2015-01-14T09:55:48-06:00 2014-03-31 381357951 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2013-04-01 382800065 HOLLAND COMMUNITY HOSPITAL HOLL 6163925141 602 MICHIGAN AVENUE HOLLAND MI 49423 DALE SOWDERS PRESIDENT & CEO 6163925141 2014-12-18 1 OLIVER JURKOVIC P00433694 2319477800 2013 2016-03-07 17:11:31Z HOLLAND HOSPITAL DALE SOWDERS 602 MICHIGAN AVENUE HOLLAND MI 49423 253063015 0 X WWW.HOLLANDHOSPITAL.ORG X 1985 MI TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, RESPECT, COMPASSION AND DIGNITY. 14 9 2431 400 1178395 152585 947167 1264629 197954717 213061896 4474152 4848427 4358372 1056378 207734408 220231330 743560 668510 0 0 104787162 113415052 0 0 809857 87403738 93229693 192934460 207313255 14799948 12918075 404640320 435874826 110485817 117860654 294154503 318014172 X TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, RESPECT, COMPASSION AND DIGNITY. 0 0 172528423 668510 211909187 HOLLAND COMMUNITY HOSPITAL OPENED ITS DOORS TO THE FIRST PATIENT IN 1917. TODAY, THANKS TO THE VISION AND HARD WORK OF STAFF, COMMUNITY MEMBERS AND MEDICAL PROFESSIONALS, WE HAVE GROWN TO BECOME THE LEADING PROVIDER OF HEALTH CARE SERVICES IN THE WEST MICHIGAN LAKESHORE REGION. OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. THIS UNWAVERING COMMITMENT TO PROVIDE EXCELLENT, COMPASSIONATE AND INCREASINGLY ADVANCED HEALTH CARE REGARDLESS OF PATIENTS ABILITY TO PAY CONTINUES UNABATED.FIRST-RATE QUALITY:HOLLAND HOSPITAL'S ONGOING COMMITMENT TO EXCELLENCE IS DEMONSTRATED IN PHYSICIAN EXPERTISE, THE HIGHEST STANDARDS OF PATIENT CENTERED CARE AND DNV ISO CERTIFICATION. WE ARE ONE OF THE FEW HOSPITALS IN THE COUNTRY TO ACHIEVE THE INTERNATIONAL STANDARD FOR QUALITY: ISO 9001-2008 CERTIFICATION. THIS UNIVERSAL BENCHMARK DEMONSTRATES OUR COMMITMENT TO ORGANIZATIONAL EXCELLENCE AND SYSTEMATIC QUALITY IMPROVEMENT RESULTING IN IMPROVED OUTCOMES AND HIGHER PATIENT SATISFACTION.'TOP 100 HOSPITALS' NINE YEARS AND COUNTING:FOR NINE YEARS IN A ROW, HOLLAND HOSPITAL HAS BEEN SELECTED AS ONE OF THE NATION'S 100 TOP HOSPITALS. TRUVEN HEALTH ANALYTICS (FORMERLY THOMSON REUTERS) ANNUALLY CONDUCTS AN INDEPENDENT REVIEW OF APPROXIMATELY 3,000 HOSPITALS AND RECOGNIZES THOSE DEMONSTRATING SUPERIOR PERFORMANCE. THE VALUATION IS BASED ON PATIENT CARE FACTORS SUCH AS SAFETY AND SATISFACTION AND FINANCIAL INDICATORS SUCH AS EXPENSES AND PROFITABILITY. ADDITIONALLY, HEALTHGRADES SELECTED HOLLAND HOSPITAL AS ONE OF AMERICA'S 100 BEST HOSPITALS FOR A SECOND CONSECUTIVE YEAR IN 2014.TOP 3 PERCENT FOR 'BEST PRACTICES':HOLLAND HOSPITAL'S 'CORE MEASURES' -THE PROCESSES WE USE TO MEASURE OUR QUALITY OF CARE ARE PROVEN BEST-PRACTICE STANDARDS FOR TREATING PATIENTS WITH CERTAIN MEDICAL CONDITIONS. HOW WELL EACH HOSPITAL APPLIES THESE LIFE-SAVING MEASURES IS TRACKED BY THE U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES AND CAN BE VIEWED AT WWW.HOSPITALCOMPARE.HHS.GOV.RECENT DATA PLACED HOLLAND HOSPITAL AT THE 97TH PERCENTILE - MEANING WE'RE IN THE TOP 3PERCENT OF HOSPITALS NATIONWIDE IN MEETING PROCESS OF CORE MEASURES. WE ALSO RANKED AMONG THE LEADING HOSPITALS IN PATIENT SAFETY AS DETERMINED BY THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION KEYSTONE CENTER FOR PATIENT SAFETY & QUALITY. LEADERS IN INNOVATIVE PRACTICES:THE HOSPITAL CONTINUES TO MEET THE GROWING HEALTH CARE NEEDS OF THE COMMUNITY BY PROVIDING EXPERIENCED SPECIALISTS, LEADING-EDGE TECHNOLOGY AND EXCEPTIONAL PATIENT CARE. ALTHOUGH THE HEALTH CARE LANDSCAPE CONTINUES TO CHANGE, HOLLAND HOSPITAL REMAINS AHEAD OF THE CURVE WITH FISCAL DISCIPLINE, EFFICIENT USE OF RESOURCES, AND WISE INVESTMENT IN NEW TECHNOLOGIES. PATIENTS WITHIN OUR SERVICE AREA AND BEYOND ARE BENEFITING