 490788 Edison Christian Health Center 1000 Edison Ave NW Grand Rapids MI 49504 board & care 460180 Mercy Health Saint Mary's 1820 44th St Kentwood MI 49512 physician services 453253 18 0 0 103831 0 377124 639347 0 1120302 Palliative Care 900099 280356 280356 0 0 In-Home Hospice Care 900099 19634255 19634255 0 0 Facility Hospice Care 900099 3803621 3803621 0 0 0 0 0 0 23718232 37153 0 0 37153 0 0 0 0 0 0 0 0 0 0 717948 0 670982 0 46966 0 46966 0 0 46966 0 103831 10797 -10797 0 -10797 Miscellaneous Revenue 900099 49114 49114 0 0 0 0 0 0 49114 24960970 23767346 0 73322 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9015008 8868729 146279 0 128879 126788 2091 0 824428 811051 13377 0 640485 630092 10393 0 2601339 595071 2006268 0 27756 0 27756 0 14000 0 14000 0 0 0 0 0 0 0 4388 0 4388 0 7049 6666 383 0 524282 524282 0 0 217202 217202 0 0 261970 261970 0 0 0 0 0 0 259819 259819 0 0 188701 188652 49 0 0 0 0 0 17970 17970 0 0 39749 0 39749 0 0 0 0 0 490162 490162 0 0 126233 0 126233 0 Purchased Services 3961327 3932519 28808 0 Misc 438310 431352 6958 0 Bad Debt 171173 171173 0 0 Medical Supplies 1870147 1870147 0 0 21830377 19403645 2426732 0 3656200 3413631 0 2734218 455000 255000 2560275 3210854 0 0 0 0 0 0 5705 2658 40550 26901 15059238 7332106 7931825 7727132 1479478 1713840 0 0 0 0 0 0 200711 1530 16329744 19085764 1961470 2594472 0 0 72444 120742 0 0 0 0 0 0 0 0 0 0 1200711 3234625 2715214 X 12409233 15191866 685886 1178684 13095119 16370550 16329744 19085764 3130593 144838 0 0 0 0 X 0 1 1 0 X X 1 Holland Home 381366927 10 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Schedule A, Part I, Line 1 Holland Home, a supported organization of Faith Hospice, provides certain management services, including human resources, information technology; finance/accounting, and executive leadership for the benefit of Faith Hospice. In exchange, Faith Hospice pays a set management fee to Holland Home. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 11580226 0 4428684 7151542 22166 0 13420 8746 2798022 0 2347186 450836 658824 0 542816 116008 7727132 24606665 148302 0 0 10797 159099 24447566 4388 509016 513404 24960970 21824032 0 0 0 10797 10797 21813235 4388 12754 17142 21830377 Schedule D, Part XI, Line 2d Expenses related to fundraising events. Schedule D, Part XI, Line 4b Amount of restricted cash contributions received. Schedule D, Part XII, Line 2d Expenses related to fundraising events. Schedule D, Part XII, Line 4b Additional adjustments related to fundraising events. Luncheon 77082 77082 0 0 0 1337 192 300 8968 0 0 77082 77082 0 0 0 1337 192 300 8968 10797 -10797 Schedule G, Part I, Line 1 Faith Hospice traditionally holds two fundraising events during the year: the summer concert and the fall luncheon. Due to COVID-19 restrictions, the summer concert was cancelled and the fall luncheon was held utilizing a hybrid virtual/in-person approach with significant restrictions on the number of physical attendees. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Hermina Breuker President/CEO, Director 0 382160 0 29079 0 0 0 19000 0 6752 0 436991 0 0 David Tiesenga Chief Financial Officer 0 294673 0 21785 0 0 0 19000 0 5769 0 341227 0 0 Therese Rouse Physician 231214 0 0 0 342 0 0 0 0 0 231556 0 0 0 Schedule J, Part I, Line 1a The organization provides reimbursement of health club dues to the Chief Financial Officer. 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 B, Line 11b The Form 990 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) understand that 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. Christian Living Services 2100 Raybrook St SE Suit 300 Grand Rapids MI 49546 261126816 Admin Services MI 501(c)(3) 12b N/A 0 Holland Home 2100 Raybrook St SE Grand Rapids MI 49546 381366927 IL/AL/SNF Care MI 501(c)(3) 10 Christian Living Services 0 Reliance Community Care Partners 2100 Raybrook St SE Unit 300 Grand Rapids MI 49546 382295909 Community Services MI 501(c)(3) 12b 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 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 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 382660300 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 Christian Living Services 0 Atrio Home Health Lakeshore 2100 Raybrook St SE Suite 300 Grand Rapids MI 49506 814839696 Home Health Care MI 501(c)(3) 12b Atrio Home Care 0 Care Resources 1471 Grace St SE Grand Rapids MI 49506 300166828 PACE Services MI 501(c)(3) 12b N/A 0 Holland Home Foundation 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 382663466 Mission Fundraising MI 501(c)(3) 7 Holland Home 0 Facility Management Services of Holland Home 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 grounds and facility maintenance MI Holland Home Unrelated 0 EHCO Group LLC 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 NA MI N/A Related 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 1 1 1 0 Holland Home m 3283304 board & care rates - set fee based on services Holland Home p 850644 reimbursement of expenses. Holland Home k 93802 rent Holland Home r 1030147 payments of principal and interest on note payable Holland Home q 15750 Reimbursement for expenses Atrio Home Care m 26828 purchase of services Atrio Home Health m 4251 purchase of services. Holland Home Foundation r 28860 transfer of contribution of revenues. Atrio Home Health Lakeshore q 1362 Purchase of services Reliance Community Care Partners n 16207 Rent Reliance Community Care Partners p 205 reimbursement of expenses. Trillium Institute b 10964 contribution Holland Home l 1337 reimbursement for expenses Care Resources l 12426 Purchase of services Atrio Home Care q 2 reimbursement of expenses Atrio Home Health Lakeshore l 9585 Purchase of services. Atrio Home Health l 78330 Purchase of services