FROM OUR RECENT FACILITY IMPROVEMENTS INCLUDING OUR NEWLY OPENED ORTHOPEDIC AND SPINE UNIT. DURING FISCAL YEAR 2014, HOLLAND HOSPITAL'S 330-MEMBER MEDICAL STAFF, 2,000 EMPLOYEES AND 400 VOLUNTEERS SERVED THE COMMUNITY BY PROVIDING:PATIENT DAYS 29,900DISCHARGES 8,200BIRTHS 1,700SURGERIES 16,100OUTPATIENT VISITS 422,100EMERGENCY ROOM VISITS 41,400URGENT CARE VISITS 28,900HOME HEALTH VISITS 41,100LAB TESTS 646,300RADIOLOGY PROCEDURES 100,900BEDS 189INNOVATIVE OUTREACH PROGRAMS:IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE MEANS TAKING OUR SERVICES INTO THE COMMUNITY TO OFFER RESIDENTS CONVENIENT ACCESS TO HEALTH PROGRAMS AND EDUCATION. WE ARE REACHING BEYOND THE TRADITIONAL HOSPITAL WALLS INTO THE COMMUNITY, WHETHER AT SCHOOLS, NEIGHBORHOODS OR BUSINESSES, WITH PROGRAMS AND SERVICES THAT ARE FOCUSED ON DISEASE PREVENTION AND WELLNESS. RESIDENTS AND EMPLOYEES ALIKE CAN TAKE ADVANTAGE OF NUMEROUS PREVENTION AND WELLNESS OFFERINGS.HEALTH EDUCATION AND SERVICES:RECOGNIZING THAT MEN AND WOMEN HAVE UNIQUE HEALTH NEEDS, HOLLAND HOSPITAL HAS RESPONDED TO THE COMMUNITY'S REQUEST FOR PROGRAMS THAT ADDRESS GENDER-RELATED HEALTH CONCERNS. OUR WOMEN'S MIDLIFE SERVICES IS DEVOTED ENTIRELY TO ADDRESSING THE PHYSICAL AND EMOTIONAL ISSUES OF MATURE WOMEN. CREATED BY WOMEN FOR WOMEN AND DIRECTED BY A CERTIFIED MENOPAUSE PRACTITIONER, WOMEN'S MIDLIFE SERVICES OFFERS THE LATEST INFORMATION ON MENOPAUSE AND RELATED ISSUES.INTERPRETATION SERVICES:OUR ON-SITE INTERPRETERS, SPECIALLY TRAINED IN MEDICAL CONDITIONS IN ACCORDANCE WITH THE NATIONAL COUNCIL ON INTERPRETING IN HEALTH CARE, ARE AVAILABLE 24 HOURS A DAY TO FACILITATE COMMUNICATION BETWEEN PATIENTS AND PROVIDERS. IN THE PAST YEAR, STAFF HANDLED 29,911 INTERPRETATION REQUESTS. VIDEO CONFERENCING SYSTEMS AT THE OFF-SITE URGENT CARE CENTER, BREAST AND BONE HEALTH CENTER AND HOLLAND HOSPITAL MEDICAL BUILDING CONNECT PATIENTS FACE-TO-FACE WITH HOSPITAL INTERPRETERS IN MINUTES ELIMINATING DELAYS DUE TO TRAVEL TIME.DIABETES EDUCATION:DIABETES IS A MAJOR HEALTH EPIDEMIC THAT WE CONTINUE TO ADDRESS THROUGH OUR DIABETES SELF-MANAGEMENT EDUCATION PROGRAM. WE ASSIST THOSE WITH DIABETES BY OFFERING INDIVIDUAL CONSULTATIONS AS WELL AS GROUP CLASSES. PARTICIPANTS LEARN ABOUT DIET AND NUTRITION, HOW TO TEST THEIR BLOOD SUGAR, AND MANAGING THE DISEASE WITH MEDICATION.COMMUNITY OUTREACH PROGRAMS:THE CENTER FOR GOOD HEALTH OFFERS A VARIETY OF EDUCATIONAL CLASSES AND PRESENTATIONS FOR CHILDREN, ADULTS AND SENIORS. IN FY 2014, THE CENTER OFFERED 576 CLASSES AND EVENTS WITH 10,274 PARTICIPANTS. IN RESPONSE TO TODAY'S EMPHASIS ON IMPROVING WORKER HEALTH TO BOOST EFFECTIVENESS AND REDUCE HEALTH CARE COSTS, CFGH WORKS WITH MANY AREA BUSINESSES TO PROVIDE WORKSITE WELLNESS PROGRAMS DIRECTLY TO EMPLOYEES.FUNDING ACCESS TO HEALTH CARE SERVICES FOR OUR COMMUNITY:THE FUND DEVELOPMENT OFFICE AT HOLLAND HOSPITAL FOCUSES ON RAISING FINANCIAL SUPPORT FOR THREE VITAL PROGRAMS: THE HOLLAND COMMUNITY HEALTH CENTER, THE SCHOOL NURSING PROGRAM AND THE FAITH COMMUNITY NURSE. FUND DEVELOPMENT IS THE SOLE SOURCE OF FUNDING FOR THE SCHOOL NURSING PROGRAM, INVESTING $500,000 PER YEAR TO SERVE OVER 11,000 AREA STUDENTS. FUND DEVELOPMENT CONTRIBUTED $750,000- $850,000 TO THE OPERATION OF THE HOLLAND COMMUNITY HEALTH CENTER WHICH PROVIDES PRIMARY HEALTH CARE TO OVER 4,900 COMMUNITY MEMBERS WHO ARE EITHER UNINSURED OR UNDER-INSURED. FUND DEVELOPMENT COVERS THE ENTIRE $35,000 COST OF THE FAITH COMMUNITY NURSE AT THE HOLLAND RESCUE MISSION'S FAMILY HOPE CENTER TO ENSURE THAT OVER 500 RESIDENTS ARE GIVEN ACCESS TO A MEDICAL PROFESSIONAL WHILE STAYING AT THE MISSION.HOLLAND COMMUNITY HEALTH CENTER:THE HOLLAND COMMUNITY HEALTH CENTER (HCHC) PROVIDES PRIMARY HEALTH CARE SERVICES FOR PEOPLE WHO ARE UNDER INSURED AND UNINSURED. OVER 4,900 NEW PATIENTS RECEIVED THEIR PRIMARY MEDICAL CARE AT THE HCHC. THE MAJORITY OF VISITS FOCUSED ON WOMEN'S AND CHILDREN'S HEALTH CARE NEEDS, CHRONIC DISEASE MANAGEMENT AND ELDER CARE. EACH YEAR THE HCHC ACQUIRES OVER $500,000 WORTH OF FREE MEDICATIONS FOR PATIENTS WHO CANNOT AFFORD THEM.THE SCHOOL NURSING PROGRAM:SCHOOL NURSES PROVIDE SERVICES TO HOLLAND PUBLIC, HOLLAND CHRISTIAN, WEST OTTAWA PUBLIC, FENNVILLE PUBLIC AND HAMILTON COMMUNITY SCHOOLS. SCHOOL YEAR 2013-2014 THEY SERVICED ALMOST 12,000 STUDENTS WITH 41,701 HEALTH ROOM VISITS, ADMINISTERED 17,072 DURING THE SCHOOL DAY AND REFERRED 332 STUDENTS FOR ADDITIONAL MEDICAL, DENTAL, VISION, OR SOCIAL CONCERN.UNCOMPENSATED MEDICAL COSTS:OUR COMMITMENT TO CARING FOR MEMBERS OF OUR COMMUNITY WHO ARE UNINSURED OR UNDER-INSURED CONTINUES TO BE ONE OF THE BIGGEST FINANCIAL CHALLENGES FOR THE HOSPITAL. IN FY 2014, HOLLAND HOSPITAL PROVIDED UN-REIMBURSED CARE TO OUR PATIENTS AT A COST OF $41.8 MILLION, A 10.6 PERCENT INCREASE OVER THE PREVIOUS YEAR.THE RISE IN UN-REIMBURSED CARE CAN BE ATTRIBUTED TO A VARIETY OF FACTORS AT BOTH THE NATIONAL AND STATE LEVELS. WHILE EMPLOYMENT IN THE STATE OF MICHIGAN HAS IMPROVED (AUGUST 2013: 9.0% UNEMPLOYED; AUGUST 2014: 7.4% UNEMPLOYED), THE GENERAL HEALTH OF MICHIGAN RESIDENTS HAS DECLINED. OBESITY, A LEADING CAUSE OF CHRONIC DISEASE, HAS INCREASED AMONG HIGH SCHOOL STUDENTS AND ADULTS - 31.1% (2012) TO 31.5% (2013) AND 12.1% (2011) TO 13.0% (2013) RESPECTIVELY, LEADING TO PATIENTS WHO REQUIRE A HIGHER LEVEL OF INTERVENTION AND RANGE OF CARE.MEDICAID EXPANSION MADE COVERAGE AVAILABLE TO 320,000 MICHIGANDERS IN THE 1ST YEAR.2014 COMMUNITY BENEFIT SUMMARY-$41.8 MILLION TOTAL COMMUNITY BENEFITUNPAID COST OF MEDICAID $ 9,900,000UNPAID COST OF MEDICARE $13,700,000CHARITY CARE $ 2,200,000 BAD DEBT $12,000,000OTHER COMMUNITY BENEFITS $ 4,000,000OTHER COMMUNITY BENEFITS INCLUDE: COMMUNITY EDUCATION & OUTREACH; CASH,IN-KIND DONATIONS & CONTRIBUTIONS; STUDENT NURSING; HOLLAND COMMUNITY HEALTH CENTER; HEALTH PROFESSIONAL EDUCATION & RESEARCH.FINANCE COMMENT: CHARITY IS NOW BEING REPORTED AT COST, IN THE PAST IT WAS REPORTED AT WHAT GROSS CHARGES WOULD HAVE BEEN. 172528423 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 154 0 1 2431 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 14 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X TERRY STEELE 6163925141 602 MICHIGAN AVE HOLLAND MI 49423 DALE M SOWDERS PRESIDENT & CEO 40.00 1.00 X X 649211 0 148829 LESLIE BROWN CHAIR 1.00 1.00 X X 0 0 0 GREG MAYBURY TREASURER 1.00 1.00 X X 0 0 0 JANE CLARK SECRETARY 1.00 1.00 X X 0 0 0 KRIS DEPREE MD TRUSTEE 1.00 1.00 X 0 0 0 BECCA DERNBERGER TRUSTEE 1.00 1.00 X 0 0 0 TONY YASICK MD TRUSTEE, MEDICAL DIRECTOR 1.00 1.00 X 0 0 0 ROGER GAMACHE TRUSTEE 1.00 1.00 X 0 0 0 CLINT GRIFFIN MD TRUSTEE, CHIEF OF STAFF 1.00 1.00 X 27682 0 0 DAWN GARCIA WARD TRUSTEE 1.00 1.00 X 0 0 0 JAMES STROOP TRUSTEE 1.00 1.00 X 0 0 0 MARK STID MD TRUSTEE, PHYSICIAN 5.00 36.00 X 0 169635 14248 PHIL KONING TRUSTEE 1.00 1.00 X 0 0 0 ELIZABETH ROLINSKI TRUSTEE 1.00 1.00 X 0 0 0 PATTI VANDORT VP, NURSING & CNO 40.00 0.00 X 275286 0 44472 MARK L PAWLAK VP, ANCILLARY SERVICES & QUALITY 40.00 0.00 X 266068 0 36531 TERRY L STEELE VP, FINANCE & CFO 40.00 1.00 X 326832 0 32141 CHARLES D KOHLRUSS VP, HR & OPERATIONS SUPPORT 40.00 0.00 X 277159 0 18342 MICHAEL W MATTHEWS VP, PHYSICIAN ADMINISTRATION 40.00 0.00 X 216880 0 13396 CARL H WIERKS MD PHYSICIAN 40.00 0.00 X 598300 0 14265 DERICK M JOHNSON DO PHYSICIAN 40.00 0.00 X 598300 0 14040 STEPHEN MAUGER DO PHYSICIAN 40.00 0.00 X 515129 0 15556 MATTHEW FLETCHER MD PHYSICIAN 40.00 0.00 X 514916 0 5874 BARTHOLOMEW D SAK MD PHYSICIAN 40.00 0.00 X 453736 0 12433 4719499 169635 370127 79 0 1 0 LAKEWOOD ELZINGA A JOINT VENTURE 86 E 6TH ST HOLLAND MI 49423 CONSTRUCTION 11345723 ARAMARK CORPORATION 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 HOUSEKEEPING 4578910 JOHNSON CONTROLS INC PO BOX 93107 CHICAGO IL 606733107 CONSTRUCTION 1185555 QUADRAMED PO BOX 347188 PITTSBURGH PA 152514188 SOFTWARE - PURCHASED MAINTENANCE 1132437 HOLLAND MOB LLC 181 WEST MADISON SUITE 4700 CHICAGO IL 60602 RENT/SERVICES 947215 57 123639 33784 1107206 1264629 NET PATIENT SERVICE REVENUE 622110 206030656 206030656 OTHER RELATED REVENUE 900099 2194079 2194079 PHARMACY SALES UNDER SEC. 340B 446110 1941568 1941568 EHR MEANINGFUL USE REVENUE 622110 1717198 1717198 LAB ACTIVITY 621500 1178395 1178395 213061896 2151485 2151485 328604 226268 102336 102336 25686 76650 35221064 47498 31885272 686348 3335792 -638850 2696942 2696942 9576 123639 9576 0 22020 24221 -2201 -2201 CAFETERIA AND HOME MEALS 722210 956243 956243 956243 220231330 211909187 1178395 5879119 668510 668510 2102412 2102412 87669207 73885896 13216540 566771 1641438 1530915 110523 15775343 13148641 2462122 164580 6226652 5141507 1085145 464649 464649 93453 16253 77200 449257 449257 14650463 10307571 4328469 14423 1250012 70731 1179281 1035944 632701 403243 3145619 4075 3141544 5017273 4519652 494661 2960 341493 305458 30817 5218 363559 217517 144702 1340 1688291 1688291 12629837 10978936 1646528 4373 308036 92372 215664 MEDICAL SUPPLIES & DRUG 33927592 33741842 183067 2683 PROVISION FOR BAD DEBTS 12408480 12408480 FOOD 1364398 1221017 142229 1152 DUES, LICENSE & SUBS 674538 399905 272518 2115 3416799 1548153 1824404 44242 207313255 172528423 33974975 809857 14322804 18080957 604225 423130 38064742 42652916 3794569 4160838 2705225 2854933 246085365 95848138 125180637 150237227 193637244 192033075 19703439 20033843 6627435 5397907 404640320 435874826 15805587 18317771 205000 220890 79834864 82217911 14640366 17104082 110485817 117860654 X 293412406 317145367 342097 283805 400000 585000 294154503 318014172 404640320 435874826 X 12918075 12976790 -2035196 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20433 20433 0 PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO THE MICHIGAN HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH GOES TOWARDS LOBBYING ACTIVITIES. 742098 185000 342098 585000 692632 503956 454490 742098 695991 438922 442281 692632 696468 640725 641202 695991 681023 519647 504202 696468 0.00000 1.00000 0.00000 0 0 7930062 7930062 103832319 33470362 70361957 3429696 854156 2575540 96698033 61523620 35174413 34195255 34195255 150237227 PROFESSIONAL LIABILITY INSURANCE 2362929 COST REPORT SETTLEMENT PAYABLE 453480 OTHER LONG-TERM LIABILITIES 1363218 INTEREST PAYABLE 543438 LOSSES IN EXCESS OF INVESTMENT IN AFFILIATES 12381017 17104082 X PART V, LINE 4: EARNINGS FROM THE PERMENANT ENDOWMENTS ARE INTENDED FOR GENERAL PURPOSES OF THE HOSPITAL. PART X, LINE 2: THE HOSPITAL HAS ADOPTED ACCOUNTING STANDARDS RELATED TO UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, REVIEWED ALL TAX POSITIONS. THE EVALUATED POTENTIAL EXPOSURE RELATED TO UNCERTAIN TAX POSITIONS WAS FOUND TO BE IMMATERIAL. CULINARY CABARET 133215 123639 9576 9576 133215 123639 9576 9576 9576 0 22020 17471 6750 1 0.95000 22020 17471 6750 24221 -2201 MI 1 0 1 0 1.00000 COLLEEN PERDOK 602 MICHIGAN AVE HOLLAND MI 49423 0 COLLEEN PERDOK 0 FUND DEVELOPMENT COORDINATOR X 0 SCHEDULE G, PART III, LINE 16: INCLUDED IN COLLEEN PERDOK'S RESPONSIBILITIES IS THE ROLE OF GAMING MANAGER, HOWEVER THE AMOUNT OF COMPENSATION ALLOCATED TO THIS ROLE IS MINIMAL. 1 1 X 1 X 1 X 1 1 1 0 1 1 2348275 2348275 0.01200 24446028 17061908 7384120 0.03790 26794303 17061908 9732395 0.04990 1580273 584310 995963 0.00510 348696 348696 0.00180 720351 720351 0.00370 2649320 584310 2065010 0.01060 29443623 17646218 11797405 0.06050 2 5134 5134 0.00000 2 1165 1165 0.00000 1 172179 172179 0.00090 5 178478 178478 0.00090 0 12408480 4148709 30508885 36694750 -6185865 X 1 1 1 HOLLAND PHO COORD. RESOURCES FOR ITS MEMBERS FOR THE DELIVERY OF QUALITY HEALTH CARE. 0.50000 0.00000 0.50000 1 1 HOLLAND COMMUNITY HOSPITAL 602 MICHIGAN AVE HOLLAND MI 49423 WWW.HOLLANDHOSPITAL.ORG 1060000036 X X X HOLLAND COMMUNITY HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X HTTP://WWW.HOLLANDHOSPITAL.ORG/UPLOADS/PU X X X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X X X X 1 0 X X 1 X 0 0 HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 1J: THE NEEDS ASSESSMENT DESCRIBED THE COMMUNITIES STRENGTHS AND OPPORTUNITIES REGARDING QUAILITY 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 SUBGROUPS 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. HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 3: EXISTING DATA WAS REVIEWED, INCLUDING THE NUMBER OF VISITS TO HEALTH CARE PROGRAMS AND FACILITIES, THE TYPES OF VISITS, POTENTIAL CAUSES, AND OTHER RELATED INFORMATION. IN ADDITION, MORE THAN 1,200 COMMUNITY MEMBERS WERE SURVEYED TO GATHER INFORMATION ABOUT THEIR PERSONAL HEALTH AND WELL-BEING, HEALTH-RELATED BEHAVIORS AND RISKS FOR DISEASES. COMMUNITY FOCUS GROUPS WERE ALSO HELD TO DISCUSS THE PERCEPTION OF NEEDS. THEY ALSO INTERVIEWED AND/OR SURVEYED 45 HEALTH CARE PROVIDERS OR KEY INFORMANTS TO PROVIDE INPUT IN REGARDS TO COMMUNITY HEALTH NEEDS. HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 4: NORTH OTTAWA COMMUNITY HEALTH SYSTEM & SPECTRUM HEALTH ZEELAND COMMUNITY HOSPITAL HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 5D: HTTP://WWW.HOLLANDHOSPITAL.ORG/UPLOADS/PUBLIC/DOCUMENTS/PATIENT_VISITORS_GUIDE/OTTAWACOUNTYCNHASUMMARY2012.PDF HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE ALONG WITH A FINANCIAL ASSISTANCE APPLICATION (ENGLISH AND SPANISH). INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE FACILITY'S WAITING ROOMS, AS WELL AS OUTLINED ON A BUSINESS CARD GIVEN TO ALL PATIENTS AT REGISTRATION. 6 LAKESHORE HEALTH PARTNERS 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE HH SERVICES - BATES ET AL LLC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE HH SERVICES - ORT LLC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE LAKESHORE HEALTH PARTNERS FM LLC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE HOLLAND COMMUNITY HEALTH CENTER 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE LAKESHORE AREA RADIATION & ONCOLOGY CENT 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE PART I, LINE 3C: FAMILY INCOME 200 TO 300 PERCENT OF THE FEDERAL POVERTY GUIDELINES QUALIFY FOR DISCOUNTED CARE ON A RATED SCALE. PART I, LINE 7: 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).A DIRECT COST AND STEP-DOWN APPROACH WAS USED TO COMPLETE THE SUBSIDIZED HEALTH SERVICES PROGRAMS (LINE 7G). PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $12,408,480. PART II, COMMUNITY BUILDING ACTIVITIES: HOLLAND HOSPITAL SERVES COMMUNITIES THAT ARE DIVERSE IN SIZE, DEMOGRAPHIC MAKEUP AND SOCIO-ECONOMIC LEVELS. FOR AT-RISK INDIVIDUALS AND FAMILIES, THE HOSPITAL OFFERS PRIMARY HEALTH CARE SERVICES THROUGH THE HOLLAND COMMUNITY HEALTH CENTER, HOLLAND RESCUE MISSION AND WITHIN FIVE AREA SCHOOL DISTRICTS WITH LARGE STUDENT POPULATIONS WHO QUALIFY FOR FREE OR REDUCED LUNCHES. MONTHLY EDUCATIONAL PROGRAMS PROVIDE HEALTH INFORMATION AND ADVICE TO TARGETED AUDIENCES INCLUDING WOMEN AND SENIORS. THROUGH ITS WEBSITE AND SOCIAL MEDIA TOOLS, THE HOSPITAL COMMUNICATES KEY HEALTH INFORMATION THROUGHOUT ITS ENTIRE SERVICE AREA AND BEYOND. ONGOING COMMUNITY WELLNESS CLASSES AND FREE SCREENINGS PROVIDE EASY ACCESS TO HEALTHY LIFESTYLE ADVICE AND SUPPORT. THE HOSPITAL'S PARTNERSHIPS WITH OTHER SERVICES PROVIDERS, LOCAL BUSINESSES, MUNICIPALITIES, CHURCHES AND SOCIAL AGENCIES BUILDS UPON THE HOSPITAL'S DAY-TO-DAY EFFORTS TO IMPROVE THE HEALTH THE COMMUNITIES IT SERVES. PART III, LINE 2: THIS IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. PART III, LINE 3: THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THERE IS A POTENTIAL THAT SOME ACCOUNTS WRITTEN OFF AS BAD DEBTS COULD HAVE BEEN ELIGIBLE UNDER THE ORGANIZATIONS CHARITY CARE POLICY, HOWEVER, DUE TO INADEQUATE APPLICATIONS FILED OR NEVER RETURNED THEY GET WRITTEN OFF TO BAD DEBTS INSTEAD. THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS APPROXIMATELY $4,148,709. THIS WAS DERIVED BY REVIEWING NOTES ON FILES FOR POTENTIAL CHARITY CARE CASES FOR THE LAST QUARTER OF THE YEAR AND APPLYING THAT AVERAGE TO THE TOTAL POPULATION. PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA RELATED TO THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALULATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. 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 A SIGNIFICANT PROVISION FOR BAD DEBTS 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. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: 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. PART III, LINE 9B: ANY BALANCE DEEMED PATIENT RESPONSIBILITY (AFTER INSURANCE PAYMENT/DETERMINATION AND AFTER ANY APPLICABLE DISCOUNT OR CHARITY) IF NOT PAID WILL RECEIVE A MINIMUM OF 2 STATEMENTS. AT DAY 60 AN EARLY OUT AGENCY WORKS THE ACCOUNT FOR HOLLAND HOSPITAL FOR A MINIMUM OF 90 DAYS. THE ACCOUNT WILL BE HELD ON HOLLAND HOSPITAL'S "BOOKS" UNTIL IT HAS AGED TO A MINIMUM OF 180 DAYS FROM DISCHARGE. AT THIS TIME THE ACCOUNT IS ELIGIBLE AND WILL BE REVIEWED TO BE SENT TO A COLLECTION AGENCY. SCHEDULE H, PART III, LINES 5 AND 6: AS PER THE INSTRUCTIONS, SCHEDULE H, PART III, LINES 5 AND 6 ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. THOSE MEDICARE COSTS NOT INCLUDED IN THE MEDICARE COST REPORT (MEDICARE ADVANTAGE AND FEE FOR SERVICE PHYSICIANS) ARE SUMMARIZED AS FOLLOWS:TOTAL COST: $2,236,734TOTAL REIMBURSEMENT: $1,525,669COST IN EXCESS OF REIMBURSEMENT: $ 711,065 PART VI, LINE 2: IN COLLABORATION WITH THE OTTAWA COUNTY HEALTH DEPARTMENT AND THE UNITED WAY, A COMMUNITY ASSESSMENT IS PERFORMED. THE UNITED WAY PUBLISHES THEIR ASSESSMENT EVERY 5 YEARS (LAST ONE IN 2012) AND THE OTTAWA COUNTY HEALTH DEPARTMENT PUBLISHES THEIR YOUTH ASSESSMENT EVERY 2 YEARS (LAST ONE IN 2012) AND EVERY 3 YEARS FOR ADULTS (LAST ONE IN 2012). THE CHNA COLLABORATIVE CONSISTED OF NORTH OTTAWA, SPECTRUM ZEELAND HOSPITALS AND THE OTTAWA COUNTY HEALTH DEPARTMENT. PART VI, LINE 3: OUR FINANCIAL ASSISTANCE POLICY IS LOCATED ON OUR WEBSITE. AT THE POINT OF REGISTRATION, A PATIENT IS OFFERED A BUSINESS CARD WITH INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM. ALSO, OUR COLLECTORS, CUSTOMER SERVICE EMPLOYEES, OR ANY OTHER HOLLAND HOSPITAL EMPLOYEE WITH WHOM THE PATIENT MIGHT HAVE CONTACT, OUR MEDICAID ELIGIBILITY VENDOR, AND THE EARLY OUT AGENCIES INFORM PATIENTS OF THE FINANCIAL ASSISTANCE POLICY. ALL OF THE ABOVE MENTIONED SOURCES MAIL FINANCIAL ASSISTANCE APPLICATIONS TO THE PATIENTS FOR CONVENIENCE UPON REQUEST. INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE FACILITY'S WAITING ROOMS. PART VI, LINE 4: HOLLAND HOSPITAL'S PRIMARY SERVICE AREA (PSA) CONSISTS OF EIGHT ZIP CODES THAT FALL WITHIN ALLEGAN AND OTTAWA COUNTIES OF WEST MICHIGAN (POPULATION: 150,675). OUR EXTENDED SERVICE AREA (ESA) OR SECONDARY SERVICE AREA CONSISTS OF FOUR MORE ZIPS TO THE NORTH, EAST AND SOUTH OF THE HOSPITAL (POPULATION: 94,449). IN OTTAWA COUNTY, THE RACIAL DEMOGRAPHIC BREAK DOWN IS 85.2 % (WHITE), 9.0% (HISPANIC), 2.8 % (ASIAN), 1.7% (AFRICAN AMERICAN ), 0.6% (NATIVE AMERICAN), AND < 0.1% (PACIFIC ISLANDER). IN THE CITY OF HOLLAND WHERE HOLLAND HOSPITAL IS LOCATED, THERE IS A SIGNIFICANTLY HIGHER PERCENTAGE OF HISPANIC INDIVIDUALS WITH THE RACIAL DEMOGRAPHIC BREAK DOWN INCLUDING 68.9 % (WHITE), 22.7% (HISPANIC), 3.0 % (ASIAN), 3.6% (AFRICAN AMERICAN ), 0.6% (NATIVE AMERICAN), AND < 0.1% (PACIFIC ISLANDER). ACCORDING TO 2010 CENSUS DATA, THE POPULATION OF OTTAWA COUNTY WAS SPREAD OUT WITH 28.70% UNDER THE AGE OF 18, 11.90% FROM 18 TO 24, 29.30% FROM 25 TO 44, 20.00% FROM 45 TO 64, AND 10.10% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 32 YEARS. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $52,347, AND THE MEDIAN INCOME FOR A FAMILY WAS $59,896. MALES HAD A MEDIAN INCOME OF $42,180 VERSUS $27,706 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $21,676. ABOUT 3.10% OF FAMILIES AND 5.50% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 4.70% OF THOSE UNDER AGE 18 AND 4.90% OF THOSE AT AGE 65 OR OVER. PART VI, LINE 5: HOLLAND HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF REPRESENTATIVES FROM DIFFERENT GEOGRAPHIC SECTORS OF THE HOSPITAL'S PRIMARY SERVICE AREA (PSA), AS WELL AS REPRESENTATIVES FROM BUSINESS AND INDUSTRY, MEDICAL STAFF, AND AT-LARGE MEMBERS. THE HOSPITAL BOARD AND MEDICAL STAFF LEADERSHIP, USING AN ONBOARDING PROCESS, CONSIDERS ALL REQUESTS FROM NEW AND ACTIVE PHYSICIANS SEEKING PRIVILEGES TO PRACTICE AT HOLLAND HOSPITAL. THE HOSPITAL'S INVESTMENT TO IMPROVE PATIENT CARE TAKES SEVERAL FORMS. IN 2014, HOLLAND HOSPITAL INVESTED MILLIONS OF DOLLARS IN UPGRADES TO ITS ELECTRONIC HEALTH RECORDS SYSTEM TO IMPROVE PATIENT SAFETY AND ENHANCE THE EFFICIENCY OF RECORDING/ACCESSING OF PATIENT MEDICAL INFORMATION. ADDITIONAL, THE HOSPITAL CONSTRUCTED A MEDICAL OFFICE BUILDING TO HELP ASSURE THE ACCESSIBILITY TO CARDIOLOGISTS AND CARDIOVASCULAR CARE FOR RESIDENTS IN THE GREATER HOLLAND AREA. THE HOSPITAL CONTINUES TO CONTRIBUTE IN EXCESS OF $1 MILLION PER YEAR IN COMMUNITY OUTREACH INITIATIVES THAT BRING PRIMARY CARE SERVICES TO THE MOST AT-RISK POPULATIONS. FREE COMMUNITY EDUCATIONAL OPPORTUNITIES ARE PROVIDED ON A CONTINUAL BASIS THROUGH PHYSICIAN PRESENTATIONS, RADIO/TELEVISION/PRINT/WEB APPEARANCES, AND IN PARTNERSHIP WITH OTHER HEALTH CARE PROVIDERS. PART VI, LINE 6: NOT AFFILIATED. PART VI, LINE 7, REPORTS FILED WITH STATES MI 1 COMMUNITY HEALTH CENTER 602 MICHIGAN AVENUE HOLLAND MI 49423 200602574 501(C)(3) 663660 0 N/A N/A OPERATIONAL CASH FLOW TO BREAK-EVEN 1 0 PART I, LINE 2: 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. X X 0 1 0 0 0 0 0 0 0 DALE M SOWDERS PRESIDENT & CEO 503023 0 125877 0 20311 0 124461 0 24368 0 798040 0 14380 0 MARK STID MD TRUSTEE, PHYSICIAN 0 150872 0 0 0 18763 0 0 0 14248 0 183883 0 0 PATTI VANDORT VP, NURSING & CNO 216085 0 41282 0 17919 0 30327 0 14145 0 319758 0 10483 0 MARK L PAWLAK VP, ANCILLARY SERVICES & QUALITY 209040 0 39936 0 17092 0 27215 0 9316 0 302599 0 0 0 TERRY L STEELE VP, FINANCE & CFO 257286 0 49153 0 20393 0 21962 0 10179 0 358973 0 0 0 CHARLES D KOHLRUSS VP, HR & OPERATIONS SUPPORT 203019 0 38786 0 35354 0 0 0 18342 0 295501 0 35248 0 MICHAEL W MATTHEWS VP, PHYSICIAN ADMINISTRATION 175115 0 41765 0 0 0 0 0 13396 0 230276 0 0 0 CARL H WIERKS MD PHYSICIAN 577597 0 0 0 20703 0 0 0 14265 0 612565 0 0 0 DERICK M JOHNSON DO PHYSICIAN 577597 0 0 0 20703 0 0 0 14040 0 612340 0 0 0 STEPHEN MAUGER DO PHYSICIAN 242928 0 0 0 272201 0 0 0 15556 0 530685 0 0 0 MATTHEW FLETCHER MD PHYSICIAN 243256 0 0 0 271660 0 0 0 5874 0 520790 0 0 0 BARTHOLOMEW D SAK MD PHYSICIAN 243417 0 0 0 210319 0 0 0 12433 0 466169 0 0 0 PART I, LINE 4B 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 2013. A MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465E7A5 2004-08-01 22000000 CONSTRUCTION OF NEW BUILDING 0 0 0 B MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 800596186 NONEAVAIL 2010-08-11 23500000 CONSTRUCTION OF NEW BUILDING 0 0 0 C MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59447PTG6 2013-02-20 37010000 CONSTRUCTION OF NEW BUILDING AND DEFEASANCE OF 2004A BONDS 0 0 0 A 22000000 225000 22000000 2008 0 0 1 1 B 23500000 14123419 139505 9376581 2011 1 0 1 1 C 39641117 3056775 18656552 243926 20471662 2015 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 1 0 0 0 0 B 0 1 0 0 0 0 0 0 0 C 0 1 0 0 1 0 0 0 0 A 0 B 0 C 0 LAKEWOOD ELZINGA A JOINT VENTURE BOARD MEMBER JAMES STROOP IS AN INDIRECT OWNER OF LAKEWOOD ELZINGA JV. 11345723 LAKEWOOD ELZINGA A JOINT VENTURE WAS SELECTED AS GENERAL CONTRACTOR FOR SEVERAL HOSPITAL PROJECTS. THE PAYMENTS TO LAKEWOOD ELZINGA A JOINT VENTURE RELATE TO CONSTRUCTION SERVICES, INCLUDING PAYMENTS TO SUBCONTRACTORS AS WELL AS THE GENERAL CONTRACTOR FEE. 0 MACATAWA ANESTHESIA PC BOARD MEMBER ANTHONY YASICK IS A SHAREHOLDER OF MACATAWA ANESTHESIA PC. 52078 THE PAYMENTS TO MACATAWA ANESTHESICA PC RELATE TO MEDICAL DIRECTOR PAYMENTS. 0 FORM 990, PART VI, SECTION B, LINE 11 HOLLAND COMMUNITY HOSPITAL'S CEO AND CFO REVIEW THE FORM 990 PRIOR TO FILING. THE CEO THEN SIGNS AND FILES THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C 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. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES CONSULTANTS TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM ANNUALLY AND RECOMMEND UPDATES/INCREASES AS DICTATED BY THE MARKET. COMPENSATION IS SET FOR THE PRESIDENT AND CEO, AND EACH VICE PRESIDENT 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. THE MOST RECENT YEAR THIS PROCESS HAS BEEN UNDERTAKEN IS AUGUST 2014. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: UNREALIZED LOSS IN AFFILIATES -2,035,196. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. HH SERVICES ORT LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 264606759 ORTHOPEDIC PHYSICIAN OFFICE MI -1181430 225563 HOLLAND COMMUNITY HOSPITAL HOLLAND HOSPITAL PHYSICIAN CLINIC 602 MICHIGAN AVENUE HOLLAND MI 49423 263479537 NOT ACTIVE MI 0 0 HOLLAND COMMUNITY HOSPITAL HOLLAND SC LLC DBA SURGERY CENTER OF WEST MICHIGAN 602 MICHIGAN AVENUE HOLLAND MI 49423 203200415 NOT ACTIVE MI 0 0 HOLLAND COMMUNITY HOSPITAL HH SERVICES - BATES ET AL LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 260396104 UROLOGY PHYSICIAN OFFICE MI -763331 443511 HOLLAND COMMUNITY HOSPITAL LAKESHORE HEALTH PARTNERS - FM LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 272647439 FAMILY MEDICINE PHYSICIAN OFFICE MI -292315 180920 HOLLAND COMMUNITY HOSPITAL HOLLAND COMMUNITY HOSPITAL AUTHORITY SELF-INSURANCE TRUST FUND 602 MICHIGAN AVENUE HOLLAND MI 49423 386389385 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 11A, I HOLLAND COMMUNITY HOSPITAL 1 HOLLAND COMMUNITY HOSPITAL AUXILIARY 602 MICHIGAN AVENUE HOLLAND MI 49423 382139025 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 11C, III-FI N/A 0 LAKESHORE HEALTH PARTNERS 602 MICHIGAN AVENUE HOLLAND MI 49423 263518481 ENDOSCOPY SERVICES MI 501(C)(3) LINE 11A, I HOLLAND COMMUNITY HOSPITAL 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 LAKESHORE HEALTH PARTNERS M 622030 CONTRACTS AND TIME TRACKING